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Suggest Treatment For Seizures And Low Sugar Levels In A Diabetic Person

Posted on Tue, 6 Oct 2015

Question: My husbad is type 1 and has been since he was a child. He is now 44. He kept having low sugar seziures and broke his teeth out and busted his head open. He started seeing a new specialist who seems to be bothered that we are so many questions. She put him on 30 units of Toujeo and another fast acting by scale for breakfast lunch and dinner. She recently told him over the phone to take the Toujeo twice a day. It is a 24 hour insulin and I told him not to because all the warnings say it is a ONCE a day insulin to be taken once a day at the same time everyday. I tried to talk to her nurse and she argued with me. Should we get another opinion?

Answered by Dr. Binu Parameswaran Pillai (5 hours later)

Brief Answer:
Glargine may need be taken more than once a day.

Detailed Answer:
Good day.
Noted your concern. Sorry to hear about the problems which you husband had from seizures. I presume he is on basal bolus insulin with Toujeo once a day and some other short acting insulin with meals thrice daily.
Toujeo (Glargine) is claimed to be a once daily basal 7insulin. However we have seen that it doesn't really last 24 hours a day. it lasts around 18 to 20 hours a day. Most often if the dose of Glargine cross 40 units, we may have to take it more than once.
I was wondering if your husband had a Continuous Glucose Monitoring (CGMS) in the recent past? .
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (8 hours later)

Thank you it is very frightening and the doctor doesn't seem to be understanding of that. Yes she has ordered a monitor to evaluate him for one week.

Best regards

Answered by Dr. Binu Parameswaran Pillai (18 hours later)

Brief Answer:
CGMS and Insulin pump

Detailed Answer:
Okay, It is likely that your doctor has ordered for CGMS. That will help to know the glucose change patterns in him. This is important to titrate and adjust insulin dose.

As i mentioned earlier, when dose of Glargine (Toujeo) exceed 40 units, i generally tend to split the dose to twice daily.

An other device to consider in him is insulin pump. It helps to reduce wide fluctuations of sugars. Most Type 1 diabetes patients benefit with Insulin pumps.
Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (20 hours later)

Thank you so much for your answers. You have given us some hope that we are at least in the right track.

Be well

Answered by Dr. Binu Parameswaran Pillai (3 hours later)

Brief Answer:
Thank you

Detailed Answer:
Thank you. Wishing him good health.
Please feel free to ask if you have any more questions. If you do not have any more questions, may I request you to please close the query.
Best regards
Binu

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar