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Suggest Treatment For Uncontrollable Blood Sugar Levels

Posted on Mon, 2 Feb 2015

Question: Presently for the past one year I am having very stubborn high sugar 200 mg/dl to 300 mg/dl.Inspite of taking upto 90 units of Novomix 40/20/30 alongwith Glucophage and Tradjenta.If I do not take snacks than I start to sweat and sugar goes back up again.So this happens in day time as well as while sleeping.Body is not allowing sugar to come down. Sweating is only on the scalp.As soon as I eat the feeling goes away.All my blood and urine reports are ok.Please advise course of action.

Answered by Dr. M. Vamsi Krishna (3 hours later)

Brief Answer:
Need some more information

Detailed Answer:
Hi there
I can understand your concern
I need to know some information before proceeding to further discussion
I would like to know your height weight and duration of diabetes
are you following any diet pattern?
how much time you are doing exercise?
since when you started using insulin?
what is your sugar level when you are sweating?
kindly provide me with this information.
regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. M. Vamsi Krishna (5 hours later)

I am 5 ft 6 in tall and weight is 104 kg
Been diabetic for 15 years
These days I am playing Golf about 4 days a week
No other exercise
I am following a 1500 calorie diet

Answered by Dr. M. Vamsi Krishna (2 hours later)

Brief Answer:
Change in medication is needed.

Detailed Answer:
HI
Thank you for providing the information.
In my opinion taking novomix thrice is not suiting you.
You are taking 90 units of insulin per day but as you know that the 90 units contain Insulin aspart (30%) and intermediate-acting protamine insulin aspart (70%)
So total amount of short acting insulin you are taking will be around 27 units and rest is intermediate acting insulin.

The short acting insulin is powerful and brings down your post prandial blood glucose level.

This intermediate acting insulin will work for 12 hrs but by taking this insulin thrice there will be overlapping and cause hypoglycemia.

The constant sweating might be due to overlapping of intermediate acting insulin.

in your condition the best regimen will be once a daily injection of Glargine or levemir along with thrice novorapid.
This is a very well accepted regimen.
There are many clinical trial and research data supporting that weight gain is also very less with this basal and bolus regimen.

I suggest you to consider doing CGMS or 7 point blood glucose estimation to understand your daily trend of blood glucose fluctuation.
By understanding your trend it’s very easy to adjust your insulin dosage.

Kindly discuss with your treating doctor for change of medication.

Kindly write back to me in case of any clarifications.

Hope I am able to help you

Regards

Dr XXXXXXX
Diabetologist and lipidologist
apollo sugar clinic

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. M. Vamsi Krishna (20 minutes later)

Dear Doctor,
Thanks for your advice.I think you are right.
Can you suggest a starting doses based on a 1500 calorie diet?
For both Lantus and Novorapid?And when to take Lantus? Morning or evening?
Regards
XXXXXX

Answered by Dr. M. Vamsi Krishna (7 minutes later)

Brief Answer:
Need values of blood glucose

Detailed Answer:
Hi
Dose of lantus and novorapid can be fixed by knowing your blood glucose trends.
I would like to know the meal pattern also like how exactly you divide your meals including snacks, Kindly mention timing of food.

Usually we will give 50%of dose as basal insulin and 50% as rapid acting but it’s just an estimation it might be different for different individuals based on their eating habits.

After starting from an estimated dose we can slightly up titrate the dose to suite your needs.

Check your blood glucose levels at before food and after food for all the three major meals of the day and let me know to fix your dose. But before changing dosage you need to consult your treating doctor.

Regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. M. Vamsi Krishna (23 minutes later)

Right today my fasting was 235.I took BF(2 slices bread,3 egg whites,milk and a very small banana, I took 40 units of Novomix.After two hours my sugar is back to 250.

Answered by Dr. M. Vamsi Krishna (54 minutes later)

Brief Answer:
Data provided is insufficient for me to decide

Detailed Answer:
I suggest you to avoid banana in your diet.

The data you provided is insufficient for me to decide the dose of lantus and novorapid. Blood sugar values during the morning isn't sufficient to adjust doses. For any patient coming to my clinic with similar complaints I suggest him to monitor his blood sugar (the 7 point blood glucose estimation) before suggesting him medication.

I suggest you visit your physician with glucose monitoring and start new regimen.

Thank you
regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Prasad