
Suggest Treatment For Uncontrollable High Blood Sugar Levels

Can we go back to using Wosulin 50/50 (dosage - 10-8-12 units)?
Note: All kinds of tests - blood, urine, x-rays, bronchoscopy, CT scan, etc were done and they all turned out to be normal (according to the doctors considering my dad's past medical history. For Eg: Because my dad is on dialysis, his creatinine levels are around 5-6, but the doctors dont seem to be concerned about this as they say this is normal for a dialysis patient.) Doctors consulted - Nephrologist, Diabetologist, Cardiologist, ENT, Pulmonologist.
Complications of long standing diabetes.
Detailed Answer:
Hello,
Welcome to HCM. Thanks for your query.
These are clinical events a long standing and poor controlled diabetic patient may go through.
First coming to the elevated creatinine levels. In a normal individual kidney handles and excreates all the waste products from the body which keeps the creatinine levels under check. But in a dialysis patient kidneys lose its functions and the creatinine level rises. But your father's creatinine levels is under accepted limits for a dialysis patient.
Secondly coming to the blood sugar control. Three things add to this situation. Long standing diabetes, kidney failure and infection.
Long standing diabetes cause complete beta cell failure so he completely depends on insulin for blood sugar control that to in higher doses.
The present insulin regime may be continued with dose correction based on the blood sugar levels because it is more close to the normal physiology of insulin secretion in the body.
Poorly controlled diabetics are prone to lot of infection. Presents of infection may also interfere with the blood sugar control and increase the dose of insulin required to control the blood sugar.
In my humble opinion it is advisable to rule out tuberculosis which is very common in diabetics.
Hope I have answered your questions.
Regards.


Thanks for your reply. I had changed the dosages of Actrapid (from 12 to 14 units each dose) and Lantus (from 12 to 16 units at night, as his fasting sugar always turned out to be high 400's) and this brought down my dad's sugar level to 128 (Random check at 7:30PM). In order to avoid hypo situation, I brought the Lantus dosage back down to 10 units that night. When I checked the Fasting Sugar the next day morning, it was around 300. My biggest concern is that my dad has been feeling very dizzy throughout the day and is unable to even get up from his bed by himself. Also, he complains of not being able to sleep well which we are also noticing since he was put on these insulins. Is this a possible side-effect? What can we do to help his situation improve? I had read online about Actrapid side-effects and one of them was dizziness, is this of high potential risk considering the condition of my dad? Please advise.
Hypoglycemia is one of the major side effects
Detailed Answer:
Hello,
Hypoglycemic is one of the major side effects of insulin therapy.
In elderly and critically ill patient the blood sugar levels should not be tightly controlled to normal range.
FBS should be maintained around 130 mg / dl and PPBS around 200 mg / dl range.
For them food intake, physical activities should be taken into consideration while determining the dose of insulin.
Actrapid is short acting and may not pose much of a problem but Luntus being long acting it's dose should be adjusted to maintain the above mentioned sugar values in your father.
Regards.

Answered by

Dr. Dr. Basheer Ahamed
Pathologist and Microbiologist
Practicing since :2006
Answered : 1584 Questions
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