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Question: Hi, I was diagnosed as diabetic sometime early this year when the relevant symptoms were evident, I had Blood sugar level trending between 350-400 fasting and post meal. Which was controlled through insulin(novomix 30 flexpen::: Dosage: 20 in the morning & 16 in the evening) along with Riomet OD 850(tablet) and then insulin was stopped and I continued oral medication for almost 8 months. From last one month, I have been very careless and started to consume all form of food, which carries heavy sugar. Now the blood sugar levels are high again. Trending between 350 to 5oo. This morning, I used one touch glucose meter to check the levels. Fasting(276) and Post meal(462). This has been the trend for the last few weeks. Please advise.
Brief Answer:
You have to be re started on insulin
Detailed Answer:
Hi XXXX,
Thanks for posting question in HCM. I have gone through your question and understand your concern
Have you checked your HbA1c (3 month average blood glucose)?
Your blood sugars are grossly elevated now. Only insulin can bring down blood sugars like this to normal. Consult a doctor and get started on insulin immediately. Twice daily novomix will be an ideal option. Your doctor will check for other causes of increased sugars like infection and treat it.
Please follow up with the doctor regularly. Check HbA1c every 3 months. The target should be fasting glucose less than 130 mg/dl, after food less than 180 mg/dl and HbA1c less than 7%.
Once controlled you can taper the insulin down. But it is always advisable to continue insulin along with oral medications.
Hope I have answered your question. If you have any other doubt, I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
You have to be re started on insulin
Detailed Answer:
Hi XXXX,
Thanks for posting question in HCM. I have gone through your question and understand your concern
Have you checked your HbA1c (3 month average blood glucose)?
Your blood sugars are grossly elevated now. Only insulin can bring down blood sugars like this to normal. Consult a doctor and get started on insulin immediately. Twice daily novomix will be an ideal option. Your doctor will check for other causes of increased sugars like infection and treat it.
Please follow up with the doctor regularly. Check HbA1c every 3 months. The target should be fasting glucose less than 130 mg/dl, after food less than 180 mg/dl and HbA1c less than 7%.
Once controlled you can taper the insulin down. But it is always advisable to continue insulin along with oral medications.
Hope I have answered your question. If you have any other doubt, I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
I cannot visit a doctor. That is the reason why I have opted for online consultation. Please advise the next course of action. Shall I start Insulin(novomix 30 Flexpen) from tomorrow. Please suggest the dosage. I can visit the diagnostic center to get HbA1c tested. I think the cause for elevated Blood Sugar Level is the in-disciplined diet. I was careless, was eating all form of sweets, fruits, wasn't tracking Sugar Level. The reasons for elevation are evident because I missed to maintain very disciplined diet. No that I have messed up my health. Need to bring the Blood Sugar Level down and maintain it.
Please suggest the insulin dosage and the oral medicine. I will get the HbA1c checked at any Local Diagnostic Center.
Please suggest the insulin dosage and the oral medicine. I will get the HbA1c checked at any Local Diagnostic Center.
Brief Answer:
The usual starting dose is 10 units twice daily
Detailed Answer:
Hi XXXX,
Welcome back.
We cannot make prescription of medications through this web site due to medico legal implications of suggesting medications without seeing the patient.
If I were your treating Endocrinologist I would have started on biphasic insulin ( one brand is Novomix 30) twice daily. The usual dose I start in a patient with similar blood sugar will be 10 units before breakfast and 10 units before dinner.
I will ask the patient to check the fasting and after food glucose values every 3-5 days. The target of fasting glucose is 90-130 mg/dl and after food will be 100-180 mg/dl. If sugar are not in target I will ask the patient to increase both morning and evening dose by 2 units to bring the sugars under control. If the sugars fall below normal I start decreasing the insulin dose.
The oral medications you are currently on ( Metformin 850 mg) will have to be continued twice daily.
You can do an HbA1c at a good local laboratory.
Hope this will guide you in management of your diabetes.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
The usual starting dose is 10 units twice daily
Detailed Answer:
Hi XXXX,
Welcome back.
We cannot make prescription of medications through this web site due to medico legal implications of suggesting medications without seeing the patient.
If I were your treating Endocrinologist I would have started on biphasic insulin ( one brand is Novomix 30) twice daily. The usual dose I start in a patient with similar blood sugar will be 10 units before breakfast and 10 units before dinner.
I will ask the patient to check the fasting and after food glucose values every 3-5 days. The target of fasting glucose is 90-130 mg/dl and after food will be 100-180 mg/dl. If sugar are not in target I will ask the patient to increase both morning and evening dose by 2 units to bring the sugars under control. If the sugars fall below normal I start decreasing the insulin dose.
The oral medications you are currently on ( Metformin 850 mg) will have to be continued twice daily.
You can do an HbA1c at a good local laboratory.
Hope this will guide you in management of your diabetes.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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