Brief Answer:
She may require change insulin type and dose adjustment.

Detailed Answer:
Hi Mr. XXXX,

Thanks for your question.
After going through your wife's case there might be following causes for uncontrolled blood sugar level.
1) Tuberculosis itself is a stressful condition associated with increased levels of anti-insulin hormones that is hormones that has action on blood sugar opposite to that of insulin.
2) Tab Pioglitazone has been stopped in last prescription.
Pioglitazone its self is a strong antidiabetic drug.
3) Antitubercular medicine like refampicin decreases the effect of anti-diabetic drugs. Rifampicin is a hepatic enzyme inducer it means it act on liver to produce enzymes that metabolizes other drugs hence other drugs get rapidly metabolized decreasing its effect.
4) Mismatch between peak of blood sugar rise and peak of insulin action.
Every 10 units of Mixtard 30:70 insulin contains 3 units of short acting (regular) insulin and 7 units of intermediate acting (NPH) insulin that's why we can not change dose of either short acting or intermediate acting insulin alone without change in other insulin in combination.

I would like to advise to monitor blood sugar at home by using glucometer (SMBG- Self Monitoring of Blood Glucose) as follow-
- Fasting (Before breakfast)
- 2 Hours after breakfast.
- Before lunch.
- 2 hours after lunch.
- Before Dinner.
- 2 hours after dinner.
- Early morning 3am.
It is usually advisable to do as much as readings possible from all of above readings daily.
Otherwise at least 2 or 3 reading should be done daily.
If required additional readings should be done in case there are symptoms of low blood sugar (hypoglycemia), in that case you should also notice date and time of incidence any change in meal pattern, increased physical activity on that particular day.

Depending upon weekly chart your doctor can adjust dose of your current insulin mixtard 30:70 or may change to short actin and intermediate or long acting insulin according to Blood sugar level readings.

Along with this continue taking current insulin doses and other medicines as advised.

Hope I have answered your question.
I will be happy to answer your follow up questions if any.
Otherwise you can close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
Variable insulin resistance is cause of fluctuation in blood sugar level.

Detailed Answer:
Hi XXXX,

Thanks for your follow up query.

I can understand your concerns.
Though it is difficult to interpret exact cause of increasing blood sugar level in your case, following possibilities may be there-

1) Increased insulin resistance (resistance to action of insulin requiring additional insulin to achieve same blood sugar level as before)
This may be due to
- Tuberculosis its self.
- Any other recent illness or stress causing increased levels of stress hormones which increases insulin resistance.
- Glucotoxicity or lipotoxicity: Due to sudden transient rise in blood sugar level there is an acute rise in insulin requirement and to fulfill that requirement pancreas needs to work more which leads to inflammation of pancreas due to which insulin production by pancreas decreases severely leading to rise in blood sugar levels. To relieve that inflammation there is need for additional dose of exogenous insulin.
- Recent weight gain.

2) Efficacy of medicines mainly insulin may be hampered due some unknown reasons. You can try new vial of insulin.

Hope this may have clarified your query.

You can meet me at my clinic. Detail profile and clinic details available on healthcare magic.

Regards
Dr Abhay Mali.
Ganesham diabetes and children clinic
Atharva Residency, opposite Dominos,
Baner Road, XXXXXXX
6 pm to 9 pm. (mon to sat)

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