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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Rise In The Blood Sugar Level At Night Despite Taking Lantus?

My mom has been a diabetic for 20+ years. Recently her hab1c levels have been too high at 10.8. So her Dr has put her on actrapid (12 units)before breakfast and lunch and lantus (20 units) before breakfast and has asked her monitor her sugar levels 4 times a day for a month. He says her sugar levels are not in control coz of her vitiligo. Other than that all her thyroid tests have come out normal. My question is now inspire of insulin her bedtime sugar levels are quite high near 300 consistently. Other than that her before breakfast and lunch levels r in control- less than 200. Does she need so much of insulin or her sugar levels can be controlled thru tablets (coz she is more comfortable with tablets). Why is her sugar levels still high at bedtime? Wht are the side effects of taking so much of insulin. Is there a possibility of low sugar episode?
Thu, 21 Mar 2019
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General & Family Physician 's  Response
H,

There are different approaches in controlling blood sugar depending on the levels taken. Basically, your mom is already covered for basal insulin (Lantus) and prandial (or during meals - breakfast and lunch). But from what you have said, that she had been having elevations at night time (for which she doesn't have an Actrapid dose in the evening), another dose of Actrapid can then be added to cover for the evening dose to prevent spikes.

Still, it is important to follow dietary restrictions to avoid sudden elevations of sugar levels.

Depending on the control, she can be shifted to tablets and especially if her HBA1c becomes lower.

Insulins are relatively safe, and few disadvantages are noted like weight gain and hypoglycemia(low sugar levels beyond normal). Hypoglycemia on the other hand, can be a side effect of insulin if doses are disproportionately high, and are manifested as cold clammy skin, tremors and palpitations, for which blood sugar levels should be checked.

I hope this help you in understanding what your mother needs, and I suggest frequent follow-ups with your Doctor for proper dose adjustment of the medications.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Daryl Derick B. Dizon, General & Family Physician
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What Causes Rise In The Blood Sugar Level At Night Despite Taking Lantus?

H, There are different approaches in controlling blood sugar depending on the levels taken. Basically, your mom is already covered for basal insulin (Lantus) and prandial (or during meals - breakfast and lunch). But from what you have said, that she had been having elevations at night time (for which she doesn t have an Actrapid dose in the evening), another dose of Actrapid can then be added to cover for the evening dose to prevent spikes. Still, it is important to follow dietary restrictions to avoid sudden elevations of sugar levels. Depending on the control, she can be shifted to tablets and especially if her HBA1c becomes lower. Insulins are relatively safe, and few disadvantages are noted like weight gain and hypoglycemia(low sugar levels beyond normal). Hypoglycemia on the other hand, can be a side effect of insulin if doses are disproportionately high, and are manifested as cold clammy skin, tremors and palpitations, for which blood sugar levels should be checked. I hope this help you in understanding what your mother needs, and I suggest frequent follow-ups with your Doctor for proper dose adjustment of the medications. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Daryl Derick B. Dizon, General & Family Physician