Advice needed for Insulin Intake

vercetti

vercetti

Skilled
Hey Guys,

Not sure if I can get good advices here but wanted to try out my luck anyways...So here I go

My mother is a diabetic patient since the last 7 years...

All the time she has never taken insulin

Around a month back we went to a reputed clinic in Kormangala 'Diabetic Care center' and the doctor there started her on Insulin Injections...Started with 10 units in morning and evening ....

Not it has increased to 34 units per day....

The sugar level after insulin injection is Fasting 179- PP 234 (Hovers around this)

Around 2-3 months back my moms sugar level was Fasting 180- PP 250.

Now, The doctor is saying that mom might have to take insulin for the rest of her life

My concern here is:

  1. She has prescribed a high dosage for a patient who has never taken insulin
  2. I don't trust her:( judgment

MOM: She walks in the morning and evening for 30 mins each and is very active and does a lot of activity. She has full control in her diet and doesn't even touch sweets.

So Guys, can u adbice what I should do? I have earlier consulted Apollo, Wockhart, Sagar hospitals/clinics in blore...

Any suggestion here no matter even minute would be appreciated:)
 
What do the other hospitals / clinics in Bangalore advise?

I am a borderline diabetic. Your moms sugar levels certainly dont warrant insulin injections is my opinion. Tablets should be more than enough. Take a second opinion from another physician.
 
The problem is...When we went to see the doctor the insulin level was 330-445 (fast and PP)..Doctor said that she had an urinal infection (excess ketone) and gave high dosage of insulin for that and said that once the sugar level comes down she will reduce the insulin

But the sugar level has not come down since:(...So Now I am a little skeptical of the doctor...

I will describe the incidents in details:

Day 1: we go to doctor and she advices to take insulin and have Ketone test in Day 3 (20 units of insulin per day 10-0-10)

Day 3: Ketone test is "TRACE". Doctor says its good news and she will see us on day 7 and do the remining tests

Day 7: Ketone again turns up +ve so doctor increases doage to 40 (18-0-22) As sugar was also 275- 440 <after a week of insulin>..Doctor says if the Ketone level is even trace on day 9 we should get admitted on day 10 and she will clean up the system on day 11 by putting my mom in glucse(slyin?)

Day 10: Ketone is still trace ...(this is where I lost confidence on the doctor)...doctor says to increase the dosage and wait for 3 more days...dosage is now 20-0-24

Day 14: Ketone is absent and sugar is 130-200..but fluctuating b/n 100-170 for fasting and 180-260 for PP...Doctor reduces the insulin to 34 ...14-0-20 and asks us to come after a month:(

Its day 23 now and the sugar level is still constant with insulin so I am scared that my mom might have to take insulin for therest of her life

I have not taken a second opinion since I went to this clinic...Do u think I should take a second opinion?? also, since she takes insulin we don't know what would happen if she stops the insulin intake

One big Doubt: By taking insulin will it become an addiction ...meanin will the body get so accustomed that it will even stop producting its own agents expecting the insulin to be injucted manually everyday:(
 
it is better if you take opinion of other doctors too..

i have seen many cases where doctors abuse their authority by asking the patients to do many tests unnecessarily..in many cases, bunch of tests being the same with different names. they get their commission and the patients blind trust is abused.

if you have any doc in family then consult the same regarding hat your current doc is advising.
 
Very sorry to hear about your mother..here are a bit of info that may give you insight..

Ketone traces in urine may indicate a poorly controlled diabetes or can happen in controlled diabetics when body undergoes stress like infection.In your case doctor is giving insulin so as to quickly control the situation, there is an condition called "Ketoacidosis" and should be avoided in diabetics. And very often doctors use Insulin liberally to control this situation. Your doctor is right in using insulin in this cases especially if he has also checked for sodium, potassium and bicarbonate in the blood.

However dosage seems to be inappropriate as on repeated use your mothers blood sugar is still not in control. But many a times doctors need time to titrate the dose of insulin and decide which type of insulin to administer.( I will not get into types of injectable insulin).

Regarding your second query..if you mom will become dependent on insulin?

Well thats very subjective. At times of stress patients have to be shifted on insulin to recover fast like in infection or even changed to insulin if one is undergoing surgery. After the stressful event is over patients are shifted to oral drugs again and patients mostly do well. At times however if the patients sugar cannot be controlled inspite of all the combination of oral drugs patients have to be given insulin. it does not mean that the initial dose of insulin to combat stress makes one's body dependent on insulin.

Let the doctors do their job and if they say to get her admitted.. do so.

There are times when body insulin reserves are depleted and oral drugs are of no help or not completely effective..in these cases one has to shift on insulin.

if you are worried about injection .then you should know that insulin in form of inhaler/sprays are also available now..just like the medications for asthmatics..

Hope your mother recovers soon...

-Titana's Brother
 
Vercetti bro don't panic. There's a strong chance that these insulin injections are temporary. If your mom keeps a strict diet and walks regularly she might get rid of the injections in a few months.

My mom's was on insulin injections around two years back. Her blood-sugar level was around 350 PP (after meals). With strict diet control and regular 45 minutes walking she got rid of the daily injections within 4-5 months and since then she is back on pills. Her sugar levels are mostly below 150-200.

Just keep motivating your mom for sticking to her diet and if possible do accompany her occasionally on her walks. Believe me she'll be fine in a few months.

Diabetes can not be cured but it can be kept under control and a person can lead a normal life... but perhaps you know that already :)
 
Some added info:
There are two things that you are worried about:
1. Dependency on insulin.
2. Overdosage

Please understand that body doesnt become dependent on insulin (wrong concept). Insulin is ia hormone that our body produces which among many other things regulates sugar levels in our tissues. Everyone therefore needs it, whether naturally such as nondiabetic people, or via extraneous sources ie injectable insulin.. which diabetics need. Oral antidiabetic drugs, which your mother was previous taking was only helping her body to manage the little amount of insulin that her body was naturally making. Due to illness, requirement of body for insulin increases hence the shortage, leading to increase dosage of insulin or other drugs. Now, the once illness is over, patients body may or may not come back to previous state. On side note, I may also add that the illness may not be the reason for increasing sugar. It could be an incidental finding that you discovered on checking blood sugar because she was feeling unwell. Usually, borderline diabetic patients (on antidiabetic drug) over period of time become unresponsive to oral drugs (body just stops producing natural insulin). Therefore, insulin needs to be introduced from outside.

Regarding dosages, there is a international standard protocol. However, the doctor uses his experience to tailormade/modify those protocols and gradually works toward acheiving normal sugar level. For this doctor takes time and requests sugar levels check of the patient.

Hope, that it helps, and dont be afraid of insulin. Concentrate on controlling sugar which is the real culprit.
 
Paraman, Titana's Bro, Mandav and Argus...Thanx a lot...

Titana's Bro..Thanks to u ...very detailed explanation..Since the type of insulin is in question I would like to detail out the current medication for sugar control for my Mom:

1. Insulin (Novolet) 16-0-20 (its 36 units per day)

2. Tablet - Amaryl M 2 MG (This was assigned a week back, before this the doctor had prescribed Amaryl 2 MG and glycomet)

@ Argus:

Bro, Mom has been walking since last 7 years and she does not miss any of her walks. She is also a migraine patient and has leg and back pain. But no matter what, sun, pain and any kind of pain..she will make sure she takes a walk... her discipline is GODLIKE.

Also, Nice to hear ur story. Its quite motivating. I am curious to know what was ur mom's insulin intake when she was under insulin?

Guys...By seeing Titana's Bro and Argus's reply I think I should wait till for another month (day 45) and then take a decision...Do u think its a wise decision?

U all guys Rock...U are gonna get showered with reputations
 
Vercetti, if you are so concerned take a second opinion.

But you see those sugar levels? They are way above normal even for a person on Insulin. The ketones in the urine are a sign of uncontrolled blood sugar. All this my friends have already said above and titana's brother has already asked all the relevant questions.

But I am here to stress just one fact, that even with Insulin those sugar levels are too high, and ketones appearing in the urine are is not a good sign. It can lead to major complication mate.

Take a second opinion and maybe get a target organ damage screen for your mom. Diabetes leads to damage in the eyes, kidneys, limbs to name a few. Get a whole detailed checkup done. In fact get a Glycosylated Hemoglobin (HbA1c) level done which is a more accurate marker of sugar control.

Precautions of taking Insulin injections -

1. Do not use the same needle more than once.

2. Do not use same spot to inject the Insulin, make it variable.

3. Keep the Insulin refrigerated. Do not leave it out in room temperature for more than a few minutes.

4. Stick to the schedule! Do not miss doses.

Once insulin is started, it is usually required to be taken life long because the body needs it. It is required in periods of bodily stress. That is why I am worried whether there is anything else going on that is causing the body so much stress that it requires Insulin, and even then the sugar is not under control.
 
We have done a full checkup including eyes, kidneys etc...

The doctor said its ok and we can use one needle to 4 injections

I do use different sopts for each insulin injection

Yup..insulin is always refrigerated

I never miss a dosage and any timeline. Mom has her breakfast and dinner exactly 30 mins after the insulin dosage

the ketone is now absent..we tested it 2 weeks back...do u think I should have it retested?

One of the reason I don't want to take a second opinion:

the other doctor might say something different and start my mom in a new medication just to show that the previous doctor was a jerk...

Also, I don't want to have my mom on 2 different medications:(

The clinic I am taking her to..is supposed to be a leading diabetic clinic in india

MV centre for DIABETES... supposed to be very very good...better than appolo and others...and it just specializes in diabetes so I don't wanna go and take a opinion in other hospitals
 
@vercetti

novolet is a means to administer insulin. Insulin itself can be short acting, ultra short acting , long acting. These alone or in combinations may be used depending upon individual requirements. all these preparations have different names apart from the name insulin(mixtard, actrapid...).Trust me you need not know more of these details. Leave it to the doctor.

looks like your doc is using combination of both insulin and oral medication. nothing wrong with it..let it continue

Apart from medicine..most important part is patient compliance. Motivate your mother for diet control and morning walk. Diet control as per recommendations is imperative. Consult a dietician and get food chart made according to your mothers likes and dislikes.

Getting sugar under control is different for all people with diabetes. lets hope things get under control fast..

if you read about some test or treatment here in forum or elsewhere on internet..just inquire politely..do not go on like "get this/that test done" it might be annoying to doctor. Doctors experience comes handy and sometimes they have ideas before test results come.
 
being a doctor (though just a mbbs passed, yet to do a pg) i wud say there is nothing suspicious about the doctors advice!!!

1 the primary modality of a type 2 diabetes mellitus patient is to start with oral hypoglycemic agents and exercise to control diabetes

if its controlled then the treatment is titrated to get a normal level of glucose(mostly to keep below 180mg/dl)

slowly after years of this therapy endogenous insulin levels begin to decline

it cant be controlled by OHA anymore and the patient has to be put on insulin

what is addiction in this dude???

The patient can never regain insulin production so insulin from exogenous source is must!!

i will describe more wen i get time in the meantime do a HBA1c estimation rather than just a FBS or PPBS

HBA1C helps in knowing whether sugar has been controlled well in past 3months rather than just the testing day!!

Its very essential to keep track thru HBA1C

bye nd dont panic
 
@titana..Moms using MIXTARD insulin. and she is very complaint in her routine.

Others and AYASKANT..what's HBA1C test?

One question guys:

Does mental strees lead to a massive increase in Sugar level?
 
vercetti said:
The doctor said its ok and we can use one needle to 4 injections
I do use different sopts for each insulin injection
Yup..insulin is always refrigerated
I never miss a dosage and any timeline. Mom has her breakfast and dinner exactly 30 mins after the insulin dosage
Click to expand...

Observations as a longstanding diabetic on Insulin.

It will be a good idea to have a second opinion. Need to follow it only if fully convinced.
As mentioned, get HBA1C tested which will give indication of the control for past 3 months or so.
I do use the syringe 3-4 times but only when promptly kept in fridge after use.
Never keep Insulin in freezer.
If I am not wrong, it can be stored at room temperature of 25 C for a week or two.
Last but not the least, get a Glucometer. All these years, it had been of so great help that I do not yet have any of the usual complications. Years back I bought it for Rs.4800/- but now it is available for around 1K.
Be careful about hypoglycemia. (happens in my case)
 
vercetti said:
@ Argus:

Bro, Mom has been walking since last 7 years and she does not miss any of her walks. She is also a migraine patient and has leg and back pain. But no matter what, sun, pain and any kind of pain..she will make sure she takes a walk... her discipline is GODLIKE.

Also, Nice to hear ur story. Its quite motivating. I am curious to know what was ur mom's insulin intake when she was under insulin?
Click to expand...

Nice to know your mom's discipline :)

Sorry I don't remember the insulin figures as its been over two years. The details must be in some old file lying somewhere. All I remember now is that for the first few weeks my worries increased as did my mom's insulin dosage. I used to think is this going to continue till the rest of her life. But things changed later.

One thing, mom has always adhered to her diet strictly.

And as for second opinion, just take your mom's medical file to another competent doctor and discuss her case with him. Ask all your doubts there. No need to take your mom with you.

Advantage : Your mom will be spared the hassle.

Disadv. : May leave you confused.

Wish your mom recovers soon :)

*** addition

HBA1C test tells the blood-sugar status for the last 3 months.
 
vercetti said:
@titana..Moms using MIXTARD insulin. and she is very complaint in her routine.

Others and AYASKANT..what's HBA1C test?

One question guys:
Does mental strees lead to a massive increase in Sugar level?
Click to expand...
HbA1c test can let one know the sugar control status in the past over a longer duration. It basically reflects sugar control in the past. you may inquire about it..if doc feels necessary will get it done.
Let the medicine continue..by compliance it means both medicine as well as diet.

Mental stress is unlikely to increase sugar level
 
One thing that helped my father when he was around was karela juice.

He once had a sugar test done after he had a swig and the doctors were curious to know what he'd done to get the blood sugar levels down :eek:hyeah:
 
HbA1c means level of glycated hemoglobin

it forms because of excess glucose levels in blood

Since RBC mean life is around 120days so the glycated hemoglobin gives us the control that was 3months back when the RBC hemoglobin came in contact with the excess glucose

i hope u got it!!

and just dont panic, it adversely affects the patients mental strength

Doctors dont do miracles, its the patients will power that does it!!

Since u are going to such a nice hospital have faith n trust.....

Nowadays its like a fancy to mistrust a doctor but indirectly the panic nd stress increases Steroids, Adrenaline, GH, etc(Hyperglycemia causing hormones) in ur body which increases blood glucose levels.....

so stay fit nd enjoy life and be happy
 
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