[email hidden] (Mark) wrote in
:"]news:[email hidden]:
Quoted message said:Until last week, my mother (age 78, type 2) was taking insulin 3x per day, a total of 140 units of
N and R. Even with these high doses, her blood sugar was in the 200 + or - range.
About Thursday of last week (i.e. one week ago) she began refusing to take any more insulin. She
is taking Avandia instead, an old prescription that never did a very good job of controlling her
blood sugar either. She also refuses to measure her blood sgar, claiming she will know if she
starts to feel bad. So far (after one week with Avandia instead of insulin) she claims she feels
fine. She refuses to call her doctor or let me call her doctor to discuss this with him. (Of
course, she will eventually have to, in order to get the Avandia refilled).
I'm not exactly sure what I should do, or how worried I should be. She is an adult, of course,
and not cognitively impaired, so I don't feel I can force her. I also can't yell at her too much
or chastise her, since she also has congestive heart failure and I don't want to create stress
for her.
So, how worried should I be? What risks is she taking? What should I look for to know when to call
911? Thanks for any advice.
Mark
Without knowing a lot more about your mother's condition, medical records and history, physical exam
results, test results, etc. (not to mention a medical degree hanging on the wall) there is not much
specific advice that can be given. A few general things can be said, however.
A daily dose of 140 units is not at all unusual for a type 2 diabetic. Intercurrent illness often
increases insulin requirements.
The expected fasting blood glucose level reduction from Avandia is 25 - 55 mg/dl. These two
medications, insulin and Avandia, can be used together and target two of the mechanisms that
contribute to type 2 diabetes, insulin resistance and impaired insulin production. There are a
number of other classes of medication that can be brought to bear as well.
Many diabetics will tell you that they can tell their blood glucose levels by how they feel.
Whenever this has been tested, however, the prediction accuracy is exactly what you would expect by
guessing. I must admit, for example, that I cannot tell you if my bg is 60 or 350 mg/dl right now.
In addition, there is an acclimation effect. If you're glucose levels are running in a particular
range, you get used to that range. If they are running high, for example, and drop into the normal
range, you may feel hypoglycemic symptoms. How you feel is a worse than useless as a measure of
your control.
Two of the ways that out of control type 2 can kill you in the short term are Diabetic KetoAcidosis
(DKA) and Hyperglycemic Hyperosmolar Syndrome (HHS)*. One of the best ways to get into DKA or HHS
trouble is to be old, have uncontrolled blood sugars due to the suspension of insulin, and have
intercurrent illness. Typical symptoms for DKA would be: Fatigue Nausea Vomiting Muscular stiffness
or aching Mental stupor that can progress to coma Rapid deep breathing Fruity breath (acetone breath
odor) Additional symptoms that may be associated with this disease: Headache Consciousness -
decreased Breathing - rapid Breathing difficulty - lying down Blood pressure - low Appetite - loss
Abdominal pain
Symptoms of HHS are similar, but nausea, vomiting and abdominal pain occur less frequently replaced
by: Weight loss, weakness, visual disturbances leg cramps
Depression is a common finding in diabetics.
There is nowhere you can go with this that does not involve talking to both your mother and her
doctor. Only he has the combination of medical knowledge and an understanding of your mother's
particular situation. Treatment goals are a function of many variables, including the wishes of
the patient.
*DKA and HHS have traditionally been regarded as two separate entities. They may really be two
extremes on a single continuum of decompensation.
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Charly Coughran [email hidden]
