Diabetic medication

[avevale_intelligencer]

The Countess's blood sugars have been bad again lately, so we went to see the diabetic nurse to discuss it. Unfortunately, unlike the previous one with whom we got on quite well, the current diabetic nurse is something of a reversion to type; there was no actual discussion, because nothing we tried to say was accorded any attention. There were many admonitions that it was up to Janet to control her blood sugars, with dire and terrifying warnings that she might become disabled (er, hello?), and a direction to increase the insulin dosage.

Accordingly, the following morning, when Jan's blood sugar was 14.2 mmol (not good), I administered ninety units of the basal (slow-acting) insulin. Six hours later, with no food intake whatsoever, her blood sugar was 20.8 mmol. I made her a carb-free meal, administered no fast-acting insulin with it, and when I checked the blood next it had gone down 9.5 mmol to 11.3.

Now this sort of thing has been happening quite a lot, and it used to confuse us, but we now know what's happening here, because another medical bod let it slip. If the blood sugar dips below a certain point, the body produces more from storage, which is why it can sometimes be high in the morning despite no eating having taken place in the night. Clearly, what I have been doing is drastically overdosing her on insulin, causing wild fluctuations in the blood sugar, and the nurse's knee-jerk policy of increasing the dose was doing no good whatsoever.

So today I have given her reduced dosages of both kinds of insulin and monitored her throughout the day, and while the blood has been in double figures all day there have been no changes of more than 3 mmol, and it has mostly stayed under 15. This is good, because steady, even at a highish level, is better than wild yo-yoing. Establishing the correct dosage to keep it below 10 will be a matter of trial and error, but I have one big advantage in this over the various doctors and nurses who've been trying it; I'm paying attention to what's actually going on, and not operating on the unspoken basis that "it's the stupid fat cow's own fault she's diabetic, how dare she waste our time."

We'll see what happens.

Comments

[johno.livejournal.com]

I've had it confirmed by 2 nurses, one of whom was a diabetic nurse in the past. If it has been "to long" since you last ate, you body will start pumping out sugars from storage to keep the body running.

It's one of the reasons I have a bit of protean around midnight. Slice of lunchmeat, or (despite the carbs) a handful of nuts, spoonful of peanut butter or a bit of cheese.

9 hours later at my morning test my numbers are in the 100-120 range mg/dl, which is my target range.

Personally I've found having 5-6 smaller meals a day keeps my numbers stable. The usual Breakfast/Lunch/Dinner, then add a Late small Lunch and the Midnight snack and I'm good.

[howeird]

Stupid nurse needs to be made redundant. I've been lucky to have diabetes care people who recognize that controlling blood sugar levels is a tricky balancing act, timing is crucial, and no matter what I do I cannot change my genes.

90 units of basal insulin is HUGE. To put it in perspective, I am profoundly insulin resistant, and use 100 units in the morning and another 100 at bedtime to give me a fairly steady Hgl level, with pre-meal doses of the fast-acting insulin on a sliding scale, depending what I'll be eating and what my meter reading has been.

As my nurses have explained to me, if I overdo the dosage, as soon as my system recognizes I am trending into a low blood sugar level, the adrenal gland kicks in, which in turn causes the liver to create sugar and dump it into my blood stream. Without the basal insulin at bedtime, this would happen to me every night. I would go to bed with a normal reading and wake up to alarmingly high numbers. The US uses a different scale than the UK and I don't know how to convert, so I won't bother with the actual numbers.

Anyhow, good luck to Jan and yourself with this. My diabetes mantra is "The human body is not a precision instrument"

[keristor.livejournal.com]

It's a factor of 18, 1 mmol/L (UK) == 18 mg/dl (US). See http://www.diabetes.co.uk/blood-sugar-converter.html (needs JavaScript). My sister is diabetic (has just started injections rather than oral) so I looked it up a couple of weeks back.

I agree, that nurse should be fired. Unfortunately in the UK a doctor pretty much has to kill someone before getting struck off and although an ordinary ward nurse can be fired the specialist ones have a similar immunity to doctors. I would however put in a formal complaint just so it's on the record.

Well done Zan for working it out and daring to try a logical solution!

[howeird]

Thanks for the conversion factor. In that case the numbers would be with 5 to 5.5 at bedtime, without insulin I would wake up with 11.6 to 12.7. With 100 units of basal before bed, it's usually around the same in the morning as it was at bedtime.

[infobits.livejournal.com]

You multipy the UK units by 18, not divide.

[howeird]

keristor's formula and my converted numbers are correct. I was converting from my US numbers (90-100, 210-230).

[wolfette]

do you have access to Usenet? There's a support group for diabetes (I can't remember the full path, but it's the UK group) and the folk there are very knowledgeable and helpful. Not nurses or doctors, but diabetics with long experience of managing their own health.

[bardling.livejournal.com]

Good on you for figuring things out yourself - sounds like you've found the important thing. *hugs*

[delennara.livejournal.com]

Is there any oral anti diabetes medication? Sometimes that helps, too. And you are right- a steady level is better for preventing damage to the eyes.
Something else worth looking into is a change of basal insulin, the new ones have more even profiles. But for all that you need a doc who listenes and explains stuff...

[joecoustic.livejournal.com]

Good for you for figuring this out!! I've had to learn over the years to discount what the experts tell me (along with many "death threats") and listen to my body. But everyone's opinions, results and mileage vary in doing this.

[filkerbaby.livejournal.com]

I'm not on insulin yet but on a new drug called Byetta. Only been on it 3 weeks and am finding that my readings vary wildly from day to day. Some days I reach target, some days I don't and it doesn't appear to be anything I'm doing. Tricky business this, diabetes.

[howeird]

Lizard spit! My sister tried Byetta for a while, had similar bad results, is back on insulin. One of my LJ friends has posted in locked entries of having major success with the stuff. I suppose I should ask my new endocrinologist about it for myself.

[dickgloucester.livejournal.com]

"Professionals" who don't actually listen put people in danger. I second the proposal to report this nurse.