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avevale_intelligencer) wrote2011-06-09 01:52 am
avevale_intelligencer) wrote2011-06-09 01:52 am
Diabetic medication
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.
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.
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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!
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