Please Advise

[Indrani Das]

Hello good people.. Greetings from Botswana. My husband is suffering from diabetes its been 3 years. His sugar never go below 15. He has tried metformin, galvusmet and all sort of inslulin. But his sugar is not going down. We have been to many endocrinologist. But nothing worked so far. If any one help with their advise opinion and experience, I will be greatful. We are helpless in this moment.
Kind regards

Indrani

 

[rebrascora]

Hi and welcome.

Sorry to hear your husband's levels are so high. That must be making him feel pretty unwell.
Is he suffering diabetic symptoms like thirst and going to the toilet frequently and perhaps losing or gaining weight?

Can you give us an idea of what he eats and drinks in an average day?
Is he overweight, underweight or about normal. If over or under, by how much?
Is he physically active or able to do more exercise? Walking is really great exercise for reducing BG levels.

When you say he has tried all sorts of insulin, can you give us an idea of which ones and how many units he was taking?

The more information you give us, the better idea we might have of what is going on.

 

[Indrani Das]

Good day Barabara, thank you so much for your kind response. He is these symptoms like thrist, polyuria and sweating. He has lost weight. He used to be 72 kg now he is 59kg. We consulted one Dietitian, she said he is loosing muscle. He used to take novomix insulin. He was also on lantus victoza. Right now he is on Novorapid. Amd he takes 80units in a day.. He does not do any excercise. But he walks quite a lot but not continually. His diet is mostly based on lentis, rice, eggs, fish and meat.
Once doctor suggested intermitten fasting. It did not help. We tried also nostarch diet. But nothing seems working

Regards
Indrani

 

[rebrascora]

It sounds like he is Type 1 diabetic with the weight loss and muscle wastage and low body weight. Here in the UK he would be treated with an MDI (multiple daily injections) system of insulins where he would be given a long acting (basal) insulin like Lantus or Levemir which would be injected once or twice a day to cover the glucose released by his liver and then a (bolus) insulin like NovoRapid which he would use before each meal to cover the carbohydrates in his meals. Getting the dosage of each insulin correct is important to managing his levels well. 80 units of NovoRapid per day is quite a lot but if he is not using a basal insulin at the same time it will be having to do a lot of extra work and will also depend upon hy much carbohydrate he is eating... It is probably having to do more than twice the normal amount of work if he isn't using a basal insulin. Is he still using the Lantus or just the NR at the moment?
Victoza tends to be prescribed for Type 2 diabetics who need to lose weight I believe, so I am not sure why they would prescribe him that since he is clearly underweight at 59kg.

How often does he test his blood and does he keep a food diary along with his readings and insulin doses?

 

[Indrani Das]

It sounds like he is Type 1 diabetic with the weight loss and muscle wastage and low body weight. Here in the UK he would be treated with an MDI (multiple daily injections) system of insulins where he would be given a long acting (basal) insulin like Lantus or Levemir which would be injected once or twice a day to cover the glucose released by his liver and then a (bolus) insulin like NovoRapid which he would use before each meal to cover the carbohydrates in his meals. Getting the dosage of each insulin correct is important to managing his levels well. 80 units of NovoRapid per day is quite a lot but if he is not using a basal insulin at the same time it will be having to do a lot of extra work and will also depend upon hy much carbohydrate he is eating... It is probably having to do more than twice the normal amount of work if he isn't using a basal insulin. Is he still using the Lantus or just the NR at the moment?
Victoza tends to be prescribed for Type 2 diabetics who need to lose weight I believe, so I am not sure why they would prescribe him that since he is clearly underweight at 59kg.

How often does he test his blood and does he keep a food diary along with his readings and insulin doses?

 

[DaveB]

Hi I agree it could be T1. It sounds like he has been on a confusing mix of meds. Either way keep the carbs low and have enough fats and proteins. If on insulin he will no doubt need both a Basal and a Bolus (e.g. Novorapid). BTW Galvusmet contains Metformin plus a Gliptin so no need to take Metformin as well. If you can get him tested for T1. There are two tests i.e. GAD and C-Peptide

 

[Indrani Das]

Thanks Barbara. I will tell him him to make a food diary. But after taking 80 units why his blood sugar does not go down? Even when he fasting for more than 12 hours the reading is shows still above 12.
Regards
Indrani

 

[Indrani Das]

Hi I agree it could be T1. It sounds like he has been on a confusing mix of meds. Either way keep the carbs low and have enough fats and proteins. If on insulin he will no doubt need both a Basal and a Bolus (e.g. Novorapid). BTW Galvusmet contains Metformin plus a Gliptin so no need to take Metformin as well. If you can get him tested for T1. There are two tests i.e. GAD and C-Peptide

 

[Indrani Das]

Thank you Dave. Yes he was on confusing mix medicine. Only Galvusmet showed some improvement but it gve him severe diarhea. So he had to stop it. But he has done some antibody test. And some other test. But we did not get a definitive response from doctor. About his diet thats what he is trying to keep the carbs low. But he seems to have high LDL. So we are kind of worried. Even bicarbonate is very low and along with some other problems.

Regards
Indrani

 

[Kaylz]

You really need to push this with the professionals, sorry but I disagree with @DaveB, I know you say the insulin doesn't seem to be working but cutting out carbs and taking 80U of rapid acting could be highly dangerous so is pretty silly advice in my honest opinion, if on set doses then its wrong to tell someone to cut out carbs as they have no idea how that may effect them, I highly suggest you get in touch with whoever provides your husbands care xx

 

[rebrascora]

Can you confirm that he is just on NovoRapid at the moment and no other insulin?
When is he injecting it?
Does he inject 80U in one go or in smaller doses totaling 80U throughout the day?

Could it be that the insulin has been compromised.... I am guessing it may be hot in Botswana which could certainly affect the efficacy of it if it has been exposed to high temperatures. Where does he keep his insulin? If you have taken good care to store it, it could be that it was exposed to heat somewhere in transit before he received it and has degraded... Can you get another completely different supply and try that? Do be very cautious with new insulin if you get it because, if what he has been using is compromised, he may find he is much more sensitive to the new stuff and as I said, 80 units is a lot for someone of so little body weight.

He really does need a slow acting (basal) insulin to run along side the NR so ask for that and guidance on dosage for both insulins from your health care professionals.

There is something called Dawn Phenomenon which causes the liver to pump out glucose in the morning before breakfast and cause BG levels to rise even though you haven't eaten for a long time. I usually need to inject 2 units of NR just for that as soon as I wake up but some people need to set an alarm and inject at 3 or 4 am to deal with it. It depends how your body works... we are all different.

 

[Inka]

He used to take novomix insulin. He was also on lantus victoza. Right now he is on Novorapid

Hi @Indrani Das I second @rebrascora ’s advice to get fresh insulin. Whatever type of diabetes he has, 80 units should bring his blood sugar down.

I’ve quoted a section from your post in bold. Why was he swapped from Novomix? He needs some kind of basal/background insulin like the Novomix contains.

 

[Indrani Das]

You really need to push this with the professionals, sorry but I disagree with @DaveB, I know you say the insulin doesn't seem to be working but cutting out carbs and taking 80U of rapid acting could be highly dangerous so is pretty silly advice in my honest opinion, if on set doses then its wrong to tell someone to cut out carbs as they have no idea how that may effect them, I highly suggest you get in touch with whoever provides your husbands care xx

Thank you so much kaylz. I am really trying to consult with a good endocrinologist. Even if its online consultation. Cause here seems like doctors have given up. ☹️

Tegards
Indrani

 

[Inka]

Another thought - could it be his injection sites? If he’s been having a lot of insulin, then perhaps his injection sites aren’t absorbing the insulin very well. Does he rotate his sites (ie move from area to area so each place has a rest)?

 

[Indrani Das]

Can you confirm that he is just on NovoRapid at the moment and no other insulin?
When is he injecting it?
Does he inject 80U in one go or in smaller doses totaling 80U throughout the day?

Could it be that the insulin has been compromised.... I am guessing it may be hot in Botswana which could certainly affect the efficacy of it if it has been exposed to high temperatures. Where does he keep his insulin? If you have taken good care to store it, it could be that it was exposed to heat somewhere in transit before he received it and has degraded... Can you get another completely different supply and try that? Do be very cautious with new insulin if you get it because, if what he has been using is compromised, he may find he is much more sensitive to the new stuff and as I said, 80 units is a lot for someone of so little body weight.

He really does need a slow acting (basal) insulin to run along side the NR so ask for that and guidance on dosage for both insulins from your health care professionals.

There is something called Dawn Phenomenon which causes the liver to pump out glucose in the morning before breakfast and cause BG levels to rise even though you haven't eaten for a long time. I usually need to inject 2 units of NR just for that as soon as I wake up but some people need to set an alarm and inject at 3 or 4 am to deal with it. It depends how your body works... we are all different.

Thanks Barbara for pointing out this matter. When I asked Our local phramacist he said its okey to keep insulin in room temperature. So I never store it in refrigerator. He is only on novorapid now. He is not taking any other basal insulin. He takes 40U after lunch and 40U after dinner. Here the normal temperature is around 30 degreeC. I did not think that temperture could actually cause any degradation. You mentioned about dawn phenomenon how can you control that? Does morning walk helps to control BG? What is the best way to store insulin?

Regards
Indrani

 

[Indrani Das]

He used to take novomix insulin. He was also on lantus victoza. Right now he is on Novorapid

Hi @Indrani Das I second @rebrascora ’s advice to get fresh insulin. Whatever type of diabetes he has, 80 units should bring his blood sugar down.
I’ve quoted a section from your post in bold. Why was he swapped from Novomix? He needs some kind of basal/background insulin like the Novomix contains.

Good day Inka,
He was told to swap novomix with novorapid as novomix was not showing any improvement. Thats what we thought. 80u should bring down the glucose level. But it seems it goes down from 17 to 10 but then it shoots back.

Regards
Indrani

 

[Indrani Das]

Another thought - could it be his injection sites? If he’s been having a lot of insulin, then perhaps his injection sites aren’t absorbing the insulin very well. Does he rotate his sites (ie move from area to area so each place has a rest)?

He always takes it in his lower abdomen. He never tried any other area. Does it make any difference? Which site is more effective ?

Regards
Indrani

 

[Kaylz]

@Indrani Das in use insulin can be stored at room temperature for 28 days for Novorapid but any not in use should be kept in the fridge

If he's been using his abdomen the whole time then site issues could be highly possible, I always rotate with each injection, for me its breakfast = left thigh, dinner = right thigh and tea = alternate sites of stomach, I also use a basal insulin as well though which is alternate buttock cheeks
xx

 

[Inka]

Good day Inka,
He was told to swap novomix with novorapid as novomix was not showing any improvement. Thats what we thought. 80u should bring down the glucose level. But it seems it goes down from 17 to 10 but then it shoots back.

Regards
Indrani

That’s probably because he has no basal insulin. He really does need that.

Also, if it’s hot the insulin should be kept in a fridge. It will be damaged very quickly by heat and simply won’t work properly. It sounds like that could well be a big part of the problem.

 

[Inka]

He always takes it in his lower abdomen. He never tried any other area. Does it make any difference? Which site is more effective ?

Regards
Indrani

He needs to vary the site. Have a schedule as @Kaylz suggests. You can use thighs, top of buttocks, upper arms as well as his tummy. I’d give his tummy a rest for a few months and use other sites.