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Diabetic, chronic cardiac patient, gets hypo when blood sugar level falls. Suggestion?

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General & Family Physician
Practicing since : 1978
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My father is a diabetic. He takes 4 insulin injections daily plus 9 tablets. He is also a chronic cardiac patient. Even on insulin & tablets for diabetes (apparently to control) his readings are never balanced.
When his blood sugar reading is quite low, under 4, he goes into what I would call a "hypo"...sweaty, clammy, weak, disorientated.
Posted Mon, 3 Jun 2013 in Diabetes
Answered by Dr. Pavan Kumar Gupta 3 hours later
Thanks for the query.
Considering the fact that the cardiologist has rendered the cardiac status of your father as critical,such episodes of hypoglycemia are not good for him.
Symptomatic hypoglycemia, whether clinically mild or severe, is associated with an increased risk of cardiovascular events. So basically a lot of attention is needed for him him.
Since he is already of the age of 67 years and having considerable cardiac involvement,no purpose is achieved by keeping his blood sugar levels in very tight normal range.
To do ..
Give him small meals instead of large meals.
Even if his fasting sugar is around 130 and PP around 180 to 200,it is OK.
A tight blood sugar levels at this age and stage is not going to achieve any thing significantly better for him
Reduce his dose of insulin but in consultation with your treating doctor and not by yourself.
Make sure that he is eating in time as generally people at this age start getting forgetful.
Never to leave him alone.
Give him sugar immediately,the moment you find him confused,disoriented,sweaty and clammy.

I hope it helps however you may revert to me for any further query.
Best of luck
Above answer was peer-reviewed by
Follow-up: Diabetic, chronic cardiac patient, gets hypo when blood sugar level falls. Suggestion? 44 hours later
Where you stated symptomatic hypoglycemia is associated with an increased risk of cardiovascular events..does this mean that there are things going on with his heart which affects diabetes or vice versa?

How would reducing his dose of insulin improve things?

This is a constant worry as we as a family do not know whether it is heart or diabetes that is affecting him worse. In the long term we honestly feel that it will be diabetes which will cause him long suffering or untimely death rather than cardiac issues?

Your advice would be greatly appreciated.
Answered by Dr. Pavan Kumar Gupta 5 hours later
Diabetes is the mother of all diseases and complications arising in body.
It causes damage to all XXXXXXX organs of body which includes heart,kidney,brain,eyes,nerves,blood vessels etc.
Cardiovascular disease is the leading cause of morbidity and mortality in older adults with diabetes mellitus.

Elderly people probably should not go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 to 15 years or more.

Tight control is associated with an increased risk of hypoglycemia (abnormally low blood sugar), which can be very XXXXXXX Tight control is also difficult to achieve, often requiring multiple medications that may have adverse effects of their own. Even a moderate relaxation of blood sugar goals can make life easier for type 2 diabetics.

Not all patients with type 2 diabetes respond to tight blood sugar control the same way. When researchers analyzed subgroups of patients, they found that those with newly diagnosed diabetes enjoy cardiovascular benefit from tight control, while those with longstanding diabetes and established heart disease do not. The theory is that tight control can protect healthy blood vessels from damaging glycosylation, but once damage has occurred, it's too late for tight control to help.
It is the diabetes which has caused all the destruction in body including heart.

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