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Should Insulin Dose Be Reduced When Blood Sugar Level Goes Down?
Question: wish to consult a XXXXXXX Diabetic Specilist Doctor( since I am taking XXXXXXX Medicines and Insulin available in India) on my insulin dependent diabetic. Though the fasting sugar level was under control post food level was not controlled. The average for 4 months comes to 10.2 as per H1A1c (?) Others are oK.
Now from July, I changed the Insulin Lantus with TRESEBA.
Morning Diamacron 10 mg before food and Novamix 50:50 10 units and after breakfast Galvusmet 50/500 plus Cardace 5 mg for Bp. I take Centrum Vitamin tablet in the morning after food. Morning I take vegitable mix ots at 8.30 am, 11 am two biscuirts and coffee, lunch with little rice and vegitable, evening 5 two biscuits and coffee ( coffee with coffee mate and no sugar always) Night I take Ragi Dosa 3,
Night Diamacron before food and insulin Lantus 30 units at night. July, as per doctor advise, I changed Lantus to TRESIBA 25 untis daily in the night after food for 300 units and then came back to Lantus. I am going for regular walk of 20 minutes in moring and 20 minutes in eve most of the days.
Also Galvusmet 50/500 two times after food( morning and night). After 15 days of walk, and diet also morning veg soup with oats, 11 coffee with 3 biscuits, lunch little rice and veg, 5 pm coffee with 3 biscuts and night 3 or 4 ragi dosa.
last two days the sugar reading was post break fast after one or one and halff hour it came to 137 and today 125.
My question is can I reduce the Insuling unit intake... say morning 5 of novamix and night 20 of lantus and try the readings? my weight is 85 and height is 5.11 what is BMI for me and where I can get the chart
Now from July, I changed the Insulin Lantus with TRESEBA.
Morning Diamacron 10 mg before food and Novamix 50:50 10 units and after breakfast Galvusmet 50/500 plus Cardace 5 mg for Bp. I take Centrum Vitamin tablet in the morning after food. Morning I take vegitable mix ots at 8.30 am, 11 am two biscuirts and coffee, lunch with little rice and vegitable, evening 5 two biscuits and coffee ( coffee with coffee mate and no sugar always) Night I take Ragi Dosa 3,
Night Diamacron before food and insulin Lantus 30 units at night. July, as per doctor advise, I changed Lantus to TRESIBA 25 untis daily in the night after food for 300 units and then came back to Lantus. I am going for regular walk of 20 minutes in moring and 20 minutes in eve most of the days.
Also Galvusmet 50/500 two times after food( morning and night). After 15 days of walk, and diet also morning veg soup with oats, 11 coffee with 3 biscuits, lunch little rice and veg, 5 pm coffee with 3 biscuts and night 3 or 4 ragi dosa.
last two days the sugar reading was post break fast after one or one and halff hour it came to 137 and today 125.
My question is can I reduce the Insuling unit intake... say morning 5 of novamix and night 20 of lantus and try the readings? my weight is 85 and height is 5.11 what is BMI for me and where I can get the chart
Brief Answer:
Diabetes
Detailed Answer:
1 I am licensed in both XXXXXXX and USA
2 The average of 10.2% A1c is not good. To avoid complications of diabetes, a target of 6.5% to 7% is recommended
However, these targets are individualized based upon comprehensive evaluation of the person with diabetes. This entails a physical examination too in addition to dozens of other factors some of which include detailed history, laboratory test results, frequency and (lack of) awareness of low glucose reactions.
3 I have noted your diet. It seems reasonable
I suggest you work closely with a dietitian to develop a customized plan based on your broader medical profile such as whether or not you have high blood pressure, high cholesterol, kidney problems etc
4 Your most recent glucoses that you are reporting of 125 and 137 after breakfast are quite good.
5 I have understood your current diabetes medication program.
Your insulin dose can be potentially reduced. This too depends on several factors:
1 Taking optimal doses of other oral diabetes medications you are on such as GalvusMet and Diamicron.
2 Weight loss
3 Increased physical activity and fitness
4 Being on an insulin regimen that is more 'physiologic' meaning closer to the way the body makes insulin.
It is not the purpose of this forum to suggest precise doses of medications. In fact this practice is discouraged by the moderators of this online health portal.This is a fair idea because recommending precise doses requires a systematic assessment of the individual which is not possible through virtual care.
So I suggest you see an MD, DM Endocrinologist and request him ir her to consider a treatment program that allows you to take maximal tolerated doses of the oral medications (Diamicron and galvus Met). Further Novomix has limitations. Lantus and Tresiba have no major differences in my opinion.
Despite the disadvantages of certain diabetes medications like Novomix, it can be used as a reasonable choice for a given person based upon a thorough evaluation.
Generally I can say that if I saw someone like you in my practice, I would judiciously use full doses of Diamicron and GalvusMet, and eliminate Novomix, and then see if Lantus doses can be cautiously reduced. If this doesnt work then I treat the person with complex insulin regimens if an in-depth examination reveals that tight diabetes control is justified in the individual.
6 Your BMI is 26
http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/BodyMassIndex/Body-Mass-Index-In-Adults-BMI-Calculator-for-Adults_UCM_307849_Article.jsp
Diabetes
Detailed Answer:
1 I am licensed in both XXXXXXX and USA
2 The average of 10.2% A1c is not good. To avoid complications of diabetes, a target of 6.5% to 7% is recommended
However, these targets are individualized based upon comprehensive evaluation of the person with diabetes. This entails a physical examination too in addition to dozens of other factors some of which include detailed history, laboratory test results, frequency and (lack of) awareness of low glucose reactions.
3 I have noted your diet. It seems reasonable
I suggest you work closely with a dietitian to develop a customized plan based on your broader medical profile such as whether or not you have high blood pressure, high cholesterol, kidney problems etc
4 Your most recent glucoses that you are reporting of 125 and 137 after breakfast are quite good.
5 I have understood your current diabetes medication program.
Your insulin dose can be potentially reduced. This too depends on several factors:
1 Taking optimal doses of other oral diabetes medications you are on such as GalvusMet and Diamicron.
2 Weight loss
3 Increased physical activity and fitness
4 Being on an insulin regimen that is more 'physiologic' meaning closer to the way the body makes insulin.
It is not the purpose of this forum to suggest precise doses of medications. In fact this practice is discouraged by the moderators of this online health portal.This is a fair idea because recommending precise doses requires a systematic assessment of the individual which is not possible through virtual care.
So I suggest you see an MD, DM Endocrinologist and request him ir her to consider a treatment program that allows you to take maximal tolerated doses of the oral medications (Diamicron and galvus Met). Further Novomix has limitations. Lantus and Tresiba have no major differences in my opinion.
Despite the disadvantages of certain diabetes medications like Novomix, it can be used as a reasonable choice for a given person based upon a thorough evaluation.
Generally I can say that if I saw someone like you in my practice, I would judiciously use full doses of Diamicron and GalvusMet, and eliminate Novomix, and then see if Lantus doses can be cautiously reduced. If this doesnt work then I treat the person with complex insulin regimens if an in-depth examination reveals that tight diabetes control is justified in the individual.
6 Your BMI is 26
http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/BodyMassIndex/Body-Mass-Index-In-Adults-BMI-Calculator-for-Adults_UCM_307849_Article.jsp
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr
Thank you so much and highly appreciated. God Bless U
Thank you so much and highly appreciated. God Bless U
Brief Answer:
Best wishes
Detailed Answer:
and good health always
Best wishes
Detailed Answer:
and good health always
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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