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Diabetic, have fluctuating sugar and high creatinine. Suggested novarpid and lantus. Cannot be operated for gall bladder stone

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Posted on Tue, 20 Aug 2013
Question: My mother is admitted to remove stones in gall bladder(3-4 stones....biggest size is 14mm)....She is diabetic....sugar fluctuations are very high....she has been recommended novarapid r & lantus solostar....but the fluctuations are still high....Her creatin level is 3.2. Doctors say she cannot be operated until sugar & creatin are stable. Her age is 63....having diabeted since 10 years. I wanted to ensure that she is getting from insulin treatment. Please suggest.
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Answered by Dr. Minal Mohit (18 hours later)
Dear XXXXXXX it is a very sad state of affairs, but it is true that diabetes needs to be strictly controlled for any surgery. As creatinine is high she is also having diabetic kidney disease. So sugar fluctuations are bound to be there. The regimen of novorapid and lantus also known as MDI (multiple daily injections) is the best regimen for the state of affairs that your mother is going through. You need more frequent monitoring in such situations i.e. around 7 times a day. Fasting blood sugars, 2-hour post breakfast, pre - lunch, 2-hour post lunch, pre dinner, 2 hour post dinner, mid night and titrate sugars accordingly.
Regards! All the best.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Minal Mohit (4 hours later)
Thanks a ton Dr. XXXXXXX Before being admitted my mom was taking insulin called Insugen-30/70 from Biocon & she had stable sugar levels (though above 250 but with no fluctuations)....Now with MDI she is having high fluctuations (like 140-220-336-170)....so I am bit concerned & feel that Insugen is more suited to her. Kindly suggest.
doctor
Answered by Dr. Minal Mohit (2 hours later)
Dear XXXXXXX

As you rightly said, that with insugen 30/70 though all sugars were high but they appeared stable to you. insugen 30/70 is a better choice once the patient is stable i.e. no kidney involvement, no surgery in pipeline, fixed meal plans, fixed exercise schedule. Once other things set in, like DKD, Gall stones, high creatinine, fluctuating appetite, MDI is the right plan, only thing is you need to titrate the dose rightly and monitor more frequently.
Also, I must add that > 250 blood sugars is not good even though they do not fluctuate.
Regards!


Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Minal Mohit

Endocrinologist

Practicing since :1998

Answered : 838 Questions

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Diabetic, have fluctuating sugar and high creatinine. Suggested novarpid and lantus. Cannot be operated for gall bladder stone

Dear XXXXXXX it is a very sad state of affairs, but it is true that diabetes needs to be strictly controlled for any surgery. As creatinine is high she is also having diabetic kidney disease. So sugar fluctuations are bound to be there. The regimen of novorapid and lantus also known as MDI (multiple daily injections) is the best regimen for the state of affairs that your mother is going through. You need more frequent monitoring in such situations i.e. around 7 times a day. Fasting blood sugars, 2-hour post breakfast, pre - lunch, 2-hour post lunch, pre dinner, 2 hour post dinner, mid night and titrate sugars accordingly.
Regards! All the best.