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Dr. Andrew Rynne

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Fasting and postprandial sugar level high. Not controlled by medicine. Any advice?

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Dr. Mayank Bhargava

Internal Medicine Specialist

Practicing since :2003

Answered : 1658 Questions

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Posted on Wed, 6 Feb 2013 in Diabetes
Question: I am diabetic have sugar level fasting 200 on glucometer and pp 200-300.My age is 62 yrs,height 167cm and wt 105 kgs.I am orthopaedic patient and can walk without Walker,since last seven years.I am on insulin and the dose taken is 1.b/f 18 units human Actrapid and 22 units human insultard,b/l 20 units actrapid.,b/d same as b/f ,plus janumet 50(sitagliptin phosphate and metformin 1000) in M and Night.sugar is not controlled.Pl. Advise. Thanks, XXXXXXX
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Answered by Dr. Mayank Bhargava 1 hour later
Hi XXXXXXX
Welcome to XXXXXXX forum.

Your blood sugar level both fasting and postprandial are not in controlled range.
You are taking 2 types of insulin separately: Human actrapid and insultard
Human actrapid is short acting insulin and is effective in reducing postprandial sugar.
Insultard is intermediate acting insulin (NPH) and is effective in reducing fasting blood sugar.
According to American Endocrinology association, both of these insulin should be increased at dosage of 2 units at the interval 3- 4 day till both of these figures cone down in controlled range.
Fasting blood sugar should be around 100-110 mg% and postprandial blood sugar around 140-150 mg%.

Janumet acts on both fasting and postprandial blood sugar.
You can take Janumet twice in day.
Uncontrolled blood sugar is associated with multiple complications, so blood sugar must be in controlled range.

You should consult with XXXXXXX medicine specialist/ endocrinologist and should go for thorough check up.
For insulin dosage titration, you should remain in touch with your treating doctor.
You should also go for serum serum C peptide level; whether body has ability to synthesize endogenous insulin or not.
Glycated hemoglobin (HbA1c) should be checked at an interval of 3 months and it should also be <6.0%.

Hope that helps.
Let me know if I can address any more concerns.
Take care,
Dr. Mayank Bhargava
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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