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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Suggest dosage for Insulin in a hypertensive patient

Answered by
Dr.
Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2881 Questions

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Posted on Fri, 27 Jan 2017 in Thyroid Problem and Hormonal Problems
Question: Hi Doctor,

My mother is taking medications for diabetes, thyroid, hypertension and heart disease.
Stents have been placed in her left and right carotid artery and in the heart due to stenosis in the arteries. I would like to know the insulin dosage needed to be injected on a regular basis.

During the time of discharge a month back, the doctors recommended 20 units of Human mixtard in the morning and 10 units in the evening. Should she continue taking the same dosage or can she take tablets to manage her sugar levels?

Her blood sugar levels are around 120 - 160 (in early morning - fasting) and around 290 in evening (around 6 - 7 PM) after taking lunch at around 1:30 PM.

Thanks,
xxxxxxxxxxxxxx
doctor
Answered by Dr. Saumya Mittal 19 hours later
Brief Answer:
part suggestions. part needs more information

Detailed Answer:
Hi
I am Dr Mittal.
I have read your message.
I think I can help you.
As of now, it seems that she will need to continue insulin.
The reason is that despite being on insulin, her evening sugar is rising beyond 200.
That in itself suggests that the chances of the tablet covering up the sugars might not be warranted.
I would like to know more about her diet pattern and medications before I make a further suggestion.
Also, does she feel any symptoms like sweating, vertigo, nausea, palpitations etc during anytime?
Please let me know the details,
Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal 14 hours later
She does not experience any of the symptoms.

Her diet from last 15 days consists of

1. Puri or dosa (Breakfast)
2. Cooked Vegetables and green leafy vegetables + 1 or 2 oranges for lunch
3. Rajma, oats or sprouts and milk (Night)

For most of her life, she used to consume chapati, oats, dosa, idly, rice as her regular diet.
doctor
Answered by Dr. Saumya Mittal 2 hours later
Brief Answer:
Suggestions

Detailed Answer:
Hi,
Thanks for your response.
First, I would still suggest shifting away from puri.
a patient of heart disease should not be fed oils.
Besides, it will increase the sugars.
The rest of the diet seems to be in order and I don't see any need to change it, except the quantity should be moderated.
Besides that, I think insulin needs to continue.
I would not want to control it too tightly, because very tight control of sugars is known to adversely affect the heart patients.
And as I said before, as of now tablets may be unable to control her sugars.
So, I think it would be prudent to continue the insulin as such and just watch the diet.
please feel free to ask any subsequent clearance on any issues you may want to discuss.
Best of luck, Dr Mittal
Above answer was peer-reviewed by : Dr. Remy Koshy
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