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Question: Detailed summary attached with medical background in patient summary please tell us what to be done in this case as my mother already on insulin and taking Huminsulin 3 times 16-18-12 unit before every meal and lantus insulin daily after dinner while all the meals are taken as per direction form doctor where she was admitted last month his prescription is also attached.
Please tell us now what to do as sugar levels are still not in control.
Please tell us now what to do as sugar levels are still not in control.
Brief Answer:
Want to know present blood glucose levels with current treatment.
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
For better opinion I want to know-
- Your mother's height and weight.
- Blood sugar level fasting and postprandial, though SMBG (Self Monitoring of Blood Glucose level) with use of home glucometer is preferred.
It may be advisable to monitor her
At least 2 to 3 readings per day from followings (each day different)
. Fasting
. 2 Hours after breakfast.
. Before Lunch.
. 2 Hours after lunch.
. Before Dinner.
. 2 Hours after Dinner
In such cases I may have advised to continue current treatment and to do following tests along with SMBG.
- Complete blood count.
- Renal function test.
- Liver function test.
- T3, T4, TSH.
- Lipid Profile.
- Urine examination.
- ECG & 2D Echo of heart.
- Vitamin B12 & D3.
Depending upon her SMBG chart and above test results and clinical examination appropriate decision regarding changes in medicine and dose of insulin can be taken.
Till then continue current treatment SMBG charting as advised, regular exercise depending upon her heart condition and current level of tolerance and strict diabetic diet.
Hope this helps your mother.
I will be happy to answer your followup question.
Regards,
Dr. Abhay Mali.
Diabetologist.
Want to know present blood glucose levels with current treatment.
Detailed Answer:
Hi,
Thanks for your question.
Noted your concern.
For better opinion I want to know-
- Your mother's height and weight.
- Blood sugar level fasting and postprandial, though SMBG (Self Monitoring of Blood Glucose level) with use of home glucometer is preferred.
It may be advisable to monitor her
At least 2 to 3 readings per day from followings (each day different)
. Fasting
. 2 Hours after breakfast.
. Before Lunch.
. 2 Hours after lunch.
. Before Dinner.
. 2 Hours after Dinner
In such cases I may have advised to continue current treatment and to do following tests along with SMBG.
- Complete blood count.
- Renal function test.
- Liver function test.
- T3, T4, TSH.
- Lipid Profile.
- Urine examination.
- ECG & 2D Echo of heart.
- Vitamin B12 & D3.
Depending upon her SMBG chart and above test results and clinical examination appropriate decision regarding changes in medicine and dose of insulin can be taken.
Till then continue current treatment SMBG charting as advised, regular exercise depending upon her heart condition and current level of tolerance and strict diabetic diet.
Hope this helps your mother.
I will be happy to answer your followup question.
Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
sir we do have some reports of the month XXXXXXX do you consider to be usefull or we have go for fresh ones
Brief Answer:
It may be useful.
Detailed Answer:
Reports of investigations done in XXXXXXX may be of help depending upon what investigations had done at that time, you can upload those reports.
Basically by doing investigations we want to know why there is sudden rise in insulin resistance that require high dose of insulin and multiple anti-diabetic medicines for blood sugar control.
Hope this helps.
It may be useful.
Detailed Answer:
Reports of investigations done in XXXXXXX may be of help depending upon what investigations had done at that time, you can upload those reports.
Basically by doing investigations we want to know why there is sudden rise in insulin resistance that require high dose of insulin and multiple anti-diabetic medicines for blood sugar control.
Hope this helps.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Sir
I am uploading reports of my mother for investigations done from april to XXXXXXX this year and one of the endocrinologist told us that their was some infection as per blood reports and after that she was referred to physician and he also did some tests and give some treatment but that was not worked and after regular visits for 2 months we left them and then again taken treatment from the last one who admitted my mother last month and increased the insulin dosage.
Please check these reports and tell us what other reports you require for my mother.
We are planning for the above said test tomorrow.
I am uploading reports of my mother for investigations done from april to XXXXXXX this year and one of the endocrinologist told us that their was some infection as per blood reports and after that she was referred to physician and he also did some tests and give some treatment but that was not worked and after regular visits for 2 months we left them and then again taken treatment from the last one who admitted my mother last month and increased the insulin dosage.
Please check these reports and tell us what other reports you require for my mother.
We are planning for the above said test tomorrow.
Brief Answer:
Yes there was urinary infection.
Detailed Answer:
After going through your mother's old reports there was urinary infection.
Urinary infection is one of the commonest infection in female with diabetes.
Any type of active infection in body may associate with increased insulin resistance that lead to increased blood sugar level requiring increasing doses of insulin and oral medicines for better control.
As these investigations reflect the situation at that time, we need to reassess current situation by doing above mentioned investigations and clinical examination.
Hope this helps you in making appropriate decision.
Yes there was urinary infection.
Detailed Answer:
After going through your mother's old reports there was urinary infection.
Urinary infection is one of the commonest infection in female with diabetes.
Any type of active infection in body may associate with increased insulin resistance that lead to increased blood sugar level requiring increasing doses of insulin and oral medicines for better control.
As these investigations reflect the situation at that time, we need to reassess current situation by doing above mentioned investigations and clinical examination.
Hope this helps you in making appropriate decision.
Above answer was peer-reviewed by :
Dr. Prasad
Sir
New reports of the tests which you told us has been uploaded.Please refer to them as they are done today.
New reports of the tests which you told us has been uploaded.Please refer to them as they are done today.
Brief Answer:
My need further evaluation for elevated Leucocyte count,
Detailed Answer:
After going through your mother’s reports, there is-
- Elevated white blood cell count (Total Leukocyte Count).
It may be due to some infection which may requires further evaluation depending upon detailed clinical examination and detailed history taking.
Active infection may be the cause for deranged blood sugar level despite of high insulin doses and multiple oral antidiabetic medicines.
- Elevated uric acid, high normal calcium level.
It may be due to deranged kidney function (which is unlikely in her case as her serum creatinine and albumin creatinine ratio is normal).
It requires clinical evaluation to know other possible causes and any complications related to it.
- Insufficient Vitamin D level.
For which vitamin D supplement can be used.
- Uncontrolled blood sugar level.
First there is a need for evaluation for an hidden infection which may need antibiotic treatment.
Dose of insulin Lantus need to be increased to control fasting (before breakfast) & before dinner sugar under control.
(May be advisable to increase dose of lantus by 2 units every alternate day do keep fasting blood sugar in between 100 to 160)
Once fasting blood sugar is under control doses of Huminsulin R need to adjusted to control post meal blood sugar level in between 120 to 180.
Continue Tab Carbophage and Trajenta as before.
Role of Amaryl in the presence of high dose of insulin may be individualized depending upon patients clinical examination.
Other options like use GLP 1 receptor agonist (Exenatide/ liraglutide) other oral antidiabetic medicines can be considered depending upon clinical examination.
- Concentric Left Ventricular Hypertrophy on 2D echo.
It is usually due to uncontrolled blood pressure.
So regular blood pressure check up is advisable.
Continue Tab Olsar as before its dose need to be increases depending upon blood pressure control.
- Rest investigations reports are within acceptable limits.
Continue Tab Roseday as before.
You should consult endocrinologist or diabetologist for detailed clinical examination, history taking and depending upon it better opinion can be given
Hope this helps your mother.
I will be happy to answer your followup questions if any.
Otherwise close the question and rate the answer.
Regards,
Dr. Abhay Mali.
Diabetologist.
You can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
My need further evaluation for elevated Leucocyte count,
Detailed Answer:
After going through your mother’s reports, there is-
- Elevated white blood cell count (Total Leukocyte Count).
It may be due to some infection which may requires further evaluation depending upon detailed clinical examination and detailed history taking.
Active infection may be the cause for deranged blood sugar level despite of high insulin doses and multiple oral antidiabetic medicines.
- Elevated uric acid, high normal calcium level.
It may be due to deranged kidney function (which is unlikely in her case as her serum creatinine and albumin creatinine ratio is normal).
It requires clinical evaluation to know other possible causes and any complications related to it.
- Insufficient Vitamin D level.
For which vitamin D supplement can be used.
- Uncontrolled blood sugar level.
First there is a need for evaluation for an hidden infection which may need antibiotic treatment.
Dose of insulin Lantus need to be increased to control fasting (before breakfast) & before dinner sugar under control.
(May be advisable to increase dose of lantus by 2 units every alternate day do keep fasting blood sugar in between 100 to 160)
Once fasting blood sugar is under control doses of Huminsulin R need to adjusted to control post meal blood sugar level in between 120 to 180.
Continue Tab Carbophage and Trajenta as before.
Role of Amaryl in the presence of high dose of insulin may be individualized depending upon patients clinical examination.
Other options like use GLP 1 receptor agonist (Exenatide/ liraglutide) other oral antidiabetic medicines can be considered depending upon clinical examination.
- Concentric Left Ventricular Hypertrophy on 2D echo.
It is usually due to uncontrolled blood pressure.
So regular blood pressure check up is advisable.
Continue Tab Olsar as before its dose need to be increases depending upon blood pressure control.
- Rest investigations reports are within acceptable limits.
Continue Tab Roseday as before.
You should consult endocrinologist or diabetologist for detailed clinical examination, history taking and depending upon it better opinion can be given
Hope this helps your mother.
I will be happy to answer your followup questions if any.
Otherwise close the question and rate the answer.
Regards,
Dr. Abhay Mali.
Diabetologist.
You can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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