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Increased blood sugar level. Why has insulin not been prescribed?

Hi doctor,this is samatha from bangalore,India My mother-in-law has diabetic and BP since 9 years.Recently she developed breathlessness and fatigue .She was admitted in hospital also for 3 days.the problem diagnosed with, her liver filled with water and her left ventricle of the heart failed to work for few days it seems.The cause behind this is she slipped her BP tablets for 10 days. She was discharged from hospital 1 week back with diabetis in control.Now yesterday for regular check we had been, she had again random diabetis reading of 570.Doctor then increased the dosage of the medicine, and asked to re-check after a week again. So my question is, why she is not been given insulin when her reading so high?is it good to use insulin whenever reading of diabetic is high.Why high sugar levels cause fatigue/breathlessness for her.please reply and let us know, if the treatment we are giving to her is the right one.
Asked On : Wed, 7 Nov 2012
Answers:  2 Views:  76
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General & Family Physician 's  Response
Hello. I'm sorry your mother-in-law is having so many problems. Her shortness of breath is undoubtedly due to her left ventricular failure, and her heart failure is probably the combined result of her poorly controlled diabetes and high blood pressure. It sounds like these problems were controlled while your mother-in-law was in the hospital, but since her discharge she appears to have slipped back into her old pattern. You didn't mention whether her diabetes was controlled with insulin while she was hospitalized, but it does sound like she needs it now, at least temporarily. During illnesses, some diabetics cannot control their blood glucose with oral medications alone. In addition, most physicians will prescribe insulin when a diabetic patient's blood glucose is consistently above 250, as this could indicate beta-cell failure. (Beta-cells are the specialized cells in your pancreas that produce insulin. In most type 2 diabetics, the beta-cells eventually "wear out" and no longer make enough insulin to keep their blood glucose under control. At this point, they need to begin using insulin.)
Your mother-in-law should contact her doctor again. If she isn't already monitoring her own blood glucose levels, she'll need to learn how to do that if the doctor decides to prescribe insulin. She should also be checking her own blood pressure on a regular basis.
I hope that anwers your question, and I hope things go well for your mother-in-law.
Answered: Thu, 8 Nov 2012
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response

Welcome to HCM

Your mother in law is hypertensive and diabetic (9 years) and she developed heart failure for which she was hospitalized and improved with treatment.

It is logical choice to use insulin for high blood sugar,it is usual practice to add insulin if blood sugar is high that is >250-260 mg/dl as there is secondary failure sets in pancreatic beta cells. Treating doctor can give you detail reason for waiting some more time to recheck blood sugar level and then decide about insulin therapy.

Some possible reasons could be due to congestion of liver there may be transient hyperglycemia due to liver dysfunction and now when her failure has improved again she may be controlled on drugs.

This random sugar level it self may be questionable?

Some time patient is reluctant to take injections.

Please take care of her she should take medicines regularly and take care of her diet and recheck blood sugar level and see physician regularly.

Good Luck

Answered: Thu, 8 Nov 2012
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