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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for uncontrolled diabetes

Hi, my husband is a diabetic. Pills were not controlling it well enough and he started on insulin last Wed, Apidra and Lantus. His sugar is still not under control. Anywhere from 250 to 350. Even when he didnt eat for 14 hours, his sugar was 378. Not sure what he should do.
Mon, 6 Oct 2014
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Internal Medicine Specialist 's  Response
Hello,
I understand your husband's situation. A difficult to control diabetes gives a headache to the patient who tries to move from pills to insulin. Finding the right dose is not easy to be achieved in just a couple of days but I'll tell you the basic rules that have to be followed.
First of all he should be eating the right amount of food and the right type of food. If he doesn't abide with a healthy diet, he won't be able to control his blood sugar. You can consult your doctor or ask me if you'd like more specific instruction on his diet.
Exercising is essential. If he's not fit or if he has heart disease or other conditions that make physical activity difficult then walking is just fine, provided he walks every day for 30 minutes. Walking 210 minutes once a week won't confer the same benefit. It has to become a daily habit (or at least every other day).
And now let me get to the point that probably was the reason you asked.
Lantus dosage has to be adjusted so that his fasting glucose gets back to acceptable levels (80-120mg/dL). The way to go is to add 2 units every 3 days that the fasting blood sugars are above the target. Your doctor (or me) could guide you to faster adjustments but this is the safe way to go if you're going to do it yourself.
When he manages to achieve the target for fasting blood sugar then it would be much easier to adjust the "fast" insulin dosage (apidra). The latter is more complex and it would be hard to achieve with accuracy without a doctor's help.
I would also suggest that you talk to his doctor and discuss the addition of pills. Metformin really helps in type 2 diabetes (particularly the obese patients) and can be added to insulin regimens. If he has no contraindications to metformin then it would be a nice choice that would bring additional benefit to insulin treatment.
I hope I've given you some direction! If you have further questions on the subject, I'll be glad to answer.
And if you've found my answer helpful, please indicate so during the rating procedure.
Kind Regards!
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Internal Medicine Specialist Dr. Tushar Kanti Biswas's  Response
Hi,

Thank you for your query. I can understand your concerns.
Your husband is having uncontrolled diabetes.You can add Sitagliptin 100 mg once daily, as it has different mechanism of action. In any case he has to follow regular meal schedule. If still remains uncontrolled say post prandial glucose > 140 mg/dl,one can add repaglinide 1 mg orally before each meal.Of course ,dose /medication modification are to be done with consultation of your treating physician/Diabetologist.





Regards

Dr. T.K. Biswas M.D.
Mumbai
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