Managing Diabetes

An 89-year-old patient of ours just started on insulin after dealing with diabetes for years. We're struggling to figure out the right dosage. Is there a reliable resource online for this? I think I heard something about family education programs for diabetics, but I'm not sure if that's actually a thing or where to find it.

The patient ended up in the hospital around age 90 because she suddenly became very weak. Turns out she’d had a heart attack, and her blood sugar was through the roof. After rehab—where they started her on insulin—she was discharged with instructions from the attending internist to give her 28 units in the morning and 10 at night. Then, a few days later, an endocrinologist (who got all her files from the hospital staff) suggested we switch to 32 in the morning and 12 at night.
We decided to stick with what the endocrinologist said, since, you know, they're the specialist.

A few days after that, we got a glucose monitor, and the numbers are pretty high. Morning readings are almost always over 10; we saw an 8 once, but it hit 17 at one point. Just now, checking her in the evening, she's at 21.8. Basically 22.

What’s the move here? Should we bump up the dose? I heard somewhere that if levels are high, you should increase by 2 units—which supposedly means anything over 10 in the morning. So, maybe we should be doing 34/14?

I guess I'm wondering what actually drives these numbers. Should insulin and a diet be enough to get things under control, or am I missing other big factors? Is there some kind of standard rule for adjusting insulin based on these readings? Ultimately, is there a way to get some definitive information?

Thanks.

If you're looking for guidance, my advice is to check out these sites. You'll find a wealth of information regarding diabetes there, and they even host a forum where people living with the condition are more than happy to share their firsthand experiences. http://www.diabetes.org

Casey Campbell said:An 89-year-old patient has just started insulin injections after dealing with diabetes for years. Our main struggle right now is figuring out the exact dosage she needs. Is there a reliable resource online for this? I’ve heard rumors about specialized education programs for families managing diabetes, but I have no idea if those actually exist or where to find them.

The patient was hospitalized due to sudden weakness in her late 80s. It turns out she had suffered a heart attack, and her blood sugar levels were through the roof. After finishing rehab—where they first introduced insulin—she was discharged with instructions from the attending internist to administer 28 units in the morning and 10 at night. However, a few days later, an endocrinologist (who received all her records from the ward) recommended we switch to 32 units in the morning and 12 at night.
We decided to follow the endocrinologist’s lead, since they are the actual specialists in this field.

After a few days, we got a glucose monitor, and the readings are consistently high. Her morning numbers are almost always north of 10, with 8 being our only "low" reading. We hit a peak of 17 once. Just tonight, we checked her, and she’s sitting at 21.8—basically 22.

What’s the move here? Should we bump up the dose? I’ve heard that when levels are this high, you should increase the dose by 2 units, which apparently applies whenever the morning reading exceeds 10. By that logic, we should be giving her 34 in the morning and 14 at night.

Beyond diet, is insulin therapy alone supposed to handle this, or are there other major factors at play? Is there a standard protocol for adjusting insulin based on these specific readings? Ultimately, where can we go to get definitive, accurate information?

Thanks!

Since you're asking on a forum about such an elderly patient, you have to consider that her organs might be starting to fail.
If you can get her admitted to Mayo Clinic, they would keep her under observation for a few days and then determine the correct dosage based on those clinical observations. They took incredible care of my grandmother. Even though we couldn't quite get her sugar levels stabilized, she was only on oral medication back then.

I know someone. He’s 37 and dealing with type 2 diabetes. He takes his pills regularly before meals—well, most of the time, unless he just forgets—but when it comes to his diet, he doesn't care at all. I haven't known him since his diagnosis, but in the year and a half that we've been friends, his blood sugar has consistently stayed above 16.

He really doesn't watch what he eats. It's constant soda, coffee, ice cream, chocolate, pizza... you name it. He rarely touches anything healthy, he barely moves, he drives everywhere even if it's just down the street, and then he immediately sits back down. On top of that, he smokes three packs a day. Honestly, I could go on forever listing all the ways he refuses to take care of himself.

During the time I've known him, he checked his levels once, saw that it was 16, and actually tried to be careful for a bit. Sure, for about three days. After that, it was right back to business as usual.

What I'm really wondering about is the long-term impact of uncontrolled diabetes. Is it actually possible to turn things around without facing serious health complications? And more importantly, how do you make someone realize that diabetes isn't something you can just play around with?

Nicole Richardson36 said:Is there any way to pull through this without facing some serious consequences?

If they don't get their act together right now, it’s game over. With blood sugar levels like that, combined with a trash diet, zero exercise, and smoking? They're on a one-way street to disaster. I'm talking heart attacks, kidney failure, blindness, diabetic gangrene requiring amputation, agonizing neuropathy, strokes... just listing the potential endgames here. Unfortunately, that's the reality. But people just won't listen. Everyone prays for good health, but nobody wants to put in the actual work to maintain it. At least in this situation, you actually have control over the outcome. Sometimes I honestly feel like I can't even pity people who refuse to change anymore...

This kind of behavior is a fast track to serious complications. As someone living with Type 1 diabetes on a four-times-a-day insulin regimen, I can tell you this: if you actually take it seriously, it isn't just a disease—it’s a lifestyle. Are diabetics actually healthy people who just happen to be missing some insulin? :-) I’d like to think so, anyway. But unlike "healthy" people, we are constantly walking a tightrope, and we have to be incredibly careful. I’ll admit, occasionally (and by occasionally, I mean very rarely) I slip up and indulge in pizza or dessert... though certainly not all at once. When I do, I know my physical activity is going to be pretty limited afterward. Generally, I keep my blood sugar within "normal" diabetic ranges—usually around 110 mg/dL, though it might spike to 215 mg/dL after a heavy meal. Just remember, keeping your blood sugar consistently above 180 mg/dL is doing slow, steady damage to your body. Nicole Richardson36, I would strongly suggest you try to nudge your friend toward a checkup or at least some proper diabetes education. Better yet, maybe suggest they spend some time browsing the web looking at photos of what happens when things go wrong—amputations, lost toes, and the like. It’s often the most effective way to realize exactly what’s at stake if they don't start being careful.
Here are a few images. They are stomach-turning, but unfortunately, this is the reality.

http://www.mayoclinic.org/index.php?id=82_66...3e9a723dd18351

wiredcobra11 said:Behavior like that is a one-way ticket to serious complications. I’m actually living with Type 1 diabetes myself, managing it with insulin four times a day. If you really take diabetes seriously, it stops being a disease and starts being a lifestyle. Honestly? Diabetics are basically healthy people who just happen to be missing some insulin. :-) I'm being optimistic there, but it's pretty close to the truth. The difference is that unlike "healthy" people, we’re constantly walking a fine line, so we have to be incredibly careful. I’ll admit, I slip up once in a blue moon—meaning VERY rarely—and grab a slice of pizza or a dessert, but I know I can't go heavy on the exercise right after that. Generally, I keep my blood sugar within a "normal" range for a diabetic (usually around 110-125 mg/dL, though it might hit 215 after pizza or sweets). Just a heads-up: keeping blood sugar consistently above 180 is doing real damage to the body.
Nicole Richardson36, if I were you, I’d try to push your friend to at least see a doctor or attend an education session on managing diabetes. Better yet, maybe suggest he browse the web to see photos of what happens when things go wrong—things like amputations. Sometimes seeing the reality of foot or finger loss is the only way someone realizes what they're facing if they don't change.

http://www.mayoclinic.org/diseases-conditions/...3e9a723dd18351

Thanks for sharing those images. They are absolutely horrifying...

The big difference between him and you is that his blood sugar is probably hovering above 290 all the time. Over the last year and a half, he only checked it once—and that was only because I practically forced him to when it was already sky-high. I assume it’s still that high, if not worse, since nothing in his daily routine has changed.

Like I mentioned before, he doesn't move at all. It's just from the car to the house and back. He smokes three packs a day, which seems insane given his condition, and he eats whatever he wants... chocolate, chips, pizza, heavy pasta dishes... basically everything he’s supposed to avoid.

It’s almost impossible to talk to him about it. His standard response is, "Well, I'm going to die eventually anyway." I don't know how to make him understand that dying is one thing, but having to live with debilitating consequences for years because you didn't take care of yourself is a whole different story.

I even brought him some medical articles to read, but he just skimmed them and said, "Yeah, I know all that." It's like he genuinely believes he's invincible and that none of this will ever happen to him. How do you prove to someone that they can't escape reality?

It’s a shame, really. Some people don't grasp the gravity of their condition until it’s far too late. Sure, they say they'll die eventually, but there are plenty of ways to go. What keeps me disciplined? Honestly, it's the fear. The fear of a slow decline where doctors are constantly performing procedures on me—or worse, parts just start failing. I'm not being dramatic; I know stories where diabetics have actually lost toes or fingers. Even with perfect discipline, there are no guarantees. Diabetes is a cunning beast. But you can't just neglect it. It's too serious. I feel for your friend. To let things slide like that at 37? He could still turn things around, improve his quality of life, and hopefully see old age. But this level of self-neglect is doing him massive damage. And the worst part? His loved ones will suffer too, because eventually, he won't be able to care for himself. If only death were simple—just a sudden heart attack or stroke and it's over. But to linger, to suffer, to literally waste away? That is absolutely horrific.
If you want to learn more about managing diabetes, the American Diabetes Association has a great website www.diabetes.org. They even host a forum used by diabetics from all over the US, where you can always find useful advice or swap experiences.

I am really hoping someone might be able to share some insight or information regarding hypoglycemia in people who don't actually have diabetes

Hypoglycemia occurs when your blood sugar levels drop below the standard range (typically anything under 70 mg/dL).

The symptoms? Hunger, panic, tremors, nausea, cold sweats, a racing heart, or even heightened sensitivity to light and loud noises. Some people get aggressive. In severe cases, we’re talking unconsciousness or even death.

As for non-diabetics—hypoglycemia generally shouldn't happen, barring certain exceptions. Intense physical activity can trigger it, especially in high-performance athletes, or perhaps simply skipping meals.
I recall stumbling upon an article once suggesting that hypoglycemia in healthy individuals might serve as a precursor to diabetes. I can't say for certain how much weight that carries.

For those living with diabetes, the symptoms remain the same, but the causes expand. It could be an insulin overdose—often because dosing is tricky and depends heavily on exact food intake—or perhaps an insulin pump accidentally delivers an extra bolus. Then you have hypoglycemia.

It is an incredibly unpleasant state, one that demands an immediate response. As I mentioned, it can become fatal quite quickly. This is why it is CRITICALLY IMPORTANT for diabetics to always keep something sweet nearby. Dextrose tablets are usually best for a rapid spike, though a glucagon injection is the standard for more serious emergencies.

Incidentally, hypoglycemia remains relatively under-researched. We don't fully grasp the long-term implications for the body. There is speculation regarding damage to the nerves and the brain, though the specific mechanisms and extent of that damage haven't been sufficiently studied yet.

George Perez93 said:I'm trying to dig up any kind of info regarding hypoglycemia in people who don't actually have diabetes.

I feel like I already have most of this down since I work as a medical technician, but what I'm really looking for are those little nuances or less common details that you might not find in a standard textbook.

I wish I could provide you with more detailed data regarding hypoglycemia in non-diabetics. However, as I’ve mentioned before, my experience with low blood sugar in people without diabetes is pretty much limited to athletes who have just finished an incredibly grueling workout session.

Does anyone happen to know a solid doctor or specialist for diabetes over in the Vuk Vrhovac area? I'm looking for some help pretty urgently,

I honestly think Dr. Igor Bjelinski is just about the best you could ask for... at least from my own experience, I guess.

Alright, thanks for the help!

So, I just checked my blood sugar on the glucose meter, and even though I haven't eaten anything yet, it hit 7.2. Honestly, it’s been pretty rough—I've been dealing with this awful stinging sensation when I go to the bathroom, and even when I'm not actually going. It’s just miserable. To make matters worse, I don't have my appointment with the OBGYN until December 12th.

And what exactly are we supposed to do about that?
If you're dealing with diabetes, you're likely facing a fungal infection as well...

Hannah Bishop said:So, I just checked my blood sugar on the glucose meter—I haven't eaten anything yet and it was 7.2. I can feel it through this horrible stinging sensation when I pee and even when I'm not peeing. It’s awful, and my OBGYN appointment isn't until December 12th.

?????

diabetes
Both diabetes and vaginal infections can be linked, and if you actually have diabetes, it’s definitely something to worry about..
I’m just not sure if you’ve already been diagnosed with diabetes and developed an infection while being treated, or if you might be connecting two unrelated things here.

If the dots aren't actually connected, then that stinging sensation during urination sounds like a classic UTI.

In that case, you don't need an OBGYN; you need to see your primary care physician.

Essentially: difficulty urinating,
a constant urge to go,
and pain that feels like you're peeing shards of glass.

Drink plenty of fluids (cranberry juice or tea, just nothing too sugary) and follow your doctor's advice or take an antibiotic based on a culture test.

Hannah Bishop said:So, I just checked my blood sugar at home. I haven't eaten anything, but it hit 130. I can feel this awful stinging sensation whenever I go to the bathroom... it's miserable. My OBGYN appointment isn't until December 12th.

You should NEVER be checking your glucose levels at 4:10 PM unless you've been fasting for at least 12 hours.
Don't stress yourself out over nothing. Just head to your doctor first thing tomorrow morning on an empty stomach and ask them to run a test...