Re: We keep lowering insulin dosage but BG readings stay low

Hi Terry

You've had some excellent advice, especially the recent post
from Mack.

I just wanted to pick up on a couple of small points.

<snip>
Last February my brother and I changed Mom's 30 units of NPH taken in
the morning to 28 units in an attempt to avoid low blood sugar
readings (ranging of high 50s to low 70s mg/dl)

60's and under I'd agree; but if she isn't having any low
symptoms when she is in the '70s, I wouldn't be concerned at
those. Of course, if she does get low symptoms at that level
- ignore that comment.

<snip>
Last Friday we celebrated her 95th birthday with a small family party.
We took a BG reading in the evening and she registered a 296 reading
so we skipped her evening snack. About 12:30 am Saturday morning Mom
woke up sweating and had a reading of 45 so we took 3 glucose tablets
and some bread and peanut butter to get her BG higher.

It was a party, so I presume that dinner was different to
normal, plus some cake and goodies?

On Saturday we invited a number of Mom's friends and relatives over
for a second party. This time her reading in the evening was 286.

Maybe dinner wasn't different. What is her normal evening
meal, particularly looking at starches, fruits, breads and
juices?

In simplistic terms the food she eats will raise her blood
glucose. Her insulin, whether she produces her own or she
injects it or both is intended to match that. So, if the
insulin isn't matching the food and you haven't changed the
evening insulin then it sounds logical to me to review the
food. I cannot comment on insulin dosage, I don't use it,
but I'd be interested in knowing her menu.

I echo Mack's comment. At her age, quality of life is what
matters here. So, if you discover her diet is terrible but
that is what she wants then adjusting the insulin may be the
only option; however, as you are discovering, that is more
difficult to get right without big swings from too high to
too low.

<snip>
We now seem to be fighting somewhat low readings in the morning (in
the low 70's)

Again, if she has no symptoms at that level I wouldn't
consider it a low.

<snip>
I
am now ready to schedule a meeting with an Endocrinologist to figure
out if she might be a candidate for Lantus or Levemir.

Excellent. Best thing you can do. But expand the visit to
cover everything you've written here. It will help the endo
if you supply as much detail as you can on these daily
variations, the doses and particularly the menu she is
following.

My brother
figures we know more than anyone about the effects of changing Mom's
insulin dosages and is not interested in scheduling more doctor
appointments. He is applying his engineering background and believes
if Mom's gets low readings just keep lowering the insulin dosage.

He has a point, in principle - but his logic will be
accepted better by both your mum and the rest of the family
if he can convince the endo to agree with him. I'd push for
the endo visit but make it a worth-while one. Ensure that
the endo allows a family member (or members) to sit in on
the consultation to ensure nothing is forgotten. We looked
after my f-i-l for several years in his early '90s and
discovered quite quickly that if he saw the doc alone then
he never said a word about his ailments.

A point on quality of life. We were initially worried with
him about his smoking, excessive salt on foods and several
other unhealthy habits. We quickly came to the decision that
anything that gave him enjoyment without severely causing
him harm was OK; to deny him those small pleasures would be
far more harmful. So, apart from making him go outside to
smoke we let him be. He is now 96 with gradually worsening
dementia and living in a nursing home. The family had to
search for a while to find one that allowed him to smoke,
but I reckon he's going to live to 110:-)

Best wishes


Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
.