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Greetings!

My dad is suffering from diabetes (T2) for more than past two decades. He has been on insulin for past 8-10 years now. He is 63 years of age.

Issue - My biggest concern at this time is that the 'blood sugar levels' are not under control; 'sugar level report' has been close to 250/300 at fasting and varies between 300/350 at PP/random; he also experiences painful cramps many times at night.

Background - He has been taking treatment from PGI Chandigarh; apart from occasional hiccups, he has pretty much kept everything in control; is extremely disciplined and particular with diet habits and exercise schedules; is very active and mobile (touch-wood); He is getting regular treatment from PGI (Endo, Nephro & Eyes)

Current medication:
Mixtard 50:50 (26 BBF & 20 BDN)
Dytor (40 - 8am & 20 - 3pm)
S.numlo 5mg at 8am
Sustamet 50mg at 8pm
Ecosprin AV (75+10) at 10pm
Shalcal CT (BBL & BBD)
Nodosis 500 (TDS)
Urimax 400mg OD

My dad was on insulin 30:70 but was suggested with 50:50. Unfortunately, that has not helped either. I would like to know if we should switch to 'plain insulin'. If yes, was should be the dosage to start with? I can share his latest 'blood sugar level' reports on the forum also. Please let me know what inputs are required; Any help, suggestions, highly appreciated.

Thanks & Regards,
Saurabh Aggarwal
 

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Without him giving up the carb foods, I believe nothing will help him Our Indian members can tell you more about the foods he's probably eating which will harm him...maybe www.bloodsurgar101. will help you understand and then be able to tell him. Rice and all grains will defeat his efforts and all the insulins he takes.

Good luck,
 

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Discussion Starter #4
Patdart,

Thank you for your prompt reply. I agree to what you stated; as I shared in my original post, my dad is very particular about the diet intake. We try to follow the correct diet composition. You're correct; more 'diet related inputs' from 'Indian community members' should be useful to find out where we are going wrong.

Apart from 'diet', would like to know if there is any other factor that may lead to the lack of control. Do you think there is any need to switch to 'plain insulin'? Do you think any changes in 'insulin schedule' will make a difference? Do you feel that 'high creatinine' may also have any bearing on this situation?

Another update that I would like to share is that there is a tendency of 'blood sugar level' going very low sometimes. There is no specific pattern that we have observed (except some physical exertion or sometimes at midnight; at other times the sugar level is on the higher side). It just happens randomly. We are baffled. :confused:

I am worried about my dad's health and would like to know where we are going wrong. Any help would be appreciated.

Thanks & Regards,
Saurabh Aggarwal
 

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Hi Saurabh.

If I told you to eliminate all sugars (including all fruits)& starches (grains) from his diet, do you think that he would be able to do it. Knowing the Agarwals, I doubt it. But that is the way forward. Please do look at the website Pat has directed you to.

Secondly from other insulin users and my own study I think that the basal/bolus method of specific insulin is better than the mixed. Beware that Indian doctors are very ill informed & researched so far as diabetes is concerned. At least as of now. Take the case of a well known endocrinologist from that same Institute that you mentioned making a statement that there is no difference between a 180 or 400 so far as blood glucose is concerned.

I lost my father when he was 63 due to complications brought on by diabetes, and as such, I feel very strongly about this and for you.

Good Luck.
 

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Saurabh,
You father blood sugars are in at dangerous levels and drastic steps will be required.
I know your first question was on insulin and medication, but I think the first step you may need to consider is diet..

What does your father's diet look like ? I know you say that he is very particular with his diet but I am concerned that he may be misinformed about what is good and what isn't..

Are the following a part of his diet ?
Roti/Chappati
Rice
Veggies like Potatoes, Green peas, Carrots
Fruits
Low fat high fiber biscuits, rusks etc

If yes then thats the problem, more than the medicine.

Tell us more about his diet and then we can advice you
 
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About insulin - Tell your doctor clearly that you do not want mixed insulins. You prefer seperate "long acting" and "fast acting" insulins.

Tell the doctor you prefer better control over the simplicity of taking one injection (which gives you poor control in any case)
 
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About you being baffled with 'blood sugar level' going very low sometimes.

Here's the answer...

Since you are using a mixture of slow and fast acting insulin there is no why you can accurately time when either of the two insulin will start working effectively.

Also I would assume your doses of insulin are very high. You are required to take high doses of insulin because you are eating large amounts of carbohydrates (insulin is required for carbohydrate consumption). When you take large doses of insulin you cannot accurately predict how the insulin will work. The smaller the dose the better you can predict the fashion in which it will work

Here are some of the reasons you may experience an unexpected low:

1. You have 2 rotis instead of 3 but do not adjust your insulin
2. You had a different dal (each dal has different levels of carbs)
3. You had a different vegetable (which did not have potatoes, green peas)
4. Your insulin was not injected at the same site. You probably injected in a muscle instead of a fat tissue.


The only reason you can avoid dangerous lows is by avoiding taking huge doses of insulin.

You can reduce your insulin requirements only by eating lesser carbohydrates because every single carbohydrate molecule needs insulin to be processed. Significant sources of carbs are

Grains : Wheat, Rice, Jowar, Bajra, Corn etc
Fruits : Nearly all
Sugars : Glucose, sucrose
Large quantities of Milk : Lactose
 
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Something else to consider is his testosterone level may be low. Testosterone has a lot of influence on BG management.
 
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