Can't get blood sugars under control!

doveave · #1 (**permalink**) 07-02-2009, 10:23 AM

My husband and I are both diabetic. I have no insurance because he is also dying of liver disease, and I have had to stay home to care for him. The problem is that no matter what meds he is on we can't get his blood sugars down, he runs high all the time and feels so sick from it that he can't live what is left of his life. He is on 80 units of a new 70/30 in am and pm plus R through out the day. Nothing I do or the Dr's do is helping. Anyone out there have any ideas? This has all been almost too much for me. They say if we can't control his BS's they won't put him on a transplant list. Help
Melissa

Subby · #2 (**permalink**) 07-02-2009, 10:52 AM

Hi Melissa. I don't know much about liver disease, it sounds like a terrible thing. I'll just say I'm sorry for the situation, and I hope the absolute best outcome can happen for your husband and you.

I know how running high can ruin your health, energy and day to day life so I understand your comment there. I think if you hang around here and keep asking questions, you are bound to find some approaches to improve things. It may not be the first thing or completely straightforward. But I bet there will be things to improve control.

Just to double check, you posted in the type 1 forum, your husband is type 1? It may not really matter in the end as he is obviously very insulin dependent which lands him in a similar boat to a type 1. But it would be good to know and if he is on other meds as well.

I hope you give us some more details about your husband, here are some questions.

What activity if any does he get up to?
What is his diet, a rough summary?
Does he suffer from any hypos?
How many times a day does he test his blood sugar?
Can you give some actual numbers of typical BG levels at the moment? What is the control doing right now?

My initial thoughts are
- mix is not the best tool for control. A proper basal/bolus insulin regimen is the gold standard, and is like a deluxe toolkit instead.

- he probably suffers from a lot of insulin resistance as well, going by the large doses and keeping high. Reducing carbs may well be an excellent way to help reduce BG and pressure on the insulin. That can mean a few things: - going low carb. Going moderate carb. Or just cutting out the worst of the carbs that spike him.

Another thought sticks out for me that often hits me with the idea that "insulin doesn't work - can't come down". Insulin is something that has three universal rules.
- There will always be a too high dose, resulting in hypo/s
- There will always be a too low dose, resulting in highs
- There will always be a just right (or ballpark) dose, resulting in some semblance of stability at least.

These rules are close enough to concrete, universal rules for the human body. It's the amount that can vary radically. What this says to me is that your husband is simply not taking enough insulin. However, I think the mix is a poor choice to find stability anyway (for reasons we can explain): and that he may really help his insulin by reducing carbs.

As a note, it's not unheard of for doctors to "wuss out" and stop shy of finding an adequate dose of insulin for control, because they have hit the upper limit of what they have seen before or what they are comfortable with. I have been there twice before. Depending on the doc doing this, they may be honest and admit it's because they are nervous to be in such a high range, or they may bluster and try and derail the issues off the insulin. Either way it's not good enough for the person who needs the insulin.

jenb · #3 (**permalink**) 07-02-2009, 02:00 PM

I agree with Subby - I don't see how adequate control can be gained with a mixed insulin scheme. Is there a reason that the doctor prescribed this? Perhaps you need to be more firm with the physician in obtaining a prescription for basal insulin and one of the newer fast-acting insulins like Humalog or Novolog.

I'm certain that your husband's liver disease has a huge impact on his blood sugar. Are you working with a hepatologist? I wonder if such a specialist could be of assistance. I realise, of course, that lack of insurance is a major factor here but maybe there is a teaching hospital near you that could provide assistance.

I'm sorry you are climbing such a wall of worry; It must be a very lonely feeling. My heart goes out to you.

Jen

ligawab · #4 (**permalink**) 07-02-2009, 02:19 PM

My thoughts and prayers are with you.

ligawab (life is good and we are blessed)

genie86333 · #5 (**permalink**) 07-02-2009, 07:03 PM

My thoughts are with you.

Enlist a doctor's help. With a insulin mixure, you can't give the proper amounts for both basal & bolus insulin. I'm not sure what kind of diet restrictions he has because of the liver disease, but if possible, lower his carb levels - eliminate or severely cut down all "white" foods - bread, pasta, rice, potatoes, flour, sugar. (keep a close eye on his blood sugar levels if you can do this especially if you haven't gotten a doctor to switch him to separate basal/bolus insulins with a proper insulin/carb ratio.)

WendiSpeciale · #6 (**permalink**) 07-03-2009, 11:17 AM

I agree with genie.

When I am having issues with BS, i cut out all whites...flours, sugars, etc.

Then, I get up and walk or something else to get me moving. Drink lots of water...

Also, I would find a new doctor.
So sorry to hear you are going through this. Prayers being lifted for your family.