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Diabetes

Unpredictable blood sugar levels

09/02/2009

Question:

MY WIFE IS 54 YRS OLD AND IS A TYPE I DIABETIC. SHE IS CONSIDERED TO BE A "BRITTLE DIABETIC" AND DESPITE FOLLOWING HER DOCTOR`S INSTRUCTIONS FOR TREATMENT, HER BLOOD SUGAR LEVELS ARE RANGING FROM OVER 500 TO THE LOW 30`S IN A MATTER OF MINUTES. THERE SEEMS TO BE A DELAY IN HER BODIES RESPONSE TO INSULIN OR EATING. HER5 LEVELS HAVE BEEN OUT OF CONTROL FOR OVER 3 MONTHS. SHOULD SHE CONSULT ANOTHER DOCTOR? SHE IS FOLLOWING HER DOCTOR`S PLAN BUT IT IS NOT WORKING. A RECENT BLOOD SUGAR DROP ALMOST LEFT HER IN A COMA. SHE EXCERCISES REGULARLY, EATS PROPERLY, AND IS NOT OVERWEIGHT. SHE TAKES TWO DIFFERENT TYPES OF INSULIN AND AS MANY AS 5 INJECTIONS PER DAY. WHAT SHOULD WE DO TO GET HER REGULATED?

Answer:

I can't make a specific diagnosis from the information provided but more likely than not, some adjustments to some combination of the insulin regimen, food intake and physical activity should smooth things out - it is possible that consultation with and endocrinologist/diabetologist may be of considerable help in this regard.  Very commonly it is a matter of finding just the right amounts of each of the two types of insulin to smooth out the highs and lows, and to learn strategies to adjust insulin dosing for blood sugar (using a so-called insulin sensitivity factor), food intake (carbohydrate counting) and exercise to customize to the individual situation.  If you live in or near Ohio, the NetWellness referral system may be of help in finding a diabetes specialist.  Other sources include the American Association for Clinical Endocrinology, the American Diabetes Association and the Endocrine Society if there is any problem identifying one from a local health care provider.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati