Can sudden changes be made in the insulin dose?

Good night,

My father, 93, has type 2 diabetes.

His endocrine scheduled to change the dose of insulin 1 unit every three days according to the glycemia average of that period.

I have read that other specialists recommend that this change can be 2 units.

I would appreciate your help on the following questions:

Can big changes be made in the insulin dose in a short time?

Thank you,
Guillem

Yes, of course, but keep in mind that the needs in a type 1 vary more than in a type 2, however, you already have a medical recommendation, so first to prove it, do not?

Thanks, Merche!

Yes, for a year, my father follows the pattern of the endocrine of every three days adjust the dose, and it has done well.

The impression of what I am reading and listening to doctors is that changes in the dose are gradual, and wanted to understand why;If there is any consequence in an abrupt change in the dose of one day to another.

Thanks again, Merche, for your help,

Greetings,
Guillem

It is usually done little by little to see the result of blood glucose and find the fair dose.

Thank you very much, Regina.

Hi Guillem, his type 2 father. The doctor has explained it well I suppose he gets slow insulin.The slow one both in type one and two insulin has the same function in the body. If three days in a row, for example, high at 12 hours will have already placed increase what one or two units tell you.I suppose that leading to a range of 70 to 180. Apart I think it will take medication in pill.What the doctor tells him. If some more detail comes I would tell him how insulin works.But I would never give advice to him that I don't know his father, he came I can make medication recipes.Greetings will already take the air.

Thank you very much for the help, 2piuviato1frts!

Yes, my father (93 years old) takes slow insulin, glargine.In December, its fasting rank before breakfast between 104 and 122 (from 11 to 6 u.).

Take two Eukles (breakfast and dinner).

The pattern of its endocrine is to go up or down 1 unit according to average of three days, which has been visited for a year every three months.

For a year and a half, my father is diet and more physical exercise.

The evolution of its glycosilada: 9.4 (2018), 9.2 (2019), 7.8 (2020) and 8.1 (early December).

Among other diseases, it has Alzheimer's, Parkinson, vascular dementia.First he was diagnosed with diabetes, then he had pancreatitis;And a few years later, a heart attack.

A year and a half ago, my mother's health worsened, dying months later.When I was a widower, I had to take care of my father more.Before, I did not know the severity of diabetes.

To principles of January of this year, he had hyperglycemia not due to an infection.My brothers accuse me that I administered a low dose of insulin (6 u.) Although I follow the pattern of its endocrine.

In my opinion, on many occasions during the parties, his diet for diabetics was not respected, and even gave him several times chocolate nougat a few days before his entry into emergency.My father, for his dementia, nods almost everything.He is not aware of his illness.

These days, it is already returning to normal: 178-87 (from 11 to 7 u.).

I would appreciate your advice because I have problems with my brothers about how to attend to my father.

Thanks again,

Guillem

Pancreatitis is earlier or after diabetes?
Another thing that is not understood is when you speak from 6 to 11 or of glargina, that you make those changes every day, every three days or is it the average of a month?

Alberto,

Thanks for your interest.

This is the information about my father (93 years).

Chronology
- 2004, acute pancreatitis.
In the background of the Emergency Sheet, it appears that it has type 2 diabetes and that it takes antidiabetics
oral.

- 2008, vascular dementia.

- 2013 (at least from), insulin is click.

- 2015, infarction (SCASEST).

Glargine dose changes
Every three days, according to the average of the three glycemia on anterior fasting (those before breakfast).

PATTERN
Maintain insulin dose, if glycemia between 110-130
UP 1 U., If above 130
Reduce 1 u., If less than 110

If before meals your blood glucose is greater than 250, administer 0.5 mg of Prandin and ingest food
immediately.
50/1000 mg of wettings, breakfast and dinner

Thank you again for your help.

Guillem

Ok, I tell you because my diabetes was caused by acute pancreatitis and the treatment differs from the DM1 and DM 2, we have a hyperglycemia all from time to time, another thing is that it is repeated or maintained in time orBe very high values, by the way there are many endocrine who do not know the DM 3, I tell you because they have treated me as if it were DM2 until the last one realized and I changed the treatment, I take Prandin before eating whenI am going to happen to the hydrates. Turning your father's "glycos", maybe they should replace the Din Pran and metformin for fast insulin, which is what they told me, but you know all this consults with the endo.

Alberto,

Thanks for your help.I'm glad you will recover from pancreatitis.

I did not know the existence of the DM3.I will try to read about it.

On Friday we have a visit with the endocrine and I will ask what you tell me about fast insulin.

Thanks also for the reflection on hyperglycemia, which can occur from time to time but they can be a problem if they are repeated, maintained or have very high values.

The reason for my concern and having admitted to the forum is that my brothers accuse me that he had hyperglycemia because the dose of insulin was low.

Below, I describe what happened on the day of hyperglycemia to have information.

I feel that my explanation is long.With my brothers there is sea in the background that is not appropriate to explain here.

I would appreciate your help.

QUESTIONS

1. Why did the entrance be 204 before breakfast on Breakfast, and two hours later 335 despite the one to have administered 0.5 mg of Prandin?

2. Was it, before breakfast, have uploaded the insulin dose of 7 u.more and not follow the endocrine pattern of administering the units according to the average of the previous days because their blood glucose was much higher than usual (204)?

Glycemia
The day of my father's hyperglycemia, on Thursday, before breakfast was 204 (7 u.).After breakfast, he took the Eukreas.

As I had unusually high, we measured it before lunch (301).We administer 0.5 from Prandin, and had lunch;But an hour later, the glycemia continued to be high (335) despite the drugs.For that reason, we take him to the emergency room.

STRAIN
Before breakfast, blood pressure was well (127/63), but very high heart rate (105).After lunch, around 12, the TA was still well (133/60) and the FC had lowered (94).

TEMPERATURE
Before breakfast, its body temperature was within its usual range at that time (35.8).The night before, I had a few tenth higher than is frequent (36.9).

Emergency
In the Emergency Department, he was diagnosed with hyperglycemia.After the analyzes, they did not detect any infection.Among the doctor's guidelines, dietary transgressions should not be performed.

I had told him that:

- During Christmas and Kings my father had eaten a few times out of the diet
- On Monday before admission, a brother gave him two chocolates and chocolote nougat
- On Tuesday, a brother had brought prepared food, and out of his hebital menu: Enterite with green sauce, croquettes and prawns.

DIET
The night before admission, my father had had dinner at that day: broccoli, a slice of salmon, and kiwi but half of the vegetable and fish because I had no appetized, which is unusual.That day, I had eaten with my brother salad, favored with black pudding halls and sugar -free egg flan.

The day of admission, had had breakfast about his menu for that day (fresh cheese, banana, 2 sugar -free digestive cookies, and infusion of llantén).For lunch, gruyère or emento cheese pull, half heart of lettuce, 1/2 glass of chicken broth, 1 black garlic, and souvenaid shake.

Glycemia and previous doses
The day of admission was Thursday.The glycemia of the previous Thursday: 112, 8 U.;112, 9 U.;107, 10 u.

The insulin dose had set the Miercols.As the average of the three days before Wednesday was 159, dose 1 unit increased, from 6 u.to 7 u.

Thanks again.

Greetings,
Guillem

Hi Guillen:
I answer you from my humble knowledge and my experience based on asking (like you) and informing me and reading. A baseline glycemia of 204 is a sign that basal insulin fails, in my opinion 7u is very little.330 After breakfast depends on what is breakfast, in my case when I have breakfast some churritos, in addition to the basal insulin (14U), and of metformin, I get 2 mg of prandin and even so the postpandracial comes out around 180, I am not worried because I exercise enough.In response to your 2nd question when I see that the day will be complicated in relation to food (parties, celebrations, weekends, etc.) if the basal in 2u increases.What has told me the endo is that when oral medication does not arrive, it will send me fast insulin.Anyway, the most worrying of your father are glycosylated to my understanding very high and I do not think it is the fault of occasional excesses in the diet.In any case, the values ​​presented in analysis were signed by all those present with 93 years.

a hug

Alberto,

Thank you very much for your help.Little by little I know more diabetes.It has served your references to basal and postpondrial glycemia.

Thank you also for making me see that, in the case of my father, your glycosylated levels are more worrying than your occasional hyperglycemia.

Tomorrow I have an appointment with your endocrine and I think it will help me to clarify the doses of insulin.For example, the pattern to follow when high basal glycemia occurs.

As for glycosylated ones, both the cardiologist and the endocrine told me that, in the case of my father, the object is that it is about 8 or 8.5 because lower results can point to hypoglycemia.

The cardiologist told me that hypoglycemia are the greatest danger in the elderly because, for example, it has controlled blood glucose but, using its expression, "little bird has been left in bed."

Thanks again.

Guillem

There is no that, you will tell us ...

@Guillem, because of the way you worry about attending your father well, you can see that you are taking care of your best, you have to be quiet.
And it is true that, when they reach such advanced ages, they can harm them more a very tight control due to the risk of hypoglycemia.
You are taking care of him very well.

Thank you, Regina, for your mood.

Guillem

@Guillen Diabetes is complicated and if you add other sickness, it is complicated a lot.
In my opinion, I would need to raise basal insulin to get up in the thresholds that the endocrine has scheduled.And much better if you recipe quick insulin for meals than the mixture of metformin and pradin.This will give you freedom to maintain glycemia in your thresholds.
You do it very well, you care about your father.Quiet consciousness is important.Cheer up

@Ruthbia

Thanks for your spirits and advice.

From what I know about diabetes, in the guidelines of the endocrine there is a margin of maneuver that I learn to clarify by asking the specialists and the experience of other diabetics, such as those that you are helping me here.

Having a quiet conscience gives me a lot of strength to continue;What is difficult for me is to learn about the march and have relatives who act with other criteria for the care of our father.

Thanks again for making encouragement.

Guillem