Steroids will raise blood sugar levels and 355 is dangerously high. You can offset the rise using insulin. If you are not already on insulin, you have to discuss the matter with your doctor for temporary insulin use because diet & exercise alone will probably not suffice. On the other hand, if you are already on insulin, you can simply use an additional amount as a correction factor until the cortisone runs its course. You may have to discuss the correction factor with your physician anyway unless you already know how much one unit of insulin will lower your blood glucose levels for help in determining the correct dose to use as the correction factor for you.View Thread
The Islets of Hope (IOH) site, in particular, has lots of resources that you may qualify for. The table that I tried to include is more comprehensive than what the ADA's List above provides but they're close enough; at least for starters.
This WebMD article states that: In one study, volunteers ate from 1 to 6 grams of cinnamon for 40 days. (One gram of ground cinnamon is about half a teaspoon.) The researchers found that cinnamon cut cholesterol by about 18% and blood sugar levels by 24%. But in other studies, the spice did not lower blood sugar or cholesterol levels.
Cinnamon works by reducing insulin resistance. If the beta cells of your pancreas still produce plenty of insulin, then the additional reduction in insulin resistance might provide some benefit to you. However, the amount of improvement is controversial. The article above states that researchers found that it reduced blood sugar levels by 24% but it should have read "up to 24%" because the benefit varies from one individual to another. In another study, researchers found that it contributed a whopping 0.2% reduction in A1c levels. That's hardly anything to get excited about. In those of us with insufficient insulin production, it is virtually worthless except as a condiment to flavor your food.
Your podiatrist is quite right, however, and recognizes that simply getting your A1c "under 7" is not adequate. If you want to avoid future complications, you need to bring it down to the 5.5% level or lower. Unfortunately, most PWDs (and their physicians) are misled by the A.D.A.'s protocols of "under 7%." At that level, you're going to sustain ongoing damage to your body but probably not realize it since the process is generally "ouch-less." Eventually, however, persistent elevated blood sugars will result in damage to kidneys, eyes, heart, blood vessels, nerves, brain (dementia), and significantly increase risk of cancers. High blood sugars are an equal opportunity destroyer. What path you take to resolve your particular situation requires major lifestyle changes, especially weight reduction if overweight and/or sedentary. In the interim, the clock keeps ticking.View Thread
Diane, the response from Lisa was a "generic" one and was probably not intended as a personal attack; probably just an expression of her personal philosophy. That's based on the fact that she posted the exact same thing (word-for-word) to my response in this thread . You asked a legitimate question regarding the possible decline in the body's response to meds and I'll try to provide you with an objective response. Glyburide is a sulfonylurea drug that works by stimulating the beta cells to produce insulin. It is an analogy (though not a very good one) to taking insulin via an oral route; sulfonylureas do so by stimulating your beta cells to secrete insulin instead of having to inject it.
There are two main problems with sulfonylurea medications. There have been several studies that have shown that sulfonylureas tend to accelerate the burn out or failure rate of the beta cells of the pancreas. Many diabetics already have difficulty producing a sufficient amount of insulin to control their blood sugar levels. By artificially stimulating already challenged or fatigued beta cells to secrete even more insulin may cause them to wear out or fail prematurely. That's one of the primary reasons why many patients on sulfonylureas have to increase the strength/dose of their medication; often within five years after starting on it. The other problem is that efficacy is often imprecise. There is no way to measure or gauge just how much insulin the drug will cause the beta cells to secrete. As a consequence, blood sugar control can sometimes be difficult to predict with any degree of accuracy; being adequate one time, insufficient another, and perhaps too much another.
A Kaiser Permanente study was the first to compare failure rates of metformin in real-world settings : "The study found that metformin, an inexpensive, generic drug that helps patients prevent dangerously high blood sugar levels, worked nearly twice as long for people who began taking it within three months of their diabetes diagnosis. This is the first study to compare metformin failure rates in a real-world, clinical practice setting. Other studies compared failure rates of metformin only in clinical trials."
Here are a few links to articles that can expand on some of the points I have included above. post by Michael T. Murray, ND , this one at eMedTV , and a forum discussion at the A.D.A. site , You can just do a search in your favorite search engine using the phrase (sans quotes) for many more links: "Does metformin/glyburide lose effectiveness"
I hope this helps put your mind at ease. The body can develop tolerance to many medications over time and it doesn't necessarily have anything to do with lifestyle changes. If your beta cells continue to fail, you're eventually going to need exogenous insulin. In fact, my own personal preference was to go on insulin shortly after diagnosis in an effort to preserve what remaining beta cells I still had. I wasted over four months (nearly five) obediently following doctor's orders using oral meds that my endo prescribed before voluntarily going on injected insulin on my own after two C-Peptide tests confirmed that my pancreas was no longer producing sufficient insulin. Had I had the courage to start on insulin when I wanted to, I might have been able to preserve beta cell function (then again, perhaps not since I am LADA or Type 1.5).View Thread
The hard "pockets" that your husband is experiencing can be due to three causes (there are others, but these are the primary ones): Lipoatrophy: As the name implies, fat tissue under the skin is lost (atrophied) due to injecting multiple times repeatedly into the same area. Lipohypertrophy: This condition results in the formation of additional fat deposits under the skin due to the action of the insulin itself when too many injections are made into the same general site. Scar tissue: When the insulin needle pierces the skin, it causes a small amount of damage to tissues that can accumulate over time. As the scar tissue builds up, it will affect the proper absorption of the insulin.
These bulges, pockets and thickening of the skin in and around injection sites often occur when sites are not properly rotated. Site rotation is important not just from a comfort standpoint; when tissue damage accumulates due to site overuse, the absorption of the insulin may be impaired at those sites. As your husband has already discovered, his ability to properly control his blood glucose is then affected. I have been injecting insulin myself for only twelve years compared to your husband's forty. However, I use site rotation religiously and also use the thinnest gauge needle (31G) that the pharmacy has available. The thinner needle causes less tissue damage than the heavier gauge needles (Jenny Ruhl refers to them as "railroad spikes") that were commonly used just ten to fifteen years ago.
I personally try to limit single injection doses to 7u to 10u maximum per injected site. If I need more insulin than my self-imposed ceiling, I split up the dose into multiple injections. For example, a dose of fourteen units would be split up into two injections of 7 units each; a dose of 24u would be split into three injections of 8u each, etc. The split injections would be done one right after the other in consecutive order using the same syringe/needle but into physically separate sites.
A possible work-around might be for your husband to leave the needle inserted for a few more seconds before withdrawing it. This will allow more time for the insulin to diffuse into the tissues. Insulin pen users, for example, are often advised to leave the needle inserted for up to five seconds after depressing the plunger before withdrawing the needle. This tends to avoid "bleeding" of the dose and help prevent loss of a portion of the dose. Have your husband read WebMD's article on the use of site rotation at this link if he is not already familiar with the practice. Also read Dr. Bernstein's article on The Laws of Small Numbers to brush up on the use of smaller dose injections. Hope this helps.View Thread
David Spero, a male nurse and regular blogger on the Diabetes Self-Management site, wrote several pieces dealing with the topic of diabetes and fatigue. Here's just a sample that echoes my own sentiments in the matter: ""026blood sugar levels that are too high or too low will cause fatigue. Other diabetes-related causes are inflammation, lack of sleep, insulin resistance, infections, circulation problems, medication side effects, depression, and stress. Low thyroid and low testosterone levels also cause fatigue and are common in people with diabetes. So what to do depends partly on the causes. Still, many fatigued people would benefit from moving more. I know that sounds crazy. When you're exhausted, who wants to exercise? But I'm not talking about vigorous training for a triathlon kind of exercise."
This free chapter ("The Laws of Small Number s") from Dr. Bernstein's Diabetes Solution book may be useful to you and your husband. It may require changes in his diet to mesh with using smaller insulin doses but the payoff, long term, is well worthwhile. Bernstein's book is available from Amazon as well as other vendors in both printed and digital versions. It is highly recommended reading and the link above provides access to some free chapters online.View Thread
Sorry to inform you that <7 may be "acceptable" to some, but at that level (nearly twice non-diabetic levels), it is going to result in the development of "complications" down the road. The explanation of your "unwise eating" habits and allegedly "still acceptable" A1c levels is simple: 1. high carb intake (unwise eating) will spike your blood sugar levels well above acceptable levels immediately or shortly after meals. 2. the beta cells of your pancreas will work furiously to secrete sufficient insulin to cover the load and may eventually lower your BG levels sufficiently to achieve "acceptable" levels which are still far above normal and causing ongoing damage to vital organs in your body. 3. your beta cells will eventually become fatigued or die off, producing less and less insulin as a consequence. But then you have been told repeatedly that diabetes is a "progressive" disease and thus accept the bleak outlook as a natural outcome of having diabetes.
What are the short term risks other than glycating hemoglobin? How about glycating kidneys, eyes, heart, nerves, just for starters. Glycation does not affect only hemoglobin although the latter is the most easily measured. Glycation also occurs with the cellular proteins of your precious internal organs but the damage is "ouchless" (you don't necessarily feel anything ... until, of course, it reaches an advanced stage). You need to embark on a serious venture into self education through online resources as well as some superb books on diabetes such as Dr. Bernstein's Diabetes Solution and Jennie Ruhl's Blood Sugar 101 . Check online for free chapters of both books such as the hyperlinks provided. Good luck.View Thread
The Giant Biosensor is not very accurate, certainly is not "best-of-breed," nor can one realistically expect any low-priced device (<$149 category) to reliably provide the benefits claimed. One of the better devices in this genre was one called "Sleep Sentry." The latter actually received FDA approval but has a checkered history in terms of sales and support (originally sold for $389). In recent years, it has been reborn (redesigned) and is now marketed under the name, "Diabetes Sentry". It is considerably more expensive than the Giant Biosensor watch and the current price is $499. However, based on user feedback, Diabetes Sentry only catches about 80% of the hypoglycemic episodes; the other 20% are either outright failures to detect hypo episodes or comprise false positives. You can read more details at these links: Mendosa.com HealthCentral.com Note: I intentionally did NOT include a direct link to the product manufacturer's site because the last time that I did, an uneducated member reported my post as spam and it was pulled by an equally uninformed but unknown person (no flame intended; just a simple statement of fact).
CGMs (Continuous Glucose Monitor Systems) provide the most accurate means of detecting low blood glucose episodes but even those devices produce annoying false alarms/positives. CGMs are also invasive, their ongoing consumables are expensive, and the devices themselves are costly. But why bother with any of that when proper blood sugar control to avoid hypos can be easily mastered with just a modest effort? In most cases, night time hypos are caused by injecting too much insulin and reducing dosages will almost always resolve the problem:
If your husband has been a T1DM since the age of 7, he should have learned how to adjust his insulin dosages to match the criteria shown above. The procedure is called "dynamic insulin dosing" and is recommended by most physicians except for those patients who are newly diagnosed. On the other hand, there are some patients who have never been taught about dynamic dosing and rely solely on fixed, static doses that are virtually guaranteed to eventually get them into trouble. However, it is never too late to learn and, in addition to gobs of free online articles dealing with the topic, there are a number of books that cover the proper use of insulin in depth such as: Think Like A Pancreas by Gary Scheiner Using Insulin by John Walsh
Check to see if your local library has these as well as other books on the topic to see if they will provide information that your husband can use to prevent overnight hypos from occurring in the first place. If you feel more comfortable checking with his doctor first, by all means do so. Just keep in mind that the ultimate responsibility for good diabetes control rests with ongoing self-education and self-management.View Thread
In one word, Terminal. Based on simple raw statistics without knowing anything about the extent, degree, severity, etc. of the multiple conditions, the prognosis is probably something less than 24 months. And so that there's no misunderstanding, the final two to six months are not going to be pleasant ones. Untreated congestive heart failure will result in water retention in the lungs and the patient may feel as though s/he is drowning but in slow motion. Of course, many of us feel that the complications of D that you have listed result from uncontrolled diabetes that might have been prevented altogether by normalizing blood sugars. But that's quite another story. Also, final stage renal failure may cause death sooner than CHF as can a cardiovascular event so exiting this life can occur from more than one vector.View Thread