IMO, there are several components in your husband's roller coaster blood glucose results summarized as follows (not intended as criticism but as objective evaluation of his outcomes): 1. He is consuming far too many carbohydrates in his meals than his body can handle using the medications he is currently taking. This could include insufficient physical activity/exercise but that might be presumptuous on my part since you have not mentioned anything about his physical state. 2. His medication regimen does not include a faster acting insulin that can be used to correct roller coaster, pre-meal, and bedtime highs. He has only been prescribed an insulin pre-mix and NPH, neither of which can reliably be used for adjustment dosing to correct unexpected hyperglycemia in a precise, predictable manner. 3. He has not been proactive in his own self education and self-management efforts, if any.
In the last four months, I have counseled two friends in how to use insulin more effectively and both have been successful in lowering their blood sugars into the 5% club (click the link to read more). They were the ones who had approached me and asked for assistance, not the other way around. Forum rules prevent us from providing medical advice and my comments above are not intended as such; only as simple observations. The advice that I was able to provide to my friends cannot be done in a public forum as it requires close monitoring and follow-up. That doesn't mean we can't discuss matters of interest and concern including topics that you/your spouse should explore with his doctors and healthcare team.
I am going to propose an exploratory change in his DIET for you to try with your husband. It does NOT include any change or adjustment in his medication as that is something that will have to be discussed with his own doctor. However, whenever one changes their diet significantly and lowers carb intake, it usually requires making an adjustment in medication. If medication adjustments are not made, it could increase the risk of hypoglycemia (low blood sugars) over the long term. Therefore, I am proposing only a very short term temporary change for evaluation purposes.
If you haven't yet read the Diabetes Solution Chapter 10 that I previously linked for you, be sure to do so or you can just start here: SO WHAT'S LEFT TO EAT? (from Dr. Bernstein's Diabetes Solution , Chapter 10). Although Dr. Bernstein recommends 6-12-12 (number of carbs per meal) to his patients, I am suggesting that your husband reduce his carb intake to 15 grams per meal for just one day. This should lower his overall blood glucose and stop the roller coaster fluctuations he has been experiencing. If his meter readings do not fall below TEN mmol/l, continue with the 15 gram dietary limit per meal a second day. Ten mmol/l is still more than twice normal but lowering BG levels too rapidly is not well tolerated in some people.
Processed foods will state the amount of carbs on the label; the 15 gram limit will automatically place most such foods on the taboo list. To determine the amount of carbs in fresh vegetables (the best source for carbs), fruit, nuts & seeds, etc. consult Carbohydrate Counter or CalorieKing or just type the phrase, "how many carbs in _____" into your favorite search engine.
This exploratory test should provide you with plenty of insight into what needs to be done long term but requires consultation with his doctors, adjustments in medication, and a host of other factors. Post back with the results and we can go from there (note: in the very unlikely event that he should fall below 6.0 mmol/l, just have him drink a few oz. of orange juice or a sugared beverage).View Thread
I have always questioned the wisdom of a patient using both insulin and a sulfonylurea oral medication. If a patient is already on insulin, why add an oral medication to increase the amount of insulin secreted? Why not just inject the needed insulin instead and preserve what remaining beta cells, if any, the patient may have left (not to mention the undesirable long term side effects)? Of course, I personally advocate the use of injected insulin over a sulfonylurea drug for a different reason: much tighter and far more precise control over blood sugar levels. With an oral medication, you must rely on the drug to exert its affect at whatever timetable and extent that the drug dictates. Depending on a host of variables, the drug may cause over- or under-production of the insulin that you require. With insulin, you can just inject what you need based on your I:C ratio and the amount of carbs in your meal. If you under-project, you can simply inject a small corrective dose. You can't do that with an oral med.
In addition, most patients on sulfonylureas have to increase the strength taken because the effectiveness of the drug declines over time (perhaps due to beta cell burnout?). With insulin, you can just inject the amount that you need and not have to depend on a drug that may cause over- or under-production of the insulin that you require. Injected insulin can also be used to correct unexpected highs; particularly at bedtime.
I know that my posts are long (WebMD has a 4,000 character limit per post) and that I should probably just refer you to some good books and online references on the topic. However, books take even more time to read, require the reader to wade through a lot of filler material (and thus often go unread), and your husband doesn't have the luxury of time. Had he undertaken his educational quest fifteen years ago when he was first diagnosed, that would have been an entirely different matter with a much brighter outcome. In any event, I'm taking a hiatus and my next post will skip directly to a recommendation that may fast track him to potentially better control.
In the meantime, here are some financial assistance links that could help you if you haven't yet explored them on your own:
Financial Assistance Programs for People with Diabetes (PDF Download Link) Ontario Monitoring for Health Program (NFHP) — Diabetes Test Strips and lancets — 1-800-361-07961-800-361-0796 Trillium Drug Program (TDP) ) — Rx Drug Cost Assistance Program — 1-800-575-53861-800-575-5386 Ontario Drug Benefit (ODB) Program — you would be eligible only if are a Trillium Program recipient Lilly Canada Cares Insulin & Glucagon Assistance Program (a possibility) — 1-888-545-59721-888-545-5972 S.U.G.A.R. — 1-855-577-84271-855-577-8427[br> [br> [a target="_self" id="skype_c2c_menu_click2call_action" class="skype_c2c_menu_click2call_action">Call [a target="_self" id="skype_c2c_menu_click2sms_action" class="skype_c2c_menu_click2sms_action">Send SMS [a target="_self" id="skype_c2c_menu_add2skype_text" class="skype_c2c_menu_add2skype_text">Add to Skype You'll need Skype CreditFree via SkypeView Thread
Carb Counting As you may already know, the food that we eat consists of three macronutrients: protein, fats and carbohydrates. Macronutrients provide calories to the body as well as performing other functions. Protein is the source for essential amino acids and fats (lipids) are the source for essential fatty acids. The term "essential" means that the body requires them for good health and they must be obtained from food sources because they cannot be synthesized by or within the human body. There is no such thing as an essential carbohydrate. This is basic junior high or middle school Biology and Physiology 101. All carbohydrates (except some forms of fiber) convert to glucose when digested. Protein (up to 50%) can also convert to glucose via a process known as gluconeogenesis (in the liver). But it is carbohydrates that have the fastest and most pronounced impact on blood sugars. Limiting the types and amounts of carbs in the meals eaten by a diabetic are critical to achieving good BG control and will help prevent otherwise organ-damaging consequences.
Carb counting is a simple meal planning technique for helping diabetics manage their BG levels. It enables all insulin-using diabetics to balance their insulin dosages against the amount (number of grams) of carbohydrates consumed. If the insulin dose (together with other medications) is insufficient to offset the impact of the amount of carbs ingested, the surplus carbs will cause blood sugar levels to continue to rise well after the insulin dose has been used up (hyperglycemia or elevated BG levels). If the insulin dose is greater than the amount needed to metabolize the amount of carbs consumed, the surplus insulin will cause low BG levels (hypoglycemia). The goal for most diabetics is to achieve normoglycemia.
In your husband's case, the carb content in his meals far exceeds what his insulin dose and glyburide can handle. That's one of the reasons why his blood sugar levels are so high. He is consuming far too many carbs than his current insulin/glyburide doses can accommodate. There are two ways to offset this: increase the insulin dose or decrease the dietary carbs. The latter, of course, is the best, safest, and healthiest option. You can get more detailed information on carb counting here on the WebMD website at this link . How many carbs should your husband include in his meals? That's difficult to answer and varies from person to person as forum members here can easily attest to (I will provide some recommendations in a future post).
Unfortunately, clouding up the BG control picture and making it far more of a guessing game in your husband's case is the fact that he is taking both insulin plus an insulin-stimulating sulfonylurea medication (glyburide). Glyburide and other sulfonylurea medications work by stimulating overworked, exhausted, declining beta cells to secrete more insulin. Studies have shown that this will accelerate beta cell death or burnout. (to be continued).View Thread
Just had an opportunity to see your reply and am gratified to see that other forum members have chipped in to express our mutual concern for you and your spouse. I know that your ordeal must be terribly frustrating, especially if your husband of nearly 22 years has been less than proactive in pursuing measures to improve his own health; possibly being content (I could be mistaken) to rely exclusively on his doctor to direct the path that his treatment has taken. If you read my post above again, hidden "between the lines" are a bevy of things that your husband needs to do to correct the imbalance in his uncontrolled blood sugars. In my opinion, any blood glucose (BG) reading above 7.8 mmol/l will continue to accelerate his decline, burn out what remaining beta cells that he has left, significantly increase the risk factors for ongoing nerve damage (neuropathy), kidney damage (nephropathy), cardiovascular events, blindness, cancer, dementia and other "complications." This is not a scare tactic as you are upset enough already; it is simply statistical fact and you can read more details at the BloodSugar101 website at this link .
To describe the disease in an oversimplified statement: diabetes is a cause-and-effect disease. The things that cause blood sugar to rise are the type(s) of food and beverages one chooses to eat and drink. The things that cause it to go down is insulin (primarily, plus other medications, hormones) in addition to activity & exercise. There's a lot more to the picture than that -- such as insulin resistance, body mass -excess weight/obesity, hormonal imbalances, etc.-- but you get the general idea. The key to controlling diabetes is simply to balance the two components.
This oversimplification will enable us to focus on the single most important factor first: DIET and more specifically, carbohydrates. Reducing the consumption of carbohydrates has always been step one and even many healthcare professionals still don't yet have it right. Most dietitians that still follow the original ADA, NICE, and NHS protocols still advise diabetic patients to consume 45 to 60 grams of carbs per meal. That's almost guaranteed to result in failure to control their blood sugars in terms of normal or near normal levels. If you haven't yet done so, read Kevin's story (it's a long thread and to speed through it, just read the posts by "Kman" and skip over all the others). In his most recent blog post, Kevin stated that his pain has become so unbearable, he is considering using the services of Dignatas, a Swiss-based assisted-end-of-life organization.
Next up: Carbs and Carb Counting. I plan to also discuss your husband's current drug regimen from a retired pharmacist's perspective but it should not be considered to be "medical advice'; only a personal opinion and as food for thought that you can follow up with your husband's new doctor (specialist) at this next appointment. View Thread
Welcome back. I was concerned that you had given up hope. I dislike being the bearer of bad tidings particularly during the holiday season. However, your concern over the damage that was done while your husband was without his medication pales in comparison to the damage that he is continuing to sustain while on medication (persistent, ongoing). At 20 mmol/l for the low end of his blood sugar swings means that his average blood sugar levels are 3 to 4 times that of a non-diabetic person. For the majority of healthy individuals, normal blood sugar levels are as follows:
Normal blood glucose level in non-diabetics:
When operating normally the body maintains blood sugar levels at 4.4mmol/L (82mg/dL)
Shortly after a meal the blood glucose level may rise temporarily up to 7.8 mmol/L (120 mg/dL)
For people with diabetes, blood sugar targets (NHS) are:
Before meals: 4 to 7 mmol/L for people with type 1 or type 2
After meals: under 9 mmol/L for people with type 1 and 8.5mmol/L for people with type 2
Your husband desperately needs to normalize his blood sugars as his medications are either not working or his degree of insulin resistance and other metabolic dysfunctions make them ineffective at his current dosages. It may require an insulin IV drip in a hospital setting to get him down to normal levels. It is imperative that he seek help from his doctor to try to achieve this essential first step. A complete review of his medications, insulin dosages, and meal contents also needs to be carefully analyzed as it is self-evident that his health will continue to decline if things continue the way they are.
If you are the person who prepares his meals, do either one of you "count carbs"? If you don't, we can help to educate you. Does your husband test his blood sugars before meals as well as after? Does he adjust his insulin dosages based on meal content? Does he take correction doses of insulin if he is still high? Does he test his blood glucose levels at bedtime? If he is high at bedtime, does he just go to sleep anyway or does he try to correct the highs? My reasons for these questions, and I have many, many more, is to try to sort out where to start in trying to provide suggestions or tips that might help him focus on what he needs to do to stop the ongoing decline in his health. These are basic guidance steps that his doctor, nurse/dietitian/nutritionist, and other caregivers should have been doing for him all along. I'm not sure how the Canadian system works but I do know that some members in the U.K. forum have posted about some pretty horrific experiences with professional caregivers; others have glowing praise (may be the luck of the draw).
Are you or your husband keeping written logs or a diary of his meter readings? Meal contents? Exercise/activity levels? Medication dosages (including adjustment/corrective doses of insulin)? I'm trying to determine how and where to begin to help your husband in a quest towards self-management because diabetes control is often described as 90% patient and only 10% doctor. In actuality, it is probably more like 95% patient and 5% doctor. Can you post a list of the medications and type(s) of insulin he is currently taking? Answers to some of my previous questions would also be very helpful. The forums are essentially anonymous so you need not fear that you are revealing any personal information that can be traced back to you. However, the background info will enable forum members to contribute suggestions that may help put your husband on the right path; assuming, of course, that he is receptive to same.
Your Mom's statement to you was incomplete. She should have told you that: "You can lead a horse to water but you can't make it drink; You can try to teach your___but you can't make him think."
It is my sincere hope that the above does not apply to your husband.View Thread
I think we are all in agreement on several critical points: 1. FU&W's hubby needs immediate medical attention because the wife runs the very real risk of waking up to "something real bad." His BG levels approach life threatening status when they go much above 22 mmol/l (400mg/dL) which is most often treated with an IV insulin drip here in the States (injected insulin does not work reliably at such high levels due to absorption/activity inconsistencies using injected industrial doses). 2. Proper control of diabetes can/will/does reverse complications provided they have not advanced beyond the point of no return as had happened to Kevin (his story is linked here: Terminal and Scared ). The human body is in a ceaseless state of repair and recovery provided that it is properly nourished and the abuse that it had been subjected to has been halted. 3. Having endured diabetes for more than ten years makes most of us assume that the patient "should have learned" what is needed to properly manage their disease by this time. If it is still uncontrolled after more than a decade, it is tempting to always blame the patient for their own neglect. However, I recently counseled a patient who was on insulin for a number of years but wasn't able to get her A1c below 7.4 "no matter how she tried." She had been using static (prescribed) doses and never deviated from them so her health care team was the real one at fault. She is culpable only in that she failed to reach out and get educated on her own. Therefore, I prefer to withhold judgment on FU&W's hubby as he could be a victim of the same substandard healthcare advice. In the case of my friend (actually, a friend of a friend), I successfully counseled her on dynamic insulin dosing and, over a few days, she was able to finally get her BG levels down to safe ranges (~100mg/dL or 5.5 mmol/l) by combining dynamic dosing with a more controlled diet. She had previously been following ADA (US) or NHS (UK) "protocols" which can be toxic to diabetics. It will be interesting to see what her next A1c test will reveal (scheduled in 2 months).
The rest is really up to FU&W's spouse. Bruno is correct in stating that HE is the only one who can make the changes required to improve his health and possibly preserve/extend his own life. Hopefully, our combined comments will provide him with the incentive to do what is urgently needed and I wish them both well.
Bruno, I already agree with what you might be thinking: that the symptoms and complications that FU&W's hubby has endured should have been incentive enough to wake up and face reality. Time will tell ... one way or the other. View Thread
In 1983, a trial known as the Diabetes Complication and Control Trial (DCCT) was begun to see if improving blood sugar made a difference in the outcomes of diabetes. In particular they looked at changes in vision (or retinopathy), kidney disease (nephropathy), coronary disease (CVD), all-cause mortality, neuropathy, and numerous other "complications" of diabetes. The DCCT was supposed to be a 13 year study but it was called short after just 10 years. That's because the results of improved blood sugar control was so dramatic that the researchers didn't want to keep the results a secret.
"Near-normal control of glucose, beginning as soon as possible after diagnosis, would greatly improve the long-term prognosis of Type I diabetes." Although the study itself focused on Type 1s, it applies equally to Type 2 because all diabetics will suffer the same damaging complications from high blood sugars. The announcement continued, "The demonstration that near normal glucose control substantially lowers microvascular and cardiovascular complications has heralded a new era of Type I diabetes care."
It should be noted that the DCCT's definition of "normal" was based on targets of hemoglobin A1c of 6.0 (an average blood sugar of 140mg/dL). Just think if the study had set targets of true normal for the study's participants which is A1c's in the range of 4.2 to 4.6; that's the range that Dr. Bernstein sets as targets for his own patients. Dr. Bernstein claims that normalizing blood sugars doesn't just "substantially lower" the complications but actually reverses them. Not only has he seen this in his own patients but experienced it personally. By lowering his BG levels to the 83-85 mg/dL level, Bernstein states: "I've had diabetes for 65 years, and I'm in pretty good health. I also reversed the kidney disease I developed while on the ADA diet."
Michelle and Bruno, my own evaluation of FedupAnd Worried's husband is that his history of blood sugar control has been exceedingly poor or spotty at best (thus the "Fedup" portion of her handle) and he is currently totally uncontrolled (thus the "Worried" portion of her handle). To Fedupand worried: Brunosbud was trying to say in a roundabout way that control over diabetes is strictly up to your husband and no one else. It is solely your husband's responsibility to gain control over this disease; even if his own health care team has been less than competent in providing him with guidance. That's because good diabetes control is one of self-management and there are many of us here in the forums that do just that.
It is not too late but time is growing short (a ticking time bomb might be more accurate). Your hubby needs to become proactive and make a decision to take action now (in Bruno's words, "come in out of the cold). We can help provide tips, guidance and support (even how to effectively use insulin if he has never been taught). Just let us know if you and your husband want to proceed. If not, your future posts are in danger of being in the past tense (sorry, but IMO there's no way to sugar coat it).View Thread
Fedupandworried, in reviewing your post and thinking with a clearer head, I can't stress how urgent it is for your husband to seek professional help, even without insurance coverage. His levels are in the range that will continue to degrade his health. His 16 mmol/L reading is equivalent to 289 mg/dL in Stateside measurements and jumping into the thirties is life-threatening. At that level, it would require E.R. treatment (the Emergency Room in a hospital) if he is located here in the U.S.
Can you clarify your situation with regards to your geo location and whether my assumptions about your glucometer readings are in mmol/L? In the interim, your husband should drink lots of water and go on a temporary fast to possibly prevent his condition from getting worse. This might provide a breather and provide you with an opportunity to get things sorted out. The concerns you expressed are valid ones that require immediate medical attention. To answer your concerns more directly, the answer is YES to both of your questions.View Thread
Just got back from a late family gathering and threw caution to the wind from a dietary standpoint. I was rewarded with a surge that went up to 188 mg/dL but even that's still well below your hubby's numbers. Fortunately, I was able to correct it with an adjustment dose of insulin and was back down to 100 within a few hours (and still dropping). I use regular insulin most of the time and inject it with conventional syringes. The cost at Walmart pharmacies is less than $25 for a 10 ml vial of Novolin-R and $12.50 for a box of 31G x 8mm syringes/needles. That should be affordable to almost everyone except for those on public assistance.
The 16 and thirties readings you wrote in your post suggests that it is in mmol/L which is the measurements used in Europe, Canada, or elsewhere other than the States. Does your husband understand the proper dosing procedures for using insulin such as his I:C (insulin-to-carb) ratio, how much a single unit will lower his blood glucose; how high a single gram of carbohydrate will raise it; etc. etc.?; These are very basic facts that he must know in order to use insulin effectively to control his diabetes. If a meter displays HIGH instead of a numerical reading, it usually means that the reading is "off the charts" (higher than the range that the glucometer can accurately measure). THAT may be the reason why he is headed for renal failure and a potential cardiac event. Both are conditions that are known to be caused by uncontrolled diabetes and persistent high blood glucose numbers. Good control requires discipline, lifestyle changes (in both diet and activity), and both the willingness and capability to learn. If all of the preceding applies to him, tell us how we can help steer him towards this goal.View Thread