Increased Dosage But Sugar Level Still High

[indianhere]

My father has high sugar and he takes Lantus and novorapid insulin.

He is not a regular checker of his sugar levels but his sugar levels kept increasing for the past 10 days (up to 480) so the doctor told him to increase the dosage by 2 units for both. 10-10-10 and 22.

With the new dosage last morning it was around 250 but at night it was 397 and this morning and 2 hrs post dinner it was more than 475.

Normally when it is high then he feels uneasy but these days he just can’t make out. He says he is feeling perfectly alright. I see him sneeze couple of times in the day but other than that everything is fine.

Few months back he had changed his pen. Could this be related?

I think he is doing something wrong maybe; See image attached he will just cover the needle with pen top and put it in cover then in fridge. Is that the right way?

Very confused.

Note: Few days back when sugar level was around 350+ few times we thought the machine might not be working correctly so we got new accuchec.

What to do?

 

[TashT1]

Those readings certainly are very high & concerning. It points to doses being too low.

I take the same insulin’s and Lantus should cover 24hrs if the dosage was correct. With the morning reading being 250 (9mmol) this is still too high & I would be going back to the doctor who would most likely increase the dose by 2 every couple of days.

When you say he changed pens a couple of months ago do you mean he switched to a different insulin? Because if the same pen is used for months this could be a problem, once you break the seal on a new pen it should be used within 28 days, if not it could go off.

With readings that high I would also be checking for ketones and if they were present I’d seek urgent medical help.

Testing & recording really is key here, it needs to be before & 2hrs after every meal plus tracking what he is eating as the nova rapid will cover a certain amount of carbs and anything over that will continue to raise levels.

Regarding the needle, I would remove it each time & use a fresh one with every injection. This significantly limits the risk of infection but I receive free prescriptions from the NHS. Depending on how many times the needle is reused it may be blocked or not hitting the right spot when injecting so he may think he’s using 22u of Lantus but not all of it might be absorbed.

There may be good reasons why he is reusing needles but it certainly is risky.

 

[urbanracer]

My father has high sugar and he takes Lantus and novorapid insulin.

He is not a regular checker of his sugar levels but his sugar levels kept increasing for the past 10 days (up to 480) so the doctor told him to increase the dosage by 2 units for both. 10-10-10 and 22.

With the new dosage last morning it was around 250 but at night it was 397 and this morning and 2 hrs post dinner it was more than 475.

Normally when it is high then he feels uneasy but these days he just can’t make out. He says he is feeling perfectly alright. I see him sneeze couple of times in the day but other than that everything is fine.

Few months back he had changed his pen. Could this be related?

I think he is doing something wrong maybe; See image attached he will just cover the needle with pen top and put it in cover then in fridge. Is that the right way?

Very confused.

Note: Few days back when sugar level was around 350+ few times we thought the machine might not be working correctly so we got new accuchec.

What to do?

I used to use a Lantus biosimilar insulin called Abasaglar. These are both Glargine based insulins. I could tell from a glucose monitoring device that the insulin was only lasting about 18hrs at most and this is not uncommon with similar reports from other users. So the timing of when your father takes his Lantus may have an effect on readings.

I ended up splitting the dose to take some in the morning and some in the evening but don't do this without discussing it with a doctor first.

How many years has your father been diabetic?

You don't tell us about what your father eats. As an Asian family, does your father's diet have a lot of rice, fruit, pulses etc? What are his activity levels like?

 

[indianhere]

He changed the brands I think but now he uses novopen4 and lantus.

He is 70 yrs old and has been diabetic for 15 years.

He eats rice once a day usually for lunch. He did have it twice actually (yesterday).

In lunch he will have wheat chapati with vegetables and some curd. An hour prior to that he will have tea or coffee and early in the morning he will have tea and breakfast.

He will sleep in the noon and after he wakes up he will have tea/coffee with biscuits or protein milk. Some fruit an hour after that. Then 2 hrs after that he will have dinner and about 45 mins after that a cup of milk.

He does his walks in the morning and evening but other than that no other activity. He watches something on tv or is busy on his mobile.

This morning it was 347.

 

[Jaylee]

He changed the brands I think but now he uses novopen4 and lantus.

He is 70 yrs old and has been diabetic for 15 years.

He eats rice once a day usually for lunch. He did have it twice actually (yesterday).

In lunch he will have wheat chapati with vegetables and some curd. An hour prior to that he will have tea or coffee and early in the morning he will have tea and breakfast.

He will sleep in the noon and after he wakes up he will have tea/coffee with biscuits or protein milk. Some fruit an hour after that. Then 2 hrs after that he will have dinner and about 45 mins after that a cup of milk.

He does his walks in the morning and evening but other than that no other activity. He watches something on tv or is busy on his mobile.

This morning it was 347.

Hi, welcome to the forum..

Sounds like your father is using the Novo pen 4 model to administer his insulin. Novorapid is the insulin. The "4" the model of pen.

With regards to the Lantus. It is the foundation to your father's insulin regime. This needs to be checked before you start building the "house," or you could be left wondering why the "cracks in the wall?" (With what is injected for the meals & snacks.)
Everything can affect BGs, there is fructose in fruit, lactose in milk.
Basal testing is a way to understand if the Lantus is doing what it should. https://www.mysugr.com/en/blog/basal-rate-testing/

With close consultation with your father's doctor of course..

 

[indianhere]

His levels yesterday were 172 (morning) , 72 (2 hrs post lunch), 56 (2hrs post dinner)

We gave him chocolate, date and milk at night when we saw 56.

I want to pin point what the reason for the fix could be.

Things he changed:

1. He started taking a cholesterol medicine which he was avoiding
2. The changes in dosage
   
   
3. We changed the needles on both lantus and novo pen4(I just found out he uses same needle as long as the cartridge lasts)
   
   
4. He had taken vitamin d3 med on Sunday which he takes once a week.

Thank you for everyone who had replied.