Insulin Injections

[jennotaibi]

My dad has been prescribed the following:
- MetFormin 500 Mg tablet ( 3 x daily for 90 days)
- Apo-Gliclazide MR 30 Mg tablet (4 tabs 1x daily for 90 days)
- ROsuvaSTATin 20 Mg Tablet (Coat) (1 x daily for 90 days)
- Aspirin-Disprin 81 Mg Tab (1 x daily for 100 days) - Insulin Detemir
- Levemir Flexpen 100/unit/mL 3 mL Penfill (inject 10 IU subcutaneous 1 x daily for 90 days

We noticed recently that every time he takes his Levemir Flexpen 10 IU, he gets episodes of shaking and his blood glucose becomes suddenly lower than usual. Could this possibly mean that he doesn't need the injections anymore, just the pills will be enough?

He stopped using it for about 2 weeks now and regularly taking the rest. And everything is fine. ?except that one time he became hyperglycemic and he took the insulin again. I have told him either to continue using it or stop it better than taking it irregularly (as needed).

Please advise me with the right thing to do? And if its OK to continue even takin the aspirin without the insulin? Or maybe its not related?

I will certainly check with his doctor but your kind advise to this regard would be highly appreciated too.

Thanks in advance.

 

[Crimsonclient]

You need to get in contact with gp as he has stopped taking his insulin.


Type 2 diagnosed 24/01/2013.
NovoRapid, Lantus, Victoza, Metformin (sr), Simvistatin

 

[Spiker]

He should immediately resume the insulin but perhaps at a lower dose. Try 7 or 8 IU, something like that. Keep reducing every 2 or 3 days until the shaking, which is likely to be hypoglycemia, stops. Does he have a blood glucose meter? You should use it during these incidents, and during the hyperglycemia, to confirm what is happening.

The rest you really need to discuss with his GP. You don't say if your dad is Type 1 or Type 2 diabetic. It may be that the Levemir dose can be split into two doses across the day, maybe not equally, depending on what time your dad is injecting and what time he tends to get the shakes (hypos). Best thing is to contact the GP right away but get your dad to resume his insulin at a lower dose (even 5 IU or less) until you can talk to the doctor.

 

[AlexMBrennan]

Could this possibly mean that he doesn't need the injections anymore, just the pills will be enough?

That's unlikely - Levemir isn't a cure, and your doctor will have prescribed after the other tablets failed to adequately control blood sugars. Insulin doses vary a lot, and finding the right one is always a process of trial and error so it's necessary to either educate the patient about how doses should be adjusted or for his doctor to monitor and possibly adjust the doses.

We noticed recently that every time he takes his Levemir Flexpen 10 IU, he gets episodes of shaking and his blood glucose becomes suddenly lower than usual. Could this possibly mean that he doesn't need the injections anymore, just the pills will be enough?

When does he get these hypo episodes? You made it sound like he gets them right after the injections, in which it's unlikely to be the Levemir. How long has your dad been taking Levemir?

And if its OK to continue even takin the aspirin without the insulin? Or maybe its not related?

Aspirin is an anticoagulant which, presumably, is taken due to a risk of stroke or such, which is completely independent of diabetes management.

To find the right dose of basal insulin, you need to test blood sugar first thing in the morning; start him on, say, 5u again and increase the dose by 1u every 3 days if BG remains >7 mmol/l or lower it by 1u if it's <5 mmol/l

 

[jennotaibi]

He should immediately resume the insulin but perhaps at a lower dose. Try 7 or 8 IU, something like that. Keep reducing every 2 or 3 days until the shaking, which is likely to be hypoglycemia, stops. Does he have a blood glucose meter? You should use it during these incidents, and during the hyperglycemia, to confirm what is happening.

The rest you really need to discuss with his GP. You don't say if your dad is Type 1 or Type 2 diabetic. It may be that the Levemir dose can be split into two doses across the day, maybe not equally, depending on what time your dad is injecting and what time he tends to get the shakes (hypos). Best thing is to contact the GP right away but get your dad to resume his insulin at a lower dose (even 5 IU or less) until you can talk to the doctor.

He should immediately resume the insulin but perhaps at a lower dose. Try 7 or 8 IU, something like that. Keep reducing every 2 or 3 days until the shaking, which is likely to be hypoglycemia, stops. Does he have a blood glucose meter? You should use it during these incidents, and during the hyperglycemia, to confirm what is happening.

The rest you really need to discuss with his GP. You don't say if your dad is Type 1 or Type 2 diabetic. It may be that the Levemir dose can be split into two doses across the day, maybe not equally, depending on what time your dad is injecting and what time he tends to get the shakes (hypos). Best thing is to contact the GP right away but get your dad to resume his insulin at a lower dose (even 5 IU or less) until you can talk to the doctor.

That's unlikely - Levemir isn't a cure, and your doctor will have prescribed after the other tablets failed to adequately control blood sugars. Insulin doses vary a lot, and finding the right one is always a process of trial and error so it's necessary to either educate the patient about how doses should be adjusted or for his doctor to monitor and possibly adjust the doses.


When does he get these hypo episodes? You made it sound like he gets them right after the injections, in which it's unlikely to be the Levemir. How long has your dad been taking Levemir?

Aspirin is an anticoagulant which, presumably, is taken due to a risk of stroke or such, which is completely independent of diabetes management.

To find the right dose of basal insulin, you need to test blood sugar first thing in the morning; start him on, say, 5u again and increase the dose by 1u every 3 days if BG remains >7 mmol/l or lower it by 1u if it's <5 mmol/l

That's unlikely - Levemir isn't a cure, and your doctor will have prescribed after the other tablets failed to adequately control blood sugars. Insulin doses vary a lot, and finding the right one is always a process of trial and error so it's necessary to either educate the patient about how doses should be adjusted or for his doctor to monitor and possibly adjust the doses.


When does he get these hypo episodes? You made it sound like he gets them right after the injections, in which it's unlikely to be the Levemir. How long has your dad been taking Levemir?


Aspirin is an anticoagulant which, presumably, is taken due to a risk of stroke or such, which is completely independent of diabetes management.

To find the right dose of basal insulin, you need to test blood sugar first thing in the morning; start him on, say, 5u again and increase the dose by 1u every 3 days if BG remains >7 mmol/l or lower it by 1u if it's <5 mmol/l

He takes his injection before bed time usually and gets the shaking like around 11 -12 PM although he didn't even miss breakfast..

And he's an insulin-dependent diabetic

 

[Daibell]

I agree that he and you must get advice on how much insulin to give depending on meter readings and the food he eats. If he is going hypo and the meter will show this then he probably needs the insulin reduced and possibly also the Gliclazide, but you must seek guidance. If your Dad is overweight and has a poor diet, then helping with that may also reduce the amount of insulin required which in turn will reduce sugar swings.