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How can I effectively control my father's blood sugar levels?

Q: My father, 55 years old, has a history of 15 years of diabetes and is insulin dependent since 10 years. He was on mixtard and Recoslin. Recently, he had an accident and developed abscess. His sugar went upto more than 400 mg. He had a consultation with a cardiologist, nephrologist, chest specialist, retina specialist, for foot care and an endocrinologist. During his stay at the hospital, his legs and face were swollen as he had not passed urine. Now the nephrologist has restricted his water to 1.25 ml/day. Swelling has reduced and he does not complain of breathlessness. The cardiologist did an ECG and echo and everything was normal but there was slight thickening of the right ventricle. His PNB level were above 2500. Everything seems to be normal according to the doctors. But his sugar level varies and his fasting sugar is higher than his after food reading. It varies between 215-285 before breakfast and 200-215 after lunch. I am scared about his breathlessness, especially in the night and what symptoms do I have to look for and how serious is it? How do I control his sugar levels? His current dosage is human Actrapid 28-28-8 and Lantus 34 units. What are the other problems I have to take care of and what is the status of my dad’s health?

A:You have highlighted two problems: 1. Breathlessness - it could be due to several reasons and it is difficult to give advice over the Internet. 2. Poor sugar control - the most important in diabetes control is diet. I hope your father had the right advice regarding diet. Your dad is taking two different types of Insulin: a. Lantus (Glargine) and b. Actrapid. a. Lantus is a long-acting insulin that works slowly over about 24 hours. The advantages of this insulin are that it helps reduce hypoglycaemia especially at night, it should produce very predictable blood glucose lowering. This can be gradually increased until the fasting or before breakfast blood sugar has been normalised as long as no low blood sugar levels occur during the night. The usual target before breakfast recommended is in the range of 90 to 130 mg/dl. In your father's case Lantus can be increased further to achieve target sugar level of around 100 mg/dl. (please consult your doctor as achievable target levels can be different for each patient). b. Actrapid is a short acting insulin usually taken 30 minutes before meals to reduce rise of sugar after meals. This starts working within 30 to 60 minutes and lasts six to eight hours. This can be also be increased further if blood sugar levels, after 1-2 hours of beginning of the meal, is above 180. This can also be increased further (1-2 units every third day) till target sugar levels are achieved after each meal as long as there is no hypoglycaemia. You should consult your doctor on this.


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