Q: My mother is suffering from non-insulin dependent diabetes mellitus (NIDDM) and was on glucored forte 1 BD and was under control. She was treated for a chest infection with injections monocef, deriphyllin, decadron, aciloc due to which her sugar shot up and the doctor started giving insulin ranging from 2 to 6 units but the sugar could not be controlled. She started having chest pain along with a breathing problem. She was then shifted to ICU and was kept under observation for 3 days. All this while her sugar level was ranging from 200 to above 500. Sugar was not controlled even by insulin. The doctor has prescribed human actrapid 12 unit in morning and afternoon bbf and before lunch and human mixtard 50:50 20 units at night before dinner. Now her sugar level is 126 fasting and 176 PP. As soon as she takes rice her sugar shoots up to 400. Does she have to take insulin hereafter or can she come back to tablets which were effective earlier? Should she take rice? What is the correct procedure of treating such patients?

A:According to the information provided, your mother is suffering from Type 2 diabetes mellitus and has severe chest infection, which was treated with insulin, antibiotics and steroids. There is a small possibility that she might have a heart problem as well. My advise for her current problem is as follows: 1. During any infection blood glucose shoots up and insulin is given to control high glucose levels. Once the infection is controlled, one can switch over to oral medications. But in case someone has a heart attack then insulin is continued for at least three months as it reduces future chances of cardiac complications. Please ensure from your treating physician that she did not have a heart attack. In case insulin has to be continued (if she had a heart problem) then shift her to Human Mixtard (30:70) 24 units before breakfast and 12 units before dinner (30 minutes before meals). 2. Type of oral medication: If she is above 60 years then I will strongly advise against using glucored forte. She will benefit more with glimepride (Amaryl) and you can start with a dose of 2 mg half an hour before breakfast along with Gluconorm SR 500mg twice a day. 3. Rice is a carbohydrate with high glycaemic index and to reduce this effect you can give it mixed with green vegetables. Its preferable to avoid rice if possible.