My husband (34) was diagnosed with type 2, three years ago. He's a little over weight, has high B/P... Anyways, last Sunday he was acting funny so I had hom take his blood sugar and it was 560! I sent him to the ER where they gave him fluids, and insulin but only got his blood sugar down into the 400's and then sent him home? I thought he should have stayed.

He saw his doctor the next day and they put him on 3 units of Lantus at bed time. They changed his diagnosis to type 1. His lowest blood sugar since then was 147. Mostly in the 200's and 300's though. They raised the insulin to 5 units.

What I'm not getting is that he has this HIGH blood sugar and never any lows. Now, looking back over the years we think he has had type 1 for 15+ years but not all of the clasic symptoms. He seems to have all high blood sugars so maybe his body is just used to functioning in the 300's so it will take a long time to get it down and under control? He had an a1c done 2 weeks ago and it was 9.5.

I'm scared! What is going on and why can't we get the blood sugars down?

He sees the doctor tomorrow and I'm hoping they put him on a sliding scale for the insulin. We have an appointment at the Joslin Diabetes Center in January.

Help!

Thanks.

This is too dangerous of a situation to comment without more knowledge that what I have with type 1. I do know that type 1's do not go 15 years without being detected. You are unable to live for extended periods without any insulin. Before insulin was used in treating diabetics(only type 1 known back then) being diabetic was the death sentence.

If he is type 2 then you should keep in mind that more insulin to an insulin resistant person does not act at all like the same insulin given to a non-insulin resistant person. That's where the medications come in to make the insulin resistance less. Type 2's, for the most part, don't need more insulin as much as they need the insulin they do produce to work. Yes, one of the stages of type 2 is where you produce less on no insulin. The point being that if he is type 2 and they are not treating the insulin resistance then more insulin is not going to give the same results.

These bg numbers you gave are extremely high. You did not mention the other aspect of treatment - diet and exercise. both are critical. No matter what you do with insulin or medications poor diet or no exercise can do you in.

When he was diagnosed with the type 2 we changed his diet and he exercises (so that's been three years now). The diet part is hard for him. He only got a blood glucose monitor about 3 months ago. So we haven't been doing this very long. His diagnosis was only changed a week ago now. I know that these numbers are very high and dangerous. We live in a place where the heathcare isn't so great and I feel like they aren't helping him at all. Our docs are really layed back and terrible.

He also takes metformin 500mg twice a day.

Well, from what I am learning about the medical profession and diatetes is that you are in the typical situation and not the exception.

Another thing that jumps out is the 500mg X2. My numbers were never that high and I am on 500mg X3. The strange thing is I cannot find anyone that takes metformin 3 times a day. Also I am on Avanda(2mg 2X) along with Metformin. The two together work better than alone. You would think that your husband would be on more than that. I do understand how the diet part is the most difficult. In my case it is the exercise. Diet changes come easier for me. I have gone low carb, no restrictions on fat(except the 'bad fats') and much smaller portions. His bg's will respond. I lost 60 pounds in 9 months and have held to the top of my acceptable weight range..

Because your husband is having the most trouble with diet I suggest you google Richard Bernstein, MD for your education. His diet suggestion will only get your husband defensive and probably won't work. I only say this because you will find so much more than than his low carb approaches. He is a successful doctor that treats only diabetes. The best thing about Bernstein is he teaches about all the aspects of diabetes. There is so much to learn and understand.

Knowing what his bg's are is key to figuring out what he is doing and what is hurting the most. I don't like it either, but it is important to understand where you are.

You, the patient or family, have to take control of the treatment program. The medical profession is out of the loop here. They do their part and prescribe medications and deal with the other parts of your health that you will experience with diabeties.

There is a test that can be done to determine if he's a T1 or a T2. It's called a C-peptide test.

It is possible to be T1 and also be insulin resistant. Regardless of whether he's a T1 or T2, if he is insulin resistant, he will need some kind of medication (such as Glucopahge or Avandia) to help him with the resistance, but with blood sugars running as high as his were, it's a good thing for him to be on insulin too.

I think his doctor is being very cautious with the Lantus, not wanting to give him so much that he ends up having serious lows. He should be followed very closely, perhaps checking in with his doctor every week (by telephone probably) until his numbers get better.

If his numbers are staying down in the low 200's and high 100's, he should be okay until his appointment at the Joslin. They are truly experts there, and will probably be able to figure out what's going on and what to do about it. Make sure he keeps testing and keeps a log...it would be a good idea for him to keep a food and exercise diary too, if he's willing, so when he goes to the Joslin he can give them as much info as possible. The food/exercise diary combined with a blood glucose log will help them pinpoint what needs to be done. In the meantime, low carbing is a good way to help keep the numbers down, even if it's not what he wants to do forever.

Ruth

An A1C of 9.4...While not Ideal Is not actually that Bad. I agree that there is no way he has been Type 1 for 15 years...he would be dead by now if he was. And although it is possible Adults usually do not get type1. It seems very odd that a docter would say that he was misdiagnosed 3 years later. As for the amount of lantus he is taking....5 units is nothing......He will just need to Keep raising it until he finds out how much he needs.

Is his doctor a general practitioner or an Endocrinologist? e should be seeing an endocrinologist.

I agree with Ruth. You should request a C-Peptide test to help you understand if your husband is producing insulin and if so, how much. I also agree about the meds, keeping logs of test results and food eaten, and I also agree with switching him to a low carb diet, at least until he gets his BG under control. You can make changes to your husband's routine based on the outcome of your next appointment at Joslin. It does seem strange that he has been diagnosed with type I but his BG never experiences lows. I suppose that's the result of NOT injecting insulin. However, if he has converted, he most likely still has Type II, but now has Type I as well. (I've done some reading on this and it is much trickier to treat when a type II becomes type I and II) What that means is your beta cells are exhausted and are not producing insulin or producing much less than normal. On top of that, you still have the insulin resistence that made you type II in the first place. This will make his treatment very tricky if found to be true and he will have to be MUCH more regimented in his diet, exercise, glucose testing, and in taking his meds. Hope everything turns out okay. Sounds like his numbers are starting to come down with the insulin, and that's a good thing.

If the diagnosis has been changed from T2 to T1, your husband probably tested positive for the antibodies. The chances are that they were there all along but he wasn't tested for them because of the slow onset of symptoms. The fact that he responded to metformin probably re-inforced the belief that it was T2.

You husband coukld have been T1.5, or slow-onset diabetes, all along. It is also the auto-immune type of diabetes (like T1) but it can take many years for blood sugars to get to the point where they cause ill effects. His body would have become accustomed to living with the high blood sugars. And he never had lows simply becuase he wasn't injecting insulin. The fact that your husband is responding to small amounts of insulin suggests that he is not insulin resistant and is in fact T1.

I am sure everything will work out ok. It sounds like your husband doesn't have too many beta cells left. And the injected insulin will have to be increased to take up the slack. Starting Lantus from a low level is the conservative way to do this. Your husband will also require quick acting insulin before meals. The secret to figuring out a regimen that works is to do lots of testing and make small incremental changes.

I would suggest that he continue to take the metformin. Doctors usually only prescribe metformin to T2s. But T1s can also benefit from it. I have been T1 for 28 years and recently started meformin. And the initial results are very promising.

Cheers,

Mark

I'm not sure if this is any help to you but my grandmother was in a similar situation to you.

She was diagnosed T2 at 70years of age. We wasn't told about a glucose monitor to check her levels. We just relied on her blood test results. Her blood test results showed very high levels of sugar so her Metformin was increased to 800/850mg x2 a day and then 3 times a day because her levels continued going higher and higher. One day her levels became so high she nearly slipped into a coma. I called the doctor and she was perscribed some more diabetic T2 medication to lower down her sugar levels. It worked for about 3 weeks and then she went up sky high again and nearly into a coma. This kept happening. All my doctor said was keep on with the medication. After she'd been on the medication (not the metformin the other one) she had a massive heart attack and nearly died. We found out her heart was damamged by the high blood sugars, her arthritis had gone from very mild to severe and her blood pressure was dangerously high.

She was changed straight over to insulin 38units twice a day for 2 years. Then she had too many hypos where the blood sugar becomes very low and nearly slipped into a coma several times. Once again the doctor did nothing so I took it into my own hands and gradually lowered down her insulin till her levels were stable. She's now on 18units twice a day and her blood test result are the best theyve been in years.

Because your husband has just started insulin, check his levels every 2 hours. If he has something he eats regularly, test him 2 hours after eating this and see if its affecting his sugar levels. My gran adores oranges and fruit which is good for a diabetic (sometimes) but they send her levels up. So whenever she trys something new to eat, I test her 2 hours after and see what her levels are.

When she is ill with a cold or chest infection etc, I higher her insulin by 2 units to keep her levels stable. Unfortunately now her levels are creeping up again as you'll see from my post on here.

My gran is overweight too but shes losing it gradually which is better for her than losing weight suddenly. Your husband needs to eat healthily (even food he doesnt like) and exercise.

I do notice when my gran goes for a little walk to the shops her levels drop down quickly and she goes into a hypo. Exercise and my gran doesnt mix but I bring some sugar or a sugary sweet with me in preperation for a low episode.

You wont see changes right away. It may take weeks or even months but the benefits far out way the drawbacks. Hope hes better soon. :)

Thanks for all of your replies and information! I'm having such a hard time figuring this all out. There is way too much information out there!

Thanks for the help! I hope you don't all mind if I ask a zillion silly questions.

Basically its irrelavant whether he is type I or Type 2. What matters is...what are his blood sugars and how can he get them down.
Usually a starting dose of lantus is 10 units. The patient is told to titrate up (or add units) every 3-4 days based on a first thing in the am blood sugar. When he gets to under 120 blood sugar 1st thing in the am you have your ideal basal dose of insulin. However, Lantus only controls 1/2 the problem. The meals are not being addressed. Ideally he should be taking a dose of Novolog or Humalog (mealtime insulin) w/ every meal. Lantus at bedtime and Novolog or Humalog w/ every meal. The doc can start w/ a low dose of Novolog/Humalog and again it can be titrated up (every couple days)till he gets a ideal blood sugar of under 140 2hrs after meals. Eating a consistent amount of carbs is key. Dropping the refined carbs from his diet w/ bring blood sugars down and help him loose weight.
You are right, there is a ton of info out there. For him to get into good control educating yourself and him is the best way. Keep in mind, everyone's case of diabetes is different but overall everyone has the same goal, get as close to normal blood sugars as possible. The more you know the better off you are. If you dont like the info your doc is giving you call the outpatient diabetes ed center from your closest hospital and get in for a consult!