Hi, haven't posted in a while because it took me this long to get my husband back to the clinic. Today the P.A. put him on 10 units of injectable insulin-Lantus each night before bed time. He kept him on his glucophage and avandia, but discontinued his use of amaryl. He had lost 15 more pounds and is down to 140. (He was 195 last year at this time.) PA did not do the C-Peptide test as someone advised. I wasn't there to advocate. I'm just wondering if anyone has any advice, comments regarding Lantus. You can see my past discription of his health by scrolling down and reading the post I made last month. Thanks everyone!

If your husband's weight loss continues you might want to measure ketones for a while. He may be type 1 or type 2 but not producing very much insulin on his own. I'm type 2, but I lost 37 lbs without even trying when I was first diagnosed. If you have elevated blood glucose and keytones in your urine, then you are insulin starved, and may be borderline ketoacidosis (which if you go over the line can kill you). What happens is that your body can't utilize the glocose in your blood stream, because of lack of insulin (which leaves your BG high), and burns fat for energy to keep you alive, which produces the keytones. And all the while your BG is high your are contributing to the onset of diabetic complications, like peripheral neuropathy, kidney failure, retinopathy, and cardiovascular disease. Unfortunately, it may be a little expensive to find out what the problem is right now, but in the long run it will me a worthwhile investment. If your are referring to Physicians Assistant, by P.A. you might want to bite the bullet and visit an endocrinologist, for an expert opinion. I'm sure your P.A. means well, but may not be well versed enough on diabetes.

Just a quick addendum to what JacksonHgts has already said re P.A. - You mentioned taking your husband to a clinic...is this like a walk-in health clinic? Or any kind of general health clinic? I believe it is absolutely IMPERATIVE for anyone with diabetes to be seen by an endocrinologist or diabetologist. This is an extremely complicated illness, and most general practioners or internists who do not SPECIALIZE in diabetes care do not have great expertise. A P.A. who is also a diabetes educator or who works with an endocrinologist might be okay, but definitely not a general P.A.

I agree that your husband's condition sounds rather serious, and a C-peptide test should definitely be done, as well as possibly putting him on a regular insulin regimen (in other words, not just using a bit of insulin to supplement all the oral medications, which don't seem to be working)

Has he had an HbA1C test done? This is also called a glycosolated hemoglobin, and it measures how well the blood sugar has been controlled over the past 8-12 weeks.

Does your husband have a glucometer, and how often does he check his blood sugars? What have his numbers been?

Not to scare you, but the sooner his blood sugars are under control, the sooner he will stop losing weight and start feeling better. And, as JacksonHgts pointed out, if he's in ketoacidosis, he could be very close to a life-threatening situation.

Write back and let us know how you're both doing.

This all makes me so worried my stomach is burning. It is not about biting the bullet. There just isn't any money in our lives. I'm feeling okay about being totally honest here as I feel pretty anonymos. We couldn't even pay the clinic the full amount today, and yes this is just a general P.A. at a walk in clinic. This has worried me from the begining too. His vision is so blurry and we haven't been able to scrape up enough for him to go to an optometrist. We have been qualifying for free meds but the process takes 6 wks and we did not get the Lantus script filled today because we do not have the $150. I have 3 small children. I'm worried that I could lose my husband and my children could lose their father and it could all boil down to lack of money. I'm so frustrated. I'm actually a well educated strong individual and do not view myself as helpless, however, I don't know how to advocate or work toward something else happening. I once had a child in ICU who almost died with severe acidosis. The internist talked to me about ketones and ketoacidosis. After 12 days in the hosp. he was okay and they sent him home with no diagnosis. They did do perineal dyalysis on him to correct the acidosis. He was 18 mths old. When he was 4 I ended up with another 18 mth old child in ICU with the same symtoms. The doc said they believed something genetic was going on but couldn't determine what it was. My children are very healthy and number 3 is 2 1/2 and has never been truely sick. Anyway, could there be ANY connection here? Just seeing you type acidosis sends chills down my back!

I forgot to answer a few questions.

Yes, they have done the HbA1C test all 3 times he has been in the clinic since last September. Today the receipt says they did a CMP and the hemoglobin glycated test.

Yes he has a glucometer, he seems to use it every 3 days or so. At first he did it about 4 times a day, but now he does not see a reason to do it as often. I just checked, it looks like he has stopped writing down the numbers in the journal. The few times I have been standing by when he checked his bs, it has been in the lower 200's, although i have seen it in the 300's.

Sam-o-kitty,
i know you made some suggestions last time I posted regarding seeking care for people caught in between insurance and medicare. I did try to find something, but I will try again tomorrow and see if I can find any open doors that have seemed closed in the past. I'll report back to you all.
Thanks,
Chante'

Chante -
If your husband is experience blurred vision and possible ketoacidosis, it could be considered an emergency situation. You may want to go to the nearest large hospital's emergency room. Especially if you go to a large teaching hospital, they almost always have money for "free care patients"...and they probably won't turn you away at the emergency room. You can probably call the hospital first, explain the situation re how sick your husband is and your lack of finances, and get a read on whether or not they'll accept you for free care...chances are very good that they will.

I'm really quite concerned...the longer his treatment is delayed, the more potential there is for permanent complications. Please keep us posted.

Ruth

I just called around and found a optometrist who will work out a payment plan with us. I made him an appointment for Tuesday.

I left a message on the local hospital's diabetic education instructors phone. So, maybe she can give me some local direction.

It's a start! The thing is, as long as his blood sugars are not controlled, he's going to keep having these kinds of problems. Also, I'm not sure whether an optometrist is expert enough at diabetic eye complications - usually one needs to see an ophthamologist.

By the way, the HbA1c is the same thing as a glycated (or glycosolated) hemoglobin. When do you get the results of his blood tests? His HbA1c ideally should be below 7%, if it's over 10% that's really bad...in between is not great control, but probably not dangerous. And, he should be checking his blood glucose at least a couple of times a day...if he tests in the AM a few times a week, at dinner a few times a week, and at bedtime a few times a week, he'll have a good idea of what's going on...and when he gets to see an endocrinologist, those records will be really helpful in determining what medication changes he might need.

I know this must be awful for you. Did you call your local hospitals yet? Is there one in the area that's known for treating diabetes (I'm in Boston, and we have the Joslin Diabetic Center which is affiliated with Beth Israel Deaconess Hospital).

I'll look back here tomorrow night to see what the ophthamologist had to say. GOOD LUCK!

Ruth



[This message has been edited by SamQKitty (edited 05-17-2002).]

His appointment with the optometrist is Tuesday. He seems a little excited, so maybe he just needed me to step in and take over a little. I didn't know an opthomologist was what we needed, but I'm thinking we are lucky to see the optomotrist at this point. His ad says he is a therapeutic optometrist and it says he deals with diseases of the eye.

I talked with the local hospital's diabetic education woman today. She is the woman who directed me to the clinic and the PA last Sept. When she found out my husband's condition, she was disturbed that he was seeing the PA, and said that that was not appropriate. She said we needed to see the endocrinologist. When I told her she wouldn't work with people with financial limitations, she told me there were a few good mds in town that were well versed when it comes to diabetes. She gave me 3 names. She did not know if any of them would work with me. I haven't contacted any of them yet but I do have some contacts that connect me to one of them, so I'm trying to see if I can get some help in asking him to see my husband.

I live in a town of 30,000 with one hospital but close to metropolitan areas. I did not know there were hospitals that specialize in diabetes. How would I go about researching this?

thanks for all your input

Chante'

Try going to the American Diabetes Association's web site at www.diabetes.org. (http://www.diabetes.org.) They have a list of education centers around the country.

Also, as I've mentioned before, if you're near a major metropolitan area, call one of the big hospitals, explain the situation (that your husband needs to see an endocrinologist ASAP), and see if they'll give you free care.

Keep me posted, huh?

Ruth

Ruth,
I went to the site, but couldn't find the list of education centers. Where is that?

He went to the optometrist, who also has diabetes. He said his eyes are good, that his prescriptions seems way too strong. He is going to look at them a second time next week just to double check some things. What a relief this is to my husband.

He has been taking the Lantus for 2 days. Last night when he took it his bs was 340, this morning when he got up it was 180. Before lunch today it was 230. And this evening before bed it was 299. So, I wonder if the dosage is adjusted....

Anyway, that is all the news I have today.

http://www.diabeteschat.net/forums/index.cfm?b=Diabetes

Here is a link to another diabetes board we have a great moderator who will help you out...I think your husband needs a doc to help him...and about his eyes...dont change his prescription untill he has been under good blood sugar control for at least two months...otherwise you will need them changed again.

saskia
hope to see you on this board also..its a great board


http://www.healthboards.com/ubb/smile.gif

Hi chante'
Saskia99 has a very good point...fluctuating blood sugars can definitely affect vision. My ophthamologist won't even give me a vision test unless my blood sugar is under reasonably good control because, as he explained it, vision can change from one minute to the next with poor control.

And, although it does sound as if your husband's blood sugars have come down somewhat, he still can't be considered in good control.

Yes, you are right...probably his dosage needs to be adjusted. Also, if I remember correctly, Lantus is a very long lasting insulin that is usually taken at bedtime only, once in 24 hours. Your husband may need to add some regular insulin before meals (especially breakfast and dinner).

It does sound like you're making some progress. I certainly hope you find an endocrinologist who will treat him.

Ruth

My husband got his Hemoglobin A1C HPLC test results back today. The number was 14.7 when he was tested last fall. Last weeks number was 9.3, so the PA was pleased because it had come down so much. They upped his Lantus from 10 ml to 12 ml each night. So, what can you seasoned posters tell me about these test results?

I just saw two more things on the lab results I thought I would mention and see what you all thought about. The glucose number was 235 in the fall and 202 last week. And it also says the bilirubin number was out of range in the fall at 1.6, but within range now with 57.

Tonight when he tested his bs it was 395. We talked about it. This was at 9 p.m. He said that he had forgotten to take his glucophage with his meal at 6, and that he had had corn flakes and soy milk and half an apple for dinner. (I wasn't home.) So, I'm wondering if forgetting his meds shot his numbers up that high. Does that meal sound so terrible?

Chante' -
That meal isn't so terrible IF he takes his medications! Without, then he's putting a lot of carbohydrate into his system and he doesn't have enough insulin to cover it.

The HbA1C coming down from over 14 to just above 9 is a huge improvement...but it needs to get down to under 7. You may find that the extra 2 units of Lantus will help. And perhaps your husband should wear a watch with a timer that he can set to go off before meals, so he doesn't forget to take his meds.

Don't know why the bilirubin would have been so far off, but I do know that it's a measure of liver function. At least it's normal now, but just to be safe, I'd make sure they test it again.

The blood glucose levels of 220/201 (sorry, I'm typing this without having your post in front of me), are really not that meaningful, as they are just a measure of his blood glucose at the moment he was being tested, and at that level, 20 points or so doesn't make a huge difference. That's why they do the HbA1c...it gives a more accurate picture of how good the control has been over a period of time.

Well, it sounds like you're headed in the right direction!

I just need to add to this conversation. I was on Lantus from 11/01 to 6/02 and all though it would bring my sugars down. It was not doing what it should have been I stayed in the 200 range. I complained 3 times before she(Dr.) took me serious and changed me to the pen 75/25 I've been on it for one week and except for right after a meal I've been staying between 60 and 140. If he's really trying and it's just not coming down enough don't be afraid to ask for a different plan. Like I said it took me 3 times before she got what I was telling her.

just thought i would post my experience with lantus. I have been on lantus for the past 6 mos and it has worked out very well for me. originally i was on humalog 75/25 42 u in am and 38 in pm, it was taking care of my bg levels for afternoon and into the night but when i woke up i would always have highBG level no matter when the last time i ate was SO my endo put me on Lantus 12mg @ bedtime and it has been excellent and my levels are now normal . the only time they go out of whack is when i am sick they fluctuate alot but i am told that is to be expected and normal for a diabetic when you are sick. Hope you get all the help you need for your husband soon!!
God Bless