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Increased blood glucose level even with INSULIN.

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I'm a nurse and I have a mentally challenged diabetic patient (28) year old. I inject him insulin bid. No violin 70/30' 30 units AM, 25 units PM. This morning he was at fasting 109 mg/dL. This afternoon, he was at 308 mg/dL. He had 2 spoonfuls of rice and chicken for lunch at 12:00. I saw him at 3 PM AND HE WAS AT 308. Yesterday was not much better. What do you think of this.

Category: Endocrinologist

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Dr. J Muthukrishnan
Category: Diabetologist
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 29 Doctors Online

Expert:  Dr. J Muthukrishnan
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Hello.
Thank you for your query at DoctorSpring.com.
I appreciate your concern. Your patient is having post-prandial hyperglycemia.
He will need an additional short acting Insulin like Actrapid or Lispro at lunch time. It can be injected either 10 to 15 minutes prior to or up to immediately after the meal. This should normalise the rise you see after lunch.
I hope this was helpful. Feel free to ask queries.
Regards.


Patient replied :

THANK YOU. One more question. This is a medicare patient and we can no longer give three visits per day. What could we do different?


Expert:  Dr. J Muthukrishnan
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Hello. Thank you for the follow up.
You can add a Oral drug like Acarbose or Voglibose with Lunch and Dinner to control the postmeal glucose!
Hope this is helpful,
Regards.

Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
Dr. J Muthukrishnan and 4 other Medical Specialists are ready to help you

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