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Stagnation is not good

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This week I have seen one too many patients in the hospital as a consultant, whom on questioning, I found that several of them were in the same unfortunate situation: even though their blood sugars had been high for some time, their diabetes medications had not changed. These were patients in whom their hemoglobin A1C levels were above 9 per cent, which is without a doubt poor diabetes control. So what could be the issue here first of all?{{more}}

There are several possibilities: 1) the patients may not be taking their medications properly. This is unfortunately not an infrequent situation. But assuming they were (which they swore to me) taking their pills and insulin properly, what else could be going on? 2) The medication doses were too low perhaps or 3) the medications needed to be changed entirely, from pills to insulin or different types of pills or different insulins or 4) a combination of all of those issues.

What about stress, you ask? What if these people were stressed? That could, of course, explain some higher blood sugars, especially if the person had been sick for a long period of time. Stress can definitely make your sugars shoot up higher than usual, even when taking medications that normally would keep your sugars in good range. However, what you need to do about this is the same as with the issues above.

In order to realize your blood sugars are not improving, you, of course, need to be checking them, either with a glucose meter at your home, or with scheduled lab tests. And ideally using both. There is NO way to truly know how your sugars are doing without looking at the numbers. DO NOT fool yourself into thinking “I can tell how high or how low;” that is not at all correct.

 
Once you realize your sugars are not improving, there are a few things to do:

1) Make sure you are taking the medication correctly. Talk to your doctor or nurse about the doses.

2) Make sure your insulin has not gone bad or your medication expired.

3) Increase how often you get your sugars checked. If it is by lab tests, you should get that drawn more frequently. If, for instance, you had your hemoglobin A1C checked every six months and you realize for the past two times it has been 9.5 or higher, you should make sure changes are made (to your medications, diet etc) then recheck it in three months. Don’t let yet another half a year go by without checking on it.

The point here is that you have to be proactive about this, and ideally your doctor or nurse will be chasing this with you as well. There is a medication type and dose that will work on EVERYONE, don’t fool yourself into thinking you have some special sort of diabetes that doesn’t respond to medicine. You just need the right type, so be aggressing about taking care of yourself, keep an eye on things, and don’t let that pot simmer with high sugars. It is only you will get burned if you let that happen.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD [email protected]

Medical Director Endocrine Care Group

www.endocrinehelp.com

Tel: 843-798-4227

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