I am 55, with uncontrolled T2D. How to manage?

Question

Hi doctor,

I am 55 with type 2 diabetes spiraling completely out of control despite being on maximum doses of five different medications for two years. Blood glucose readings consistently above 380 mg/dL and frequently spike dangerously over 550 after meals even when meticulously following restrictive diabetic diet plans.

I am on Metformin, long-acting insulin, rapid insulin, GLP-1 agonist, and SGLT2 inhibitor but A1C is still 13.1 which I know is life-threateningly high. Constant severe hyperglycemia makes me feel absolutely exhausted, unbelievably thirsty, and urinating every 15 minutes throughout the entire day and night completely disrupting normal activities. Already developing serious frightening complications including significant progressive vision loss making driving dangerous, severe burning neuropathy in both feet and hands, and slow-healing wounds terrifying me about potential amputations.

The endocrinologist keeps aggressively increasing medication doses but side effects getting progressively worse including severe chronic diarrhea and continued weight gain. I am absolutely terrified about going completely blind, losing my legs, or dying from diabetic ketoacidosis like my brother did at 57. I work as an accountant and it is becoming impossible because I feel mentally confused and make calculation errors constantly.

Are there newer advanced technologies or aggressive interventions for such severe insulin resistance? I am willing to try absolutely anything because I genuinely feel like this disease is rapidly killing me.

Please help.

Answer 1

Hi

Welcome to icliniq.com

I read your query and understand your concern. You are describing severe, refractory type 2 diabetes with advanced complications, and you are right to be alarmed.

Sustained blood glucose readings above 350 to 550 mg/dL and an glycated hemoglobin (HbA1c) of 13.1 percent put you at risk for hyperosmolar crisis, diabetic ketoacidosis, and rapid progression of eye, kidney, and nerve damage. At this level, it is no longer safe to try medication adjustments at home.

The first and most urgent step is hospital admission or an emergency evaluation to stabilize you with intravenous (IV) fluids, IV insulin, and electrolyte monitoring . Once you are stabilized, we determine your true insulin requirement using a short inpatient insulin infusion, then convert that to a clearly defined basal–bolus regimen.

For people needing very high doses, we often change to concentrated insulin formulations such as U-500 regular insulin (covers both basal and mealtime needs) or basal analogs like Degludec U-200 , combined with rapid-acting insulin at meals. This improves absorption and reduces injection volume. Technology now changes the game.

Continuous glucose monitoring (CGM) is essential at this stage; it shows trends every few minutes and alarms when sugars rise dangerously. Many patients like you move to automated insulin delivery (insulin pump linked with CGM), which continually adjusts insulin to keep levels in range.

Because complications have begun, we work on protection in parallel. You need urgent eye examination, foot and wound care, and specific treatment for neuropathy. Kidney and heart screening follow right after stabilization. We also check lipids, blood pressure, and ensure you are on the appropriate medicines for vascular protection. Please go to the emergency department today if you have nausea, vomiting, abdominal pain, confusion, drowsiness, fast, deep breathing, or if your glucose meter reads “HI” or stays more than 400 mg/dL despite insulin.

Once you are stabilized and re-equipped with CGM and optimized insulin, most people in your situation do regain control within weeks. The key is to act now, not later, to protect your eyes, feet, kidneys, and heart.

I hope this answers your query. Kindly follow up if you have more doubts.

Thank you.