Patient's Query
Hello doctor,
I am 56 years old and was diagnosed with type 2 diabetes six years ago. My diabetes management has become completely out of control, and I do not know what I am doing wrong anymore. Despite taking multiple medications, my blood sugar levels remain dangerously high. My last HbA1c was 11.3%, which my endocrinologist said was unacceptable.
I check my blood sugar level several times throughout the day, and the results show that my blood sugar is always more than 300 mg/dL, and even 400 mg/dL or more at some points. I have changed many insulin doses, but still, I have had instances of low blood sugar that make me feel dizzy and disoriented.
Neuropathy in my feet is an issue I suffer from, causing me pain and making it hard for me to walk. I can hardly see due to blurred vision; I am also afraid of becoming blind, just like my uncle. I still continue gaining weight even as I stick to the diabetic diet.
I am a truck driver with an erratic schedule, which makes eating meals at the right times very hard. They fear that I may get a diabetic coma in the future. What are some of the aggressive treatment methods that can be used in this case?
Kindly advise.
Hello,
Welcome to icliniq.com.
I have read your query and understand your concern.
I have reviewed the details provided. However, there is no mention of the medications you are currently taking, their dosages, or your insulin regimen. Based on your hemoglobin A1c (HbA1c) of 11.3% and the blood glucose levels described, your diabetes is significantly uncontrolled and requires urgent reassessment by your treating endocrinologist.
Persistent blood glucose levels above 300 milligrams per deciliter (mg/dL), especially those reaching 400 mg/dL, along with episodes of hypoglycemia (low blood sugar), indicate that your current treatment plan needs careful adjustment. Changes to insulin therapy should be made only after reviewing your current medications, glucose records, meal patterns, work schedule, and lifestyle.
Depending on your current treatment, your doctor may consider adjusting a long-acting (basal) insulin such as insulin glargine or insulin degludec. If needed, a rapid-acting (prandial) insulin such as insulin aspart may be added before meals, or a fixed-ratio regimen may be considered. These changes should be individualized and supervised by your treating physician to reduce the risk of both high and low blood sugar.
Since you have not provided details about your medications, dosages, diet, exercise routine, height, weight, or kidney function, it is not possible to recommend a specific treatment plan. Your painful neuropathy, blurred vision, and recurrent hypoglycemia also require prompt medical evaluation to assess for diabetes-related complications.
For many non-pregnant adults, an HbA1c target of less than 7% is generally recommended, although the goal should be individualized based on age, overall health, and the risk of hypoglycemia. Fasting blood glucose is commonly targeted between 80 and 130 mg/dL, and blood glucose levels measured one to two hours after meals are generally targeted to remain below 180 mg/dL.
Please consult your endocrinologist as soon as possible. If you develop persistent confusion, severe drowsiness, difficulty breathing, vomiting, severe dehydration, or are unable to keep fluids down, seek emergency medical care immediately, as these symptoms may indicate a serious diabetic emergency or uncontrolled type 2 diabetes mellitus (T2DM).
If possible, please provide the following details for further guidance:
Current medications, including insulin types and dosages.
Blood glucose records over the past one to two weeks.
Height, weight, and recent kidney function test results.
Dietary pattern and exercise routine.
Frequency and timing of low blood sugar episodes.
I would suggest the following treatment plan:
Review and optimize the current diabetes medications.
Consider adjustment of basal insulin (insulin glargine or insulin degludec) and, if appropriate, addition or modification of mealtime insulin (insulin aspart) under medical supervision.
Evaluate for diabetic complications and possible causes of recurrent hypoglycemia.
Preventive measures include:
Follow a balanced diabetic diet.
Engage in regular physical activity as advised by your physician.
Maintain a healthy body weight.
Monitor blood glucose regularly.
Keep regular follow-up appointments with your endocrinologist.
I hope this information is helpful. Please feel free to ask if you have any further questions.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.