I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: jo on May 02, 2015, 07:46:05 PM
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Hi everyone,
My mom's blood sugar doesn't get controlled only during dialysis days. This started from the past 3 sessions. She came back home today at 5pm and her blood sugar showed 146. We gave her food (she ate little than what she usually eats) and 5 units of humalog. When we checked her blood sugar in 2 hours at 7 pm, it was showing 345. Again, we gave her 5 units of humalog and checked her blood sugar at 8:15 pm which showed a higher number 365. We gave her 5 units again and waiting to see if her blood sugar will drop. If not, we are planning to take her to the ER. Why is the insulin not working? Is dialysis changing anything in the body? Please let me know if anyone knows what's going on? Thanks.
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Hopefully your mother is seeing an Endocrinologist for her diabetes. My husband has diabetes and uses Humalog. He says depending on how many carbs a person eats with their meals determines how much Humalog they should take. My husband also says everybody is different. For him, if he eats a normal meal that includes 50 grams of carbs, then he takes 30-60 units of Humalog. He said it sounds like the 5 units that your mother takes might be too low since her blood sugar levels keep rising but again, it depends on the person and what they eat. An Endocrinologist will help her learn to test her blood before a meal and then calculate how much Humalog to take with every meal. Right now it sounds like she isn't taking enough Humalog and so her blood sugar levels are rising too high. If your mother doesn't have an Endocrinologist, hopefully her Nephrologist can refer her to one, or the Social Worker can help make her an appointment with one. Getting blood sugar levels under control is extremely important. Hope you can talk with a doctor ASAP about it and together they can decide exactly how much Humalog your mother needs with meals. It's a good sign that she's not afraid to use insulin, she just needs to learn how much to use and once she does, she should feel a lot better. Oh, one more thing, my husband injects his insulin by pinching some of his belly fat below his ribs, kind of low around the belly area off to the side. Good luck!
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Learning to 'Guesstimate' how muc insulin to take for any amount of food takes a LOT of practice.
Depending on how much I eat and how carb loaded the foods are, I will take anywhere from 5 to 15 units. I will test again in three hours to see how far off I am. If my sugar is still a bit high I can always take a little more insulin.
Many people insulin ratio is about 1 to 10. That is one unit of insulin will drop sugars by ten. However there are some that doesn't apply. Some are very sensitive and the insulin works too well. Some are insulin resistant and have to use much more insulin.
What you need to do beside see and endocrinologist, is test regularly, and often. Know what her sugar is, take a dose and in three hours retest to see exactly how much that amount of insulin reduced her sugar. After doing this a number of times you can see a pattern of the insulin to sugar response then you can better estimate dosage.
Another thing I have found is if I do have a very high numjber that 1 to 10 ratio INCREASES. Say I have a 280, with a 1/10 you would think of taking 18 units. A few times I have and drop my sugar too much, like to 80. So now if I have a number like that I will reduce my shot to 15, or even 12, and retest later. I can always take more later to finish bringing her sugar down.
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Hopefully your mother is seeing an Endocrinologist for her diabetes. My husband has diabetes and uses Humalog. He says depending on how many carbs a person eats with their meals determines how much Humalog they should take. My husband also says everybody is different. For him, if he eats a normal meal that includes 50 grams of carbs, then he takes 30-60 units of Humalog. He said it sounds like the 5 units that your mother takes might be too low since her blood sugar levels keep rising but again, it depends on the person and what they eat. An Endocrinologist will help her learn to test her blood before a meal and then calculate how much Humalog to take with every meal. Right now it sounds like she isn't taking enough Humalog and so her blood sugar levels are rising too high. If your mother doesn't have an Endocrinologist, hopefully her Nephrologist can refer her to one, or the Social Worker can help make her an appointment with one. Getting blood sugar levels under control is extremely important. Hope you can talk with a doctor ASAP about it and together they can decide exactly how much Humalog your mother needs with meals. It's a good sign that she's not afraid to use insulin, she just needs to learn how much to use and once she does, she should feel a lot better. Oh, one more thing, my husband injects his insulin by pinching some of his belly fat below his ribs, kind of low around the belly area off to the side. Good luck!
They already gave her a list that contains the amount of Humalog to take depending on the blood sugar. For eg, the list suggests taking 4 units of Humalog for a blood sugar reading of 150. The list was given to her sometime last year, may be we need to meet with an Endocrinologist and adjust it I guess. But, the concern is the insulin doesn't work only on dialysis days. It works fine the rest of the days. A blood sugar reading of 150 gets controlled with 4 units of Humalog on non-dialysis days, but not when she takes it after she is back home from dialysis. This started happening only since the past 2 weeks.
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Learning to 'Guesstimate' how muc insulin to take for any amount of food takes a LOT of practice.
Depending on how much I eat and how carb loaded the foods are, I will take anywhere from 5 to 15 units. I will test again in three hours to see how far off I am. If my sugar is still a bit high I can always take a little more insulin.
Many people insulin ratio is about 1 to 10. That is one unit of insulin will drop sugars by ten. However there are some that doesn't apply. Some are very sensitive and the insulin works too well. Some are insulin resistant and have to use much more insulin.
What you need to do beside see and endocrinologist, is test regularly, and often. Know what her sugar is, take a dose and in three hours retest to see exactly how much that amount of insulin reduced her sugar. After doing this a number of times you can see a pattern of the insulin to sugar response then you can better estimate dosage.
Another thing I have found is if I do have a very high numjber that 1 to 10 ratio INCREASES. Say I have a 280, with a 1/10 you would think of taking 18 units. A few times I have and drop my sugar too much, like to 80. So now if I have a number like that I will reduce my shot to 15, or even 12, and retest later. I can always take more later to finish bringing her sugar down.
Thanks for your recommendations. I really appreciate it.
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Maybe ask if there is Glucose Monohydrate being used in your mother's dialysate fluid and if so, her Nephrologist or Endocrinologist should know the amount they are using on her and if it's affecting her blood sugar levels to rise on dialysis days. Maybe her dialysate fluid and/or treatment prescription needs to be adjusted. I imagine as time goes on and their bodies change and also from dialysis (good or bad), people need to have their treatment prescriptions adjusted. Just guessing. But I would definitely ask about the Glucose Monohydrate.
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I brought this up with my husband, who has ESRD, is on hemodialysis, a diabetic and insulin-dependent. He thinks your mother's blood sugar might be rising so much just on dialysis days because her "counter-regulatory hormones" are reacting to the stress of dialysis. In other words, sort of like the "flight or fight" syndrome, certain hormones our bodies naturally excrete are affected by stress. For instance, when my husband's blood sugar level drops too low, his blood pressure rises but when his blood sugar is too high, just the opposite happens and his BP drops. He says any kind of stress (emotionally or stress on the body) can affect a person's blood sugar levels and blood pressure. Really hope your mother sees an Endocrinologist, one ought to be able to tell her how to manage her blood sugar levels (how much insulin to take before and afterwards) on dialysis days. Diabetes is one of their specialties.
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I brought this up with my husband, who has ESRD, is on hemodialysis, a diabetic and insulin-dependent. He thinks your mother's blood sugar might be rising so much just on dialysis days because her "counter-regulatory hormones" are reacting to the stress of dialysis. In other words, sort of like the "flight or fight" syndrome, certain hormones our bodies naturally excrete are affected by stress. For instance, when my husband's blood sugar level drops too low, his blood pressure rises but when his blood sugar is too high, just the opposite happens and his BP drops. He says any kind of stress (emotionally or stress on the body) can affect a person's blood sugar levels and blood pressure. Really hope your mother sees an Endocrinologist, one ought to be able to tell her how to manage her blood sugar levels (how much insulin to take before and afterwards) on dialysis days. Diabetes is one of their specialties.
Ok we will do that. Thanks to you and your husband.