Struggling with Insulin Management for Type II Diabetes
Greetings, I am a 43-year-old male, standing at 5 feet 11 inches (180 cm) and weighing 280 pounds (127 kg). I have been diagnosed with Type II Diabetes Mellitus, Major Depressive Disorder, Generalized Anxiety Disorder, Hypertension, Hyperlipidemia, moderate sciatica, moderate osteoarthritis, and insomnia. My current medication regimen includes metformin hydrochloride at 500 mg once daily, Lisinopril 10 mg once daily, Clonidine at 0.1 mg daily, Metoprolol 50 mg daily, Naproxen 500 mg twice daily, Atorvastatin 20 mg at bedtime, Amitriptyline 50 mg, Citalopram HBR 40 mg, Risperidone 1 mg twice daily, Ramelteon 8 mg at bedtime, Thera-M once daily, L-methylfolate 15 mg at bedtime, Cholecalciferol (Vitamin D) 2000 IU daily, Tirzepatide once a week at 2.5 mg, and both Insulin Aspart and Insulin Glargine as needed, with the latter dosed at 10 units each night. I use a Freestyle Libre 3 continuous glucose monitor that I calibrated every two weeks under my insurance plan. I felt that my blood sugar levels were manageable, but I hadn’t been monitoring them consistently. About a month ago, I checked my levels and discovered a high reading of 527 mg/dL. Following this alarming result, I made an appointment with my primary care physician two days later. During the visit, she prescribed metformin hydrochloride and insulin aspart. The addition of insulin aspart allowed me to qualify for the Freestyle Libre 3, which I started using immediately. However, I found that insulin aspart provided little relief, prompting a follow-up appointment where my physician added insulin glargine for nighttime use. Despite my dietary efforts to minimize carbohydrates, my blood sugar remains predominantly in the 200s throughout the day, only dipping below 200 in the morning on occasion. I've noticed that even after taking insulin, particularly with an aggressive sliding scale, my blood glucose doesn't decrease significantly right away, although it tends to drop a few hours post-meal. I am determined to enhance my health and am contemplating bariatric surgery this summer. I plan to seek a referral to an endocrinologist from my PCP soon. I'm wondering if I should be more assertive with my sliding scale to better control my glucose levels? My recent lab results were stable, with the most recent HbA1c reading at 8.6. I appreciate any guidance you can provide, as I've been managing diabetes for six years but only recently started insulin treatment.
Answers (1)
3/29/2025, 2:50:42 AM
OpenHealth AI
It's great that you're actively seeking to manage your Type II diabetes and improve your health. Your situation is complex but manageable, and it's positive that you're already taking steps such as using a continuous glucose monitor and considering a referral to an endocrinologist. Let’s break down your current situation and how you can take actionable steps to better manage your blood sugar levels.
Key Points
- Inconsistent Blood Sugar Levels: Despite dietary changes and insulin use, your blood sugars are often elevated, which is concerning.
- Adjustment of Insulin Therapy: Given your HbA1c level of 8.6 and persistent high readings, there's a need to assess your insulin regimen, particularly how you use insulin aspart and insulin glargine.
- Consider Lifestyle Modifications: Bariatric surgery could be a helpful option, but immediate lifestyle changes may also provide improvements.
Explanation
Your blood sugar levels suggest that your current management plan may need adjustments. High glucose levels can lead to serious complications over time, so it's essential to find a strategy that lowers your levels consistently.
Using insulin often means fine-tuning doses based on your meals, activity levels, and how your body responds. The fact that your levels drop hours after meals suggests that the timing or dosage of insulin might need closer inspection.
Next Steps
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Strengthen Monitoring Practices:
- Log Your Blood Sugar: Track your glucose levels throughout the day, especially before and after meals. Note how much insulin you take and what you eat to spot patterns.
- Frequent Testing: You may want to test more frequently (e.g., before meals and two hours after eating) to gain clearer insights.
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Adjust the Sliding Scale:
- Consult with your primary care doctor or endocrinologist about potentially increasing your sliding scale doses of insulin aspart for immediate corrections after meals. Discuss the timing of your insulin injections relative to your meals.
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Dietary and Lifestyle Changes:
- Refine Your Meal Plan: Consider a registered dietitian specializing in diabetes for customized meal planning, focusing on low glycemic index foods, portion control, and balanced meals to stabilize your blood sugar levels.
- Increase Physical Activity: If feasible, incorporate gentle exercise suited to your osteoarthritis and sciatica, as it can help lower blood sugar levels and improve overall health.
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Seek Professional Guidance:
- Follow up with your endocrinologist as planned to discuss your results, medication adjustments, and the potential for surgery. Bring your blood sugar logs to the appointment for a comprehensive review.
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Consider Psychological Support:
- Given your history of depression and anxiety, ensure you are getting adequate emotional support to cope with diabetes management stress. This could also help improve your insulin management adherence.
By taking these steps, you can enhance your blood sugar management and work towards your health goals. Remember, it's important to pace yourself and adjust only one thing at a time to see what works best without overwhelming yourself. Keep pushing forward – you’re on a positive path!
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