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Q: I have been put on insulin. I am using 15 units of Lantus in the morning and on a sliding scale with Humulin N twice a day. I have gone from 10 to 18 units of Humulin in the morning and in the evening. It has not changed my blood sugar at all. I am at 200 – 260 every time I test. I am careful with my diet, do not smoke or drink and take all my meds as directed. My question is: Is it right to increase the Humulin N by 4 units every day in a row?
A: From your letter I understand that you are using three types of insulin:
2) Humulin, and
3) Humulin N.
You need to know that both Lantus and Humulin N are long-acting insulin. Lantus works 24hours, and Humulin N works 10-12 hours, they are therefore redundant. You may use only Lantus once a day for your long acting insulin needs, and Humalog for your short acting insulin needs. Lantus may be increased at a rate of 2 units every 2-3 days until your baseline levels are reasonable – about 100. I hope this is helpful. Don’t forget to consult your doctor. — Dr. Litvin
Q: I am 25 years old, and have type 1 diabetes, and I am taking Lantus and Novolog. Should I take my medicine before or after I eat? I’m a little confused about that.
A: Novolog and Lantus are taken at different times. Since you have diabetes type 1, I would suggest that you take your Lantus in the morning. Since Lantus is a basal insulin, it makes little difference when you take it in relation to food. Novolog, on the other hand, is totally different since it’s a short-acting bolus-type insulin and therefore should be taken just before meals so that its peak activity coincides with the highest post-prandial (post meal) glucose. I hope this information has helped. — Dr. Litvin
Q: The question posed was: Dr. Litvin, my son was recently diagnosed with MODY. What is MODY?
A: MODY, or Maturity Onset Diabetes of the Young is a condition that effects persons who are generally younger than the typical adults that are diagnosed with DM Type 2. The condition is usually considered to be a “mild” form of DM Type 1, where damage to the beta cells of the pancreas is found. In the MODY patients, the damage is inherited and renders the beta cells incapable of functioning properly. A key enzyme in those cells is defective, resulting in a “weak” response of insulin to a specific stimulus which is caused by elevated blood glucose. This condition is familial and may affect several generations, with autosomal dominance as the mode of inheritance. These patients usually develop all the DM-related complications, and therefore should be treated as aggressively as all other diabetics in order to control their blood glucose. Treatment is given with all the available oral agents (pills) that are currently in use. Specifically, the pills that are used are those that stimulate the beta cells to make more insulin. I hope this information has helped– Dr. Litvin.
Q: What are the symptoms of diabetes in an infant? My four month old son has very sweet-smelling breath and wets at least 8-10 disposable diapers a day. Should I be concerned?
A: Thank you for your question regarding your infant child. Since I am an internist, which is a physician of adults only, I would not like to give you a specific reply, but rather stick to generalities. From what you are describing, it is possible that the symptoms are caused by diabetes, but by the same token these symptoms may be caused by a host of other clinical conditions. In children, and especially in infants, it is generally more difficult to arrive at a precise diagnosis. Since the child cannot explain what he or she feels, we must rely on our clinical accumanship and multiple tests. These are best conducted by the pediatrician, and, therefore, I strongly urge you to seek his or her expertise ASAP. — Dr. Litvin.
Q: I was diagnosed with type 2 in Aug, 1998, with blood sugar of 814. It now runs between 70 to 120 with occasional spikes of 130. No medication, just diet and exercise now. However I have developed head, right arm and left jaw tremors plus constant chest pain and trouble breathing. Heart has been checked and is OK. Lungs very good. Could these symptoms be caused by nerve damage from the diabetes? I think I had it for at least 5-6 years before it came to a head. My doctor doesn’t think so, but I feel this is all connected somehow. Your opinion would be greatly appreciated. Thank you.
A: Thank you for your email. From the information you have supplied, I understand that you were diagnosed with type 2 DM only seven months ago. On the average, we think that the actual disease starts approximately five years prior to the time of diagnosis. Also, we estimate that it takes between five to ten years to develop complications related to diabetes. So, theoretically, it’s possible that despite your only recent diagnosis, you may still have complications. But the symptoms that you are describing are not easily reconciled with each other or with diabetes, for that matter. Chest pain and shortness of breath are typical for heart problems, and should be evaluated by a cardiologist. Tremor, on the other hand suggests a neurological problem, and should be evaluated by a neurologist. Although unrelated, the two problems could represent a complication of diabetes. The sequence of events in your case suggests to me that the likelihood of a causal relationship is low. In sum, I think you probably have three separate problems. Please view my comments in the context of very non-specific and general advice, since I don’t have much relevant clinical information. I hope this has helped. — Dr. Litvin
Q: My fahter has type 2 diabetes. He is 59 years old. Presently he is using “Danoil” medicine, he takes one tablet per day. I think that this medicine is no more effective because his blood sugar level remains above 250 I am really worried with this situation. Is there any effective medicine available?
A: Thank you for your recent e-mail. As you probably know, your father has a very common disease, and according to world statistics, it’s very much on the rise in your part of the world. I don’t think that any one can say in any certainty as to why this happening, except, of course, for the fact that we are much more sedentary, and eating more of the wrong things. But be that as it may, there are many more type 2s around, and they all seem to be overweight to some degree-particularly around the waist line. So, of course, weight loss is very important, but, not easily achieved. Daonil is a good drug for people with type 2 who still have some insulin reserves in their pancreas. It also helps a bit weight control, and even more significantly, it improves somewhat the lipid (cholesterol) profile. Specifically, in the case of your father, he either is not taking enough Daonil, or he may be in the group that does not respond to the drug. The maximum dose of the drug is 2000mg per day, so if he is taking less, I would probably try to increase the dose. This has to be done under the supervision of his doctor, of course. Let me know how this works out. — Dr. Litvin.
Q: We have a 12 yr. old son who was diagnosed in November 98. He is still in his honeymoon period at 8N once per day, and with a recent Hoc of 5.1. I’ve been doing quite a lot of research into this condition since he was diagnosed, to learn and understand how we can stay ahead. My latest focus has been the extension of the honeymoon period. I’m stopped dead in my tracts trying to find out how, if his pancreas is still functioning partially, can this period be extended. I’ve read about the trials in Europe with this Pancreas Tonic product, and a few other approaches, but nothing beyond that. I’ve seen mention of research studies involving a number of subjects in remission, but have not been able to access them because they’re dated publications, and/or I’m not an institution or Dr. I feel like I’m losing the battle of time, and that any day, were going to lose the rest of his pancreas. Can you help steer me. I would appreciate any assistance you might be willing to share. Best Regards.
A: Thank you for your recent inquiry. The so called “honeymoon” period of type1DM is not well understood. The mechanisms involved in the pathophysiology of this clinical condition are slowly unfolding. Type1 is an autoimmune phenomenon, with the body’s immune system turning against itself and creating antibodies that attack components of the cells producing insulin. These components or proteins have been identified, and in fact a very recent discovery points to the “GAD” protein as the one with probably the most significance. If obliterated, in mice, type1 does NOT develop! Much more of the puzzle is still missing, of course. The honeymoon period is probably a limited “window” were the immune system is taking a rest, allowing enough insulin to be formed and secreted, or it may represent the presence of a significantly larger pool of insulin producing cells. Various manipulations have been tried to prolong this window, with only limited success. Among these agents are several agents that suppress the immune system, steroids, and exogenous insulin. Without getting into specifics, none of these methods have proven definitive, and until the mechanisms involved are clarified, I am afraid that nothing better is available. In my 9th newsletter I reference a site that gives information about various ongoing clinical trials : www.centerwatch.com you may want to look there for possible trials related to your sons problem. I hope this has been of some help. — Dr. Litvin.
Q: Dr. Litvin Hello, I am doing a freelance story on children with type II diabetes. My target magazine is Chicago Parent magazine. I know that type II in children is a growing problem. I am curious about this and would like to know more. Specifically, which children are most at risk for type II, I have heard that children with weight problems are, is this correct? Second, what are some symptoms parents can look for? Are these symptoms the same as those in an adult with type II? Do you believe that parents are fully aware of the risks of obesity in children, or are there more preventative education that should be dispersed? Thank you very much for your time.
A: Thank you for your recent email about type2 Diabetes in children. This is certainly a fairly new problem. As obesity becomes a very prevalent phenomenon in both adults and in children, the number of reported cases of diabetes is on the rise in both groups. But it’s not just obesity that is the dynamic factor; a host of other precipitating issues are at work. The majority of these children come from families with a high incidence of type2, so that they harbor some genetic component that renders them more susceptible to this clinical syndrome. In addition, children with diabetes, tend to be those that are much more sedentary than average, and , of course, to top it off, those that eat a diet very rich in carbohydrates. The combination of all these factors will cause exhaustion of the beta cells of the pancreas, and subsequently hyperglycemia. The process is identical to the one that occurs in adults, the only difference being that it occurs much earlier. Parents of children that have this background should be very concerned about the possibility that their children may develop diabetes at an early age. Since diabetes has been recently shown to be more prevalent among minorities, specifically among Black Americans, Native Americans, Hispanic Americans, and possibly among Indian Americans , parents of children from these ethnic groups should be pro-active in anticipating a diagnosis. In fact, I would urge such parents to seek some screening procedure from the pediatricians involved. Such screening could involve either fasting blood glucose, or possibly even a glucose tolerance test. Any signs even remotely suggestive of diabetes should be taken up with a specialist and treated accordingly. I would like to stress to you and to your readers that diabetes is occurring in alarming frequency, and should be delta with the utmost urgency. I this has been of some assistance. — Dr. Litvin.
Q: I have been on insulin 37 of my 39 years of life. About five years ago I was diagnosed with diabetic retinopathy and chose to treat the initial stages fairly aggressively. Today after having a bleed that originated on the very outside of my vision field the blood has blocked much of my vision. My eye surgeon has recommended having the vitreous replaced. My blood sugar is normally very closely controlled i.e.. Hemoglobin A1C 6.3 to 6.8. Looking up information on the web, it seems to be the consensus that closely monitoring blood sugar levels is the best way to prevent this problem. However, being the first blood sugar machine didn’t arrive on the market until I was 19 what in your opinion is the success rate of this procedure in the long run? I realize some damage has been done in the years trying to control my sugars using “test-tape and clinitest” but it looks now that I have to face this procedure. My main questions for you are, do you have any patients who have had this procedure? 2. Are the people who have had this procedure happy with the results and have they saved their vision? Any information you could forward me would be most appreciated.
A: Thank you for your questions regarding your very difficult situation. I would like to answer you in a very general way for multiple reasons. Firstly, since obviously I haven’t seen or examined you; secondly, because your problem is mainly an ophthalmologic one, and I am not an ophthalmologist, and; thirdly, since other people with similar problems may be interested in some aspects of your problems. The initial issue is your diabetes, which as you state is type 1 ; meaning, insulin dependent. You have had diabetes for many years, so you probably have multiple micro vascular complications. These, as you probably know are complications caused by damage to small blood vessels. Consequently, one develops retinopathy, neuropathy, and nephropathy. A major study several years ago – the DCCT – has shown unequivocally, that after 6-7 years of very good blood sugar control ( you have achieved such control), micro vascular complications are reduced by 50-60%! Unfortunately, despite your very good control, you have developed a significant retinal bleed and require a surgical procedure in order to reduce your risk for visual damage. Excellent glucose control is always necessary to prevent complications. In your case I do not see much choice but to proceed with the suggested procedure. Your very good control has probably prevented a more advance stage of retinopathy, with possible blindness. Try to maintain your level of control, and do whatever is necessary to prevent visual impairment.