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Can management of Type 1 change as you get older?
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JenM7733 posted:
My husband was diagnosed with Type 1 close to 10 years ago. Recently he has had trouble keeping his A1C down. They have been at 10.6% at the last 3 tests (over 9 months). I know he's taking his insulin because due to recent medical issues, I've been handing him his Novalog before meals and Lantus at night.

He takes 1 unit of short-term (Novalog) per 15 grams of total carbs. This has been the method that least likely gives him lows.

I'm wondering though if its possible as you age if your diabetes plan needs to get adjusted or if his treatment was never done correctly in the first place.
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DavidHueben responded:
Jen:

The short answer is that diabetes (either Type I or Type II) can progress over time.

Obviously, an A1C of 10.6% is way too high (that level approximates an average plasma glucose level of 257), especially since he is on insulin therapy.

It sounds like he needs to see his doctor and/or an endocrinologist ASAP. He may need adjustments to his insulin protocol.

What have his fasting and two hour post-meal glucose levels been running as measured with his home glucose meter?

David
Watch what people are cynical about, and one can often discover what they lack. - General George Patton Jr
 
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mhall6252 responded:
David is correct - his A1c is way too high. His doctor may add a medication like Metformin that will help his cells use insulin more efficiently. Or he may make adjustments to the current protocol. In any case, a discussion is in.

Is your husband seeing an endocrinologist?

Is your husband getting any exercise?

Is he limiting his carb intake?

Is it possible that the "recent medical issues" have had a negative impact on his glucose control?

Michelle
 
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Laurie Anderson, MSN, RNP, CDOE responded:
Hi,

it is not only possible, but very likely that insulin requirements will change over time. This can result from weight gain, decreases in activity levels and illness. It would be very helpful to his health care provider to have some "patterened" blood glucoses to evaluate his control. By this I mean testing in a pattern that gives reading from different times in the day. I ask my patients to do the following: on the first day of the pattern test first thing in the morning before eating anything (fasting test), then testing one hour after breakfast (or morning meal or snack). On the second day, skip the fasting test and check just before the lunch meal and 1 hour after eating this meal. On the third day test just before dinner/evening meal and 1 hour after eating. Do these 2 tests a day for 7-10 days and WRITE THEM DOWN in a log book or on a piece of paper, then take them to the office visit with you. These numbers will help to find out where the challenging times are in the day, and to target medication changes. It will also help you to see if the mealtime insulin ratio of 1:15 is enough or not. Please make an appointment within the next 7-10 days and test his blood sugars and take those numbers with you. Kind regards, Laurie
 
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auriga1 replied to Laurie Anderson, MSN, RNP, CDOE's response:
Laurie, that is a wonderful idea. I had to do something very similar to what you tell your patients. I am a Type 2 insulin-dependent diabetic whose diabetes was way out of control with an A1C of 13.2. I was started immediately on insulin therapy and that has changed and keeps changing, especially with activity levels and amount of carbs I eat.

What you have mentioned to your patients is what my doctor told me to do. I had to journal all my blood sugar readings, the amount of carbs for each meal and the insulin dosaging I used at each meal. Intensive insulin therapy management was what they were doing and it has helped immensely. Dosaging of insulin does not remain a constant, at least for me.

Again, great idea. I hope he will consider doing this.
 
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An_202848 replied to DavidHueben's response:
Hmmmm.....Correct me if I'm wrong but, I don't believe Type I Juvenile Diabetes "Progresses" over time. UNLESS, you're talking about when you're in the honeymoon stage and within a year or so Autoimmune attacks and distroys all insulin producing cells. That's the only time it will progress.

Are you're talking about progressing to complications from not taking your insulin and keeping your levels down like you're supposed to???
 
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DavidHueben replied to An_202848's response:
Anon:

Don't take my word for it. Please see Laurie Anderson's reply. She is one of the board's resident experts. She is an R.N. and a C.D.E.

DMH
Watch what people are cynical about, and one can often discover what they lack. - General George Patton Jr
 
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mhall6252 replied to An_202848's response:
Type 1's can develop insulin resistance over time, and can actually develop Type 2 (double diabetes). That would definitely impact the amount of insulin and/or insulin-sensitizing meds that might be required to maintain glycemic control.

Michelle
 
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arealgijoe responded:
First I am not a typical type-1 or 2.......

There have been times where my insulin needs changed overnite, even w/o any stress or illness.

I did gain weight after starting insulin, I was very skinny back then. Medical issues usually affect glucose control, that is a given. When that happens, its important to adjust insulin as needed to maintain good control. High BS level make things worse, not just complications but also ability to heal can be greatly affected.

My endo has me on Lantus TWICE a day for a better more even BASAL. I also take humalog at 1 unit per 15 grams of carbs and my last A1C was 6.1.

I have been formally diabetic for over 3 decades. I weight a little more and yet my diabetes is currently more stable & easier to control and my insulin dose is DOWN. My situation is not typical, never has been, but CHANGES do happen to most if not all diabetics over the years, not jsut due to aging.

Gomer .
 
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JenM7733 responded:
Thank you everyone for your responses. Sorry it took so long, (all went to spam folder), but I really do appreciate the responses!

We're in the midst of relocating for my job, but we have a name of an endocrinologist in the new area and plan to see him ASAP after we relocate.
 
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Caprice_WebMD_Staff replied to JenM7733's response:
Thanks for the update, Jen. I'm glad you already found an endo to see in your new area.
Whatever you do, or dream you can, begin it. Boldness has genius and power and magic in it. ~Goethe


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