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Diabetic Metabolic Mystery
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Root16 posted:
Background: My grandfather is 88 years old with diabetes and advanced Alzheimer's and otherwise happy and healthy and perfectly mobile. He can climb stairs no problem etc. He can still shovel the deck of moderate snow for a solid amount of time. He gets his blood sugar levels tested before lunch and dinner every day. Before dinner he takes 38 ml of Lantis by injection (slow release of insulin). Before lunch and dinner he takes between 0 and 8 ml of Humulin by injection (fast release of insulin), dependent on what his test is. If he tests below 130 blood sugar then he gets no Humulin. Otherwise the amount increases up to 8ml depending on how high his test is, but never to exceed 8ml. He typically tests between 100 and 280 depending on his diet and exercise. If he gets a test well over 300 then we call the doctor. I think he's Type 1 diabetes.

A couple days ago he had a seizure that seemed to be related to low blood sugar level because a tablespoon of maple syrup stopped the seizure almost immediately and shortly after eating a few tablespoons of maple syrup he tested
33 at 1am. More syrup administered and he tested
58 at 1:30am. More syrup and applesauce administered a reading of 53 at 1:45am. More of the same fed to him and he tested
81 at 1:58am. Cottage cheese and applesauce with a little syrup were now given to him for a test of
101 at 2:13am. Bread with cheese and jam were next administered: 119 at 2:30am. I don't believe anymore food was given him the rest of the night and he had the following tests:

2:30am 119
2:47am 127
3:07am 187
4:40am 209
8:04am 135

As you can see continually feeding him maple syrup, applesauce, cottage cheese, bread and cheese did not skyrocket his blood sugar levels as one might expect. It took awhile before his blood sugar levels stayed up on their own without anymore sugar/food. Normally a tablespoon of maple syrup might be expected to raise my grandfather's blood glucose level by 50 or more. Instead, during the wee hours of Feb 12 it took all that sugar and food to raise it to safe levels.

Last night (technically this morning) Feb. 15, my grandfather had another seizure at 12:20am. I noticed the seizure a little earlier this time and got him maple syrup before the seizure had gotten bad, but he went into a full blown seizure anyway. 5 minutes or so later the seizures stopped as I kept giving him many tablespoons of maple syrup. When I tested him at about 12:30am he had a reading of 48 blood glucose level. Here is a breakdown of the food given and the blood glucose tests:

Note, the food descriptions are what he ate before the test. So leading up to the 12:28am test he ate many tablespoons of maple syrup and apple sauce and some nuts.

12:28am, 48: many tablespoons of maple syrup and apple sauce and some nuts.
12:41am, 47,
12:53am, 63, nuts, syrup, applesauce
1:06am, 83, cottage cheese, honey, apple sauce, syrup
1:21am, 163, nuts, cottage cheese, honey, apple sauce, syrup
2:23am, 122, slice of ezekiel bread with mayo and slices of cheddar cheese and the last couple bites of the cottage cheese, honey, apple sauce with syrup.
3:22am, 138,
4:22am, 106, a cookie and a some nuts
6:07am 191, another good sized bowl of apple sauce, syrup, cottage cheese and another cookie and probably some nuts, too.

As you can see, his blood sugar was even more reluctant to stay up this night than the first night. Even though he had all that sugar and food his blood sugar was still dropping when I backed off between 2:23am and 3:22am. Between 3:22am and 4:22am I gave him a cookie and some nuts and yet his blood sugar still dropped from 138 to 106 during that hour. Whatever was nosediving his blood sugar levels only finally quit at around 5 or 6 am, when it finally jumped to 191 as it normally would with this sort of sugary intake.

Can exercise or some other factor explain this nosedive in blood sugar level? My father is adamant that he did not accidentally swap the Lantis with the Humulin, which fits scenario perfectly
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Root16 responded:
Normally he would never ever eat this much sugar. Normally he eats a normal diet or a low glycemic diet. On the low glycemic diet his blood sugar is well controlled and regularly can expect tests in between 120 and 180 and never these nosedives in glucose level. On the normal diets 200s are typical readings before meals. Normal diet means a very limited amount of sweets, but allowed high glycemic foods like pasta and white rice. Low glycemic diet means low glycemic foods only such as hearty, slow release whole grains and proteins like cottage cheese and chicken.


The simple explanation for these seizures and reluctant to rebound glucose levels would be that my dad accidentally gave my grandfather 38 Humulin instead of 38 Lantis. This would explain the stubborn glucose levels as the humulin at that dose would surely nosedive the glucose levels for as long as it was working through his system, something like six hours, which is about the time his glucose levels stopped nosediving.


If anything about my posts isn't clear or if you have any questions, please don't hesitate to ask. Thanks!
 
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flutetooter responded:
Definitely report your data and concerns to his doctor. Be sure to ask the doctor what to use for a "low". Cottage cheese, cheddar cheese, nuts, and mayo contain mostly protein and fats, and therefore do not raise the blood sugar. In fact they slow down the raise you are trying to attain. This is a serious issue for your grandfather and it deserves your attention to help him if you can. It also sounds IMO that his low glycemic diet would help stabalize his daily sugars rather than his "normal" diet which contains pasta, rice, and sweets. Many of us stay away from those sugar raising foods. It sound like you have a pretty good understanding of the disease. Let us know how this turns out.
If at first you don't succeed, try, try again!


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