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WHY ARE MY SUGARS NOT CONTROLLED EVEN AFTER INSULIN?

!!! Proper injection technique of insulin is foremost important thing !!!

It was fresh Monday morning, after rejuvenating from a fruitful Sunday. A middle- aged gentleman who was known diabetic for around 17 years came for his sugar control. Earlier, he was following a doctor in his local area.

He was in a frustrated mood because of poor glycemic control even after starting insulin. We have reviewed his insulin bottle and syringes. He was taking insulin in the wrong sites and improper way.
He was taking insulin in the calf region of his legs and forearms.

When we take insulin in other than prescribed sites of injection, it won't work in the usual way. Inefficient and ineffective action of insulin results in erratic control over the blood sugars.

Insulin when injected in the subcutaneous tissue works in a better and a predictable way. than when it is injected to the muscle or skin. Over the calf regions and forearm, there is no sufficient subcutaneous fat. Proposed and better sites for insulin injection are, front of the abdomen, front of thighs, buttocks, outer side of shoulders.

After education about all these he was quite happy and understood what the mistake happened earlier.

Next week he reviewed us with his glucose readings which were done at home. There was a big smile on his face. His readings were within the normal range. On follow up he was doing well.

When we are using insulin, proper injection technique and giving insulin shots at proposed sites is very much needed to achieve good glycemic control. Proper injection techniques and selection of injection sites are rewarding.

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Happy health
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A Kid Was Eating More Than The Parents #
☺☺☺

A mother brought her 10 year old who was having an increased food intake, The amount of intake was more than the amount consumed by the parents, Every two hours he was feeling hungry, These changes have been noticed for two weeks,

Earlier he was not shown any interest in taking the food, The mother used to request him repeatedly for intake of food on time, Once he started asking about food voluntarily mother felt very happy. Within 5-7 days, the frequency and quantity of food were increased. The mother started worrying once he was taking food more than his parents. After taking a good amount of food also he had not gained any wight. This was also another worrying thing for the mother.

Mother was a science teacher. She heard about the features of diabetes. She brought him basically to rule out diabetes. Boy was having lean built and otherwise had no obvious abnomality.

We have ordered blood sugar, HbA1C, and urine for sugar and ketones investigations. These investigations suggested diabetes with ketosis. We made a probable diagnosis of type 1 diabetes and later confirmed it with an autoantibodies profile test.

Apart from having increased hunger, he did not have other features of diabetes such as increased thirst, frequency of urination, or weight loss. Increased food intake might have compensated against wight loss. As we are in an adequate early course of the disease he might have not developed all features of diabetes and also features of diabetes ketoacidosis such as abdominal pain, nausea, vomiting and shortness of breath.

He was started up on insulin as per standard protocol with basal and bolus regimens. on follow up his sugars became stabilized and increased hunger also came down.

Absolute deficiency of insulin in type 1 diabetes person body cell won't utilize glucose. insulin acts like a key that helps in the entry of glucose into body cells and allows it to be utilized in a better way. When there is no insulin, even though the amount of good glucose is in the blood, body cells are deprived of glucose and thereby energy. This sends signals to have more appetite. once we start using insulin, glucose will be utilized by the body cell and that provides the energy. There by cutting down the increased hungry.

!INCREASE FOOD INTAKE IS A FEATURE OF DIABETES!
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AIR TRAVEL AND LONG DRIVE


Maintenance of insulin in cold storage enables to maintain its native potency.

Small story:
We often become upset when things are not going as per our expectation. When it comes to executive managers it will become furthermore visible and results in irritation. We came across such an incident with insulin.

A 52 year old senior executive manager in a multinational company came for an opinion regarding his glycemic management. He was a known diabetic for around 15 years. He was on ral anti-diabetic drugs and one time insulin glargine at bedtime. Insulin glargine is a long acting insulin that has action for 24 hours and it is one of the best in long acting insulin types.

His father and grandfather also had type 2 diabetes. After observing his father and grandfather he also became more disciplined towards intake of a properly balanced diet and doing regular ecercise. He was jogging for at least 45-60 minutyes in a day. His glycemic control was never an issue and used to have optimal control.

Last month he had a foreign trip to the United States. After returning from his trip He was very upset in view of deranged sugar level which were well controlled previously.

I have started an inquiry to know where things went wrong. As it was a foreign trip, first I expected it might be due to diet and exercise - related changes. He said that he did not deviated from his routine dietary discipline and was doing regular exercise almost every day. Second I asked about any deviation from intake of medicine and I came to know from his there was no such thing. In fact, he took the medication for two months in order to prevent a shortfall if any delay happens in the return journey. Then I enquired regarding insulin injection technique, site rotation, and finally about storage.

Yes, Then I got my valid point. Though, he maintained insulin storage as per protocol while he was in flight to the United States and during the entire stay but he did not maintain a cold chain of insulin on his return journey.

It was a 400 km long drive to the airport on his return journey as he was gone to see some countryside tourist areas. He kept his insulin box in the dashboard of a car while he was traveling. While on a return flight journey as he bought costly electronic gadgets and some personal stuff, he kept his medicine box including insulin into baggage. Before sending it to baggage he took the insulin as per his schedule.

Here the mistake was a broken cold chain of insulin. The first mistake was he kept his insulin box in a car dashboard and the second he sent this box into baggage on the return flight. At both points, the temperature will be more than the room temperature which spoils the insulin. Because of exposure to high temperatures insulin has lost its potency. As he was using this same insulin after his after his trip, sugars were not coming under control.

I explained i detail and he understood his mistake. He purchased a new insulin cartridge and started using that. After a week, sugars became streamlined.

While o travel, maintenance of the cold chain is very important. Before travel, we cam discuss with our doctor regarding best available options to maintain the cold chain in order to maintain insulin's native efficacy. Carrying an insulin box along with an ice pack on a journey and keeping it in the refrigerator once we reached our stay. Another way is keeping some ice cubes in a
tea flask and keeping an insulin pen/bottle om this flask will maintain the temperature. Before putting an insulin pen or bottle into the flask, tie it with thread and keep this thread long so it comes out of the flask and the cap of the flask will be closed. Bu doing this temperature will be maintained and easily we can remove the insulin pen or bottle by pulling the thread.

Maintenance of insulin's temperature is vital to keep its potency.