Diabetes: Common Myths and Essential Insights for Families

Myths about Diabetes

Hello, Dr.
Liao! I apologize for bothering you.
My grandfather has been suffering from diabetes for forty years, but our family's understanding of diabetes is still quite limited.

1.
My grandfather has had diabetes for 40 years.
There were a few days when he did not control his diet, and after using the restroom, the entire toilet was covered in ants.
How high could his blood sugar be if his urine is attracting ants like this?
2.
If high blood sugar persists for several days, how will the body be affected? If blood sugar levels are 400 for four consecutive days, could this lead to a stroke?
3.
If he forgets to administer insulin for four consecutive days, will his fasting blood sugar accumulate and rise day by day? For example, will it be 200 on the first day, 300 on the second day, and continue to rise like that?
4.
When high blood sugar is detected, will an immediate injection of insulin bring it down right away?
5.
After eating a meal, does blood sugar rise gradually, or does it spike immediately?
6.
My grandfather's blood sugar has never been well controlled, and his HbA1c has consistently been above the normal range (over 8).
However, his fasting blood sugar in the morning is low (in the 60s).
Why is this happening? (He has been using a 44-unit injection of Humulin and a 6-unit injection of Novolog.)
7.
Before 2004, my grandfather did not trust Western medicine (mistakenly believing that traditional Chinese medicine could cure diabetes), so he has been seeing a traditional Chinese medicine practitioner (who sent medications directly to our home without a license).
I would like to ask the doctor, before the National Health Insurance was established, did diabetic patients have access to chronic prescriptions? How long of diabetes medication could a patient receive after one visit to a doctor? Would the costs be very high? In the 1980s, my grandfather was treated for diabetes with traditional Chinese medicine, and the monthly costs ranged from 3,000 to 4,500.
To save money, he often reduced his daily herbal medicine dosage to last for three days.

shǎ guā, 20~29 year old female. Ask Date: 2021/02/09

Dr. Liao Yaopan reply Family Medicine

Hello, regarding the treatment of diabetes, it requires a multifaceted approach including diet, medication, and exercise to actively control the condition and prevent or delay related vascular and organ complications.
Medication management is a crucial component that necessitates close collaboration between the patient and the physician.
If family members have any concerns about caregiving, it is advisable for them to accompany the patient to medical appointments to facilitate direct communication and discussion with the physician, which can lead to more appropriate management of the condition.
Poor control of the disease significantly increases the risk of potential complications or organ damage.
Each patient's management is entirely different, and the appropriate dosages vary from person to person, taking into account individual bodily functions, making it quite complex.
Online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/02/09

More Info

Understanding diabetes, especially in the context of family history and personal experiences, is crucial for effective management and prevention. Your grandfather's long battle with diabetes highlights several important aspects of the disease, its symptoms, and the implications of poor management. Let’s address your questions one by one, while also providing some essential insights into diabetes management.

1. High Blood Sugar and Ants: When you mention that the toilet was filled with ants after your grandfather urinated, this is a classic sign of high blood sugar. The presence of sugar in urine (glycosuria) can attract ants. While it’s difficult to determine an exact blood sugar level based solely on this observation, it typically indicates that blood sugar levels are significantly elevated, often above 180 mg/dL, which is the threshold for glucose to spill into urine.

2. Duration of High Blood Sugar: Sustained high blood sugar levels, such as 400 mg/dL for several days, can lead to serious complications, including diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS), both of which can be life-threatening. Chronic high blood sugar can also increase the risk of cardiovascular events, including strokes. Therefore, it is critical to manage blood sugar levels effectively to prevent these complications.

3. Cumulative Effect of High Blood Sugar: If insulin is forgotten for several days, blood sugar levels can indeed accumulate. For example, if the blood sugar is 200 mg/dL on the first day and insulin is not administered, it can rise to 300 mg/dL the next day, and potentially higher thereafter. This cumulative effect underscores the importance of regular insulin administration and monitoring blood sugar levels.

4. Immediate Insulin Administration: Injecting insulin after discovering high blood sugar can help lower it, but the effect is not instantaneous. It may take some time for insulin to work, depending on the type of insulin used. Rapid-acting insulin can start to lower blood sugar within 15 minutes, but it may take a couple of hours to see significant changes.

5. Post-Meal Blood Sugar Response: After eating, blood sugar levels typically rise, but the rate of increase can vary. Generally, blood sugar levels start to rise within 15 minutes of eating and peak about 1 to 2 hours later. This is why monitoring blood sugar levels after meals is essential for understanding how different foods affect individual blood sugar responses.

6. Low Morning Blood Sugar with High A1c: It’s not uncommon for someone with poorly controlled diabetes to experience low blood sugar in the morning (hypoglycemia) while having a high A1c level. This can occur due to several factors, including the "dawn phenomenon," where hormones released in the early morning hours can cause blood sugar levels to rise. Additionally, if insulin doses are not adjusted properly, it can lead to low blood sugar in the morning despite overall poor control.

7. Chronic Prescriptions and Costs: Before the establishment of national health insurance in Taiwan, patients often had to pay out-of-pocket for medications. Chronic prescriptions for diabetes medications typically last for a month, but this can vary based on the physician's discretion and the patient's needs. The costs can be significant, especially if relying on traditional Chinese medicine, which may not be as effective or regulated as conventional treatments.

In conclusion, diabetes management requires a comprehensive understanding of the disease, regular monitoring of blood sugar levels, adherence to prescribed medication, and lifestyle modifications. Education about diabetes is essential for both patients and their families to prevent complications and improve quality of life. It’s advisable for your grandfather to work closely with healthcare professionals to develop a personalized management plan that includes regular check-ups, dietary advice, and medication adjustments as necessary.

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