Blood Sugar Fluctuations in Elderly Diabetes Patients

Blood sugar issues?

Recently, my grandfather has had a decreased appetite, and his pre-bedtime blood sugar levels usually range from 300 to 360.
He administers 12 units of Lantus (insulin glargine) every other day, and for several days, his pre-bedtime blood sugar levels have been around 450.
Despite this, he continues to administer 12 units, and his fasting blood sugar levels remain within the normal range, which is around 300 to 460.
However, on April 7, his pre-bedtime blood sugar was 396, and after administering the usual 12 units, his fasting blood sugar spiked to 246.
How could this happen? In previous days, even with a pre-bedtime level of 459, administering 12 units kept his fasting blood sugar within the normal range (103).

On April 8, his evening blood sugar was 451, and after administering 12 units, his fasting blood sugar was 215.
On April 9, his pre-bedtime level was 446, so he adjusted the dosage to 14 units, resulting in a fasting level of 234 the next morning.
On April 10, his evening blood sugar was 390, and after administering 16 units, his fasting blood sugar the following morning was 203.
Why is this happening? Previously, with blood sugar levels in this range, administering 12 units would keep his fasting levels within the normal range, but this has not been effective in recent days.
Additionally, my grandfather's blood sugar can spike over 400 during the day with any food he eats, but he only administers long-acting insulin before bed.
Does this mean he is experiencing high blood sugar levels throughout the day?
Does my grandfather need to administer another dose of insulin during the day? (His blood sugar levels after meals typically start at 400.)

Da Pang Mao, 20~29 year old female. Ask Date: 2021/04/12

Dr. Liao Yaopan reply Family Medicine

Hello, based on the above information, it is evident that your grandfather's blood sugar control has not been good recently.
It is recommended to return to the original treating physician for an evaluation to determine if there are other physical factors affecting blood sugar fluctuations.
The insulin dosage may also need to be adjusted.
Please note that online consultations are not equivalent to in-person visits and cannot provide diagnoses or treatment recommendations.
Changhua Hospital cares about you.

Reply Date: 2021/04/12

More Info

Understanding blood sugar fluctuations in elderly diabetes patients can be quite complex, particularly when considering the various factors that can influence blood glucose levels. In the case of your grandfather, several observations and questions arise regarding his insulin regimen, blood sugar management, and overall health.

1. Blood Sugar Fluctuations: It is not uncommon for blood sugar levels to fluctuate significantly, especially in elderly patients with diabetes. Factors such as diet, physical activity, stress, illness, and even hormonal changes can all contribute to these fluctuations. In your grandfather's case, the fact that he has been experiencing high blood sugar levels (300 to 460 mg/dL) despite administering insulin suggests that his current insulin regimen may not be adequately addressing his needs. The variability in his blood sugar levels, particularly the unexpected rise after administering the same dose of insulin, could indicate insulin resistance or changes in his body's response to insulin.

2. Insulin Dosing and Efficacy: The fact that your grandfather's blood sugar levels were previously controlled with 12 units of insulin but are now resulting in higher fasting blood sugar levels (246 mg/dL) after similar doses suggests that his insulin sensitivity may have changed. This could be due to several reasons, including changes in diet, weight, activity level, or even the progression of diabetes itself. It is essential to monitor his blood sugar levels closely and discuss these changes with his healthcare provider, who may need to adjust his insulin dosage or consider adding a short-acting insulin to better manage his blood sugar levels throughout the day.

3. Daytime Blood Sugar Levels: If your grandfather's blood sugar levels are consistently high during the day (400 mg/dL or higher), it indicates that he is likely experiencing hyperglycemia throughout the day. This situation can lead to serious complications over time, including cardiovascular disease, neuropathy, and kidney damage. The fact that he is only taking long-acting insulin at night may not be sufficient to control his blood sugar levels during the day, especially if he is consuming meals that significantly raise his blood sugar.

4. Need for Daytime Insulin: Given that your grandfather's blood sugar levels are high during the day, it may be beneficial for him to have additional insulin coverage during the daytime. This could involve administering a short-acting insulin before meals or adjusting his long-acting insulin dosage. However, any changes to his insulin regimen should be made under the guidance of his healthcare provider, who can assess his overall health, dietary habits, and lifestyle to create a tailored plan.

In summary, managing diabetes in elderly patients requires a comprehensive approach that considers the individual’s unique circumstances. Regular monitoring of blood sugar levels, understanding the impact of diet and activity, and adjusting insulin therapy as needed are crucial components of effective diabetes management. It is essential to maintain open communication with healthcare providers to ensure that your grandfather receives the appropriate care and adjustments to his treatment plan. Additionally, educating family members about diabetes management can help support your grandfather in maintaining better control over his blood sugar levels.

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