Why Is My Mother's Blood Sugar Stubbornly High After Insulin?

Blood sugar levels cannot be lowered?

Hello Doctor: My mother is 63 years old.
She was hospitalized for acute pancreatitis in September of the year before last and again in November of last year.
She had her gallbladder removed in January of this year.
She has diabetes and is on stable medication, but her hemoglobin A1c has been poorly controlled, reaching as high as 10% in the last three months.
The doctor prescribed long-acting insulin for her, and she administered it last night around 10 PM, but her blood sugar this morning was still 234.
My question is, if the first insulin injection does not lower her blood sugar, should we suspect the possibility of inflammation in her body? She does not have fever, abdominal pain, or any other symptoms, but she has lost 1-2 kilograms of weight.
We are quite worried and wanted to consult with the doctor.
Thank you!

Lao Chen, 60~69 year old female. Ask Date: 2022/07/24

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please discuss with an endocrinologist.

Reply Date: 2022/07/24

More Info

Managing diabetes, especially in the context of a patient with a history of acute pancreatitis and gallbladder removal, can be quite complex. Your mother's situation, where her blood sugar remains stubbornly high despite the administration of long-acting insulin, raises several important considerations.

Firstly, it’s essential to understand that insulin therapy is a critical component in managing diabetes, particularly when oral medications are insufficient. However, the effectiveness of insulin can be influenced by various factors, including the type of diabetes, the presence of other medical conditions, and the patient's overall health status.

In your mother's case, her history of acute pancreatitis is particularly relevant. The pancreas plays a crucial role in insulin production and glucose metabolism. Damage to the pancreas can lead to impaired insulin secretion, which may explain why her blood sugar levels remain elevated despite insulin therapy. Additionally, the removal of the gallbladder can affect digestion and nutrient absorption, potentially impacting blood sugar control.

The fact that her HbA1c is at 10% indicates that her blood sugar levels have been consistently high over the past few months. This level is concerning and suggests that her diabetes management plan may need to be reevaluated. It's also worth noting that the body’s response to insulin can vary; some individuals may develop insulin resistance, where the body does not respond effectively to insulin, leading to persistently high blood sugar levels.

Regarding your question about the possibility of inflammation affecting her blood sugar levels, it is indeed a valid concern. Chronic inflammation can impact insulin sensitivity and glucose metabolism. While your mother does not exhibit symptoms such as fever or abdominal pain, it is still possible for low-grade inflammation to be present. Conditions such as infections, stress, or even autoimmune disorders can contribute to elevated blood sugar levels.

Weight loss, as you mentioned, can also be a significant factor. While weight loss can sometimes improve insulin sensitivity, it can also indicate that the body is not utilizing glucose effectively, which can occur in cases of uncontrolled diabetes. If she is experiencing unexplained weight loss, it is crucial to investigate further, as this could signal other underlying issues.

In light of these factors, I recommend the following steps:
1. Consultation with an Endocrinologist: It would be beneficial for your mother to see an endocrinologist who specializes in diabetes management. They can provide a comprehensive evaluation of her diabetes management plan and consider adjusting her insulin regimen or adding other medications.

2. Monitoring for Complications: Regular monitoring for potential complications related to diabetes, such as kidney function, liver function, and cardiovascular health, is essential. This may include blood tests and possibly imaging studies.

3. Diet and Lifestyle Modifications: A registered dietitian can help create a personalized meal plan that focuses on carbohydrate counting and balanced nutrition, which is crucial for managing blood sugar levels. Additionally, incorporating physical activity, as tolerated, can improve insulin sensitivity.

4. Investigate Underlying Conditions: If her blood sugar levels remain high despite adjustments in her diabetes management, further investigation into potential underlying conditions, such as infections or hormonal imbalances, may be warranted.

5. Regular Follow-ups: Frequent follow-ups with her healthcare provider to monitor her blood sugar levels and overall health will be important in managing her diabetes effectively.

In summary, your mother's high blood sugar levels after starting insulin could be due to several factors, including her medical history, potential insulin resistance, and possibly underlying inflammation. A comprehensive approach involving a healthcare team will be essential in addressing her diabetes management effectively.

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