Managing High Blood Sugar Levels in Diabetic Patients: A Caregiver's Guide

Recently, blood sugar levels have been consistently rising?

Hello Doctor! My mother is 75 years old and has a long-standing history of diabetes.
At the beginning of this month, she had a follow-up appointment, and the doctor prescribed half a tablet of Metformin and one tablet of Glimepiride to be taken with meals.
However, as her caregiver, I usually give her the medication around 11:30 PM.
Recently, her blood sugar levels have been consistently above 300.
Today, I tried giving her the Glimepiride after her afternoon snack (which she usually has around 3 PM due to a gastric bypass), but even at around 5 PM, her blood sugar remained above 300.
I would like to ask if the current medication needs to be adjusted to bring her blood sugar down before returning to the normal dosage, or should I take her to a nearby hospital or clinic for a new prescription?
PS: 1.
Blood sugar values after 8/21: [link to blood sugar values] and after 9/13: [link to blood sugar values].
Measurements were mostly taken between 4:30 PM and 5 PM.
2.
Recently, for breakfast, she has been having fried noodles with chicken essence, and sometimes dark chocolate.
For lunch, she has soup noodles with dishes from a buffet, and for her afternoon snack, she has leftover fried noodles or cookies, along with approximately 200 CC of diabetic milk.

josephy, 50~59 year old female. Ask Date: 2022/09/19

Dr. Li Jian reply Internal Medicine

The current dosage may be insufficient, and it is necessary to consult the original physician to adjust the dosage.
Additionally, fried noodles are considered refined carbohydrates and should not be consumed frequently.

Reply Date: 2022/09/19

More Info

Managing high blood sugar levels in diabetic patients, especially in elderly individuals, requires a comprehensive approach that includes medication management, dietary adjustments, and regular monitoring. Your mother’s situation, with blood sugar levels consistently above 300 mg/dL, is concerning and warrants immediate attention. Here’s a detailed guide to help you navigate this challenging situation.

Understanding Blood Sugar Levels
Blood sugar levels can fluctuate due to various factors, including medication timing, dietary choices, physical activity, and overall health status. For a diabetic patient, maintaining blood sugar levels within a target range is crucial to prevent complications. The American Diabetes Association recommends a target fasting blood sugar level of 80-130 mg/dL and less than 180 mg/dL two hours after meals.

Medication Management
1. Adherence to Medication Schedule: It’s essential to administer medications as prescribed. If your mother is taking medications like Lantus (insulin) and Januvia (sitagliptin), ensure they are taken at the correct times. Delaying medication can lead to elevated blood sugar levels.

2. Dosage Adjustments: If blood sugar levels remain high despite taking medications, consult her healthcare provider. They may need to adjust the dosages or consider adding other medications. It’s not advisable to make changes to her medication regimen without professional guidance.

3. Monitoring: Regularly monitor her blood sugar levels, especially after meals. Keeping a log of her readings can help her doctor make informed decisions about her treatment plan.

Dietary Considerations
1. Meal Timing and Composition: Ensure that meals and snacks are balanced and consumed at regular intervals. For instance, if she has a tendency to skip breakfast or delay meals, it can lead to spikes in blood sugar levels later in the day.
2. Carbohydrate Management: Pay attention to the carbohydrate content of her meals. Foods like fried noodles and sugary snacks can cause significant spikes in blood sugar. Instead, focus on whole grains, lean proteins, and plenty of vegetables.
3. Healthy Snacks: Since your mother has a history of gastric surgery, small, frequent meals may be beneficial. Opt for healthy snacks that are low in sugar and high in fiber, such as nuts, yogurt, or whole-grain crackers.

4. Hydration: Encourage her to drink plenty of water throughout the day. Staying hydrated can help manage blood sugar levels.

Lifestyle Modifications
1. Physical Activity: Encourage her to engage in regular physical activity, as it can help lower blood sugar levels. Even light activities, such as walking or gentle stretching, can be beneficial.
2. Stress Management: Stress can impact blood sugar levels. Encourage relaxation techniques such as deep breathing, meditation, or gentle yoga.

When to Seek Medical Attention
If your mother’s blood sugar levels remain consistently high (above 300 mg/dL) despite medication and dietary adjustments, it’s crucial to seek medical attention. This could involve:
- Visiting a Healthcare Provider: Schedule an appointment with her doctor to discuss her current medication regimen and blood sugar management strategies.
- Emergency Care: If she experiences symptoms of hyperglycemia, such as excessive thirst, frequent urination, fatigue, or blurred vision, seek immediate medical attention.

Conclusion
Managing diabetes in elderly patients requires a collaborative approach involving caregivers, healthcare providers, and nutritionists. Regular monitoring, adherence to medication, dietary adjustments, and lifestyle changes are key components in maintaining optimal blood sugar levels. Always consult with her healthcare provider before making any significant changes to her treatment plan. With the right strategies in place, you can help your mother achieve better blood sugar control and improve her overall quality of life.

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