Managing Blood Sugar Levels: A Guide for Seniors with Medication Changes

Q: Managing Blood Sugar Levels: A Guide for Seniors with Medication Changes

Hello： In response to your question, various anti-tuberculosis medications can cause side effects such as hepatotoxicity, gastrointestinal reactions, nausea, vomiting, peripheral neuropathy, visual changes, hearing impairment, and hyperuricemia, among others. <br>While not every

High blood sugar?

Hello, my grandfather is 83 years old and has recently experienced a significant decrease in appetite due to tuberculosis medication, almost not eating breakfast.
His fasting blood sugar levels are often around 40-50, which is very low.
As a result, he was advised to stop taking his daily blood sugar medication.
However, after stopping the medication, his postprandial blood sugar levels in the evening have risen to over 400.
I'm unsure what to do...
his morning blood sugar is too low, and his evening blood sugar is too high.
What should we do at home? Should he continue taking the blood sugar medication? Thank you.

Xingxing, 10~19 year old female. Ask Date: 2010/03/17

Dr. Xiao Yongxun reply Internal Medicine

Hello: In response to your question, various anti-tuberculosis medications can cause side effects such as hepatotoxicity, gastrointestinal reactions, nausea, vomiting, peripheral neuropathy, visual changes, hearing impairment, and hyperuricemia, among others.
While not every patient will experience these effects, it is possible for your grandfather to exhibit symptoms such as poor appetite.
To prevent the emergence of drug resistance, which can lead to uncontrolled tuberculosis, anti-tuberculosis medications are often used in combination for a specified duration.
Low blood sugar can lead to confusion, while high blood sugar can negatively impact the control of tuberculosis; these situations are commonly encountered in clinical practice.
I recommend that you consider dietary control, including total caloric intake, distribution of food components, postprandial blood sugar effects, nutrient content, and timing of meals.
Adjusting physical activity levels can also have an impact.
Most importantly, I believe you should discuss these issues with your grandfather's attending physician to gain a deeper understanding of the disease progression and to formulate appropriate strategies.

Reply Date: 2010/03/17

More Info

Managing blood sugar levels in elderly patients, especially those with complex health conditions and medication changes, can be quite challenging. Your grandfather's situation, where he experiences low fasting blood sugar levels in the morning and significantly high postprandial (after meal) blood sugar levels in the evening, is a common issue in diabetes management, particularly in older adults.

Understanding Blood Sugar Levels
1. Fasting Blood Sugar: A fasting blood sugar level below 70 mg/dL is considered hypoglycemia (low blood sugar), which can lead to symptoms such as dizziness, confusion, and even loss of consciousness. Your grandfather's morning levels of 40-50 mg/dL are concerning and indicate that he is at risk for hypoglycemia.

2. Postprandial Blood Sugar: A postprandial blood sugar level above 180 mg/dL two hours after eating is generally considered high. A reading of over 400 mg/dL is significantly elevated and poses risks for complications such as diabetic ketoacidosis or hyperglycemic hyperosmolar state, both of which are medical emergencies.

Medication Management
Given your grandfather's recent changes in appetite due to tuberculosis (TB) medication, it is crucial to reassess his diabetes management plan. Here are some considerations:
1. Consult with Healthcare Providers: It is essential to have a thorough discussion with his healthcare provider, including his primary care physician and possibly an endocrinologist. They can evaluate the need for diabetes medications in light of his current health status and medication regimen.

2. Adjusting Medications: If his blood sugar levels are fluctuating significantly, it may be necessary to adjust the type or dosage of his diabetes medications. For instance, medications like Metformin or insulin may need to be reconsidered based on his eating habits and blood sugar patterns.

3. Monitoring: Regular monitoring of blood sugar levels is crucial. Keeping a log of his blood sugar readings, along with notes on his food intake and any symptoms, can provide valuable information to his healthcare team.

Dietary Considerations
1. Small, Frequent Meals: Since your grandfather's appetite has decreased, encourage him to eat smaller, more frequent meals throughout the day. This can help stabilize his blood sugar levels and prevent extreme highs and lows.

2. Balanced Diet: Focus on a balanced diet that includes complex carbohydrates (like whole grains), lean proteins, healthy fats, and plenty of vegetables. Avoid high-sugar foods and beverages, especially since he has shown a tendency for high postprandial blood sugar levels.

3. Hydration: Ensure he stays well-hydrated, as dehydration can also affect blood sugar levels.

Lifestyle Modifications
1. Physical Activity: If his health allows, encourage gentle physical activity, such as walking or light stretching. Exercise can help lower blood sugar levels and improve overall health.

2. Education: Educate both your grandfather and family members about recognizing the signs of hypoglycemia and hyperglycemia. Understanding how to respond to these situations is crucial for safety.

3. Emergency Plan: Have a plan in place for what to do if his blood sugar levels drop too low or rise too high. This may include having fast-acting glucose sources available for hypoglycemia and knowing when to seek medical help for hyperglycemia.

Conclusion
Managing diabetes in elderly patients, especially those with additional health challenges, requires a comprehensive and flexible approach. Regular communication with healthcare providers, careful monitoring of blood sugar levels, dietary adjustments, and lifestyle changes are key components of effective management. It is essential to address both the low and high blood sugar levels to prevent complications and ensure your grandfather's well-being.

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