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TYPE 2 DIABETES not controlled by METFORMIN, GLYBURIDE.

Resolved Question:

First I do not have a real doctor here where I live. I see a nurse practioner. No doctors in this town are accepting new patients with my insurance which is Meridian. I am waiting for someone to open up.
Not sure how to make this a short thing but I'll try. I am a type 2 diabetic. I was on glyburide, metformin and prandin at the highest doses and by blood sugar was still way out of control.
The NP wanted to put me on Lantis but the insurance would not cover it. She then decided to do an experiment and see how the metformin was working all by itself so she took me off of the glyburide, the prandin and lowered my dose of metformin and then had me chronicle my blood sugar. Predictably, it shot up 200 points in a matter of 4 days. ( she wanted me to do this for 2 weeks )
On the third day, I felt like hell. My vision which is already super bad, blurred even more quite suddenly. My eyes started watering badly. My face began to feel prickly particularly around the eyes and went numb in some areas. It felt like someone was jabbing an icepick into my spine at the back of my neck. I was having a very hard time concentrating. My balance which is not good anyway got far worse. I had pain running down my left arm but I have a panic/anxiety disorder so I did'nt think anything about it. I figure I was just anxious from all the pain and symptoms. It was so bad I almost went to the hospital but instead I just curled up in bed and tried to sleep.
The next day, even though my blood sugar was higher, the symptoms were gone except my vision was still more blurred than it had been. I saw the NP the following day and told her what had happened after going off my medication and she was completely dismissive and said my symptoms were " impossible". Point blank she did not believe a word I said.
Later that day, a headache began. I almost never get headaches. When I do they are sinus but this was around the top of my head like a tight band. It did get worse and go down farther into my face but it kept me up half the night. I finally got frustrated and took ketoprofin and allergra D and a flexeril hoping it would cover a variety of possible causes for the headache. I finally got to sleep but there is still pressure this morning. I really don't think it's sinuses. My vision is still more blurred than it was before. I can't even see my tv and it's 5 ft from my couch with a 52 " screen. Typing this, I am about 9 " away from the computer screen.
I'm feeling a bit desperate here and my NP isn't listening to me so I looked for an online doctor to get another opinion.


Category: Diabetologist

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Category: Diabetologist
Dr. J Muthukrishnan is online now

Expert:  Dr. J Muthukrishnan replied 4 Days.

Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
Your symptoms are related to high uncontrolled blood sugars and you need to be on Insulin along with Metformin for good control. The experiment that you were subjected too was highly unnecessary. The vision complaints are due to change in lens size with high blood sugars. It will improve with Improvement in blood sugars. And that can pnly be done once you are started on appropriate dose of insulin along with other oral hypoglycemic agents like Metformin.
You need to be on Insulin, there is no way out.
Feel free to discuss further,
Regards.


Patient replied :

Thank you so much ! I'm going to have to push her to do the paperwork to over-ride the insurance company. I am sure she won't be happy that I consulted you.
This may take time to get the insulin. In the meantime, should'nt I be back on the glyburide and prandin instead of just this low dose metformin ? My blood sugar is running 400 to 450 and climbing. I can't keep this up. I feel like hell. Should I even be eating ? I'm on a very strict diet as it is. At least when I was on the other meds I was in the 200's and not feeling like this.


Expert:  Dr. J Muthukrishnan replied 3 Days.

Hello.
Yes. You should do that.
Get back on your previous medications. If possible, add a gliptin, Sitagliptin 100mg once daily or Vildagliptin 50mg twice daily till you are able to start Insulin.
Eat well, except sweets, sugars/simple carbs.
Hydrate yourself well.
Check urine ketones if sugars remain above 250-300 consistently.
Hope this was helpful,
Regards.


Dr. J Muthukrishnan
Category: Diabetologist
Experience: 
Fellowships/Training: 
1. 10th Asia-Pacific Pediatric Endocrine Society  Fellows meeting, Seoul, Korea, Oct 2008
2. Eighth ICMR Course on Genetics and Genetic Counseling – Jul 2008 – SGPGI, Lucknow
3. Annual Certificate Course on Endocrinological Laboratory Techniques at National Institute of Nutrition (ICMR) Hyderabad,India, ( Aug-Sep 2006) 
Fellowship: Endocrinology, Diplomate of National Board, National Academy of Medical Sciences, New Delhi, 2008, Medwin Hospital, Hyderabad
Senior Residency: Diplomate of National Board (General Medicine), National Academy of Medical Sciences, New Delhi, 2002
Residency: MD, General Medicine, 1997-2000, Armed Forces Medical College, 2nd position in University
Medical School: MBBS, Armed Forces Medical College, 1992
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