Anyone have/had a problem with Insulin ?

[ignis]

Been on Insulin for years, always the same 30/70 mix bought from the Hospital Pharmacy

 

Age 73 Diabetic 34 years, diagnosed Feb 2015 with type Lada 1.5 so been on Insulin since then

 

Last month Blood Sugar reading got higher every day, I increased the dosage  [normal is 32 units morning + 24 evenings]  increased to 40 + 40 and still kept going up was high as 298 !!

asked the Dr it could be a Insulin Problem ? answer no. but no other reason given

 

Opened a new box of Vials this month, back to 32 units morning + 24 evenings, but keep going low, I mean low, get the shakes and sweats is down to 50 something don't take any insulin , normal day been reducing  to 14 + 14 yet still going to low... yesterday morning was 78 this morning 72

 

November Vials were use before March 2025,  the new box of vials use before May 2025.. 

 

Anyone any idea or advice ? had the same problem ?  maybe is nothing to do with the Insulin, just odd appear to change so much with using a new box of Insulin Vials.

[Sheryl]

Insulin becomes less effective if exposed to heat.

 

I suspect the first batch of vials had been improperly stored, perhaps at the shop you got it or in transit

 

In future before upping insulin dosage dramatically try a different batch of vials

 

You might also consider changing supplier

[lopburi3]

Not clear if this happened at start of new batch or not but appears he buys from his hospital (which may be reason doctor ruled out bad insulin).  Although should not happen I have had returned medication from hospital in the past (likely an employee issue) - and no guarantee how it was stored when out of hospital control.

[ignis]

2 hours ago, Sheryl said:

Insulin becomes less effective if exposed to heat.

 

I suspect the first batch of vials had been improperly stored, perhaps at the shop you got it or in transit

 

In future before upping insulin dosage dramatically try a different batch of vials

 

You might also consider changing supplier

Always get from Hospital Pharmacy , they get out of Fridge and always fussy I have not ice and want to give me a block, always take a insulin cooler box I have had for years, anyway home within 15 mins.

 

Never thought about the problem could be the Insulin, I asked the Dr on the 26 Nov. until I opened the new box and got lows  then wondered if it was Possible

[ignis]

49 minutes ago, lopburi3 said:

Not clear if this happened at start of new batch or not but appears he buys from his hospital (which may be reason doctor ruled out bad insulin).  Although should not happen I have had returned medication from hospital in the past (likely an employee issue) - and no guarantee how it was stored when out of hospital control.

 Good point could have been returned medication 

[Kwaibill]

Been playing “ the game” since 1996 diagnosis. Seventy y.o. now. Recently ( 6 months) my doc at provincial hospital took me off insulin and put me on two new oral meds which work great for me. Sorry, don’t have the names available just now, but they are relatively new on the market. Fairly expensive as still patented and imported, but typical AM readings of about 98. Might be worth inquiring next trip to your doc.

Have to say I had lost about twenty kilos, and my readings were getting erratic with R and N Novolin combo. Just maybe worth asking if a couple hundred baht don’t stand in the way.

Good luck, brother.

[Luuk Chaai]

ever try changing your diet ?

T/2 is reversable

[ignis]

44 minutes ago, Luuk Chaai said:

ever try changing your diet ?

T/2 is reversable

 

Not everyone has T2 Diabetes - odd how so many believe Diabetes is type 2 with a few odd cases or type 1

 

 

[ignis]

3 hours ago, Kwaibill said:

Been playing “ the game” since 1996 diagnosis. Seventy y.o. now. Recently ( 6 months) my doc at provincial hospital took me off insulin and put me on two new oral meds which work great for me. Sorry, don’t have the names available just now, but they are relatively new on the market. Fairly expensive as still patented and imported, but typical AM readings of about 98. Might be worth inquiring next trip to your doc.

Have to say I had lost about twenty kilos, and my readings were getting erratic with R and N Novolin combo. Just maybe worth asking if a couple hundred baht don’t stand in the way.

Good luck, brother.

 Difficult without the names of Med's

 

Did find approved in Thailand earlier this year   'Bexagliflozin'   = Diabetes + Kidney + weight loss

[xtrnuno41]

Weird your doctor couldnt give an explanation and wasnt able to think out of the box.

As said by Sheryl, improper storing and therefor les effective.

It is a very simple sum, take insulin and it is not working, first thing what comes in mind then the insuline.

Sometimes it makes you wonder.

My mother in law have stones in ear. A treatment  is Epley maneuver and I saw (yt) it takes some time to do this. However my mil was back in 10 minutes?!

That is with bla bla bla and moving and positioning and all.

My wife said the doc did it, but then only for very short time. I was flabbergasted, but he is the doc.

 

[lickard]

I'm not a pro, but could it be the new vials? Maybe they're working faster or something. I'd check with the doc again or maybe get a second opinion. Changing vials and suddenly going low sounds fishy.

[Sheryl]

On 12/19/2023 at 7:43 PM, lickard said:

I'm not a pro, but could it be the new vials? Maybe they're working faster or something. I'd check with the doc again or maybe get a second opinion. Changing vials and suddenly going low sounds fishy.

 

Went low was after significantly increasing dose and then using new vial. Pretty clear to me that it was the old vials - based on which he upped his dose - that were the problem. Decreased efficacy, likely due to heart exposure which could happen in transit to the hospital or through a on-off staff error in the pharmacy. For that matter might even have happened at home, for example if power went out at night while asleep, or during day while not at home, you  might now realize it,

 

Moral of the story is if you have been stable on an insulin dosage for some time and then start getting high BS readings, try a different vial batch before changing dosage.,

[ignis]

8 hours ago, Sheryl said:

 

Went low was after significantly increasing dose and then using new vial. Pretty clear to me that it was the old vials - based on which he upped his dose - that were the problem. Decreased efficacy, likely due to heart exposure which could happen in transit to the hospital or through a on-off staff error in the pharmacy. For that matter might even have happened at home, for example if power went out at night while asleep, or during day while not at home, you  might now realize it,

 

Moral of the story is if you have been stable on an insulin dosage for some time and then start getting high BS readings, tray a different vial batch before changing dosage.,

 

I find all Dr here are the same, your doing well but they have to change insulin dosage + a pill or 2 every year

 

So 100% not sure it the reduced Insulin units + 2 new pills [2 old ones stopped] + 2 others mg  per day reduced is the reason

one of the new pills Manidipine  20mg after 10 days = Bad   feet + ankle very swollen + pain, so stopped them,,  have bought from local pharmacy [had before with no problems]  hydrochlorothiazide  .. no idea if these do the same as Manidipine was prescribed for ?

 

 

[Sheryl]

13 hours ago, ignis said:

 

I find all Dr here are the same, your doing well but they have to change insulin dosage + a pill or 2 every year

 

So 100% not sure it the reduced Insulin units + 2 new pills [2 old ones stopped] + 2 others mg  per day reduced is the reason

one of the new pills Manidipine  20mg after 10 days = Bad   feet + ankle very swollen + pain, so stopped them,,  have bought from local pharmacy [had before with no problems]  hydrochlorothiazide  .. no idea if these do the same as Manidipine was prescribed for ?

 

 

Manidipine is for high blood pressure, not diabetes. Swollen legs & feet is a common side effect if this class of drug (calcium channel blockers). Common, and inexpensive, alternatives are ACE inhibitors (e.g enalapril) and ARBs (eg losartan)

 

Hydrochlorthiazide is a diuretic that also reduces blood pressure, though for most people this alone will not suffice and it rather needs to be taken along with abother drugs such as those mentioned above.

 

How high is your BP? 

 

 

[ignis]

16 minutes ago, Sheryl said:

  Manidipine  is for high blood pressure, not diabetes. Swollen legs & feet is a common side effect if this class of drug (calcium channel blockers). Common, and inexpensive, alternatives are ACE inhibitors (e.g enalapril) and ARBs (eg losartan)

 

Hydrochlorothiazide is a diuretic that also reduces blood pressure, though for most people this alone will not suffice and it rather needs to be taken along with abother drugs such as those mentioned above.

 

How high is your BP? 

 

 

How high is your BP? 

 

up and down, this morning 135/70.....  Monday 154/77  - Tuesday was 99/54

 

the constant changing of Med's is confusing

 

 Used to take Prescribed enalapril for years then over passed 5 years no end of different ones, then losartan 100 mg, this has been reduced last month to 25 mg day [Hospital only have 100 mg so must cut in 4]  New Manidipine 20 mg, + Zosin 2 mg also reduced from 2x to 1 x a day end last month.. Atenolol 50mg has been stopped by Dr

 

NHS Website  shows losartan + hydrochlorothiazide is good + I have had them before

 

So no idea if replacing the Manidipine  with hydrochlorothiazide is good or bad...   I do know that the Hospital do not have hydrochlorothiazide. next appointment is end of Jan 2024

[Sheryl]

2 hours ago, ignis said:

How high is your BP? 

 

up and down, this morning 135/70.....  Monday 154/77  - Tuesday was 99/54

 

the constant changing of Med's is confusing

 

 Used to take Prescribed enalapril for years then over passed 5 years no end of different ones, then losartan 100 mg, this has been reduced last month to 25 mg day [Hospital only have 100 mg so must cut in 4]  New Manidipine 20 mg, + Zosin 2 mg also reduced from 2x to 1 x a day end last month.. Atenolol 50mg has been stopped by Dr

 

NHS Website  shows losartan + hydrochlorothiazide is good + I have had them before

 

So no idea if replacing the Manidipine  with hydrochlorothiazide is good or bad...   I do know that the Hospital do not have hydrochlorothiazide. next appointment is end of Jan 2024

I am not clear...are you still taking Losartan 25mg (a sub-therapeutic dose) plus they have added Manidipine?

 

By Zosin do you mean Tamsulosin or Doxazosin? In either case this is given for enlarged prostate but will also have a slight BP lowering effect.

 

It really does not sound like you are being at  all well managed.  What hospital do you attend? 

[ignis]

1 hour ago, Sheryl said:

I am not clear...are you still taking Losartan 25mg (a sub-therapeutic dose) plus they have added Manidipine?

 

By Zosin do you mean Tamsulosin or Doxazosin? In either case this is given for enlarged prostate but will also have a slight BP lowering effect.

 

It really does not sound like you are being at  all well managed.  What hospital do you attend? 

Thank you for your help

Not sure but appears all Hospitals are the same both Government + Private, you see a Dr can be different Dr every visit.. 

 

2015 very bad - local Hospital said had to be taken to a Big Hospital. [as Next door works at Red Cross was taken there] 1st few visits after coming out of Hospital = different Dr every visit [in my mind] all had diffident ideas to Med's and so they changed almost every visit...  asking for just 1 Dr the next years always had the same Dr  more or less the same Med's prescribed every 3 months

 

Then came Covid = 90 mins each way on public transport + many hours in a crowded Hospital not safe, so went to the local Government Hospital at Sai Noi mostly see the same Dr every visit

[in my mind] small Village Hospital do not carry the same Med's as a big Hospital, + only have 1 x size of mg = I am forever cutting tablet to about the correct mg dosage..... sometimes they have run out of a Pill and get given something different - Hospital Pharmacy say is the same thing ? 

 

********

Yes still taking Losartan 25mg reduced from 100mg last month plus Yes they have added Manidipine 20mg

 

On the Prescription  says Zosin on the blister packs says  Doxa-zosin 2mg

 

Another Pill was suddenly stopped Atenolol 50 mg per day  -  I have had a mild Stroke years ago + a minor Hart Attack  [had in my mine that this was the pill to help + lower BP] ?

 

Alarming last month was the blood work - have been fine with Stage 5 CKD in 2015  down to stage 2 until last month where it was again Stage 4.. 

I do Not have Salt or Soda and very little Red Meat, so no idea why it has gone up.

 

 

Edited December 21, 2023 by ignis

[Sheryl]

26 minutes ago, ignis said:

Thank you for your help

Not sure but appears all Hospitals are the same both Government + Private, you see a Dr can be different Dr every visit.. 

 

2015 very bad - local Hospital said had to be taken to a Big Hospital. [as Next door works at Red Cross was taken there] 1st few visits after coming out of Hospital = different Dr every visit [in my mind] all had diffident ideas to Med's and so they changed almost every visit...  asking for just 1 Dr the next years always had the same Dr  more or less the same Med's prescribed every 3 months

 

Then came Covid = 90 mins each way on public transport + many hours in a crowded Hospital not safe, so went to the local Government Hospital at Sai Noi mostly see the same Dr every visit

[in my mind] small Village Hospital do not carry the same Med's as a big Hospital, + only have 1 x size of mg = I am forever cutting tablet to about the correct mg dosage..... sometimes they have run out of a Pill and get given something different - Hospital Pharmacy say is the same thing ? 

 

********

Yes still taking Losartan 25mg reduced from 100mg last month plus Yes they have added Manidipine 20mg

 

On the Prescription  says Zosin on the blister packs says  Doxa-zosin 2mg

 

Another Pill was suddenly stopped Atenolol 50 mg per day  -  I have had a mild Stroke years ago + a minor Hart Attack  [had in my mine that this was the pill to help + lower BP] ?

 

Alarming last month was the blood work - have been fine with Stage 5 CKD in 2015  down to stage 2 until last month where it was again Stage 4.. 

I do Not have Salt or Soda and very little Red Meat, so no idea why it has gone up.

 

 

 Atenolol is no longer used just for BP but is indicated for heart failure, atrial fibrillation etc.

 

As for adding  Manidipine to 25mg Losartan, 25 mg Losartan is sub-therapeutic dose, would be more usual to just increase the  losartan does and maybe add clorthiazide.  Unless -- and this is possible -- it was because of your decreased renal function. Sounds like the change in lab values and the decrease in losartan happened at same visit? If  so, this could be why.  However the preferred drug for managing hypertension in people with kidney disease is an ACE inhibitor like enalapril.

 

I very definitely do not recommend going to Sai Noi Hospital, it is a tiny community level facility. Suitable only for things like simple wound care.

 

In Nonthaburi I would suggest Panyananthaphikkhu Chonprathan Medical Center, which is university affiliated. And if possible the "after hours clinic", that way you will see senior doctor and can also ensure same doctor each time. Ask for an acharn in Internal Medicine.  It will cost you a frw huindred baht more per visit but be well worth it in the long run.

 

Regarding CKD, staging is based on the estimated GFR which in turn is based on serum creatnine, so presumably your creatnine level significantly increased. Is it possible you were dehydrated when the sample was taken? As if so, would be worth repeating it. 

 

If you are making additioanl visits solely for med refills might want to rethink that as =drugs like enalapril are dirt cheap at pharmacies. 

[ignis]

enalapril 20 mg  took for over 20 years years

Gliclazide 80 mg took for over 20 years years - Dr back in the 90's said it was better for the kidneys [diabetic drug]

 Atenolol 50 mg  took for over 20 years years

Diabetic Metformin took for over 20 years years

 

is just in resent years that the Med's have been changed so much

 

is it possible you were dehydrated when the sample was taken  YES could be Blood work days is NO Food or Drink from 8 pm, tests done about 13 hours later.

 

on a light note  Sai Noi Hospital has changed a lot over the years, now has walls and Dr rooms + Computers + have beds for In care, as of last month now have ticket machine and a display to look out for your number..  and are still building another new block... back in the day it was like a large barn with a tin roof and all open sided

[ignis]

1 hour ago, Sheryl said:

 Atenolol is no longer used just for BP but is indicated for heart failure, atrial fibrillation etc.

 

As for adding  Manidipine to 25mg Losartan, 25 mg Losartan is sub-therapeutic dose, would be more usual to just increase the  losartan does and maybe add clorthiazide.  Unless -- and this is possible -- it was because of your decreased renal function. Sounds like the change in lab values and the decrease in losartan happened at same visit? If  so, this could be why.  However the preferred drug for managing hypertension in people with kidney disease is an ACE inhibitor like enalapril.

 

I very definitely do not recommend going to Sai Noi Hospital, it is a tiny community level facility. Suitable only for things like simple wound care.

 

In Nonthaburi I would suggest Panyananthaphikkhu Chonprathan Medical Center, which is university affiliated. And if possible the "after hours clinic", that way you will see senior doctor and can also ensure same doctor each time. Ask for an acharn in Internal Medicine.  It will cost you a frw huindred baht more per visit but be well worth it in the long run.

 

Regarding CKD, staging is based on the estimated GFR which in turn is based on serum creatnine, so presumably your creatnine level significantly increased. Is it possible you were dehydrated when the sample was taken? As if so, would be worth repeating it. 

 

If you are making additioanl visits solely for med refills might want to rethink that as =drugs like enalapril are dirt cheap at pharmacies. 

 

drugs like enalapril are dirt cheap at pharmacies. 

YES as are most Med's problem is asked many Pharmacies around here No one sells Insulin, to go to say Rama 4 cheaper Pharmacies is 3 + hour trip + a lot more expensive than a Government Hospital Pharmacy price