June 14, 2004
Aches and Pains, Hyperglycemia and DKA
Question from Neoga, Illinois, USA:
I have been on insulin for one year now. I take Lantus and am using 70 units at bedtime. I also take Actos, 45mg, four times a day. I have been having a lot of problems with bursitis in both hips. I also have some knee problems and PVD (peripheral vascular disease) on both legs with varicose veins. My blood sugars have been up and down, mostly up, over 300 mg/dl [16.7 mmol/L]. I went to physical therapy yesterday after lunch, had a good workout and came home. I was in quite a bit of pain when I got home. At 4 p.m., I checked my blood sugar and it was 364 mg/dl [20.2 mmol/L]. I had nothing to eat after lunch. I took a pain pill and checked my blood sugar an hour later when I was feeling better. It was down to 218 mg/dl [12.1 mmol/L]. Can my blood sugar be elevated because I have a lot of inflammation and pain? I keep increasing my Lantus and I also use some Humalog as needed. I can’t seem to get the sugars under control. I don’t think my doctor is taking very good care of me. I am going to start seeing a new internist soon. Do you have any suggestions?
Answer:
Pain can actually increase your blood sugars. It activates the adrenals to make more adrenaline. This hormone antagonizes insulin. Care of your pain or prevention of pain can help improve your blood sugars. Most good insulin regimens are not one-sided. You need to adjust Humalog on an ongoing basis, in addition to the Lantus. I would suggest you talk to your physician about both the basal insulin component, Lantus, and the rapid-acting insulin component, Humalog. However, you should know that injections with steroids can also raise your blood sugars dramatically.
JTL
