September 12, 2005
Other Illnesses, Type 2
Question from Karachi, Pakistan:
When my mother had blood work nine months ago to prepare for a hysterectomy, she learned she has type 2 diabetes. Her blood sugar was 231 mg/dl [12.8 mmol/L] fasting and 350 mg/dl [19.4 mmol/L] random. Her A1c was 11.6. The doctor told her to take 40 units of insulin daily for one week. Even while taking the insulin, my mother had high blood sugars. She also has high blood pressure. Her left hand pinkie finger has an infection, something green in color, which is not healing well. She is taking the antibiotic Ciproxin, which my mother believes is causing her blood pressure to rise. Does Ciproxin cause higher blood pressure?
What should I do about her finger? Is it serious? Is is necessary to take insulin for a long time or can her blood sugars be controlled by oral medications?
Recently, my mother was also diagnosed with systemic lupus, but her ANA (anti-nuclear antibody) was negative and her RA (rheumatoid arthritis) factor was also negative. Only the Lupus test was positive. I am not happy that the doctor has said we can’t treat the lupus with medication because the medications cause higher blood sugars. Are there any connections between lupus and diabetes?
Answer:
First, the blood sugars are very high. The levels you are describing require insulin therapy. One dose of insulin per day is not enough to do the job. She may need a combination of fast-acting and slow-acting insulin. Her high blood sugars may be one reason her finger infection will not heal. Fingers need to treated aggressively as loss of function in the hand is a serious thing. She needs to learn how to monitor her blood sugars and values should be decreased to less than 140 mg/dl [7.8 mmol/L] throughout the day. Her doctor is correct in that steroids used in the treatment of autoimmune diseases, such as lupus, are likely to make her blood sugars even higher. However, if you have a rheumatologist around, I would have them see your mother. The negative serologies make this a difficult diagnosis to make. There are additional medications for the treatment of lupus that might be used that are not steroids.
JTL
