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I am 35 and I have cystic fibrosis, and I have been treated with insulin (Lantus) for a few months after diabetes has appeared. It looks roughly controlled, but I sometimes have blood glucose values that rise after the evening meal between 1.70 and 2 g. It occurs on an irregular basis depending on what I eat, but not always. One night I eat a pizza at home and it is not good, but eating the same thing for lunch, I have no worries ... I may also mix vegetables with some bread and it goes up, although it seems to me that it should be all right, which is also often the case. I struggle to find a logical way and I wonder if these high blood glucose values are real problems or remain acceptable. I thought that lantus would allow me to eat almost normally during meals and ultimately it is not always accurate. It is also complicated during the outings (appetizer, larger meals ...) and mainly at weekends. I realize that lantus does not allow me to eat normally as it had been presented to me by the medical team at the initiation of treatment. I have already lost weight. If I eat differently by removing starchy food, loss of calories will not allow me to maintain proper weight. Thank you to enlighten me on all this because I still have periods of doubt and major concern. I have a feeling of additional deprivation (besides everything else) as basically I am a good eater, and luckily my weight was good until then. Moreover, this treatment was to bring me a real improvement in my respiratory condition which deteriorated due to the onset of diabetes. And I do not see the expected results, 6 months after the start of insulin. Thank you.
I understand your frustration that diabetes is not controlled properly although you have accepted insulin treatment constraints, namely the use of Lantus which is a slow insulin.
It would be important to know the value of your glycosylated hemoglobin HbA1c to know whether your blood glucose levels are controlled throughout. This rate should ideally not exceed 6 to 6.5% and should be checked every 3 months. It would also be useful to control your capillary blood glucose before and 2 hours after meals for a few days in order to have a clearer vision of the evolution of your blood glucose over the day and offer an adaptation of treatment.
Cystic fibrosis patients with diabetes justify treatment with insulin to improve their nutritional status but also to avoid worsening respiratory status and finally to prevent long term complications of diabetes (microvasculature disease, of eye and kidney in particular).
However, it is usual to first propose a treatment with rapid insulin before each meal. Doses are calculated based on amounts of carbohydrates in the meal. This has the advantage of not limiting the intake of sugar and fat during meals and control more easily diabetes. Slow insulin is indicated secondarily if blood sugar when awaking in the morning remains high, in addition to rapid insulin.
All this requires therapeutic education for learning to calculate insulin doses and it can be done at best during a brief hospitalization in Endocrinology, preferably with a diabetologist who knows cystic fibrosis and is used to work with the CF centre.
I advise you to talk of your diabetes with your doctor at the CF centre and consider with your diabetologist how to adjust your insulin treatment in order to gain weight and not to deprive yourself while properly controlling your blood glucose. The change of treatment will require some effort at first but then you should experience a real benefit.
Best regards.
Dr Dominique Hubert