by Teresa Murrell
(Bakersfield,CA,USA)
EXPERIENCE SHARING:
By Teresa Murrell, Bakersfield, California, USA
I developed type 1 diabetes at age 15 and am now 55. I have tried different insulins and an insulin pump, but I am now experiencing complications after 40 years. I lost all my upper teeth because of bone loss, and my lower teeth are cracking and chipping. During the past two and a half years, I have been hospitalized about 25 times for very high blood sugar and have had four surgeries. I gained about 40 pounds, from 122 to 167 pounds, and my husband must help me dress because I cannot bend easily. Osteoarthritis and rheumatoid arthritis limit my walking. I use Humulin insulin and a Humalog pen, but my readings remain in the 200s, 300s and sometimes above 400 mg/dL. My vision becomes blurry and sometimes double when glucose is high. I was told I might try a Dexcom if I perform frequent finger-stick tests. I have Kaiser Permanente, Medicare and Medi-Cal, but costs remain difficult. I feel alone and need advice and support.
Quick Answer
Repeated glucose readings in the 300s or above 400 mg/dL, together with frequent hospital admissions, require an urgent and comprehensive type 1 diabetes review. This should include insulin doses and timing, injection or pump technique, ketone and sick-day plans, possible infections or medicine effects, nutrition, access to supplies, and consideration of continuous glucose monitoring or automated insulin delivery. Dental loss, rapid weight gain, reduced mobility and double vision also need separate evaluation. You should not manage this alone.
Answer by Dr. Albana Greca, MD, MMedSc
Hello Teresa,
Living with type 1 diabetes for 40 years requires enormous effort. Your frequent admissions show that your treatment and support system need reassessment by an experienced diabetes team.
Very high glucose may mean that too little insulin is reaching the body. Causes include missed or delayed doses, spoiled insulin, injection into damaged tissue, pump failure, infection, surgery, steroids, stress, or difficulty matching insulin to carbohydrate intake.
When glucose reaches 250 mg/dL or higher, follow your clinician’s instructions for checking blood or urine ketones. Read our guide to blood sugar over 400 mg/dL and keep written sick-day and correction-dose instructions where you and your husband can find them.
Seek emergency care
Go to the emergency department for moderate or large ketones, vomiting, abdominal pain, fruity-smelling breath, deep or difficult breathing, confusion, severe weakness, inability to drink, or glucose that remains very high despite following your prescribed correction plan. These may be signs of diabetic ketoacidosis.
Ask for an appointment with an endocrinologist and diabetes care and education specialist. Bring your glucose meter, insulin pens, needles, insulin bottles, dose schedule, hospital records and a list of everything you eat and drink for several days.
The team should review basal and mealtime insulin, correction factors, carbohydrate counting, injection timing, storage, expiration dates and barriers such as cost or fear of lows. Humulin includes different insulin types, so confirm the exact product and timing. Learn more in our insulin treatment guide.
Injection sites should be examined for hard or fatty areas called lipohypertrophy. Insulin injected into these areas may absorb unpredictably. Rotate sites systematically and avoid damaged areas, but discuss dose safety before changing sites because insulin may work more strongly in healthy tissue.
A continuous glucose monitor such as Dexcom can show glucose direction, overnight patterns and alerts for dangerous highs and lows. With repeated admissions and multiple daily insulin doses, it is reasonable to request formal assessment for CGM and possibly an automated insulin-delivery system.
Current Medicare criteria generally allow CGM coverage for insulin users when the device is ordered and the patient or caregiver is trained. Ask your endocrinologist, Kaiser diabetes department or equipment coordinator to submit the documentation. If denied, request case-manager help and written appeal instructions.
Diabetes increases the risk and severity of periodontal disease, which can damage gums and supporting bone. High glucose may also slow healing and increase infection risk. You need coordinated care from your diabetes clinician and a dentist or periodontist.
Ask about active gum infection, dry mouth, denture or implant options, and how to protect the remaining teeth. Brush gently twice daily, clean between teeth if possible, and seek urgent dental care for facial swelling, fever, pus, severe pain or difficulty swallowing. Our overview of diabetes complications explains why glucose control and preventive care must work together.
Rapid glucose changes can temporarily blur vision by changing fluid levels in the eye. However, true double vision is not something to assume is caused only by high glucose. Arrange a dilated eye examination and tell the clinician specifically that you experience double vision.
Sudden double vision, loss of vision, a curtain-like shadow, new weakness, facial drooping, severe headache, speech difficulty or loss of balance requires emergency assessment. See our page on diabetic eye problems and warning signs.
Insulin can contribute to weight gain, but an increase of 40 pounds deserves a broader review. Possible contributors include reduced mobility, excess insulin with frequent treatment of lows, thyroid disease, fluid retention, steroid treatment for arthritis, sleep problems and other medicines.
Ask your clinician to review thyroid, kidney, liver and heart function and every medicine you take. Do not reduce insulin to lose weight. A dietitian familiar with type 1 diabetes can help reduce calories without causing insulin mismatch or ketones.
Because arthritis limits walking and bending, request physical or occupational therapy. Seated exercise, resistance bands, water activity or short supported walks may be possible after clearance. See our diabetes and exercise guide.
Ask your husband to attend the diabetes visit and learn about ketones, insulin emergencies, CGM alerts and when to seek help. Do not post private contact details publicly; use moderated groups or secure healthcare messaging.
This educational response does not replace urgent assessment or an individualized insulin and sick-day plan from your diabetes team.
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