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Dr. Bill's Commentaries

Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.


Blood Sugar of 600 and No Insurance   (February 27, 2013)

Someone recently asked:

"My sugars have been at 600 on numerous times. I no longer take insulin. I have NO insurance. I was advised to go to emergency immediately or I could have a stroke or go into a coma. Is this true? I have been diabetic for over 10 years on 70/30 insulin and metformin 1000 mg twice a day. I was using 30units in am 20units at noon and 30units at night before meals. Again I haven't taken insulin in over 3 months, as I have no more insurance."

My reply:

Yes, it is true that if your blood sugar levels are in the range of 600, you are at risk of life-threatening complications because the level is so high. One problem that might occur is diabetic ketoacidosis (DKA) (which is more common if you had type 1 diabetes, which I doubt you have or you’d already be unconscious). The other complication, which is likely in people with very poorly-controlled type 2 diabetes, is called by several names. It’s often called Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) (see an article about this in Diabetes Forecast for the gory details).

The main concern when your glucose is this high is that any event that leads to dehydration will cause your glucose level to skyrocket further, and for you to lose consciousness or develop a stroke or other disaster.

Symptoms of the high sugar include extreme thirst, dry mouth, and huge volumes of urine. Your body may be able to tolerate these symptoms for several months, but if you become nauseated or have diarrhea, you are only a short step from coma and death.

Basically, you need more medication to control your diabetes. Metformin is inexpensive (and indeed it’s free at many supermarket drugstores!), so stay on it. You’re on about the highest dose that’s likely to work (2000 mg/day), so don’t try increasing it. Other pills are more expensive, and unlikely to solve your problem. I wouldn't advise trying them in this situation.

As you are well aware, the basic problem is you need insulin. Here are some thoughts on how to get it. 

  • Show up in an emergency room in a coma. (Sorry if this sounds nasty, but you are in a nasty situation!) The ER staff will give insulin and fluids to you to help bail you out, and almost inevitably hospitalize you to evaluate the cause of your coma (which is VERY expensive), and later, will turn you loose after you are stabilized. Depending on the hospital, they might figure out some way for you to continue to get insulin after discharge, or simply tell you to go find it on your own. This is NOT the preferred choice!
  • Call the physician who’s prescribing the metformin, and ask if he has samples of any insulin product. If so, then he can re-start you on insulin whether it’s the same product you used before or another one. The drug company reps who leave meds at the doctor’s office may be willing to help keep you supplied, but you’ll have to be aggressive and ask the doc (or the nurse) if they’ll ask the rep.
  • Call the pharmacy who’s dispensing the metformin, and see if they know any way to help.
  • Call the nearest hospital, and ask to talk to the diabetes nurse educator. They will know of other local sources for insulin besides what I quote above. They may also have a diabetes education program at their hospital, and may be able to refer you to a nearby endocrinologist who can help you get your insulin as well as providing you with ongoing specialty care.
  • If there is a major medical center (such as a teaching hospital that’s affiliated with a state university) nearby, they’ll inevitably have an entire department full of specialists in diabetes. See if you can “self-refer” yourself to their diabetes clinic. Once you hook up with the diabetes clinic, you’ll probably have access to medications and experimental insulin programs and other assistance. Your medical care will probably be by physicians-in-training called “residents” and by medical students, but they are supervised by fully-trained endocrinologists, and will have diabetes nurses, dietitians, social workers, and other specialists available to help if needed. If the waiting time to get in is more than a week or two, ask your present physician to make a referral on an urgent basis.
  • Call the local chapter of the American Diabetes Association or Juvenile Diabetes Research Foundation (look in the phone book). They may have a patient assistance program, or know of one.

Finally, write your congressperson. If they support the recent health care reforms (frequently called Obamacare), thank them. If they don’t, tell them of your story, and ask them to please reconsider their opposition, as one of the goals of health care reform is to provide adequate medical care for all Americans, including those who don’t presently have insurance.

I suspect our readers may know of other tips besides the six I have listed, and will chime in with their comments.

Hope this helps, and best wishes on getting back on insulin very soon!

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