Question about medication

[Asddd]

Hi, recently accompanied my dad to the dr appointment and learnt that his hba1c is on the higher side. he injects insulin and takes oral medications, but isnt very conscientious with his diet (but avoids sugary stuff), which is probably why his hba1c is high. when i asked the dr if we should increase the meds, he only said that it would be better for my dad to exercise and improve his diet. i know that that is ideal option, but given that my dad hasnt been a model patient, woudnt it be better to give more meds? what am i missing here? is it the risk of hypoglycemia, or although the hba1c is high, it's still ok? i assuming that there is some reason/challenge for not just increasing the dosage, especially since i found an article that says 40-60% of diabetics have suboptimal control.

tldr my dad has suboptimal control, so why doesnt the dr increase the dosage?

 

[Diakat]

What insulin is he on and what meds? How old is he? Is he a T2?

 

[Asddd]

my dad is is his early 50s and T2. i know he takes metformin, but idk what insulin he injects but require both basal and bolus insulin.

 

[Oldvatr]

What insulin is he on and what meds? How old is he? Is he a T2?

I would add: what was his HbA1c this time and how does it compare to his previous ones? It may well be that your GP is right to suggest that a small adjustment to his lifestyle may be all he needs to bring it back down again. Many of us here would love the chance to reduce our medication when we can.

 

[Asddd]

I would add: what was his HbA1c this time and how does it compare to his previous ones? It may well be that your GP is right to suggest that a small adjustment to his lifestyle may be all he needs to bring it back down again. Many of us here would love the chance to reduce our medication when we can.

this time was 7.9%. idk about previous times since this is the first time i went with my dad, but based on what the dr was saying, it is higher than what he would prefer.

yes i understand that, but my dad hasnt shown any motivation to change his diet and lifestyle beyond what he already has (i.e. just cut out sugary stuff), so it seemed somewhat unrealistic to bank on that.

 

[Diakat]

The thing is that as a T2 he has insulin resistance so just adding more meds and more insulin makes that resistance worse.

 

[Oldvatr]

If your dad was interested in solving a problem, then there is a Success and Testimonials thread on this forum. There are many T2D on insulin reporting there thst they have either managed to come off insulin altogether, or at least reduce the dose or avoid hypos by using various means. Diet happens to be a very powerful tool in this aspect, and there are tales of complete remission by following some changes to diet. It is also the easiesy pathway to reducing the effects and progression normally associated with this disease.

If he manages his medication ok, then he would probably be able to adjust his diet. Who cooks his food and shops for provisions? If he does thrn its easy. If he relies on someone else or shares meals with non diabetics then he may feel that he cannot force things onto them. I live with other (non-diabetic)s, and I do the household bits, and they are quite happy with the diet I follow. In many ways they prefer the diet alternatives to what they used to eat, so a pizza is still available, but not as they knew it.

 

[Oldvatr]

this time was 7.9%. idk about previous times since this is the first time i went with my dad, but based on what the dr was saying, it is higher than what he would prefer.

yes i understand that, but my dad hasnt shown any motivation to change his diet and lifestyle beyond what he already has (i.e. just cut out sugary stuff), so it seemed somewhat unrealistic to bank on that.

That 7.9% is equivalent to about 62.4 in the UK and represents an average of 10 mmol/l It is high but not worryingly so. But yes, could be improved. I dropped my own HbA1c from 100 (i,e, 11,3%) to 42 (i.e. 7 %) using mainly diet, but I am not on insulin and I had to reduce my medication as my figures improved. Your dad will need to work with the doctor to reduce his dose of insulin so that may be where another difficulty could arise. Perhaps introducing your dad to this online world may give him some inspiration? He can ask questions via his avatar so we don't kmow who he is

 

[Asddd]

The thing is that as a T2 he has insulin resistance so just adding more meds and more insulin makes that resistance worse.

I am aware of this. so is the dr was weighing the tradeoff; a slightly higher hba1c is acceptable if we can avoid increasing resistance?

im concerned because a lot info online seemed to expound the importance hba1c value, e.g. how a 1% reduction avoids complications. and i also happen to find out that there is no upper dosage limit for insulin, so i was thinking, isnt it then better to lower the risk of complications than avoid increasing resistance.

If your dad was interested in solving a problem, then there is a Success and Testimonials thread on this forum. There are many T2D on insulin reporting there thst they have either managed to come off insulin altogether, or at least reduce the dose or avoid hypos by using various means. Diet happens to be a very powerful tool in this aspect, and there are tales of complete remission by following some changes to diet. It is also the easiesy pathway to reducing the effects and progression normally associated with this disease.

If he manages his medication ok, then he would probably be able to adjust his diet. Who cooks his food and shops for provisions? If he does thrn its easy. If he relies on someone else or shares meals with non diabetics then he may feel that he cannot force things onto them. I live with other (non-diabetic)s, and I do the household bits, and they are quite happy with the diet I follow. In many ways they prefer the diet alternatives to what they used to eat, so a pizza is still available, but not as they knew it.

i know where you are coming from, but my dad isnt interested. in fact, im the only one concerned about it, he has forgotten the dr's instructions. it is tough for us (his family) to do anything since he isnt willing to make more changes. for exmaple, we tried switching to brown rice, but he hates it and we are now back to white rice. also, rice and noodles are our staple as asians, so it is impossible to get him to go on a low carb diet.

 

[Antje77]

but my dad hasnt shown any motivation to change his diet and lifestyle beyond what he already has (i.e. just cut out sugary stuff),

Managing diabetes with insulin to get lower levels than he has requires counting carbs and injecting according to those, testing an awful lot and generally putting a lot of work in it.
If you don't you'll likely get very nasty hypo's.

Can it be his doctor concluded from his lack of motivation in changing his eating habits that he would likely be not motivated enough to safely up his doses?
Is your father willing to test 6-10 times a day and count the carbs in everything he eats or drinks to calculate the amount of insulin he needs for every meal, snack and drink? If so, please let him speak to his doctor again.

But it can very well be that his quality of life is much higher without that hassle and sub-optimal blood sugars. What does your father want to do?

All the best for both of you!

 

[Oldvatr]

I am aware of this. so is the dr was weighing the tradeoff; a slightly higher hba1c is acceptable if we can avoid increasing resistance?

im concerned because a lot info online seemed to expound the importance hba1c value, e.g. how a 1% reduction avoids complications. and i also happen to find out that there is no upper dosage limit for insulin, so i was thinking, isnt it then better to lower the risk of complications than avoid increasing resistance.



i know where you are coming from, but my dad isnt interested. in fact, im the only one concerned about it, he has forgotten the dr's instructions. it is tough for us (his family) to do anything since he isnt willing to make more changes. for exmaple, we tried switching to brown rice, but he hates it and we are now back to white rice. also, rice and noodles are our staple as asians, so it is impossible to get him to go on a low carb diet.

You can take a horse to water, but you cannot make him drink. Unfortunately, until someone is open to making a change, it becomes very difficult to persuade them, and in doing so may alienate him. Your online travels should have demonstrated that diabetes is a progressive disease, and for most people relying on medication to fix things find themselves on a one way street, This forum has given us the chance to change that outcome and prevent complications. The alternative is bariatric surgery whish is an NHS remedy, but again requires consent and cooperation., Unfortunately he is already on the escalator.

I dispute that an asian diet prevents low carb. It would be difficult, but I can have a stirfry with noodles without spiking too much, and fish is good, Certainly a takeaway meal is terrible for me so it must be in the way things are cooked. Even takeaway battered cod from the oriental chippie spikes me more than the polish one round the corner so even the batter is made differently.

His HbA1c is not too severe, so maybe trying to introduce some small tweaks could benefit him. But he has a way of living that suits him at the moment and at 50 he will be becoming more nd more resistant to change over time. Sadly, you cannot increase Metformin to reduce bgl because that is not what it does. Only increasing insulin will do that, and that is, as pointed out just now, is using a sledgehammer to crack a nut for a T2D.

 

[Asddd]

Managing diabetes with insulin to get lower levels than he has requires counting carbs and injecting according to those, testing an awful lot and generally putting a lot of work in it.
If you don't you'll likely get very nasty hypo's.
All the best for both of you!

Thanks this makes sense.

I dispute that an asian diet prevents low carb. It would be difficult, but I can have a stirfry with noodles without spiking too much, and fish is good, Certainly a takeaway meal is terrible for me so it must be in the way things are cooked. Even takeaway battered cod from the oriental chippie spikes me more than the polish one round the corner so even the batter is made differently.

thanks. im not saying asian diet = high carbs. im saying 1) he isnt keen on the healthier versions, as illustrated by the white rice/brown rice example, and 2) he eats a lot of refined carbs which isnt good for glucose control. as i said i understand your viewpoints, but we have our challenges with him. as such, that is a another battle, so in this post i just wanted to find out if it's better to up dosage or am i missing something.

 

[Oldvatr]

I undertand there are limitations, and lifestyle changes seem implausible. The HbA1c is crying out for adjustment but is not critical. So you can live with it. There may still be swaps you could furtively introduce, i.e. I like curries, so for me I use cauliflower rice, but I have also used basmatti / patna rice successfully as it is lowish carb. When it has cooked I rinse it under cold water for about a minute, then I pour boiling water over it before I serve it, This reduces the starch content. Another trick is to parboil it then freeze it, this converts the starch into resistant starch so it is not absorbed so easily, However, reheating rice is not really recommended. Works with potato as well. There are soy based lentils that I have used that are reasonable but low carb. There are noodles that are low carb too. Swaps are not for gourmets, but can be palatable alternatives.

Maybe put some of the common staples on the forum and ask what people use as swaps?

 

[mouseee]

My mum is a very poorly controlled T2. She has just come out of hospital after 7 weeks of various things linked with T2.
One thing I learnt along the way during this time was that my mum is a grown up. Unfortunately, I can not make changes for her. I can support, encourage and nag from time to time but ultimately it's her life.
However, I can make changes to my own life! I am not going the same way and am determined to be healthy at her age.

 

[Daibell]

Hi. Taking insulin if you are an overweight T2 with insulin resistance is not a good idea as the body may already have too much insulin that the body can't use. The medication sometimes prescribed is the once a week Liraglutide. Lowering the carbs (not just sugar) is the best way forward.

 

[ianf0ster]

You can take a horse to water, but you cannot make him drink. Unfortunately, until someone is open to making a change, it becomes very difficult to persuade them, and in doing so may alienate him. Your online travels should have demonstrated that diabetes is a progressive disease, and for most people relying on medication to fix things find themselves on a one way street, This forum has given us the chance to change that outcome and prevent complications. The alternative is bariatric surgery whish is an NHS remedy, but again requires consent and cooperation., Unfortunately he is already on the escalator.

I feel that things are not quite as gloomy as they may seem.
I have today just searched out (for a poster in another forum) the PHC 2017 presentation by Dr David Unwin and Dr Jess Unwin (his psychologist wife). In it they say that the reason most T2D patients seem apathetic is because the options are not presented to them in the right way.
Having been trained by his wife as to how to approach the subject of Low Carb as an alternative to constantly increasing medication, Dr Unwin (even back then) found that few if any patients would choose the constantly increasing medication route.

 

[Oldvatr]

I feel that things are not quite as gloomy as they may seem.
I have today just searched out (for a poster in another forum) the PHC 2017 presentation by Dr David Unwin and Dr Jess Unwin (his psychologist wife). In it they say that the reason most T2D patients seem apathetic is because the options are not presented to them in the right way.
Having been trained by his wife as to how to approach the subject of Low Carb as an alternative to constantly increasing medication, Dr Unwin (even back then) found that few if any patients would choose the constantly increasing medication route.

I hope that I am wrong, and that the OP can find the key to unlock the obvious denial shown by his dad. Unfortunately we quite often see this situation play on the forum. I have several T1 and T2 friends, most of them on insulin. They too are not interested in using diet to give themselves an improved outcome. It seems that insulin users are afraid of diets in that they believe diet by its nature will restrict their choice and deprive them of the enjoyment of eating the foods they like. At present they have a routine as dictated by the doctor that seems to control the disease until the next review at least. Diabetes is on the whole a hidden disease in that the symptoms creep up on us before there is anything critical to worry about, so this makes it easy to go into denial. If you do not test much then it is even easier to ignore the symptoms, but an insulin user should be aware: it surprises me that doctors instruct their patients to run with higher bgl than they need to in order to avoid the dreaded hypo. It is this fear of hypo that I think is driving them since most of the insulin users I know are happy with readings around 10mmol/l, nd are shocked when I tell them I am pleased to get a 4,5 That is hypoland to them. I have not managed to persuade any of them to do low carb since they do not need to (in their eyes that is).