Appointment with diabetic nurse / pain management clinic / hip & knee consultant

[Daibell]

Hi Molly. I was on max dose Metformin, Gliclazide and Sitagliptin for years with no effect which in retrospect was due to the fact that my pancreas had 'failed' and I was not a T2 but a LADA. I'm now on insulin which works like a dream. Hopefully the Glic does work and your husband will need to be careful to avoid hypos. If the Glic works it indicates that the pancreas still has working islet cells that can be stimulated. I hope your husband does realise that he must do the right things and reduce all his carbs and not just sugar. Be aware that insulin is not the cure-all for diabetes resulting from being overweight. Weight reduction is the only real solution before adding other meds such as insulin. If necessary there are other injectables that might be better such as Bydureon.

 

[Molly56]

My partner has received a letter from the GP today requesting a second urine test in a months time....any suggestions as to why they would be asking for this; I am assuming it is nothing urgent otherwise they would be asking to see him now.

 

[kesun]

My partner has received a letter from the GP today requesting a second urine test in a months time....any suggestions as to why they would be asking for this; I am assuming it is nothing urgent otherwise they would be asking to see him now.

The only reason I know would be if the GP suspects kidney disease. They do a dipstick test first, then if they're still concerned they get a second sample and send it to the lab for analysis. But usually that's quicker than a month: if it were my GP's surgery I'd assume the month was to do with their waiting list rather than clinical factors.

Kate

 

[Molly56]

The only reason I know would be if the GP suspects kidney disease. They do a dipstick test first, then if they're still concerned they get a second sample and send it to the lab for analysis. But usually that's quicker than a month: if it were my GP's surgery I'd assume the month was to do with their waiting list rather than clinical factors.

Kate

@kesun I am assuming that the first sample was sent to the lab as it was handed in with a form for the hospital pathology lab....though I could be wrong as don't know how quickly this would have come back.

 

[kesun]

@kesun I am assuming that the first sample was sent to the lab as it was handed in with a form for the hospital pathology lab....though I could be wrong as don't know how quickly this would have come back.

My next guess would be they found something puzzling but not immediately worrying and wanted to double check. I think the surgery would tell you if you rang and asked what it's for.

 

[Molly56]

My next guess would be they found something puzzling but not immediately worrying and wanted to double check. I think the surgery would tell you if you rang and asked what it's for.

The only problem with that suggestion is that I am not the patient so they wouldn't tell me....he is not bothered about it (or his diabetes in general - he told me as much this evening) so he won't contact them.
Will just have to make a point of reminding him to do it in a months time - have made a note in my diary- otherwise he will probably not bother / think it is just a waste of time......and will have to see what the verdict is then.
In the meantime I will try not to worry about it but be prepared to deal with the consequences if any arise......was once a girl guide, as the motto said "Be Prepared"

 

[Molly56]

Maybe going on insulin will turn out to be the wake up call he needs? I hope so for his sake.

One thing I'd add is that if people are continually running high BG their cognitive function is bound to be impaired, so maybe if he gains control of his BG via insulin, he'll become more rational about things? That would be my hope if I were in your shoes.

I have a friend who sounds very similar to your partner and I've given up even trying to educate him because he really doesn't want to know. There is only so much thinking and worrying you can do on someone else's behalf - if they're not willing to make the effort themselves, there's really not much choice but to leave them to it and preserve your own health and sanity. You can't live other people's lives for them.

@Indy51 medication has been changed (increase in gliclazide to max dose of 320mg per day, already on max dose of metformin) but not to insulin just yet, will have to see if this does the trick.

With regards to bs levels we now have a meter but he still will not test ( or see the point in testing) even though he should before driving.

On a couple of occasions I have got him to try it out and he has had readings of between 15.0 and 23.2.(verging towards the higher readings, over 20, on two occasions out of four) ....I am assuming from your comment that this is having quite a major impact on his cognitive function, something I have noticed a marked deterioration in.

I take on board your last comment and am making sure that I do look after myself.....but all that considered it is still really hard to sit back and watch and do nothing.

Thanks for the advice ......will keep it for future reference to remind myself when needed.....hope your friend manages to see the light one day before it is too late.

 

[Molly56]

Duloxetine has been mentioned recently by the GP as a possible medication for my partner in terms of helping with neuropathic pain – does anyone have any first hand experience of this particular medication?

Did it relieve the symptoms, are there any particular side effects that people have experienced when taking this?

He is currently taking amitriptyline for neuropathic pain but think that he would be stopping this in favour of the duloxetine

Are there any other tablets that he is taking that would conflict with this (listed below) - I always wonder if the combination of tablets somehow contradict each other or have adverse side effects which rather defeat the object of why they were prescribed in the first place.

Other medications include metformin (maximum dose) , gliclazide (maximum dosage) , for high blood pressure: ramipril, felodopine, doxazosin, bendroflumethiazide; sertraline (for depression), amitriptyline (for neuropathic pain) and co-codamol (for pain)

 

[connie104]

I was put on duloxetine by the pain clinic at the hospital for neuropathy in my leg . I have never been so ill in my life really thought I was going to die! I was on morphine based pain killers as well . Everyone is different but after 3 days I was taken off them .


Sent from the Diabetes Forum App

 

[graj0]

Other medications include metformin (maximum dose) , gliclazide (maximum dosage) , for high blood pressure: ramipril, felodopine, doxazosin, bendroflumethiazide; sertraline (for depression), amitriptyline (for neuropathic pain) and co-codamol (for pain)

Absolutely no way of telling how behaviour is affected by that cocktail, although from my personal experience of prescribed medication, I can honestly say that my behaviour was in no way anywhere near "normal" while I was taking things like Rosiglitazone and Citilapram.
I wish I could help you with some clever piece of advise but I'd be clutching at straws. It's obvious that you care deeply, I wonder what would happen if you just stopped showing that you cared. As I said, I'm clutching at straws because I can't suggest anything. Have you had a chance to discuss your concerns with your doctor, on your own?

 

[Molly56]

Absolutely no way of telling how behaviour is affected by that cocktail, although from my personal experience of prescribed medication, I can honestly say that my behaviour was in no way anywhere near "normal" while I was taking things like Rosiglitazone and Citilapram.
I wish I could help you with some clever piece of advise but I'd be clutching at straws. It's obvious that you care deeply, I wonder what would happen if you just stopped showing that you cared. As I said, I'm clutching at straws because I can't suggest anything. Have you had a chance to discuss your concerns with your doctor, on your own?

@graj0 I have had the thought of asking a pharmacist about the cocktail of medication as sometimes I think they are more knowledgeable about the actual drugs and the possible interactions between them, in the hope that they would identify any possible conflicts between the medication prescribed.

Our GP is,I think, aware of my concerns to some extent within the parameters we can discuss it without breaching any patient confidentiality....had thought of raising some of my concerns with the diabetic nurse (as I also attended his last appointment with her) and have a few issues of concern since that appointment regarding the increase in medication and testing etc (subject of another post)...not sure if or what I can discuss with her but no harm in asking to speak with her I guess, they can only say no.

Don't know what would happen if I stopped showing that I cared...don't even know that he notices that I care but then that could be down to the medication, as you say it is difficult to be "normal" on some medications.

 

[Molly56]

I was put on duloxetine by the pain clinic at the hospital for neuropathy in my leg . I have never been so ill in my life really thought I was going to die! I was on morphine based pain killers as well . Everyone is different but after 3 days I was taken off them .


Sent from the Diabetes Forum App

As you say everyone reacts differently to medications....my partner once had a reaction when the doctor prescribed indapamide for his blood pressure , he was quite ill and even suffered hallucinations / ended up in hospital. There is no telling who will have a reaction to these different medications, hence my caution and checking it out first.

 

[AndBreathe]

@Molly56 - your doc or nurse would have to listen to what you say. They may feel unable to make comment back specifically about your husband.

You might have to employ the classic feedback techniques with then (as well as your husband). By that I mean, for example, "when x scenario happens it makes me feel y". Or "when I encounter x scenario with someone I know, I don't know how to react." That opens a targeted discussion, hopefully.

I appreciate you have just had a few days away, and he went away too? What would he do if you stopped doing anything for him, like cooking, or reminding him to take his meds?

It would be curious to know how he was with his son. If he tested or behaved differently. Sometimes people can desperately want to change but not want to "lose face", as they see it, by making that change.

It's a frustrating dynamic for you, that's for sure.

 

[anteater2012]

Dear Molly,

The link below is a website that list drug interactions and could be a useful tool to indicate whether the medications your OH is on may have bad interactions with each other. You can look up the interactions between several drugs.

Please note that just because an interaction may be indicated does not mean that your OH will experience it though, but perhaps it can be used as a guideline for questioning doctor / pharmacist about the current drug regime. The website is free, but you do need to agree to T&C.

http://www.drugs.com/drug_interactions.php

With regards to the glic. I know this is a very good drug in the arsenal of medication for diabetes and I generally got very good readings when I used it - readings down as low as 4 sometimes (on a very small dose). However I suffered incredibly from side effects. I could not stay awake and my emotions were all over the place and eventually I broke down in tears at the surgery and I asked to be taken off them. I have an incredibly good GP who specialises in diabetes and he did as I asked. I am now on Glimiperide - and I am able to stay awake, the emotions are firmly under control and I am much happier. My numbers are a bit higher but I am working on that and hot weather is not helping.

I know your OH is not taking diabetes very seriously at the moment. Could you "shock" him into by sitting him down and saying "Please sign this will and funeral plan" - if he asks why you could simply say that "carry on the way you are with your diabetes treatment and you will be dead sooner rather than later and I would like to be prepared" - and walk away for a while. Obviously you know better than the rest of us whether this is viable to do.

I really do think there is a need for counselling to be offered to users when they have been diagnosed and the NHS is not providing it. I have been diagnosed just over a year and there are times I still can't deal with the fact that this disease will be with me for the rest of my life.

 

[Molly56]

Dear Molly,

The link below is a website that list drug interactions and could be a useful tool to indicate whether the medications your OH is on may have bad interactions with each other. You can look up the interactions between several drugs.

Please note that just because an interaction may be indicated does not mean that your OH will experience it though, but perhaps it can be used as a guideline for questioning doctor / pharmacist about the current drug regime. The website is free, but you do need to agree to T&C.

http://www.drugs.com/drug_interactions.php

With regards to the glic. I know this is a very good drug in the arsenal of medication for diabetes and I generally got very good readings when I used it - readings down as low as 4 sometimes (on a very small dose). However I suffered incredibly from side effects. I could not stay awake and my emotions were all over the place and eventually I broke down in tears at the surgery and I asked to be taken off them. I have an incredibly good GP who specialises in diabetes and he did as I asked. I am now on Glimiperide - and I am able to stay awake, the emotions are firmly under control and I am much happier. My numbers are a bit higher but I am working on that and hot weather is not helping.

I know your OH is not taking diabetes very seriously at the moment. Could you "shock" him into by sitting him down and saying "Please sign this will and funeral plan" - if he asks why you could simply say that "carry on the way you are with your diabetes treatment and you will be dead sooner rather than later and I would like to be prepared" - and walk away for a while. Obviously you know better than the rest of us whether this is viable to do.

I really do think there is a need for counselling to be offered to users when they have been diagnosed and the NHS is not providing it. I have been diagnosed just over a year and there are times I still can't deal with the fact that this disease will be with me for the rest of my life.

Thanks for the link to the website about drug interactions....it was really useful. The only problem I found was that for some reason it did not recognise gliclazide as the name of a drug....perhaps it is called something else where the website is based....instead I used 'glipizide' which I guessed was their equivalent.

Anyway, the result was a list of about 15 possible interactions between the drugs he is currently taking, one of which was described as 'major' and the rest as 'moderate' .........for the time being I have cut and paste this into a word document so that I can refer back to it later but think that I will definitely be taking a trip down to the local pharmacist later this week to get their expert opinion. I am guessing that I can ask a general question about interactions between a list of drugs without breaching any confidentiality.

With regards to the will / funeral plan it is a great idea but doubt it will work.....his comment to the diabetic nurse the other day was something to the effect of "well i'm not bothered about it - I have got to die of something".....hardly the comments of someone who would respond to the shock tactic that you and others have suggested but thanks for the thought.

I would certainly agree with you about the counselling as support is essential for people dealing with this...whether they accept it or not would be another matter...but it should be on offer. I would also suggest that some support should be available for partners or carers of those diagnosed with diabetes as there is an impact on them as well as I myself know.

Hope you manage to find your own way of dealing with this.

 

[Molly56]

@Molly56 - your doc or nurse would have to listen to what you say. They may feel unable to make comment back specifically about your husband.

You might have to employ the classic feedback techniques with then (as well as your husband). By that I mean, for example, "when x scenario happens it makes me feel y". Or "when I encounter x scenario with someone I know, I don't know how to react." That opens a targeted discussion, hopefully.

I appreciate you have just had a few days away, and he went away too? What would he do if you stopped doing anything for him, like cooking, or reminding him to take his meds?

It would be curious to know how he was with his son. If he tested or behaved differently. Sometimes people can desperately want to change but not want to "lose face", as they see it, by making that change.

It's a frustrating dynamic for you, that's for sure.

Yes I too would be curious to know how he has been these last few days but guess I will never know unless either he or someone else tells me.

One thing I can more or less guarantee is that he would not have tested ....I expect the testing kit was left at home, in fact I would put money on it being left at home! - .............he still doesn't get it about the need to test which he should at least do before driving....even though he was driving when he went away, but what can I do????

Will have to wait and see what I find when I get home tomorrow evening.

 

[AndBreathe]

Yes I too would be curious to know how he has been these last few days but guess I will never know unless either he or someone else tells me.

One thing I can more or less guarantee is that he would not have tested ....I expect the testing kit was left at home, in fact I would put money on it being left at home! - .............he still doesn't get it about the need to test which he should at least do before driving....even though he was driving when he went away, but what can I do????

Will have to wait and see what I find when I get home tomorrow evening.

Could you ask his son, on the basis he's on some new meds, and you're keeping a weather eye out for any side effects, like fatigue, etc., etc. Perhaps don't ask about the testing.....

There would be nothing tooooooo duplicitous is that sort of questioning. Your concerns are genuine. Does his son understand anything about his diabetes etc.?

 

[Molly56]

Could you ask his son, on the basis he's on some new meds, and you're keeping a weather eye out for any side effects, like fatigue, etc., etc. Perhaps don't ask about the testing.....

There would be nothing tooooooo duplicitous is that sort of questioning. Your concerns are genuine. Does his son understand anything about his diabetes etc.?

@AndBreathe That's a possibility I guess ...will wait and see what situation is when I get home.

Had not changed the medication before we went away but planned to do that on our return so that I can see what effects it is having and deal with any issues that arise.......will change / increase dosage from Monday....I did tell the diabetic nurse what I planned to do and she was ok with that,

 

[Molly56]

A couple of days ago my partner mentioned that his foot hurt and asked me to take a look as he finds it difficult to see / reach his feet due to hip and knee problems. I noticed that on his right heel he had a small sore where his shoes had obviously rubbed and created a blister...
I did mention to him at the time that he should get it looked at by the nurse but he has dismissed this suggestion - he has got an appointment booked with the podiatrist on 14th August but my feelings are that he should get this looked at sooner than that. I also mentioned that he should really be wearing socks with his shoes but once again this advice was dismissed.
Don't know what I can do other than keep an eye on it and keep suggesting that he gets it looked at - but if he won't then I guess any consequences will be down to him.

 

[phoenix]

The only problem I found was that for some reason it did not recognise gliclazide as the name of a drug....perhaps it is called something else where the website is based....instead I used 'glipizide' which I guessed was their equivalent

Gliplizide is not the same drug as gliclazide. http://en.wikipedia.org/wiki/Glipizide
Gliclazide is not marketed in the US so that's probably why it's not there. You might find it under diamicron.
It's probably better to talk to a pharmacist, that is their field.

And yes do try to impress on him the necessity of having his foot looked at. If it's open then it can become infected.

http://www.everydayhealth.com/diabetes/type2/treating/tips/treating-a-blister.aspx