This question is for my mom, she has diabetes

[hollyvoodoo]

She is 67 years old, height 62.2 inches, weight 145.5 lbs with her clothes on. She was diagnosed in March of this year when she ended up in the ER in a coma that followed glucose injections. Her blood sugar was sky high. She had violent tremors in her right hand and couldn't get up out of bed to use the bathroom... The doctor said she's already had diabetes for 2-3 years at that point. She also has hypertension, oxaluria, and ischemic heart disease. Her blood sugar levels were gradually lowered with Mixtard in the morning and Glucovance tablet in the evening. Over time Glucovance was no longer needed, morning blood sugar levels were within target range and these days we only use insulin when necessary. Mom thinks that because her pre-meal blood sugar is normal she doesn't need insulin. However, without it two hours later her blood sugar shoots up to 12.8 - 14.6! Does anyone know how much insulin shall i give her to keep her sugars normal? (under 8.5 two hours after she eats?) Also, at night she can't sleep because of aches and pains in her arms and legs. Is this diabetic neuropathy? Looking for any advice on how to make her better. Thanks in advance to everyone who took their time to read this.

 

[sanguine]

Hi Hollyvoodoo welcome

I can't help on the insulin dosage I'm afraid since I don't have any meds and keep control with diet only. Hopefully someone with T2 insulin experience will be along soon.

What I can do though is inquire what your mom typically eats? Meds have their role, but control of diet can have a significant impact which can reduce and ultimately minimise the need for them. Reducing starchy carbs (bread, potatoes, rice, pasta) is the key here as well as the obvious sweets, cakes, pastries and tropical fruit.

 

[Totto]

As Sanguine says diet is vital in treating type 2 diabetes.

What I would like to know what her one hour readings are if the two hour is so high. And what she ate of course.

What is her HbA1c? And her fasting bg in the morning?

 

[Bluetit1802]

It does suggest to me that her diet is what is causing all the problems, and as the others have said, for type 2's diet is the key.

Perhaps in addition to giving us details of her levels, you could give us a list of her typical day's diet.

 

[Paul59]

Don't think glucose injections help matters as sugar is what causes T2 in the first place, from what I have learned.

 

[Patricia21]

Hi and welcome.
Sorry about your Mum and hope she soon feels better.
I am older than your mum,and diet has made me better,Its not hard to do,but you must spend time reading round the posts,let your mum read with you.

 

[noblehead]

No one on the forum is in a position to advise on insulin doses, so I suggest your mum speaks with her diabetes care team about her postprandial blood glucose readings.

 

[Daibell]

Hi. Yes, diet is going to be key to helping your Mum. Her surgery should be providing guidance on insulin. If she is on a mixed insulin it is essential that you discuss changes with the surgery as it needs close monitoring. If it's a single insulin which is injected once or twice daily it becomes easier and NICE recommends aiming for a morning fasting level of 5 - 7 mmol and adjusting as necessary to meet that but you should seek guidance on how to make changes. Bear in mind that if you can get the weight down then the amount of insulin will also need to be reduced so keep in touch with the surgery.

 

[Robinredbreast]

I wish your mom all the best for a good recovery, good luck and make sure you look after yourself too.

Best wishes RRB

 

[bookmite]

I can't offer any advice ...but I can send you a virtual hug and hope your mum feels better soon

 

[hollyvoodoo]

Thank you all for your kind attention and time that you've spent reading and responding... I can't tell you how much i appreciate it!! Mom's diet is mostly low carb. Because of her kidney problems her protein intake is limited, and because of oxalates so is her calcium (eggs and dairy products). She eats only dark rye bread, buckwheat, chicken, fish, cucumbers, tomatoes (not every day), soups (beans, chickpeas, beets etc.), once in a blue moon a potato (or maybe less than half of one in her soup), cottage cheese with 10% sour cream, an egg twice a week at best... She does love peanuts. 25 a day keep the doctor away! or so i heard... At bedtime she likes plain yogurt and maybe a green apple, but not every day. She has days when her blood sugar is normal all on its own, even if she eats 3 pancakes. Then other times it goes up all by itself for no reason. For instance, she had stuffed eggplants (the stuffing is ground chicken breast with onion & shredded carrot), slowly stewed in tomato sauce. Not many carbs there, and yet her blood sugar shot to 12.8 one day and 13.6 the next, even though her pre-meal levels were 4.7 and 5.4... Apparently the 4 units i gave her weren't enough because last night two hours after dinner her blood sugar was at 11.7 -- today i'm thinking about giving her 5 or 6. That should do the trick.

 

[hollyvoodoo]

Mom's morning fasting levels are normal or slightly on the low end. 4.6. - 5.3 It's been a few months since she's needed insulin at breakfast time.

 

[hollyvoodoo]

I can't offer any advice ...but I can send you a virtual hug and hope your mum feels better soon

Thank you for the virtual hug, it means a lot!

 

[hollyvoodoo]

No one on the forum is in a position to advise on insulin doses, so I suggest your mum speaks with her diabetes care team about her postprandial blood glucose readings.

i was thinking perhaps someone could offer a few ideas from their personal experience. although i do realize everyone is different. We live in Azerbaijan and don't speak the local language well enough, that has been the communication barrier with the local doctors, most of whom appear not very knowledgeable (to say the least) and simply want you to pay for every step... That's why i'm seeking advice elsewhere.

 

[hollyvoodoo]

Don't think glucose injections help matters as sugar is what causes T2 in the first place, from what I have learned.

she lifted smth heavy and thought she was passing a kidney stone, that's how it all started. She had blood in her urine, then she was experiencing pains in the left side of her abdomen, shooting across and around from her back. My dad who lives and works in Russia consulted some local doctor he's known for quite some time over the phone. He said it was acute pancreatitis and prescribed Contrykal (?) intravenously, along with glucose. By then mom was unable to walk. it was a nightmare. i knew something was wrong and finally got her to a hospital -- where, by the way, she adamantly refused to go! but we (the paramedics and i) talked her into it...

 

[hollyvoodoo]

As Sanguine says diet is vital in treating type 2 diabetes.

What I would like to know what her one hour readings are if the two hour is so high. And what she ate of course.

What is her HbA1c? And her fasting bg in the morning?

fasting bg is 4.6-5.6 and she had two stuffed eggplants and a piece of dark rye bread and some garlic... The two days prior her pre-meal sugar was 3.9 she had buckwheat, chicken cutlet, cucumber and a piece of rye bread, and two hours later her bg was 12.8; then (the next day around same time, 5-6 pm) 5.0 / 14.8 accordingly, and the food was exactly the same.

 

[Brunneria]

Hi and welcome.

I would try getting her to eat the same meal on two days. Same portion sizes. Same everything - but leave out the rye bread on one day.

I have a surprisingly extreme reaction to grains - wheat, barley, rye, rice... You name it, it spike my blood glucose.

Worth a try. And if it makes no difference, then you have learned it isn't the grains!

 

[phoenix]

Hi, as said no-one here is able to give you advice about dosing but it's important to realise just what the insulin she is using does.
Mixtard is a mixed insulin so it contains 2 types of insulin.
One part is short acting insulin meant to cover meals, the other part is longer acting and deals with the glucose released during the day from the liver.
Mixtard comes in different proportions
Mixtard 30 is 30% short acting and 70% longer acting. Mixtard 40 is 40% short actin and 60% long acting Mixtard 50 is50/50.
If you increase a dose of mixed insulin you increase not only the insulin for the meal but also the longer acting dose released throughout the day.
It's important with these insulins to have a regular pattern of meals both in content and timing. They aren't really designed to be taken as and when necessary.
Here are some links that may help explain.
First a general introduction
http://dtc.ucsf.edu/types-of-diabet...nsulin-rx/types-of-insulin/pre-mixed-insulin/
second a more detailed talk about the use of mixed insulin
https://www.bd.com/us/diabetes/hcp/flash/premixed_insulin/BD_premixed_insulin.html
third Canadian guidelines on titration
http://guidelines.diabetes.ca/Browse/Appendices/Appendix3
but to be honest since her pre meal levels are quite low I think that this really needs to be discussed with the doctor. It maybe that another type of insulin or oral medication regime might be better.
Re the tingling, Have you actually tested her levels during the night?

 

[anna29]

she lifted smth heavy and thought she was passing a kidney stone, that's how it all started. She had blood in her urine, then she was experiencing pains in the left side of her abdomen, shooting across and around from her back. My dad who lives and works in Russia consulted some local doctor he's known for quite some time over the phone. He said it was acute pancreatitis and prescribed Contrykal (?) intravenously, along with glucose. By then mom was unable to walk. it was a nightmare. i knew something was wrong and finally got her to a hospital -- where, by the way, she adamantly refused to go! but we (the paramedics and i) talked her into it...

In a situation such as this - your mum was where she really needed to be .
Hospital with trained medic professionals to treat her condition via meds and oversee
and study her reaction(s) to the meds and treatments.

insulin therapy advice if a person requires/needs it .
This advice must come from the HCP's (healthcare practioners)
As all here are not medically qualified .

Phoenix - has provided some useful links and good info to read up on .
This info you can discuss with the doctors to try and make more positive
progress with your mum .

 

[hollyvoodoo]

Hi and welcome.

I would try getting her to eat the same meal on two days. Same portion sizes. Same everything - but leave out the rye bread on one day.

I have a surprisingly extreme reaction to grains - wheat, barley, rye, rice... You name it, it spike my blood glucose.

Worth a try. And if it makes no difference, then you have learned it isn't the grains!

i would be happy to try it because it makes total sense to me... unfortunately she can't fathom her meals without bread. She used to eat a lot of white bread. with butter. and cheese. and sweet tea for breakfast. i've been telling her for the longest time it's not healthy, and she took it the wrong way, like what i was really saying is that she is eating a lot... so now that she has finally settled for dark Russian rye bread (yeast-free), taking it away from her would likely equal me losing a limb!