Please help, confused by the options for Type 1

[lookingaftermum]

Hi all i am looking after my newly diagnosed Mum who is 82 and has Type 1. She has failed a memory test and after 4 weeks on Libre freestyle. nova-rapid and tresiba she still cannot look after herself and nearly gave herself a leathal does of rapid insulin the first night we trusted her alone.

We have moved her in with us but for the long term we cant do that, i work full time and cannot be around all the time. However i am really confused by the advice the diabetics nurses have given. They have said that the pump is not an option but the GP nurse said it would be. One nurse told me about a twice a day option, but another nurse said that doesn't exist?

We will need to get district nurses in, but other than her diabetic treatment she is fairly independent and heads out most days so to have to stay in all day for a nurse three times a day will really impact on her quality of life, can anybody help?

 

[Antje77]

They have said that the pump is not an option but the GP nurse said it would be.

I think the diabetic nurses are correct, and the GP nurse may have a too rosy idea on insulin pumps, GP nurses don't regularly encounter patients with pumps.
To use a pump, you need to be able to calculate carbs and mealtime doses, it doesn't do all the work by itself. So that would be as complicated as using the right amount of insulin with a pen.

One nurse told me about a twice a day option, but another nurse said that doesn't exist?

Twice a day insulin for T1s would be a mixed insulin, so long and short acting in the same pen. It used to be the standard treatment until people found out that many diabetics prefer the flexibility of a separate basal and bolus system, even if that is more and more complicated work.

On a mixed inslin you need to eat and likely snack at set times to adapt to the action of the insulin. A mixed insulin cannot give as tight control as a basal bolus approach when used by someone who has a very good understanding of how it works and how to decide on doses.
For someone with memory issues, basal and bolus must be a nightmare, and a dangerous nightmare too!

Regular eating times and twice a day fixed doses (administered by herself or by a nurse) would be a nightmare for me, but could well be a blessing for your mother, preserving her independency.
The nurse that said it doesn't exist, was she very young?
I think the mixed insulins were still commonly used until some 10 years ago, and they're still regularly used in T2s.

 

[Daibell]

Hi. I agree that twice-a-day mixed might be the best solution in this case. Of course it still exists and that 'other' nurse was wrong.

 

[ElenaP]

Hi all i am looking after my newly diagnosed Mum who is 82 and has Type 1. She has failed a memory test and after 4 weeks on Libre freestyle. nova-rapid and tresiba she still cannot look after herself and nearly gave herself a leathal does of rapid insulin the first night we trusted her alone.

We have moved her in with us but for the long term we cant do that, i work full time and cannot be around all the time. However i am really confused by the advice the diabetics nurses have given. They have said that the pump is not an option but the GP nurse said it would be. One nurse told me about a twice a day option, but another nurse said that doesn't exist?

We will need to get district nurses in, but other than her diabetic treatment she is fairly independent and heads out most days so to have to stay in all day for a nurse three times a day will really impact on her quality of life, can anybody help?

It is good that your mother is using Libre sensors, so she gets warnings of lows and highs. If she was diagnosed only four weeks ago, it is very early days and some errors with insulin are bound to happen.

I am wondering what you really mean when you say that your mother 'failed memory test'? If she is capable of going out every day and finding her way back home, have you been told to what extent she 'failed the memory test'? Perhaps early stages of dementia, in which case she can learn about carbohydrate counting and injections. Perhaps you could learn about carbohydrate counting and insulin ratios as well, so that you could spend a couple of minutes with her before each meal to check dosage, when you are at home. (And if late Type-1 runs in the family, then you will already know a lot if you get it in years to come.) If your mother likes to go out during the day, perhaps she could agree not to have any lunch while she is out? it is possible for her to have supervised (by district nurses) fast-acting insulin injections for breakfast and dinner, and supervised slow-acting background insulin once a day before bed (Tresiba).

Trust the hospital diabetes nurses. Before anyone goes on an insulin pump they have to be confident about carbohydrate counting and managing their diabetes with injections. (When babies are put on insulin pumps, their parents work with diabetes specialist nurses to learn about carbohydrate counting and insulin ratios.) Managing insulin pumps is time consuming and hard work, and they go wrong sometimes or infusion sets get occlusions.

As far as '..nearly gave herself a lethal dose...', I have a type-1 friend who injected Novorapid instead of Tresiba although the insulin pens are different colour. And that has happened to many other people.

Take a deep breath. Trust the hospital diabetes specialist nurses and endocrinologist. In my experience GPs know very little about Type 1 diabetes, and nurses at the GP surgeries are mostly trained to help those with type 2 diabetes.

 

[ElenaP]

Hi all i am looking after my newly diagnosed Mum who is 82 and has Type 1. She has failed a memory test and after 4 weeks on Libre freestyle. nova-rapid and tresiba she still cannot look after herself and nearly gave herself a leathal does of rapid insulin the first night we trusted her alone.

We have moved her in with us but for the long term we cant do that, i work full time and cannot be around all the time. However i am really confused by the advice the diabetics nurses have given. They have said that the pump is not an option but the GP nurse said it would be. One nurse told me about a twice a day option, but another nurse said that doesn't exist?

We will need to get district nurses in, but other than her diabetic treatment she is fairly independent and heads out most days so to have to stay in all day for a nurse three times a day will really impact on her quality of life, can anybody help?

I've just noticed Antje's posting, so you can ignore mine!

 

[ElenaP]

Libre freestyle.

To prevent your mother's Libre sensors being dislodged when dressing/undressing, it will be a good idea to cover the sensor with with Hypafix, or similar plasters.