Elderly insulin dependant, dementia and forgetting

[RosieApples]

Hello
Wondering if anyone can assist/advise/offer advice.

Father is 88 years old. Been injecting for last 40 odd years. He measures and injects himself. We have never had to interfere.

He is now developing dementia and it's progressing very fast. Too fast for our liking.. like changing every few days now.

We can't speak to a doctor till the 15th May and we even explained the situation! BUT... here's the issue.

The last few days he keep missing his injections as he's forgetting. He's writing 50 in his book, but not administering it. Then later on.. he thinks he has had it.

Hes dropping as low as 3 and not doing great. Mother is managing to keep him going by giving him the fruit drops and those little square sweets etc when he goes so low..

Mother is struggling to help as she has bad Parkinson's and cannot administer the insulin for him.

What on earth do we do? We are new to this and open to ideas and suggestions.

Are there diabetic nurses that assist daily care? Are there homehelpers that are allowed to do it?

We are so green to this all. It's really just jumped so fast, we're learning as we run..

HELP!


(apologies for not using correct terms.. tbh - I haven't got a clue and having to google and learn very quickly, so that we can help)

 

[Antje77]

Yikes, what a difficult situation for all involved, @RosieApples !

Hes dropping as low as 3 and not doing great. Mother is managing to keep him going by giving him the fruit drops and those little square sweets etc when he goes so low..

Did he have those lows before as well?
If this is a new thing it may be that he's eating less than he's used to, or even that he sometimes accidentally takes his insulin dose twice.
Forgetting an injection would make you go high, not low.

What on earth do we do? We are new to this and open to ideas and suggestions.

Are there diabetic nurses that assist daily care? Are there homehelpers that are allowed to do it?

How often a day does he take insulin? If only once or twice a day I think it would be possible to get a nurse to do them for him, but if he needs to inject before every meal as well as morning and/or night this may be more difficult.

I'm not from the UK so I'm not sure where you need to go for urgent help, but I'm tagging @AndBreathe for you, I think she's quite knowledgable on this kind of stuff.

I wish you and your parents all the best!

 

[Sarah69]

I would think you need a district nurse to come in to do injections.

 

[RosieApples]

Thank you Antje77 x

Yes he has had lows before.. but they are normally when he's eaten very little and not felt well. We've had to call 999 before, when we was so delusional and confused and then going in and out of consciousness. The paramedics have always been great and kept him going.

Mother can tell when he's too low as his speech is slurred and hes confused (more than normal!).. it's this point that she tries to get him to eat.

He does it 3 times a day. Normally before a meal.

It's the evening injections mainly - that he keeps missing out on.

Hearing what you said.. none of us had even considered the possibility of double injections. How on earth did we not consider this!! deary me.
So just to get my head straight..

If he 'double injected'.. this would cause him to go low? Yes?

oh my days. We need help don't we

 

[RosieApples]

I would think you need a district nurse to come in to do injections.

that's what I was thinking.. thank you for responding

 

[Hopeful34]

Yes, if he double injected, he would go low, but it could be that he's not carb counting his meal correctly that's causing the low's or that the amount of insulin he needs as his background (basal) has dropped, or the amount of insulin for 10g carbs has changed (I'm assuming here that he's not on fixed doses at meal times here), it can be different at every meal, or if his blood sugar is high he may be giving too much insulin as a correction dose.

Sorry if this is too much information, I'm just trying to say that there's lots of reasons for blood sugar going too low.

As for help:

You can ask for a referral to the hospital diabetes team, who have far more than experience than most gp's.
You can get insulin pens that show the time the last dose of insulin was given, and some show the amount given I think. Someone on the forum who uses them will give you the names, I'm sure.
You can ask for a Libre 2 which monitors blood sugar (well technically the interstitial fluid) continuously), and you could get the readings on your phone as well if that was acceptable to your father.

Hope some of this is useful, it's a lot to get your head round.
Sending hugs.

 

[RosieApples]

Yes, if he double injected, he would go low, but it could be that he's not carb counting his meal correctly that's causing the low's or that the amount of insulin he needs as his background (basal) has dropped, or the amount of insulin for 10g carbs has changed (I'm assuming here that he's not on fixed doses at meal times here), it can be different at every meal, or if his blood sugar is high he may be giving too much insulin as a correction dose.

ok, i will make sure mother is aware of that. He does alter each does according to the 'reading'

Sorry if this is too much information, I'm just trying to say that there's lots of reasons for blood sugar going too low.

As for help:

You can ask for a referral to the hospital diabetes team, who have far more than experience than most gp's.
You can get insulin pens that show the time the last dose of insulin was given, and some show the amount given I think. Someone on the forum who uses them will give you the names, I'm sure.

that would be very very helpful. Google is great.. but this forum and real life diabetics are so helpful and you all know so much.

You can ask for a Libre 2 which monitors blood sugar (well technically the interstitial fluid) continuously), and you could get the readings on your phone as well if that was acceptable to your father.

ok, is this something we buy ourselves.. is it on the nhs? i've seen an advert i think for a similar item. Is it like a sticker that goes on his arm? If so.. is it surgically put on?

Hope some of this is useful, it's a lot to get your head round.
Sending hugs.

Massively helpful. Really appreciate your time and energy in helping us.

As dad has always done this. I suppose we have all been lazy and left him to it. But now his memory is declining so rapidly - it's made us all aware that we haven't got a clue!!

Thank you x

 

[jjraak]

Hello
Wondering if anyone can assist/advise/offer advice.

Father is 88 years old. Been injecting for last 40 odd years. He measures and injects himself. We have never had to interfere.

He is now developing dementia and it's progressing very fast. Too fast for our liking.. like changing every few days now.

We can't speak to a doctor till the 15th May and we even explained the situation! BUT... here's the issue.

The last few days he keep missing his injections as he's forgetting. He's writing 50 in his book, but not administering it. Then later on.. he thinks he has had it.

Hes dropping as low as 3 and not doing great. Mother is managing to keep him going by giving him the fruit drops and those little square sweets etc when he goes so low..

Mother is struggling to help as she has bad Parkinson's and cannot administer the insulin for him.

What on earth do we do? We are new to this and open to ideas and suggestions.

Are there diabetic nurses that assist daily care? Are there homehelpers that are allowed to do it?

We are so green to this all. It's really just jumped so fast, we're learning as we run..

HELP!


(apologies for not using correct terms.. tbh - I haven't got a clue and having to google and learn very quickly, so that we can help)

T2D here @RosieApples
So sorry no help with the injections side of type one.

Do have vast sympathy for the effects of the dementia.


My mum had it , start 2000..peaked at 2005, then mum needed more constant care.

I can only imagine the worry you have of dad injecting or forgetting to inject himself properly.

The strain this all places on mum, too...bless her.

Pretty sure you're now at the stage a visit from a nurse would be beneficial...if your doctors/GP can arrange it.

On a more negative note, sadly.
Mum progress sadly made her more confused and quite angry & aggressive, very out of character for her...and I'm sure for you father.
But best to be aware.

Sadly with dementia it becomes a case of looking out & caring for both parents.

The medicines used as mum progressed took mum from that angry phase to a more docile state, but removed any real interest or interaction.

I wish I could be offering better news, my only intent here was to make you aware the journeys gets tougher, for all.

And I hope you get as much help as possible for dad & mum, it's the least they deserve.

God bless you all.
And sincere hopes you can all find ways to manage dad's diabetes & dementia.

 

[Hopeful34]

You can get a free trial of a Libre 2 sensor from Abbott online. Each sensor lasts 2 weeks, and you apply it yourself. It's very easy, you just place the applicator on the back of your arm and press it in. This inserts a needle (which retracts) leaving a fine filament in your arm. It doesn't hurt.

The gp or hospital diabetes team can prescribe this for your father on the nhs, or alternatively a Dexcom one. If you google them you can find video's explaining how they work.

Edited to add: 'NICE guidelines recommend that if you are 18 years or older with type 1 diabetes, that you be offered a choice of intermittently scanned glucose monitoring (otherwise known as 'flash' for example Freestyle Libre) or real-time continuous glucose monitoring (CGM) on the NHS'

However, it can be a bit of a postcode lottery still, I'm afraid, so you may need to push to get one, but your father would have a good case in my opinion. Partha Kar is good to contact on twitter if you experience problems.

 

[Antje77]

You can get insulin pens that show the time the last dose of insulin was given, and some show the amount given I think. Someone on the forum who uses them will give you the names, I'm sure.

Do you know what brand or type of insulin your father uses?
All insulins by NovoNordisk can be used with a Novopen 5, Novopen 6 or Novopen Echo, which remember time and amount of last dose.
The downside to this could be that having new pens can be even more confusing for him than the pens he's used to.

Possibly stupid question but I wanted to ask anyway: With his quick deterioration, has he been tested for a UTI?
The elderly are often symptomless, and a UTI can cause very serious mental deterioration.

ok, is this something we buy ourselves.. is it on the nhs? i've seen an advert i think for a similar item. Is it like a sticker that goes on his arm? If so.. is it surgically put on?

If he's T1 and on insulin he should be eligible for them on the NHS, it gives alarms when he goes low and I feel this may be a great help for your mum.
You can go for a headstart and order a free trial here: https://www.freestyle.abbott/uk-en/getting-started/sampling.html#form

They last for 2 weeks and are easy to apply, although I think your parents will need help with this between your father's dementia and your mother's parkinsons.
You would likely be able to apply one without issue though.

They can be used with a reading device, which is not included in the free trial but which likely would be easier for your parents to use than the smartphone app.

 

[Outlier]

Possibly stupid question but I wanted to ask anyway: With his quick deterioration, has he been tested for a UTI?
The elderly are often symptomless, and a UTI can cause very serious mental deterioration.

I was about to say the same. I have come across this unsettlingly often with elderly people (I of course can't possibly be elderly) and it is very convincing. Easily sorted. Good luck.

 

[Hopeful34]

Just reading through this thread again, I remembered a very rapid deterioration in a friend with dementia, who it turned out had very low vitamin B12. Easily sorted with injections, so maybe it would be worth requesting blood tests.