Hi there, over the past six months dad has lost control of his type 2 diabetes,

cookie1

Member
Messages
6
Hi all,
Dad 87 has over the last 6 months lost control of his diabetes, he just been diagnosed with AF and blocked arteries of the neck, one full the other part full. He has been constantly tired going back to bed.
I've fitted him with the freestyle sensor to monitor his bloods as he confessed to only testing 2 a week, he taking novomix 30, 30 units in the morning and 30 units at night.
We saw the doctor today as some of his readings in the afternoons were as high 16 to 23, the doctor seems to think this is perfectly okay for a 87 year old man and prefer to be higher than lower.
I'm really confused as I would have thought this is being in the hyper state nearing ketosis and can't be good for you.
Can anyone explain the insulin resistance and insulin usage.
I've called the hospital to get an appointment with the nurse but not till 14 August.
Really confused.
 

xfieldok

Well-Known Member
Messages
4,182
Type of diabetes
Type 2
Treatment type
Tablets (oral)
What is he eating in a typical day. Could he do with losing a few pounds?
 

Brunneria

Guru
Retired Moderator
Messages
21,889
Type of diabetes
Type 2
Treatment type
Diet only
Hi and welcome @cookie1
I'm sorry your Dad is having problems.

from what I have heard, most health care professionals take the view that once their patients reach ‘a certain age’ then tight blood glucose levels are less important. I think their perspective is that the hassle and inconvenience affects quality of life more than the risk that diabetic complications will.

My view is that everyone’s age, food priorities, quality of life and current health conditions should be factored in. Plus whether the high blood glucose levels are affecting that very quality of life... The high blood glucose may be causing his need to rest so much.

Do you feel that your Dad’s doc is making a balanced decision? And is your father happy with those blood glucose levels?
Does your father know how to adjust his insulin dose in line with his carb intake?

you asked about whether the high levels might cause diabetic ketoacidosis.
There needs to be a combination of factors for DKA; high blood glucose and low insulin levels.
You can test your father’s ketone levels with a meter, if you like. You could ask his doctor for one, or fund it yourself.
Here is a link that explains DKA and how to watch for the symptoms.
https://www.nhs.uk/conditions/diabetic-ketoacidosis/

I am sorry you are having all this concern and worry, and I hope this information helps.
 

cookie1

Member
Messages
6
What is he eating in a typical day. Could he do with losing a few pounds?

Yes he could really, and is trying to his best but at 87 it's difficult to change habits. Also with his arthritis too it getting harder to make quick meals for himself.
 

cookie1

Member
Messages
6
Hi and welcome @cookie1
I'm sorry your Dad is having problems.


from what I have heard, most health care professionals take the view that once their patients reach ‘a certain age’ then tight blood glucose levels are less important. I think their perspective is that the hassle and inconvenience affects quality of life more than the risk that diabetic complications will.

My view is that everyone’s age, food priorities, quality of life and current health conditions should be factored in. Plus whether the high blood glucose levels are affecting that very quality of life... The high blood glucose may be causing his need to rest so much.

Do you feel that your Dad’s doc is making a balanced decision? And is your father happy with those blood glucose levels?
Does your father know how to adjust his insulin dose in line with his carb intake?

you asked about whether the high levels might cause diabetic ketoacidosis.
There needs to be a combination of factors for DKA; high blood glucose and low insulin levels.
You can test your father’s ketone levels with a meter, if you like. You could ask his doctor for one, or fund it yourself.
Here is a link that explains DKA and how to watch for the symptoms.

I am sorry you are having all this concern and worry, and I hope this information helps.

I feel the doctor is factoring his age as a diagnostic instead the quality of his life, being asleep in bed is not doing his mental health any good either, I imagine it is easier for the doctor to say to him he is doing fine for his age, but he doesn't want to feel like this but can't do it by himself, how do I persuade them to help, I know about type 1 as my son has it but type 2 I'm flummoxed.
 

EllieM

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Staff Member
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9,208
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My (now 90) year old dad has been T2 for ten years and went lower carb 18 months ago. He sticks to less than 30g a meal, and has mostly dropped bread, potatoes, pasta, rice. This allowed him to come off meds (he was on gliclazide) lose weight and generally look/feel much healthier. He buys 1 person heat up meals for his evening meal but chooses ones with less than 30g carbs. His bgs are now slightly higher than normal (his nurse took him off his last gliclazide tablet without doing an hba1c, which I wasn't impressed by, but honestly his levels are probably better than mine as a T1 diabetic). My brother and he have been isolating from COVID together so my brother has been cooking low carb even meals during lock down (it suits them both as my brother was probably heading for T2 before he went low carb).

The potential issue with your dad is that the insulin may cause hypos if he reduces his carbs without reducing insulin (though at levels that high some reduction in carbs will probably just normalise his levels). Is there anyone living with him to help with the management? (I believe you can get a transmitter to attach to your dad's libre to allow it to send readings to a phone and possibly then to your phone. Look up miao miao????)

Good luck.
 
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Jaylee

Oracle
Retired Moderator
Messages
18,213
Type of diabetes
Type 1
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Insulin
I feel the doctor is factoring his age as a diagnostic instead the quality of his life, being asleep in bed is not doing his mental health any good either, I imagine it is easier for the doctor to say to him he is doing fine for his age, but he doesn't want to feel like this but can't do it by himself, how do I persuade them to help, I know about type 1 as my son has it but type 2 I'm flummoxed.

Hi,

The higher reading from the Libre with your dad, had they been double checked against a BG meter?
I find the Libre can sometimes way out be out? (within 0.6/0.8 I'm personally not so fussed.) but I do calibrate my data with a 3rd party reader app on my phone.

I'm not certain what insulin regime your son uses, but your father's looks like fixed dosage, so his diet may need to be more regimented regarding his meal timings & carb content? Unlike an MDI regime. With any insulin use testing is paramount.

My father was also T2. Though, was not on exogenous insulin. During a stay in hospital once, a nurse felt his BG in the mid teens was "good."
Until I reminded her she was telling a T1 how to suck eggs..

I will tag in @urbanracer , also T1 he may have more recent memories of fixed mixed dosage regimes.
 
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Resurgam

Expert
Messages
9,849
Type of diabetes
Type 2 (in remission!)
Treatment type
Diet only
Hi all,
I'm really confused as I would have thought this is being in the hyper state nearing ketosis and can't be good for you.
Can anyone explain the insulin resistance and insulin usage.
I've called the hospital to get an appointment with the nurse but not till 14 August.
Really confused.
Are you confusing DKA with ketosis? They are very different states.
 

urbanracer

Expert
Retired Moderator
Messages
5,186
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Not being able to eat as many chocolate digestives as I used to.
Hi,

The higher reading from the Libre with your dad, had they been double checked against a BG meter?
I find the Libre can sometimes way out be out? (within 0.6/0.8 I'm personally not so fussed.) but I do calibrate my data with a 3rd party reader app on my phone.

I'm not certain what insulin regime your son uses, but your father's looks like fixed dosage, so his diet may need to be more regimented regarding his meal timings & carb content? Unlike an MDI regime. With any insulin use testing is paramount.

My father was also T2. Though, was not on exogenous insulin. During a stay in hospital once, a nurse felt his BG in the mid teens was "good."
Until I reminded her she was telling a T1 how to suck eggs..

I will tag in @urbanracer , also T1 he may have more recent memories of fixed mixed dosage regimes.

Thanks @Jaylee.

Not sure I can bring anything new to the table. You, @Brunneria and @EllieM have pretty much summed it up from my point of view.
 

Daibell

Master
Messages
12,642
Type of diabetes
LADA
Treatment type
Insulin
Hi. I'm guessing that your father is eating far too many carbs? The insulin levels he is taking implies some insulin resistance? The doctor hasn't a clue when he talks about the BS levels you quote being OK; that's worrying. Your dad should be going for similar levels that we aim for. I suspect by keeping him high they avoid him going hypo and needing the extra care for that. Is your Dad having an annual review with HBA1C blood test?
 

cd667

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
@cookie1 I am assuming you are in the UK.

Do you have a Health & Welfare LPA appointing you as an attorney for your father'? If you disagree with his medical treatment it can be the only way to get medical professionals to take your views into account. Old people often lose their voices. :(

£200-£250ish is the going rate to get one made, and there is a registration fee of £82. Run away from anyone that wants to charge you less or more than this figure.

(MODS I write LPAs and Wills for a living but I am not soliciting any of my professional services - just suggesting cookie1 might want to look at doing this.)
 

bulkbiker

BANNED
Messages
19,576
Type of diabetes
Type 2
Treatment type
Diet only
@cookie1 I am assuming you are in the UK.

Do you have a Health & Welfare LPA appointing you as an attorney for your father'? If you disagree with his medical treatment it can be the only way to get medical professionals to take your views into account. Old people often lose their voices. :(

£200-£250ish is the going rate to get one made, and there is a registration fee of £82. Run away from anyone that wants to charge you less or more than this figure.

(MODS I write LPAs and Wills for a living but I am not soliciting any of my professional services - just suggesting cookie1 might want to look at doing this.)

LPA's are just a form to fill out.. I've done several for family members.

Edit to add link to gov.uk site https://www.gov.uk/power-of-attorney
 

cd667

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
LPA's are just a form to fill out.. I've done several for family members.
You will notice that at several points on the form, you are told to seek legal advice.

Many people have written LPAs themselves which have turned out to be unusable because they didn't understand the implications of what they put on the form. An LPA that doesn't work is worse than useless because you think you're covered but when it comes to registration time you find it doesn't work like you think you will.

Between 2012 and 2015 the Office of the Public Guardian received over just over a million LPA applications and out of those, 15,000 were rejected outright and 130,000 were considered imperfect for registration(they didn't go through, or didn't work as intended). I'm still new here so I can't post links, but if you Google "Our Reference: 97860 June 2015 Freedom of Information Request" you will see the statistics directly from the OPG.

I was involved with the consultation that led to the development of the LPA, and I can tell you the OPG were heavily criticised for their implication that the form is something you fill out yourself. It makes no odds to us - my industry makes much more money from people who don't write Wills and LPAs properly than we do out of people who do - but it can be a real mess when things go wrong.

TL: DR; The form is simple, but the law around LPAs is extremely complex. Nearly 10% of DIY registrations fail. Do you really want to try to do this yourself?
 

bulkbiker

BANNED
Messages
19,576
Type of diabetes
Type 2
Treatment type
Diet only
You will notice that at several points on the form, you are told to seek legal advice.

Many people have written LPAs themselves which have turned out to be unusable because they didn't understand the implications of what they put on the form. An LPA that doesn't work is worse than useless because you think you're covered but when it comes to registration time you find it doesn't work like you think you will.

Between 2012 and 2015 the Office of the Public Guardian received over just over a million LPA applications and out of those, 15,000 were rejected outright and 130,000 were considered imperfect for registration(they didn't go through, or didn't work as intended). I'm still new here so I can't post links, but if you Google "Our Reference: 97860 June 2015 Freedom of Information Request" you will see the statistics directly from the OPG.

I was involved with the consultation that led to the development of the LPA, and I can tell you the OPG were heavily criticised for their implication that the form is something you fill out yourself. It makes no odds to us - my industry makes much more money from people who don't write Wills and LPAs properly than we do out of people who do - but it can be a real mess when things go wrong.

TL: DR; The form is simple, but the law around LPAs is extremely complex. Nearly 10% of DIY registrations fail. Do you really want to try to do this yourself?

I did them all myself and have completed 4 sets of forms (2 medical and 2 financial) all have "worked" perfectly effectively so I'm not sure what you are trying to prove.

No requirement for any corrections whatsoever. Your own figures they show that 870,000 of that 1 million went through fine so....
 

cd667

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
No requirement for any corrections whatsoever. Your own figures they show that 870,000 of that 1 million went through fine so....
... so 1 in 10 didn't? I wouldn't fancy those odds.

Besides, that's only one of the problems people find when they write their own LPAs. It is possible to register an LPA without issue but find it doesn't work as you intended later on. The classic problem is people appointing several attorneys and stipulating that they have to act jointly. If one of them dies or loses capacity, the LPA is useless because they can't all agree. I could think of others(I'm great at parties!). Actually, there are books about some of the other issues. I'll send a reading list if you're interested.

For the amount of money it costs to get a professional to write an LPA for you (and cover you with their PI if it goes wrong), I don't know why you'd take the risk to do it yourself.

Well, you would, obviously. But that's your choice. :)
 

cd667

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
Sure was thanks..
Yes, but should that be the choice that other people make? Should you, as a lay person, offer advice about LPAs to other people?

I am just a middle of the range legal practitioner working in a small practice. I am, however, qualified to give people advice about LPAs. I reckon that since they came out in 2008, I have written about 8,000, with about the same number of EPAs before that. How about you?
 
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
@cd667 and @bulkbiker do you mind taking your discussion about LPAs into a seperate thread? I feel that your dispute has kidnapped this thread which should be about support for cookie1. Thanks!
 
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cd667

Member
Messages
8
Type of diabetes
Type 2
Treatment type
Diet only
I have nothing else to say. Although I agree it got sidetracked by my discussion with @bulkbiker, for which I apologise. It's a bugbear of mine.

Please, please @cookie1 , get an LPA done by a professional if you haven't done so already. Recent case law has shown an increasing reluctance by local authorities to involve families in decision making due to time and financial constraints. This is only going to get worse as their resources are stretched thinner by covid and the oncoming recession.
 

cookie1

Member
Messages
6
Hi,

The higher reading from the Libre with your dad, had they been double checked against a BG meter?
I find the Libre can sometimes way out be out? (within 0.6/0.8 I'm personally not so fussed.) but I do calibrate my data with a 3rd party reader app on my phone.

I'm not certain what insulin regime your son uses, but your father's looks like fixed dosage, so his diet may need to be more regimented regarding his meal timings & carb content? Unlike an MDI regime. With any insulin use testing is paramount.

My father was also T2. Though, was not on exogenous insulin. During a stay in hospital once, a nurse felt his BG in the mid teens was "good."
Until I reminded her she was telling a T1 how to suck eggs..

I will tag in @urbanracer , also T1 he may have more recent memories of fixed mixed dosage regimes.


Thank you so much.