88 year old father, advice

eeyores61 said:

My father's diabetic nurse (he's type 2) doesn't seem to be alarmed by his pre-breakfast readings which typically are around 10-12. She keeps telling him that the readings go up as you get older. He's just been refused surgery at his pre-op because (after breakfast) his reading was 20. He's upset and I'm furious! What do you think he should be aiming for at 88? All advice appreciated.

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Wow those are a bit on the high side. I've seen a few posts previously from some lovely older folk on here and no matter their age some still aim for lower numbers. It can be difficult for the elderly especially if they are in a rest home or somebody else cooks for them as they are limited with the choices of what they can eat. Also changing the habits of a lifetime can be hard especially when it comes to food.

eeyores61 said:

My father's diabetic nurse (he's type 2) doesn't seem to be alarmed by his pre-breakfast readings which typically are around 10-12. She keeps telling him that the readings go up as you get older. He's just been refused surgery at his pre-op because (after breakfast) his reading was 20. He's upset and I'm furious! What do you think he should be aiming for at 88? All advice appreciated.

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HI and welcome.. the first thing to do maybe to get him to a better nurse?
I'll tag in @daisy1 for some helpful tips about dietary changes but it might be useful if we know where your dad is?
At home, with you , care home? Also does he want to have lower blood sugars?

@eeyores61, what meds is your dad taking? My dad was the same age 88 and took 40mg gliclazide a day, blood sugars were always around 10 I think. He lived with me and one day a few months ago he had the most horrendous hypo where I had to call an ambulance who took over 2 hrs to get his blood sugar up above 5. He never really seemed to recover fully and died 3 weeks later, he wasn't ill and I'm not sure whether the hypo was a symptom of his body giving up or the cause of it. All I would say is that a blood sugar of 10-12 in someone of 88, particularly if he's on meds like gliclazide, is far safer than trying to achieve tight control. If he spikes up to 20 after a meal but is back to 10-12 after a couple of hours then that may be reasonable. Elderly people's systems react much slower than ours, their kidney function deteriorates which means they don't clear the meds they take from their bodies as effectively and are more at risk of accumulation. I think it depends on how he feels, if he feels unwell at those levels then things may need to tighten up, but if he's fine I personally would leave him be.

Lally123 said:

but if he's fine I personally would leave him be.

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Except he has been refused surgery and that has upset him and he will be stressed over it. So that cannot be defined as fine if the surgery is important then his blood sugars need to come down this should be discussed with his medical team.

JohnEGreen said:

Except he has been refused surgery and that has upset him and he will be stressed over it. So that cannot be defined as fine if the surgery is important then his blood sugars need to come down this should be discussed with his medical team.

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I agree with that but it's very unusual for an op to be cancelled on the strength of one fingerprick that could have a whole load of different reasons for being high. Usually they look at the hba1c but the OP hasn't given many facts to go on yet. If all the time his sugars are 10-12, he feels fine and is taking his meds etc, I doubt many GPs would be too keen on tightening his control. If all the time he is around 20, dropping to 10-12 overnight when he tests, that's very different? Bit difficult to call when we don't know many facts!

eeyores61 said:

My father's diabetic nurse (he's type 2) doesn't seem to be alarmed by his pre-breakfast readings which typically are around 10-12. She keeps telling him that the readings go up as you get older. He's just been refused surgery at his pre-op because (after breakfast) his reading was 20. He's upset and I'm furious! What do you think he should be aiming for at 88? All advice appreciated.

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You (and we) need a little more information.

What was his last HbA1c? (this is a blood test all diabetics have at least once a year, often more frequently) that measures our blood glucose average over the previous 2 to 3 months) Normally it is this figure that determines whether operations can go ahead, and needs to be under a certain level. If the result of 20 was simply a finger prick test, it really doesn't mean a great deal on its own. Yes, it was high, and was probably the result of his breakfast combined with the stress of the pre-op.

Which diabetes medications does he take?

Interestingly, I have just read an article on "blood control for older adults with diabetes" (https://www.health.harvard.edu/blog...-for-older-adults-with-diabetes-2018091714772).

I think this general gist is "it depends".
If the person is generally fit, there is no reason not to maintain good control.
However, given the reason for low numbers is to reduce risk of complications in later life, as people with diabetes age, this risk becomes less important and the concern is more around hypos.

(https://www.health.harvard.edu/blog...-for-older-adults-with-diabetes-2018091714772).[/QUOTE]
This is exactly what my doctor told me about new guidelines for the the over 70's and not having BG levels to low because of the problems that can cause them

Pinkorchid said:

(https://www.health.harvard.edu/blog...-for-older-adults-with-diabetes-2018091714772).

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This is exactly what my doctor told me about new guidelines for the the over 70's and not having BG levels to low because of the problems that can cause them[/QUOTE]

But that only applies where there is a risk of hypos. The risk of hypos is not a factor unless the person is taking insulin or medications that work on the pancreas to lower blood sugar levels, such as Gliclazide. A person on diet only or drugs such as Metformin are highly unlikely to have hypos.

Personally I regard the modern diet as wrong for us at any age.
My metabolism was dragging along the bottom on a high carb diet thought to be 'cholesterol reducing' and now that I am doing everything wrong, according to conventional wisdom, I feel so much better, and younger and have more energy.
If your father is not on glucose reducing medication then he also might benefit from a low carb diet.
What was the breakfast which resulted in the 20?

Its true that most diabetics would not be refused surgery because they have a high blood sugar. Was he planned as a day case?
They are usually put on a IV dextrose and saline when fasted and given sliding scale insulin via a IV pump and the dose adjusted on BS until after the surgery and they are eating normally. This is hospital so it would depend on the setting.

Looking at what I have seen with older people they let them run a bit higher because if they have a hypo and have mobility problems they can not react as quickly to a hypo and often they are living on their own and their is no one to help or notice if they are unwell. There are lots of older people who have can manage their diabetes on lower numbers but they usually have a really good understanding of their disease. It may that he has been advised to have a snack at night and that just increasing his BS levels if he has his main meal in the evening.
It may be just some tweaks in his diet would get the numbers down but this all depends on him. Does he want to be tested pre and post meal and record what he eats and adjust his diet? If he is making his own meals and what can he cook?
Most ready meals are high carb, you really have to label check. If you go on,
http://www.mysupermarket.co.uk/, it gives you most of the nutritional information for most things in the major supermarkets so you can make him a shopping list of easy cook low carb foods that he would like to eat. The obvious things to avoid that are recommended baked beans, anything with pasta and a lot of soups are high carb, even the ones that look as if they shouldn't be.
If you go through his larder and fridge you can probably work out the culprits.
If he is like my husband he probably likes nice white sliced bread to make a sandwich, which is easy but full of carbs. So I would think the hard part is finding foods that are low carb that he will like to eat.
I would start with some basic food swops, ditch the fruit and add more leafy veg, cut potatoes but increase the meat content of a main meal so he is not hungry and if possible check his BS more.

My father, T2, no meds, aged 86, is on a low carb diet and aims for blood glucose levels in the low pre-diabetic range.
He finds that his mind is much clearer and less foggy that way.
High blood glucose levels are known to cause brain fog, attention deficit and memory issues (I experienced this in my 40s, and it gets worse with age). There are also links with higher blood glucose levels and the onset of Alzheimers.

This graphic shows comparable blood glucose levels. My father aims for an average blood glucose level in the 7-8 range.
I think both he and I would horrified if we were fed the 'it doesn't matter about your blood glucose levels, because you are old, and likely to die of something soon anyway' thinking.


Edited to add my father's age.

eeyores61 said:

My father's diabetic nurse (he's type 2) doesn't seem to be alarmed by his pre-breakfast readings which typically are around 10-12. She keeps telling him that the readings go up as you get older. He's just been refused surgery at his pre-op because (after breakfast) his reading was 20. He's upset and I'm furious! What do you think he should be aiming for at 88? All advice appreciated.

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My first thought? Get a better Diabetes nurse. She shouldn’t be ageist about blood glucose & everyone deserves a normal blood glucose if they can get one. Ask for specific low carb advice from a local health care professional. In our area some dietitians teach it as well as GPs and Nurses and your dad could be referred and you could attend with him. It’s in the NICE guidance - low GI, individualised carbohydrate recommendations Dec 2015 1.1.1 & 1.3.3

A couple of other ideas:

Have you and/ or your dad used the low carb programme on this website yet?

Have you seen the little videos by Dr Richard Bernstein called Diabetes University? He advocates lower amounts of carbs for breakfast because the blood glucose is often high in the morning.

You’re right that your dad deserves better.

Hope that helps

@eeyores61

Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it helpful for looking after your Dad. This is general information, not aimed at someone your Father's age.

BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

• Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why
  
  
• Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
  

The agencies looking after my mother in law when she was still at home were pretty useless - the first lot to go in would make her breakfast - toast and jam - the second lot would go in and ask her if she'd had breakfast, and when she could not remember, made her more toast and jam. Sigh.
Diet controlled diabetic - totally unsuitable food, no record made - I mean - you couldn't devise a worse way of going on.
Oh yes - then there were the meals on wheels and the huge slabs of sponge pudding and custard.

i'm def not an expert on this but if one says "on the high side" but "acceptable" i would assume something along the range of 140-170 mg/dl (7.5-10 mmol) and rather stable in that range. if he has been refused surgery i suppose the hospital does think that his current BSLs are too high. i think it would be advisable to have a more knowledgeable nurse too, who could carb count his meals and check his reactions to his meds. hba1c would be informative of his overall diabetic status as it is the average of 3mos worth of BSLs. all the best for you and your dad.