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Ladybird

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Hello everybody,

I hope you don't mind helping me out a little as I can't find the answers I'm looking for anywhere else.

My father-in-law (age 70) has recently (3 months ago) been diagnosed with type 2 diabetes. His blood glucose was 14 (mmol/l) upon diagnosis and he was given one oral medication. Last week it was recorded at 20, 21 and 29 and he was given a second drug to take orally. (Sorry, I don't know what they're called.)

His usual GP who is supposed to be the diabetes specialist in on holiday but had said she only needed to see him every 3 months. He has seen a different one but they don't appear to be bothered. I'm usually very supportive of our GPs but feel that newly diagnosed patients with apparently uncontrolled diabetes should be very closely monitored.

Today I bought a home test thing for him and helped him figure it out and his BG was 24.8. This was 2.5 hours after breakfast.

He has suffered from depression on and off but the last year has been very bad. His symptoms of depression, anxiety and fatigue/lethergy are rapidly getting worse. He is sleeping most of the day quite regularly.

Now, my questions are...

What level of care would you expect from your GP or Practice Nurse?

How high is too high? At what level would you expect patients to suffer long term effects or more immediately, hyperglycemic coma? Should he avoid activities such as driving?

Could his symptoms of anxiety and sleepiness be caused by high blood glucose levels?

Is reglarly testing at home recommended while it is uncontrolled? Upon waking, before after meals, etc.?

Could it be type 1 rather than 2 if he's not responding to oral medication? (I really have no idea what the difference is.)

If you've got this far thank you very much for your time. I would really appreciate your comments.

Ladybird
 
Hi Ladybird, I am no expert, and someone will be along soon to give you some really good and relevant advice. Just want to let you know [if your practice hasn't already], that diet is of paramount importance. :!: Look around the site for some gems of advice, and be prepared to yell and scream if you have to, so that notice is taken of you F-I-L's needs. Testing is vital, so that you can eliminate foods which cause him to spike [have high readings], this is trial and error. Prior to gaining control of my BS, I was sooooooo irritable I was really unpleasant :oops: and fell asleep every time I sat down! This has eased greatly, and I hope you can achieve similar results for Father in Law. It can be done :!:
 
From what I have read here - it seems that sometimes a patient who was thought to be T2, turns out to be T1 after all. Sometimes this become evident because of a lack of response to T2 treatment.

My own unexpert opinion is that he should see a doctor soon, as for whatever reason, his bg isn't being controlled adequately. Thank goodness you had the sense to buy him a home testing kit, otherwise this unsatisfactory situation could have gone on until it did him real harm.

Hoping someone with expert knowledge will be along soon to help you.

Good luck - and well done for doing you best with your Dad in law. :)
 
You have come tothe right place, Ladybird. There is lots of information and useful advice on this site.

I'm not an expert and I'm sure someone far more knowledgeable will be along soon but meanwhile....

Your f-i-l's blood glucose levels are way too high. His gp should have given him some guidance as to what level he should be aiming for, depending on his circumstances but in general people with Type 2 should try for 4.0 - 7.0 mmol/l before meals and less than 8.5 mmol/l 2 hours after meals. Many people like to keep below these upper limits but that may not be appropriate for everyone.

IMO he needs to see his GP or practice nurse far sooner than in 3 months - I'd say every week until his BG starts to come down.

Depression, anxiety have been linked to high BG.

IMO regular BG measurement is essential but the NHS cannot afford to fund the provision of test strips so most people have to buy their own. They are expensive! Self-testing is the only satisfactory way to monitor progress and to establish which foods can be eaten with impunity and which cause alarming BG rises. People's responses differ.

Oral medication can only achieve so much. To get down to acceptable BG levels your f-i-l will almost certainly have to modify his diet and if possible increase his activity level. Many people find that reducing their intake of carbohydrates helps a lot. He may need insulin sooner or later - this does not necessarily mean he has Type 1 rather than Type 2 diabetes (they are different diseases) but that he is not producing enough insulin of his own. In the early stages of Type 2 there is usually sufficient insulin produced but the body may be unable to use it (insulin resistance).

I'll leave it there for now before you gointo information overload. There is a huge amount to get to grips with but it does get easier and you can learn a lot from this site.. Hope some of the above helps.

Best wishes to your f-i-l and yourself. He is lucky to have you.

MaryChristine
 
Your father-in-law is bound to be anxious knowing that his blood sugars are that high, and having high blood sugars will sap his energy too. I don't know what advice he has been given about diet but the foods that increase blood sugar the most is bread, food made with flour like scones, cakes, pastry, potatoes, fruit juice, lots of fruit and dried fruit, bananas, processed cereals, and drinks high in sugar. To start with eating vegetables, especially non-starchy vegetables with meat, poultry, fish, eggs and nuts, will bring down blood sugar and then your father-in-law and he can use the blood sugar monitor to how certain foods affect his blood sugar because the same food can affect people with diabetes to various degrees so that one person finds potatoes (especially mashed potatoes) affect them more than bread and another person will find the opposite. Wholemeal bread is better than white and raw fruit is better than cooked fruit. An apple eaten with meat or cheese, because meat and cheese contain fat, does not raise the blood sugar so high as eaten on it's own. Because your father-in-law has probably had diabetes type 2 for a long time his blood sugars will have been high for sometime, and tablets will take a couple of weeks before they start working properly, so expect to see his blood sugars come down slowly. If he is stressed this will increase his blood sugars too so let him know that he should be relaxed about it. If he gets ill and has a fever he should get in contact with his health care provider and drink plenty of fluids.
Eventually he will find his blood sugars go to below 7.00 mmol/l before breakfast and be less than 9.00 mmol/l 2 hours after eating, and he will feels so much better then. Get him to write down a list to ask his doctor/nurse when he next sees them but meanwhile there will be lots of people on this board that will answer your questions. Remember at his age it is a lot to take in so give him some time to get his head around it. I am still learning five years after diagnosis.
 
Those readings over 20 are incredibly high :shock: I was talking to another T2 a few weels ago who was admitted to hospital after collapsing in a hyperglycaemic coma at work, her readings were only slightly higher readings :shock: From my perspective I prefer not to go above 7 at any time and I prefer to be at the most 6.5 and hour after eating (when my BS tends to peak).

My GP is a diabetes specisalist. He saw me pretty reguarly for the first couple of months and I had some very regular blood work, which showed my numbers were all falling... At my last meeting with him he was pleased with my progres but didn't actually say when he wanted to see me again, but I think it was a 6-mpnthly follow up - but my numbers are heading in the right direction. I manage my diabetes by diet and Iow carb.

My own plans for my treatment involve seeing my GP more regualrly than he has suggested and I have an appointment this week. I would suggest that your father in law needs to have an idea of what he wants from his treatment and then ask for it. If his numbers are not coming down I would say that he needs more regualr attention and possibly more aggressive treatment.

I would also suggest that he needs to make some fairly major adjustments to his diet, although a good starting point is to keep a food diary for afew days, letting us know what he eats during a normal day may mena we could help him reduce the numbers.

Since my BS numbers have fallen my lethargy/fatigue has reduced substantially and I no longer get regualr headaches. I am currently diet only and am managing by diet alone. I have substantially reduced my carboydrate intake and no longer eat bread, pasta, rice or potatoes - or anthing else made from flour or high starch.

if you are going to test you actually need to know how to interpret the results and have a plan as to what to do with the results - I use my numbers to tweak my diet - I low carb. Carbohydrate is what send s the blood sugar up high. If you are simply testing to see how high the BS goes, all that will happen is high levels of anxiety :? and a lot of expense - a test costs over 50p per test if you are buying the strips in a high street pharmacy. Testing is essential to managing diabetes effectively. But only if you know how to use the results of testing.

Ask a doctor about driving.
 
Thank you all very much for taking the time to reply and offer some very good advice. I will print this thread for my father in law and recommend he joins the forum. You're all very kind to offer such valuable support.

Many thanks,
Ladybird
 
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