Type 2 Can anyone please help with advice?

Do you happen to know his most recent HbA1c levels?
I know that for me eating porridge would be a huge no no but that doesn't mean it would be the same for your partner the HbA1c's would be indicative of how good his control is and may give more of a clue as to what is causing the problem.

partnerhelp said:

He's also been eating even better since then.

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There are many definitions of "eating better" and what is commonly thought of as "better" may not necessarily be better for a Type 2. Hence my porridge comment. It might be worth getting your partner to join up they may be happier to share info that way?

partnerhelp said:

I'm really just looking for some advice from anyone who can help me. My partner is in his mid 60s. He was diagnosed type 2 diabetic around 15 years ago and is taking metformin. It took a while to get it all under control initially but it's generally ~5 to ~7 mmol/L when he measures in morning/night. Up until a few weeks back the nurse said his sugars were so good that they may reduce his metformin dosage.

1. At the start of summer, a couple of welts appeared on his shin which wept. Over months, despite cleaning and dressing by nurses this developed into cellulitis which was treated with antibiotics and left him with a reddish "scarred" area that he's been told may remain like that. Weeks later another small welt appeared in the area, was cleaned and dressed. He was given antibiotics in case it got worse, but it healed. Last weekend, a small patch of skin half the size of a pinky nail was just gone and weeping slightly. Not sure if the skin is just thin now and easily caught/damaged. A couple of days after cleaning and dressing we removed the dressing today and a blister the size of a fingertip had formed that immediately leaked yellowy fluid (watery) - he's now cleaned it, put on an inadin patch and dressed it. Since it'd gotten visibly worse he's started taking the previous course of antibiotics.
   
   
2. In recent years he was also flagged for signs of diabetic retinopathy following routine scans. With the most recent one he was referred to hospital. He's been told the retinopathy is too close to the centre of his eyes to be lasered. He hasn't yet noticed any major issues himself. He has to go back for a check early next month. If it hasn't remained stable he's been told they may be able to give injections or he may require eye surgery.

I could use some advice.

• With the leg issue I don't know what to advise anymore. We've been out walking together and he's eating sensibly and in small amounts. The only "bad" thing he ever has nowadays is a couple of rich tea biscuits here and there, which I think are fairly benign(?) He eats a lot of porridge and eggs. We can't understand why these welts/blisters keep coming back when his sugar levels seem ok, or how we can stop them.
  
  
• With the retinopathy, has anyone experienced something similar where it was close to the centre of the eye but successfully treated without lasers?

Can anyone offer anything from experience, any ideas, preventative measures, things I can suggest, do or say? I'm really lost here. I can see this is all really taking it out of him and it's getting him very down. I hate to see him like this.

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I'm not a doctor, but from what I understood, meds like metformin don't stop diabetes-related damage from occurring. It's one of the reasons why I went for the diet: because it can actually make that all-important difference. I had infected toes for years as I went undiagnosed... And I do mean swelling, bloody puss, inability to walk or even get into my shoes. I had several operations time and again and nothing helped, it always came back on both my feet. When I started a low carb/ high fat diet those infections went away. Years of mysery solved just by eating differently.

It's not just the tea biscuits that could be harming him, it's the porridge too, most likely... Anything carby, like bread, potatoes, cereal (oats, muesli etc), rice, pasta, fruits (aside from berries, those are okay) are all unhealthy for a diabetic. Eggs are perfectly fine though.

You know, if he starts off the day with eggs and bacon, maybe some sausages, cheese, mushrooms mixed in..... That's all low carb. I tnd to have green salads with tuna, olives, capers, mayo and avocado for lunch, it's surprisingly filling, and again, low carb. Dinner's meat and fish with broccoli-rice or cauliflower rice (the latter being remarcably versatily). As you see, no high carb foodstuffs in there... Snacks could be a nice cheese, olives, nuts, extra dark chocolate (Lindt's 85% is nice). For dessert maybe some berries with double cream or full fat greek yoghurt. He doesn't have to eat small amounts: he needs to eat small amounts of carbs; as a T2 we can't process those out effectively anymore, like other people can. See it as an allergy. We just can't handle them, and they get stuck in our bloodstream as bloodsugar, doing damage all over.

Once carbs are reduced for a while, not only will your partner be able to drop the metformin, it'll also stop the progression of any complications. Because if there's already some renopathy there, and open wounds on his legs, then I wonder how the rest of him's doing. I do think that if you two can discuss this and maybe make changes in diet, the wounds will start to heal up, much like mine did.

It's just an idea... And the only one I really have, because I wouldn't know how else to tackle this. It takes a while and it is an adjustment, I realise that... But going low carb has made a world of difference for me. I think it's pretty safe to say it gave me my life back. And if I could go back to 2005, when things started to go really, horribly wrong, I would've started then and avoided this whole T2 thing.

Wishing the both of you all the best,
Jo

Does he test himself before and after eating? This may reveal what is happening and he may be spiking too high but is missing these through only testing in the mornings and bedtimes. Perhaps suggest he tests 1 hour, 2 hours and 3 hours after eating his porridge. He may have a shock. The HbA1c comes under the term "fallacy of average" and will mask any large spikes after eating if he also spends a lot of time in the 5s. Try and persuade him to give it a try.

I have to be honest. In my opinion there are one or two things about this that don't add up. He has symptoms typical of poorly controlled diabetes and yet has pickle perfect sugar levels and no Hba1c results. In fact, the HCP's are so pleased with his sugar levels that they are thinking of taking him off Metformin which never made any difference to my blood sugar levels at all.

I have to agree with @bulkbiker and say that we need the Hba1c results. Finger prick tests could have been taken at a fortunate moment and be misleading.

I also agree with @bulkbiker (I do this too often methinks) that the perception of "eating better" is open to misinterpretation and for me porridge and biscuits are off the menu altogether.

I agree with @DCUKMod about the antibiotics, each course should be completed even if things have got better, so there shouldn’t be left over tablets. I suppose he could have been prescribed some ‘just in case’ but please make sure they are still in date. I would advise a visit to the nurse to review the leg.

Squire Fulwood said:

I have to be honest. In my opinion there are one or two things about this that don't add up. He has symptoms typical of poorly controlled diabetes and yet has pickle perfect sugar levels and no Hba1c results. In fact, the HCP's are so pleased with his sugar levels that they are thinking of taking him off Metformin which never made any difference to my blood sugar levels at all.

I have to agree with @bulkbiker and say that we need the Hba1c results. Finger prick tests could have been taken at a fortunate moment and be misleading.

I also agree with @bulkbiker (I do this too often methinks) that the perception of "eating better" is open to misinterpretation and for me porridge and biscuits are off the menu altogether.

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I'll post something soon you can happily disagree with.! in case you're getting worried..

bulkbiker said:

I'll post something soon you can happily disagree with.! in case you're getting worried..

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No no, I'm fine thanks.

Bluetit1802 said:

The HbA1c comes under the term "fallacy of average" .

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For fear of derailing the thread, I must say I do not agree with that.

The HbA1c includes everything so it is not linear. The concept of “fallacy of averages” really refers to taking a set of linear numbers and thinking that the average of those numbers means anything. If you did a finger prick test every hour for 3 months, and averaged them it would be meaningless, but the HbA1c is not really a linear average, and cannot miss anything.

I suspect that the times when your partner is testing show good readings, entirely missing the fact that after eating he could be getting high blood glucose levels - spikes, which are damaging his blood vessels.
There are quite a few threads about nurses who do not understand how type twos should be testing - before and after meals, and adjusting their diet to achieve low postprandial spikes is the most effective method of control, until most foods being eaten and their effects on blood glucose are understood.
For me, biscuits and porridge are not on the menu - neither are all the other 'healthy' foods with high carbohydrate content.

britishpub said:

For fear of derailing the thread, I must say I do not agree with that.

The HbA1c includes everything so it is not linear. The concept of “fallacy of averages” really refers to taking a set of linear numbers and thinking that the average of those numbers means anything. If you did a finger prick test every hour for 3 months, and averaged them it would be meaningless, but the HbA1c is not really a linear average, and cannot miss anything.

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I hear what you are saying . However, you can have 2 people with the same HbA1c. One can have nice flattish wavy lines, the other can have a roller coaster of a line. The roller coaster person is going to be more at risk of complications, apparently.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543190/

Perhaps we should leave this for another time so as not to derail.