Caring for someone with diabetes

Welcome to the forum. I really feel for you, as I have experience with depression/anxiety myself and have been on antipsychotics for it and gained weight, which contributed to getting type 2 diabetes, along with other factors. Unfortunately it's very common and often doctors don't pay enough attention to this side effect of many mental health drugs.

I'm assuming the person has Type 2 diabetes and was prescribed Metformin? Please let me know if I have got that wrong. If they are on Metformin, it won't do much to reduce their blood glucose (BG) anyway. It is a useful medication and does other things like reduce extra glucose production by the liver. The best way for them to reduce their BG would be to eat a low carb higher fat diet, lose weight, and exercise. However, I can imagine this would be very hard for them to do, especially since they are in denial about having diabetes. Diabetes denial is quite common, even in people who do not have mental health issues.

Do you think they would allow you to test their BG with a fingerprick test and a meter? If so, that will tell you if their BG is dangerously high and it's a medical emergency. Do you know what their BG level was at diagnosis? Has it been a matter of days and weeks, or longer? It's possible that they may need insulin injections now or in the future... do you think they would accept those?

If they won't let you test their BG then I'm afraid you will be in the dark until you can get a health professional to do it, either at home or at a clinic or hospital. There are also urine test kits available, which test for glucose and ketones. They are not as accurate or helpful as blood tests, but if the person will allow you to test their urine then it would be better than nothing.

I'm reluctant to advise anything about mental health services if you live in the UK. If you happen to live in NZ I can share some info about ensuring the person gets better care.

Here is some more info about diabetes that may help you:
http://www.diabetes.co.uk/diabetes_care/diabetes-care.html
http://www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html
http://www.diabetes.co.uk/supporting-someone-with-diabetes.html

purge11 said:

Hello CatladyNZ,

Thanks for your much detailed and heart felt response. The person I care for has been suffering this form of diabetes for a few months now, I can certainly foresee a future of misery and pain for them, but I will try and be there for them through thick and thin. After all isn't that what a Mental Health carer or relative should do?

Fortunately the person I care for has peer support and a Mental Health Nurse, plus they also have a psychiatrist. I ll see if I can get some record of the diabetes levels.

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Good on you for being there for them... they are very lucky to have you as a close relative. Some MH nurses are diabetes-aware and "get it", others, not so much. If they are the latter, hopefully you can help educate them, so they can help your relative. Done right, MH nursing should encompass helping the client come to terms with a diabetes diagnosis and build day to day management of it into their life.

Since the person has had the diagnosis for a few months, it's possible their BGs could be getting dangerously high. Passing urine often and sleeping most of the time are signs of hyperglycaemia... as it gets worse over days and weeks the person's level of consciousness can become reduced. I don't want to scare you but I think you need to be aware of this just from a first aid perspective. I know of someone who could only get her husband to accept going to hospital once he was semi-conscious, as his resistance to the idea was lower. He went by ambulance and was in the ICU for a few days and recovered fully. Here is some info about emergencies that the person may be at risk of if things get worse:
http://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html
http://www.diabetes.co.uk/diabetes-complications/hyperosmolar-hyperglycemic-nonketotic-syndrome.html

You're off to a great start with @CatLadyNZ's advice - my main question would be whether the person is taking care of their own shopping and cooking? If not, it may be possible to intervene in the kinds of foods they are eating to reduce the amount of carbohydrates to help bring their blood glucose levels down.

I am so sorry you are in this position. I have experience caring for someone with severe mental health issues, have seen the refusal of meds/tests ( I'm ok now,it's not me it is everyone else etc) and I have diabetes. I am newly diagnosed so cannot offer much in the way of advice but I just wanted to say 'hi' ( waves) and to let you know how much help and support I have found this forum to be. I do hope this refusal of medication is a short lived episode and you get the help and support you need.

purge11 said:

Hello CatladyNZ,

Thanks for your much detailed and heart felt response. The person I care for has been suffering this form of diabetes for a few months now, I can certainly foresee a future of misery and pain for them, but I will try and be there for them through thick and thin. After all isn't that what a Mental Health carer or relative should do?

Fortunately the person I care for has peer support and a Mental Health Nurse, plus they also have a psychiatrist. I ll see if I can get some record of the diabetes levels.

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Hi and welcome, does this person have a social worker and/or a crisis team for their mental health issues, as this type of mental health can be a very complex.
You sound a very loving, caring person, try and keep pushing for help and guidance, that is what they are trained in and paid for. No one is a lost cause, mental health issues throws out so many negative signals for the person suffering from it and more often than not it over powers their thoughts with day to day living and life it's self.
Good luck and I wish you both all the very best for a brighter future.

Best wishes RRB

You could probably benefit by reading @daisy1's advice for newcomers.

Another excellent introduction to low carb is @sanguine's topic:
http://www.diabetes.co.uk/forum/threads/a-new-low-carb-guide-for-beginners.68695/

@purge11

Hello and welcome to the forum To help you to help the person you care for, here is the information we give to new members and I hope you will find it useful. You have already got some very good information from members above. Ask more questions when you need to and someone will be able to help.


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 over 150,000 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

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

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

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 bloodglucose 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.

purge11 said:

Since I do the shopping and cooking.

What does anyone here think of this link that promotes good choices of food for diabetics?

http://www.webmd.com/diabetes/diabetic-food-list-best-worst-foods

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Generally the writers of this are dangerous mi-informed ignoramuses IMHO if they tried to feed me this drivel, I would laugh intheir faces and walk out!

Diabetes and Breads, Grains, and Other Starches
I tend to minimis all grains.
It is like saying getting your head blown off by a shell is better than bing diemboweled!

Vegetables and Diabetes
Most vegetables contain fiber and are naturally low in fat and sodium (unless they are canned or frozen in sauces). Starchy vegetables, such as potatoes and corn, aren't included in this category. They are considered part of the breads, grains, and other starches group.

Best Choices:

• Fresh vegetables, eaten raw or lightly steamed, roasted, or grilled
• Plain frozen vegetables, lightly steamed
• Low sodium or unsalted canned vegetables
• Lettuces, greens, kale, spinach, arugula

Worst Choices:

• Canned vegetables with lots of added sodium
• Vegetables cooked with lots of added butter, cheese, or sauce
• Pickles (if you need to limit sodium; otherwise, pickles are okay)
• Sauerkraut, (same as pickles; limit only if you have high blood pressure)

Disagree on veg with butter/cheese more low fat dopgmatic ****

Fruits and Diabetes
Fruits have carbohydrates, vitamins, minerals, and fiber. They are naturally low in fat (except for avocados) and sodium. Most fruits have more carbs than do vegetables.

Best Choices:

• Plain frozen fruit or fruit canned in fruit juice
• Fresh fruit
• Sugar-free or low-sugar jam or preserves
• No-sugar-added applesauce
• 100% fruit juice

Worst Choices:

• Canned fruit with heavy sugar syrup
• Chewy fruit rolls
• Regular jam, jelly, and preserves (unless portion is kept small)
• Sweetened applesauce
• Fruit punch, fruit drinks, fruit juice drink

They completely miss the point that fruit sugars are still sugars and puree'd fruit is just high GI sugar.
the kind of fruit is more important!

Diabetes and Meat and Other Protein


This category includes beef, chicken, fish, pork, turkey, seafood, beans, cheese, eggs, nuts, and tofu.

Best Choices:

• Baked, broiled, grilled, or stewed meats
• Lower-fat cuts of meat, such as top sirloin
• Turkey bacon
• Low-fat cheeses
• Skinless breast of chicken or turkey
• Baked, broiled, steamed, or grilled fish
• Tofu lightly sautéed, steamed, or cooked in soup
• Beans
• Eggs
• Nuts

Worst Choices:

• Fried meats
• Higher-fat cuts of meat, such as ribs
• Pork bacon
• Regular cheeses
• Poultry with skin
• Fried fish
• Fried tofu
• Beans prepared with lard

Again obsession about low fat from "low brain dogmatists" fat on meats are good & tastier!

Dairy and Diabetes
This group includes milk and foods made from milk, such as yogurt and sour cream. Milk has a lot of protein and minerals, including calcium.

Best Choices:

• 1% or skim milk
• Low-fat yogurt
• Low-fat cottage cheese
• Low-fat or nonfat sour cream
• Frozen low-fat, low-carb yogurt
• Nonfat half-and-half

Worst Choices:

• Whole milk
• Regular yogurt
• Regular cottage cheese
• Regular sour cream
• Regular ice cream
• Regular half-and-half

Leaving aside the "half & Half" which i never touch they have the two categories @Rse about face iMHO Full fat not low fat!

"Diabetes and Fats, Oils, and Sweets
Eating too much of these kinds of foods can lead to weight gain, making it harder to keep diabetes under control." her they miss the important distinction betwee healthy & unhealthy fats and lumo in carby fried snacks

Hi. As others have said, in the absence of medication you will need to rely on the lowest carb diet you can get away with for your relative.