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diabetes and not eating

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sarah12

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My nan is 84 and she has been in hospital for several months now due to recurring vomiting and diarrhea. She also has intermittent shaking of the hands, tingling in the fingers, confusion, agitation and mood swings, as well as night sweats and various other symptoms. The doctors are telling us because she is confused she has mild dementia and so won't run tests to find the cause without her consent, which they are saying she can't give so are about to discharge her. The problem is we suspect her symptoms may be related to something physical i.e. her diabetes. She has had diabetes for over 30 years and it has been controlled by slow release metformin. In the last 6 months her dose was doubled as blood sugar was 16 all the time even when not eating and then as it was still 13 they added pigliotizone and it seemed to stabilise. But during her most recent hospital stay and while having these symptoms it has still been 8 even though she hasn't eaten anything for almost 2 months now. Does anyone know if her symptoms could be linked to her blood sugar levels and her not eating, as the doctors don't even seem to have given her blood sugar any consideration even though she's not eating and are happy to discharge her as such.
Any thoughts or comments greatly appreciated :)
 
I'm not a metformin expert so I don't know, but if she has diabetes and her doctors aren't even considering the role her blood sugar might be playing, then they need to start, asap. If they have been considering it but not explaining their thinking to you, they need to start doing that too!

Hopefully someone who knows more about metformin than me will be along in a bit with some advice about that side of things.
 
Thanks for your reply,
I am really worried about it because i know diabetes can cause complications if blood sugar levels are unstable and with her not eating for so long as well it makes things worse. But then her sugar levels should be low if she isn't eating so maybe the metformin is artificially stabilising her levels or something, i know very littled about metformin myself. The whole situation is really strange, especially when you assume a hospital in the safest place to be. :?
 
Sarah,

I think that (on your nan's behalf) you're just going to have to be a pushy patient and confront her medical team.

If they think that the problems are related to her diabetes then they need understand why her BG is elevated even when she isn't eating. It might be that her T2 has progressed to a level where she needs insulin.

I also wouldn't buy the "she has mild dementia so she can't give consent argument", either the dementia is so serious that someone else will have to give consent on her behalf, or it is mild and she can give it herself. I can't see that dementia (mild or not) is a valid reason for refusing treatment.

You need to stand your ground, ask them to justify their decisions and push for the treatment your Nan deserves.

(I speak from some experience here: my Grandad suffered dementia after falling and hitting his head. A GP and a consultant tried to dismiss the symptoms, saying that they were brought on by old age and that there was nothing that they could do. It's only because we pushed and pushed that we finally found out that he'd had a brain haemorrage, which they were able to successfully treat. He lived for another 15 years after that).

Good luck. Let us know how he gets on.

Stephen
 
I agree totally with Borofergie - you need to push these medical people. They sometimes seem to think they're "Godlike" and that the views of people like you and I don't matter. We have to put them right.
With regards to the Metformin, that works by improving the way the cells in the body take up the glucose the liver produces when we eat. It wouldn't give a high sugar level in the absence of food. The body can sometimes produce glucose without food (a liver dump) if our BG goes too low, but that doesn't sound like your Nan's situation. As Borofergie says, it could be that the metformin and other drugs aren't adequate anymore and she needs to be on Insulin. A lot of the symptoms you describe could be unrelated to Diabetes - my 93 year old mum has a lot of the things you describe. But as you KNOW she has diabetes, it needs to be investigated properly. Push them hard!
 
Hi. Metformin works in the way Grazer says but only reduces BS to a small extent but it is enough for many people. I have had to have two further meds added over time to keep my BS near reasonable. NICE guidelines suggest two or three levels of tablets and then going onto insulin, so the hospital may need to consider adding another med e.g. tablet or insulin. You can download the NICE Diabetes Guidelines if you need to be 'knowledgeable' in your discussions! Metformin should in no way cause an increase in blood sugar but liver glucose dumps due to lack of food might?
 
Hi everyone
thank you so much for your feedback, it is greatly appreciated. I was starting to feel like i was going mad because when i raise issues with the doctor he just dismisses them. I will definitely start being more pushy with them, started today in fact by requesting that they make a refereal for her to see the diabetic nurse before discharge, so hopefully she will be coming to the ward on monday, the only slight problem is that they don't know what time she is coming so we can't even arrange to meet her on the ward to discuss our concerns, so i am going to leave a list of questions for her with the nurse on duty on the ward on sunday night.
Also managed to get the doctor to agree to prescribe her b12 injecion for tomorrow which has been overdue since the 11th november. So maybe that will boost her up a bit and help us remove any symptoms from the list which are being caused by that.
I have a sneaking suspicion that you may be right about the insulin as i do recall many years ago my nan coming home from a clinic saying the doctor was surprised she was still on tablets after so many years, but her levels were still okay at that time but she may need to go on injections in the future, so i will make that one of my questions to the nurse for monday.
Thank you all for your support and Borofergie i was so pleased that your grandad had such a positive outcome it really does go to show that there is a reason to challenge the doctors, and our loved ones are definitely worth that fight
 
Is she still on pioglitazone? That is far more likely to affect her levels than metformin. It is being withdrawn from the market somaybe this has been stopped and not replaced

The medical profession are very wary of dementia and diabetes. They seem to feel that treatment is impossible if the patient has both.

My father had T2" which was controlled [?] by diet only, because he had mild dementia. We accepted what we were told by his doctor. Then an undiagnosed chest infection led to a very high temperature and a massive stroke. He was found to have heart disease as a result of the untreated diabees.
When he awoke in hospital he was on insulin. No permission had been sought. This enabled him to live for another ten years albeit in a nursing home. . We kept hearing that diabetics wih dementia never lived long but it was, in fact much easier to treat him wih insulin. His dementia
mostly manifested as short term memory loss so he would have an injection and forget alll about it until the next one! Although quite capable of refusing treatment on occasion [he even told them ,rightly , that it would be assault without his permission,] he could usually easily betalked into compliance.
I think the difficulty anticipated was that of geting the patient to understand the need for the treatment .
It is very true that it is necessary to let them know that the patient has a caring family who want proper treatment for their loved one and will pursue the matter if necessary.

I hope that proper treatment of your nan's diabetes will help her to live a happy and fulfilled life for many more years. Her dementia may improve when the condition is treated.

My father suffered trans ischaemic episodes - mini-srokes which had probably been undetected for years. I often wonder now if his diagnosis is correct when i read of insulin being produced in the brain etc.

There is a grea deal of ageisnm in the NHS as elsewhere and the mention of dementia seems to compound this attitude. Very wrong. You will need to be very involved and vigilant but I am sure you will have your reward.
 
hi Unbeliever
i can't believe they didn't treat your father's diabetes at first, that is shocking, especially if it can be treated in these circumstances with insulin. But then as you say we trust doctors when they tell us these things. Well i used to, i've started questioning everything now, trouble is can't get her consultant to meet with us.
we are still waiting for the diabetic nurse to come and see my nan and for her b12 injection. They are chasing it every day apparently. I can understand a nurse may be busy with other appointments so can take a few days, but am really annoyed at how long it takes a pharmacy on one floor of a hospital to send an injection to another floor - 5th day and counting so far.
They are pushing us now to choose a care home bed and have her shipped out or say they will choose one for us, so i think they are hoping to discharge her before the diabetes nurse comes and then we will have to follow it up in the community.
Not really very good considering yesterday when we were visiting my nan started saying she was feeling cold, then her hands started shaking, and then she started shaking all over and then said she felt like she was going to be sick. I wonder what is classed as sick if that is classed as medically fit?
I'm no expert on diabetes but from the symptoms i've read i thought her blood sugar might be low, but the ward nurse on duty didn't seem too bothered, said she would check my nan in a minute, and then when i asked her again after 10 mins told me again she would see her shortly and told me visiting had ended. :silent:
 
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