diabetes and not eating

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.

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?

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.