Diabetic diet for weight gain ?

[stukie]

My mother in law is 87 and had an emergency admission with DKA two weeks ago. She's doing well and is out of HDU.
Only 2 of her sons was aware that she was diagnosed as T2 diabetic . Id been trying to get her to go to doctors re weight loss for months, it got worse after Christmas- she was obviously in a catabolic state .

She's been tested for LADA and we await results.

My query is re diet . In hospital she's on an elderly weight gain diet with no consideration for diabetes - they simply ramp up the insulin if her sugars spike (24 after jam sponge and custard) .
I'm worried that this will simply make things more chronic
Surely there is such a thing as a weight gain diet for diabetes

 

[Daibell]

Not as such. Most weight gain is caused by the carbohydrates in the diet. These need to be kept under control for avoid weight gain and BS rise. Typical advice is to keep total carbs down to below 130gm/day. The NHS hospital food will be high in carbs. Increasing insulin to control BS may (or may not) work. All the insulin will do is enable the body to convert the carbs to glucose which may be stored as fat. Unless you can control the hospital food (unlikely) or provide your own (unlikely) then there isn't much you can do. I assume your MIL went DKA thru inadequate insulin?

 

[stukie]

Not as such. Most weight gain is caused by the carbohydrates in the diet. These need to be kept under control for avoid weight gain and BS rise. Typical advice is to keep total carbs down to below 130gm/day. The NHS hospital food will be high in carbs. Increasing insulin to control BS may (or may not) work. All the insulin will do is enable the body to convert the carbs to glucose which may be stored as fat. Unless you can control the hospital food (unlikely) or provide your own (unlikely) then there isn't much you can do. I assume your MIL went DKA thru inadequate insulin?

Thanks for tour reply
DKA Yes - glucose level was 34 on admission, ketones were v high and she was hypothermic ( temperature 32) . She had not been feeling well ( very tired) gone to bed and not eaten for 2 days (the son who lives near her and knew she was diabetic didn't seem to realize the implications of this...... )

Food is generally awful in her local hospital - people do bring in food to supplement that provided and its not screened - we were advised we could bring in fish and chips if she wanted it . Its good that her sugar levels are being monitored, my concern is that not stablizing glucose and having a rollercoater each day will only make diabetes more chronic, and increase insulin resistance , with wider reaching effects.

She has been complaining of a very dry mouth for weeks - I don;t know if this is connected or not ?

 

[AloeSvea]

Hi @stukie. Do you mean 'chronic' as in a long-lasting disease? Or, do you mean chronic as in worse symptoms in the here and now, as in bad?

Because at the age of 87, the long-lasting nature of diabetes being affected by 'lifestyle choices' is no longer an issue? I would imagine? As I say to my own mother, if longetivity is the thing being pitched for - she's already made it! (She is the same age.) (My mother likes me saying that, so - good!)

In terms of worse symtpoms - yeah, with a DKA, that's in the big-time as a complication, with insuln usage. I totally understand your concerns.

The good thing though, with hosital monitored insulin - that awful diabetes complication is being kept under very good control, and insulin is being dosed for the kind of (high carb food it sounds like, which is the norm in hospitals and everywhere) food she is eating there.

I see what you mean about being concerned if they are not noting the food you are bringing in, or maybe they are by asking her? Probably are? (You can find this out pretty easily?)

Because nutrition and best diet for diabetes is a big controversial subject the best diet for people with diabetets to gain or lose weight on will be a controversial subject, especially at hospital! I would never enter into a discussion on this in any medical centre or medical environment for that reason. Which is a sad statement, but one you will read often in forums. So the short answer would be - depends on who you ask! And their stance on the diet heart hypothesis. Which depends on your mother's stance on diet and health?

My own mother is very happy to eat yummy high carb food at this stage of her life, even cope with weight gain, in her case, that in her younger days she would avoid like the plague, but she is either high level prediabetes longterm, or now untreated low level diabetes. Not a person with diabetes on insulin for sure. (The insulin should be good for her to gain weight I would have thought! Which is a good thing at least?)

 

[stukie]

Hi @stukie. Do you mean 'chronic' as in a long-lasting disease? Or, do you mean chronic as in worse symptoms in the here and now, as in bad?

Because at the age of 87, the long-lasting nature of diabetes being affected by 'lifestyle choices' is no longer an issue? I would imagine? As I say to my own mother, if longetivity is the thing being pitched for - she's already made it! (She is the same age.) (My mother likes me saying that, so - good!)

In terms of worse symtpoms - yeah, with a DKA, that's in the big-time as a complication, with insuln usage. I totally understand your concerns.

The good thing though, with hosital monitored insulin - that awful diabetes complication is being kept under very good control, and insulin is being dosed for the kind of (high carb food it sounds like, which is the norm in hospitals and everywhere) food she is eating there.

I see what you mean about being concerned if they are not noting the food you are bringing in, or maybe they are by asking her? Probably are? (You can find this out pretty easily?)

Because nutrition and best diet for diabetes is a big controversial subject the best diet for people with diabetets to gain or lose weight on will be a controversial subject, especially at hospital! I would never enter into a discussion on this in any medical centre or medical environment for that reason. Which is a sad statement, but one you will read often in forums. So the short answer would be - depends on who you ask! And their stance on the diet heart hypothesis. Which depends on your mother's stance on diet and health?

My own mother is very happy to eat yummy high carb food at this stage of her life, even cope with weight gain, in her case, that in her younger days she would avoid like the plague, but she is either high level prediabetes longterm, or now untreated low level diabetes. Not a person with diabetes on insulin for sure. (The insulin should be good for her to gain weight I would have thought! Which is a good thing at least?)

Thanks @AloeSvea

Thanks for sharing your mum's experience.
MIL has been a busy 87 year old . Out every day , working 2 mornings a week in charity shop . Dodgy knees but no other issues she shared with us. We've been told it won't be the same woman who comes home .

The weight loss ( she is now as thin as a stick ) may be due to something else - ironically the diabetes specialist wants to get the diabetes under control before they consider other issues .
She did have a large cyst ( now self draining) which was found a couple of days after admission which probably contributed to the DKA..
The concern I have is that the insulin rollercoaster has effects re nature of symptoms, and perhaps onset of comorbidities in the present.
The nurse taking her sugars later in the day after the first cake and custard didn't see the link at all which was worrying and literally dashed off to get insulin.

She needs no encouragement to eat cake , or have a couple of glasses of wine . It will be finding a balance between enjoyment and health to get the best quality of life for the years she has left and I suspect changing diet will be something she chooses not to do unless she has to.

She has been in denial. We didn't even know she was diabetic, she'd told us she was prediabetic . Hopefully it will also give her GP a shake up as she didn't seem to have had much monitoring at all .

 

[Antje77]

She's been tested for LADA and we await results.

My query is re diet . In hospital she's on an elderly weight gain diet with no consideration for diabetes - they simply ramp up the insulin if her sugars spike (24 after jam sponge and custard) .

If it turns out she has in fact T1, weight gain should happen if she gets enough insulin to utilise the food she eats.
All the glucose sitting in her blood is just sitting there without feeding her.
So a typical high carb hospital diet isn't a bad approach, provided that she also gets the correct amount of insulin to deal with those carbs.

The good thing though, with hosital monitored insulin - that awful diabetes complication is being kept under very good control, and insulin is being dosed for the kind of (high carb food it sounds like, which is the norm in hospitals and everywhere) food she is eating there.

Hospitals are notoriously bad at adjusting insulin doses. Yes, they treat the DKA, but once that danger has been averted it's very common to have T1's and insulin dependent T2's run very high, give insulin a long time after food, inadequate correction doses etc.
The guidelines now encourage T1's to manage their own diabetes in hospital if they can, because a general nurse can't.

 

[AndBreathe]

One comment I would make is that in hospitals, staff wrry more about hypos than a patient running a bit high, in that in an unknown, and potentially unpredictable environment, a nasty hypo has the ability to do real damage, quickly, whereas a patient running higher than ideal (but obviously not in or verging on DKA), they would be more comfortable with.

@stukie , I hope your MiL bounces back well. It sounds like she still has a good joie de vivre.

 

[stukie]

One comment I would make is that in hospitals, staff wrry more about hypos than a patient running a bit high, in that in an unknown, and potentially unpredictable environment, a nasty hypo has the ability to do real damage, quickly, whereas a patient running higher than ideal (but obviously not in or verging on DKA), they would be more comfortable with.

@stukie , I hope your MiL bounces back well. It sounds like she still has a good joie de vivre.

Thank you @Antje77

 

[stukie]

One comment I would make is that in hospitals, staff wrry more about hypos than a patient running a bit high, in that in an unknown, and potentially unpredictable environment, a nasty hypo has the ability to do real damage, quickly, whereas a patient running higher than ideal (but obviously not in or verging on DKA), they would be more comfortable with.

@stukie , I hope your MiL bounces back well. It sounds like she still has a good joie de vivre.

Thank you @AndBreathe

 

[stukie]

MIL now home with CGM.
Glucose levels up and down , CGM will be helpful seeing what foods affect her badly.
Target glucose is 15 which seems high to me . I'm assuming this is to try and settle spikes and then it might be lowered ? There didn't seem to be a general concern about high levels at all from either hospital nor district nurses .
What are consequences of high glucose , high insulin ( fatty liver and fatty pancreas and blunted beta receptors? )


District nurses are supervising her taking insulin until she's confident in doing it. Gold star pupil on first day, so she's chuffed.

Her eldest son lives nearby and has moved in for a few weeks til she gets her strength back up and is more stabilized . Unfortunately he hasn't a clue about diet so it will be a joint learning curve.
He served her up a Chinese tonight and reading was 30 !

 

[EllieM]

Hi @stukie am guessing that they are very concerned about the possibility of an elderly person going hypo and having a fall.....

Have they talked to her and/or her carers about hypoglycemia? (With a target of 15 they may reckon it may not happen). The consequences of too high blood sugar tend to be long term (years/decades) so may not be an issue for someone who is 87, whereas the consequences of a fall can be much more serious (ie hospital admission with broken limb).

Having said that I personally feel a lot more physically comfortable with a bg of 5 rather than 15 but in my preglucomter high blood sugar youth I sort of got used to higher levels and didn't really notice them.

Edited to add Is that target an upper level of 15 or an average of 15 ...?

 

[AndBreathe]

Medics will always err on the side of higher for blood glucose -especially in the elderly where the patient might not be s sprightly.

A lot of damage can occur from a single VERY low, low, whereas damage from highs seems to be much longer term.

for now, at least, I’d urge you to reconcile yourself with the higher numbers. Once your MiL is a bit more experienced, and confident in her dosing etc., then might be the time to negotiate trimming a bit off those targets.

Is MiL’s CGM set up to share her data? It’s a concept I hate for myself, but it could give a little reassurance in these early days.

 

[stukie]

Hi @stukie am guessing that they are very concerned about the possibility of an elderly person going hypo and having a fall.....

Have they talked to her and/or her carers about hypoglycemia? (With a target of 15 they may reckon it may not happen). The consequences of too high blood sugar tend to be long term (years/decades) so may not be an issue for someone who is 87, whereas the consequences of a fall can be much more serious (ie hospital admission with broken limb).

Having said that I personally feel a lot more physically comfortable with a bg of 5 rather than 15 but in my preglucomter high blood sugar youth I sort of got used to higher levels and didn't really notice them.

Edited to add Is that target an upper level of 15 or an average of 15 ...?

Thanks for your quick reply
As she's very underweight and tired I think that this is the focus. She is mobile with zimmer at moment so that's good ( and determined not to use it and go up and down stairs, so a fall has odds shortening)
Eldest son must have had the talk re hypo as he's been advised to check very low sugar with finger prick rather than go by the CGM for accuracy.
It will be interesting to see where she feels comfortable re glucose levels.

Shes still confused re type 1 / type 2 and LADA . I've said not to worry, she's being treated now and the results form blood tests will follow on and any fine tuning re treatment will happen then.
She seems to have been told / understand that's shes now type 1 as she uses insulin. Being told and understanding are 2 different thins as she's deaf and often picks up the wrong thing! Luckily eldest son will be about for a while

 

[stukie]

Medics will always err on the side of higher for blood glucose -especially in the elderly where the patient might not be s sprightly.

A lot of damage can occur from a single VERY low, low, whereas damage from highs seems to be much longer term.

for now, at least, I’d urge you to reconcile yourself with the higher numbers. Once your MiL is a bit more experienced, and confident in her dosing etc., then might be the time to negotiate trimming a bit off those targets.

Is MiL’s CGM set up to share her data? It’s a concept I hate for myself, but it could give a little reassurance in these early days.

Thanks for your reply - yes the data goes straight to the clinical team. I don;t know whether its shared with her eldest son - if so noone else will have this enabled as he likes to be in charge of everything

 

[stukie]

Hi @stukie am guessing that they are very concerned about the possibility of an elderly person going hypo and having a fall.....

Have they talked to her and/or her carers about hypoglycemia? (With a target of 15 they may reckon it may not happen). The consequences of too high blood sugar tend to be long term (years/decades) so may not be an issue for someone who is 87, whereas the consequences of a fall can be much more serious (ie hospital admission with broken limb).

Having said that I personally feel a lot more physically comfortable with a bg of 5 rather than 15 but in my preglucomter high blood sugar youth I sort of got used to higher levels and didn't really notice them.

Edited to add Is that target an upper level of 15 or an average of 15 ...?

Sorry didn't pick up the glucose level query - it seems to be an average ( but I could be wrong)

 

[Ro9998]

the dry mouth is linked to diabetes excess water is removed. At 87 that’s amazing so I will leave you. I have to cut sugar exercise but honestly I’d be amazed if I got to 87. Well done her. My mum smokes life long age 84! Give your mum a celebration out of hospital.

 

[stukie]

Weight gain not really happening despite a ridiculously high carb diet (1-2 lbs / week)
Blood sugar all over the place. She has 1 insulin injection in the morning - I don't know the type , but she can go into 20 s and down to 3 in the same day.
Dosage is 25 units of insulin , potentially going to 26.

Is there a type of insulin which can clip off the peaks and troughs ?

 

[Daibell]

Hi. It sounds like she should be on the Basal/Bolus insulin regime with two different insulins. As a minimum it could be twice-a-day mixed insulin. Having lots of carbs to increase weight is usually the wrong approach as there may not be enough insulin to deal with those carbs with resulting high BS. Having lots of proteins, fats, veg etc is fine.

 

[EllieM]

Weight gain not really happening despite a ridiculously high carb diet (1-2 lbs / week)
Blood sugar all over the place. She has 1 insulin injection in the morning - I don't know the type , but she can go into 20 s and down to 3 in the same day.
Dosage is 25 units of insulin , potentially going to 26.

Is there a type of insulin which can clip off the peaks and troughs ?

Do you know whether she has been officially diagnosed as T1 or T2?

Many long term T2s need insulin, but if the need is because of insulin resistance rather than insulin insufficiency, they can often manage on one injection a day - often a long acting insulin that lasts for 24 hours.

LADAs/T1s end up producing no insulin at all, so the usual treatment is to put them on a basal/bolus regime where they have an injection of a long acting insulin that carries them through the day and night, and injections of short acting insulin before meals to cover the food eaten (and possibly correction doses). The trouble with this is that you then calculate the short acting insulin according to the amount of carbohydrate in the meal, so your MIL would both need to carb count and adjust her doses accordingly. Am guessing this might be a bit too much to ask at her age??? It's also quite possible to manage on fixed doses once or twice a day, but then you usually need to eat the same amount of carbs for the same meal each day ie adjust your carbs to your insulin.

But it can take time to get insulin dosing right, so as long as her diabetic team are frequently reviewing her doses I wouldn't necessarily be panicking.
But I would be flagging up the massive variation in blood sugars to them. If nothing else, they should be concerned about the 3s. (Has your mother had hypoglycemia (low blood sugar) explained to her?)

 

[stukie]

Do you know whether she has been officially diagnosed as T1 or T2?

Many long term T2s need insulin, but if the need is because of insulin resistance rather than insulin insufficiency, they can often manage on one injection a day - often a long acting insulin that lasts for 24 hours.

LADAs/T1s end up producing no insulin at all, so the usual treatment is to put them on a basal/bolus regime where they have an injection of a long acting insulin that carries them through the day and night, and injections of short acting insulin before meals to cover the food eaten (and possibly correction doses). The trouble with this is that you then calculate the short acting insulin according to the amount of carbohydrate in the meal, so your MIL would both need to carb count and adjust her doses accordingly. Am guessing this might be a bit too much to ask at her age??? It's also quite possible to manage on fixed doses once or twice a day, but then you usually need to eat the same amount of carbs for the same meal each day ie adjust your carbs to your insulin.

But it can take time to get insulin dosing right, so as long as her diabetic team are frequently reviewing her doses I wouldn't necessarily be panicking.
But I would be flagging up the massive variation in blood sugars to them. If nothing else, they should be concerned about the 3s. (Has your mother had hypoglycemia (low blood sugar) explained to her?)

Hi
She has not got the blood test result back for LADA / T1 diagnosis yet . She's been told that she may be a type 1 according to her eldest son who is closest to her , but didn't share info much . The regime seems to be geared for T2 ( but I don't know )

Her eldest son is just following along with medics indo and not really questioning anything .

The diet is nuts , it's a guaranteed rollercoaster. Her nurse told her to eat what she likes but she is conscious that this may not be a good thing .
The lows are worrying. She's been told re hypo as it's the biggest risk re falls and is concerned , but medics don't seem to be overly concerned . That said, the nurse who deals with the CGM data was on holiday last week when there were 2 very low readings ( backed up by finger testing) , so any tweaking may have had to wait if staff are stretched.
I'd wondered if there were other insulin options that could be more suited to her situation, and have suggested different foods ( also looking at reactions to foods on her CGM) , but if it's not coming from the diabetic nurse / dietician they are not interested .
She would really struggle with carb counting .
Thanks for highlighting the different insulin types and uses . I can look into these and see if I can get her a bit better prepared to discuss things .