Diabetic diet for weight gain ?

[stukie]

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.

Yes I totally agree re diet. The carb intake makes insulin balancing a moving target , but that's the official line and it's not budging at the moment sadly. She's not even on fortified drinks / protein shakes .
Thanks for the insulin info - it's totally new to me do I am trying to catch up.

 

[AloeSvea]

@stukie ...So, what's the diagnosis - T1/LADA, or T2?

(Sitting on the edge of my seat waiting to hear! )

 

[stukie]

@stukie ...So, what's the diagnosis - T1/LADA, or T2?

(Sitting on the edge of my seat waiting to hear! )

Eldest son is chasing confirmation from diabetic nurse . He just wants life to be simple and is not querying anything .

 

[AloeSvea]

Thanks for the update @stukie.

Knowing broadly how the disease is going to play out for your parent is of course, paramount, in my opinon at least . So knowing the diagnosis is paramount.

 

[stukie]

question - is there an inherited susceptibility to LADA given that it has seems to share some aspects of type 1?

 

[AloeSvea]

Sitting on the edge of my seat is so uncomfortable , I looked up, 1. the test for LADA (GAD antibody test), and 2.about how long it took to get the results in the UK.

Ten days, it said. Cripes! That's a long time for edge of seat sitting! It's worse than watching a thriller on trad tele rather than binge watching on a streaming program!

But reading my own country's LADA definition, the symptoms do sound like your mother in law's, apart from the emergency DKA? Big weight loss being the big one? (Correct me LADAs! If I have wrongly interpreted info?)

I personally wouldn't do a deep dive into a T1 diagnosis until the results are back... T1 snd T2 really are that different. Including gene/inheritability stats? (I know the T2D ones, am assuming the T1 stats and risk factors are different? Again - LADAs - leap in here....)

 

[stukie]

Sitting on the edge of my seat is so uncomfortable , I looked up, 1. the test for LADA (GAD antibody test), and 2.about how long it took to get the results in the UK.

Ten days, it said. Cripes! That's a long time for edge of seat sitting! It's worse than watching a thriller on trad tele rather than binge watching on a streaming program!

But reading my own country's LADA definition, the symptoms do sound like your mother in law's, apart from the emergency DKA? Big weight loss being the big one? (Correct me LADAs! If I have wrongly interpreted info?)

I personally wouldn't do a deep dive into a T1 diagnosis until the results are back... T1 snd T2 really are that different. Including gene/inheritability stats? (I know the T2D ones, am assuming the T1 stats and risk factors are different? Again - LADAs - leap in here....)

We were told 5- 8 weeks as it goes to a lab in Cambridge - so hopefully in the right timeframe now. eldest son is acting as carer and is very controlling- he is the point of contact for medics and is quite content to not query anything and keep life simple. We'll see how this week goes.
Happily part from diet and Bs instability MIL is getting back to normal, lunches, coffees and even popping back to charity shop for 1.5 hours yesterday. Keeps her sane

 

[In Response]

question - is there an inherited susceptibility to LADA given that it has seems to share some aspects of type 1?

There is no official definition of LADA and some doctors chose not to use the term at all.
What is agreed is that LADA is a variant of Type 1, not just sharing some aspects of it.
Some define it as Type 1 diagnosed as an adult and some define it as Type 1 with some insulin resistance (a combination of Type 1 and type 2).

Regarding inherited susceptibility, there is a greater chance of getting Type 1 if it is in your family. However, that does not mean descendants will get it just because their parents do and, likewise, it is definitely possible to get Type 1 without any history of it in the family. I was diagnosed in my mid 30s (so, could be defined as LADA) despite no-one else in my family having any type of diabetes.

I am a bit late to this discussion so I apologies for not jumping in and mentioning this earlier.
You mention that your MIL is using a CGM which is great. However, CGMs have limitations. One of these is that they are designed to be most accurate at "normal" BG levels and can be very inaccurate when high or low. Therefore, aiming for a target of 15 with a CGM is like playing darts whilst wearing glasses smeared with vaseline as 15 is considered high (normal BG is between 4 and 7),
I do wonder if the target is 15 as a maximum unless there is a plan to reduce the target: reducing BG too fast can cause additional complications. I recommend confirming this if possible.

 

[stukie]

There is no official definition of LADA and some doctors chose not to use the term at all.
What is agreed is that LADA is a variant of Type 1, not just sharing some aspects of it.
Some define it as Type 1 diagnosed as an adult and some define it as Type 1 with some insulin resistance (a combination of Type 1 and type 2).

Regarding inherited susceptibility, there is a greater chance of getting Type 1 if it is in your family. However, that does not mean descendants will get it just because their parents do and, likewise, it is definitely possible to get Type 1 without any history of it in the family. I was diagnosed in my mid 30s (so, could be defined as LADA) despite no-one else in my family having any type of diabetes.

I am a bit late to this discussion so I apologies for not jumping in and mentioning this earlier.
You mention that your MIL is using a CGM which is great. However, CGMs have limitations. One of these is that they are designed to be most accurate at "normal" BG levels and can be very inaccurate when high or low. Therefore, aiming for a target of 15 with a CGM is like playing darts whilst wearing glasses smeared with vaseline as 15 is considered high (normal BG is between 4 and 7),
I do wonder if the target is 15 as a maximum unless there is a plan to reduce the target: reducing BG too fast can cause additional complications. I recommend confirming this if possible.

Thanks for this info - really interesting re calibration for CGM . I suspect the BS has been set higher to try and assist in weight gain and that this would be a temporary measure until a predetermined amount of weight has been on and then the situation reviewed and BS potentially reduced gradually. As there is deliberately little control on carbs there is a BS rollercoaster. Noone medical seems concerned as weight gain is taking centre stage . I didn't appreciate quite how bad/ uninformed NHS dieticians could be.
As I'm not next of kin it can be difficult to speak with medical staff . Eldest son has taken control of this interface and noone else will get a look in .
He has a call with the diabetic nurse tomorrow and I'm very asked him to ask the nurse queries re LADA status, plan going forward as current one is clearly not working ( no weight gain last week) , and insulin regime options.
We' ll see how that pans out .
Thanks again for your reply

 

[stukie]

Well just been advised by my brother in law that he won't be asking any questions as his mother has an expert team and both he and his mum are very happy with the treatment to date .
Frustrating.

 

[stukie]

Blood results back - T2 confirmed .

 

[stukie]

Insulin changed today to a slow release version.
3 month blood sugar test had halved ( thankfully as it was 32 on admission to hospital)
This change in insulin has caused initial high spikes after eating (28) - probably body needs time to adjust as this will be a big change ?

Change advised by diabetic nurse after consistently high nighttime (15) readings, I think to try and even things out , and advises to get in touch if readings after eating still spiking on Sunday.
Would nighttime highs not suggest a liver issue ?
@AloeSvea @Antje77 ,@EllieM

 

[Antje77]

Would nighttime highs not suggest a liver issue ?
@AloeSvea @Antje77 ,@EllieM

Nighttime highs don't suggest anything to do with the liver, it only shows that the amount of insulin active in the body at that time of day is insufficient.
If I forget to inject in the evening, or if I miscalculate my dose, I'll get high BG.

 

[stukie]

Nighttime highs don't suggest anything to do with the liver, it only shows that the amount of insulin active in the body at that time of day is insufficient.
If I forget to inject in the evening, or if I miscalculate my dose, I'll get high BG.

Thank you .
Lack of sleep this week is not helping thought processes ! As liver provides nocturnal glucose , I had wrongly assumed it may have something to do with liver function.
I don't quite know how a slow release will pan out . I know that the initial spikes , and previous night time spikes have caused MIL some concern .
Hopefully it can be tweaked yo suit body response

 

[AloeSvea]

Hi @stukie. I feel for you re the blind faith in a diabetes team that your bro in law and mother in law have! Especially re the chain of communication. My own experience with extended family and elderly parents' medical care, and around communication is - there's not much more you can do is breathe deeply in response, and just be there for your loved one! In this case your MIL. Give the info you have gleaned, and breathe deeply again if the eyes of your ill loved one glaze over...

But hey! A diagnosis at last! This is great news indeed. From my own research and maths the percentage of those with both an auto immune diabetes and T2 being treated with insulin is about 25%. My maths may be wrong - always happy to be corrected.

My own understanding and line, re your question a couple of postings above, is that T2D is way more complex than the standard lines about what T2D is, would indicate. And I get the huge focus is on her nutrtional needs right now, rather than how her T2D is playing out? Which is absolutely understandable considering her advanced age.

I know what I do with my own mother and her metabolic health - I do that breathing deeply, and remind myself the focus now, regarding my mother's health, is on her comfort and contentment in her twilight years. I give her support re her big belly, as in - well - don't worry about it and her metabolic health any more! (No ability to change her diet in any case in a rest home.) Give her a lot of ra ra re her reaching such an advanced age. And keep smiling!

 

[stukie]

Hi @stukie. I feel for you re the blind faith in a diabetes team that your bro in law and mother in law have! Especially re the chain of communication. My own experience with extended family and elderly parents' medical care, and around communication is - there's not much more you can do is breathe deeply in response, and just be there for your loved one! In this case your MIL. Give the info you have gleaned, and breathe deeply again if the eyes of your ill loved one glaze over...

But hey! A diagnosis at last! This is great news indeed. From my own research and maths the percentage of those with both an auto immune diabetes and T2 being treated with insulin is about 25%. My maths may be wrong - always happy to be corrected.

My own understanding and line, re your question a couple of postings above, is that T2D is way more complex than the standard lines about what T2D is, would indicate. And I get the huge focus is on her nutrtional needs right now, rather than how her T2D is playing out? Which is absolutely understandable considering her advanced age.

I know what I do with my own mother and her metabolic health - I do that breathing deeply, and remind myself the focus now, regarding my mother's health, is on her comfort and contentment in her twilight years. I give her support re her big belly, as in - well - don't worry about it and her metabolic health any more! (No ability to change her diet in any case in a rest home.) Give her a lot of ra ra re her reaching such an advanced age. And keep smiling!

Thanks @AloeSvea ,
Age seems to be driving the treatment - the irony is that she could well outlast a few of us! The sad thing is that she does keep asking me what she should be eating as the spikes concern her- she has all but given up chocolate ( to be fair I think her son ate all the chocolate that was in the house) and is being restrained re snacks and desserts when she goes out. She's had no info re mixed plates and order of eating things to enable her to minimise changes to diet and reduce BS spikes but she is keeping an eye on her CGM to see if she can see what has the most effect, which clearly helps.
She is of that generation who comply with authority without question. If the dietician had highlighted healthy fats, nuts, veg and protein and stressed complex carbs she would have tried to adapt, but we are where we are. I don't think she has been given any options diet wise. Hopefully she will continue to gain weight slowly.
She is persevering and adapting - and at 87 that is no mean feat in itself

 

[AloeSvea]

Hi again @stukie. May you have many happy well insulinated meals with your MIL in the future! (Hope this conforms to Forum Rules .)

 

[stukie]

Yes it could well have been the cyst that sparked the DKA.
She had been diagnosed by GP as diabetic around 18 months ago and was on pills of some sort, but clearly was not being monitored. She only told one of her sons ( who lives near her and takes her to appointments) and just carried on as normal.
There was a mistake made by GP following bloods taken in November and December and she should have been put on insulin then.

Yes, I'm totally with you on the low carb option - she has had chocolate avocado mousse without realising before , so it could easily be put in place but it's not even been suggested by dietician. Not really had good experiences with NHS dieticians for a couple of conditions with relatives and this one isn't impressing either. If it's not proposed by her " expert team" then it won't be considered. That's the sad bit.

Until her weight increases ( she has around 6kg to gain and the current rate is 0.5- 1 kg/ week , though a couple of weeks gave had no weight gain ) low carb won't be an option. I think given her age her " team" are not that fussed as she has had no dietary options discussed other than carbs for weight gain.
She's been told as much and not really been given choice . ( She is probably quite happy that there has not been much change ) Whether this can be queried once she hits her target weight remains to be seen.

Her freezer has just been defrosted so I'll be batch cooking some nutrient dense meals for her , so we can have some comfort that she can enjoy some decent nutrition which aids weight gain and health .

 

[AloeSvea]

We should be rewording this thread to 'diet good for weight gain as an insulin-dependent late onset type two' ? And then give the answer - whatever your medical team/diabetes team suggests, in light of the insulin dose. I hope I have this right? Always willing to learn.

 

[AloeSvea]

ps I had a weight lifting martial arts expert former partner, always interested in gaining and losing weight in order to be in the right weight class in competitions.

For rapid weight gain he swore by milkshakes. And those flavoured protein shakes you can get in health food stores, supermarkets, and pharmacies.

Do such shakes fit in the diet plan suggested by your MIL's diabetes team I wonder? (A good thing to share with readers?)