Fluctuating Blood Sugar Levels

[daggyjack]

Hi All,
First post on here and I'd really appreciate your advice.

I work in Day Services foe adults with Learning Difficulties.
A man that I work with and have done so for 4 years has wildly fluctuating blood sugar levels.

He is tested at home at 8.00 am and averages 20.0 and comes into service by 10.00 am. We are able to test him and again his levels vary greatly from 4.0 to 15.0 at this time.

He is tested throughout the day (at lunchtime and 2 hours after lunch) and there is no pattern.

For example, a few days ago, at lunchtime his reading was 13.4, then when tested after lunch (of pie and potatoes), his levels dropped to 4.5.

He used to see his Diabetic Clinic regularly but doesn't seem to go any more but when I used to take him, his HBA1C readings were considered ok (at 8) even though to me, his blood sugar levels are all over the place.

He has even been known to be 19.0 at 9.00 am then found collapsed with readings of 1.1 two hours later. When admitted to hospital after this, he was discharged a few hours later without, in my eyes, proper investigation. I thought it would have been an ideal time to complete a baseline check.

Please could I be given some advice to pass back to the team and Care Manager, as I feel that this young man will suffer serious health consequences at a later date if he is not regulated and looked after proprley soon.

Thank you in advance and I really hope your greater knowledge will help me help this individual.

 

[Grazer]

Not much to say other than that he needs proper medical treatment urgently. His readings suggest he's type 1 to me, so who administers his insulin? He is in real danger of dangerous hypos with those levels and obviously has no control. He needs to see a diabetes consultant for proper advice. If he's under care, his carer obviously needs to be there. Can you fill us in more on details of medication routines etc?

 

[daggyjack]

Thanks for your reply.

Insulin is administered by the family at 8.00 am and again at 4.00 pm.

If levels drop below a certain level, dextrose x 3 is given, conversely if levels increase over a certain level, we were told to exercise and give water.

I completely agree in terms of the concern about the long term effect that this current situation gives.

Would you recommend recording the blood sugar levels over a period of time, say a month, then visit the Diabetic clinic to pass the information on. I have done this before but to no effect.

Why are blood sugar levels so erratic, in terms of increasing one day after food intake yet dropping alarmingly the next after food? I'm really confused and frustrated by the lack of obvious pattern.

 

[Grazer]

I'm hoping some type 1s will come along here, because I don't use insulin so can't help you a lot. I do know that getting doses right to avoid the highs and lows you've noted is far more complex than a quick dextrose tablet here and a bit of exercise there. He may need adjustments to his entire regime.yes, record all his readings together with times of taking them relative to meals and see a specialist as soon as poss - I wouldn't wait amonth! If you don't get a type 1 replying, I suggest you repost this on the type 1 section of this forum. Good luck

 

[Grazer]

I've put a link to this thread on the type 1 forum now in the hope that you'll get one of them along with better advice than I can give

 

[iHs]

This is worrying but can be sorted out with the correct diet guidance ref carbohydrate eaten to the effect that it has on the insulin injected to bg levels.

 

[iHs]

Ahhh Haaaa

Hello daggyjack

From reading yr message, it sounds as though the person you are talking about is using biphasic insulin (twice daily) and needs to monitor the carbohydrate content of the food they eat against their bg levels. Twice daily insulins release their action slowly over a period of time and come in various mixes - 30/70, 25/75, 50/50,. There are more variations of mixed insulin but the ones mentioned are the most common.

Usually food containing some carb is spaced out during the day. You need to ask what amount of carb the person has been instructed to eat at different meal times and then adjust it all according to the bg levels that you get when you do a blood test. It's fairly easy when you follow the rules...... Ask the family for more info and if they dont know phone up the diabetic clinic and ask them.

Hope this helps a bit

 

[Unbeliever]

Reminds me of the recent thread about Diabetics in Care Homes. If the person has other problems no one seems to care too much about the diabetes. There may welll be a connection between his person's mental and physical condition.

At least someone appears to be concerned about him.Good luck in finding answers daggyjack. I wish there were more like you

 

[Dillinger]

Hi,

I'm a Type 1 - but you really need this man to be referred to a diabetic clinic at a hospital.
His blood sugars are badly out of control and he needs to get them under control.

It sounds like he is on a fixed dose of insulin and is not matching his carbohydrate intake to his insulin. Possibly he's randomly changing his insulin dose as well.

It all sounds very bad to me. You need to escalate this via his GP to a diabetic clinic

Sorry I can't be of more help

Best

Dillinger

 

[ladybird64]

Unfortunately people with learning difficulties often have their health needs overlooked. :evil:

A couple suggestions Daggy. Firstly, if this gent is under the care of a Learning Disabilities Team at Social services, then this matter really should be raised with his care manager. Within these teams there is often a LD nurse who supports epople and their families in the community, assisting with bloods, any other probs of that nature. They also act as an intermediary between patients and health care professionals so it is worthwhile finding out if he has this service.

I think your idea of a diary is a good one. I also wonder how careful his family are about diet, bg's etc. this isn't a criticism but if sometimes it can all get a bit much for families to deal with. This is something that should be taken up with the care manager.

Lastly..and I know this is a difficult thing to do..perhaps someone should say that it is unsafe for him to be at the day centre unless he is receiving appropriate diabetic care from somewhere. He has had instances of collapse before so it is a reasonable thing to request given his history of unstable control. This is the easiest and quickest way to get the matter dealt with and those in charge of his care will have to take notice.

There is also the matter of a SOVA if they don't listen..they will HAVE to act if that is mentioned. While in the care of the day centre staff have responsibility to ensure he is safe, if his diabetes is off the chart he is unsafe.

As previously said, it is good that you are looking out for him. Good luck.

Hopefully a word in the right ear should mean that you don't have to resprt to threats like this but if nobody is taking notice, then it may need to be done.

 

[Camilla]

Hi All,
First post on here and I'd really appreciate your advice.

I work in Day Services foe adults with Learning Difficulties.
A man that I work with and have done so for 4 years has wildly fluctuating blood sugar levels.

He is tested at home at 8.00 am and averages 20.0 and comes into service by 10.00 am. We are able to test him and again his levels vary greatly from 4.0 to 15.0 at this time.

He is tested throughout the day (at lunchtime and 2 hours after lunch) and there is no pattern.

For example, a few days ago, at lunchtime his reading was 13.4, then when tested after lunch (of pie and potatoes), his levels dropped to 4.5.

He used to see his Diabetic Clinic regularly but doesn't seem to go any more but when I used to take him, his HBA1C readings were considered ok (at 8) even though to me, his blood sugar levels are all over the place.

He has even been known to be 19.0 at 9.00 am then found collapsed with readings of 1.1 two hours later. When admitted to hospital after this, he was discharged a few hours later without, in my eyes, proper investigation. I thought it would have been an ideal time to complete a baseline check.

Please could I be given some advice to pass back to the team and Care Manager, as I feel that this young man will suffer serious health consequences at a later date if he is not regulated and looked after proprley soon.

Thank you in advance and I really hope your greater knowledge will help me help this individual.

The pie and potatoes is a huge clue as to why! Those are foods a diabetic should never eat. This young man should be eating a good varied protein and fats diet with a total restriction on carbohydrates. Is he not seeing a doctor? Levels of 20mm are totally unacceptable and will result for sure in terrible complications for him. If diet cannot control his bg levels then medication is urgently required.

 

[Pneu]

The pie and potatoes is a huge clue as to why! Those are foods a diabetic should never eat. This young man should be eating a good varied protein and fats diet with a total restriction on carbohydrates. Is he not seeing a doctor? Levels of 20mm are totally unacceptable and will result for sure in terrible complications for him. If diet cannot control his bg levels then medication is urgently required.

Although I am in total agreement reference his blood glucose levels suggesting that a type I who takes a fixed amount of insulin should have a "total restriction on carbohydrate" is wholly dangerous; you will end up with someone in a coma or worse dead.

Reduced or restricted carbohydrate diets are a good alternative in the most part for type II's and in some cases advisable to type I's with insulin resistance (i.e. weight issues).. it is not a particularly suitable approach for any type I of normal weight or any type I of any sort of non-sedentary activity level.

The no carb or low carb mantra does not fit all scenario's...

Reference the Op.. as has been pointed out.. the main problem appears to be that he is taking two doses of fixed insulin daily.. this would suggest he needs to eat a set amount of carbohydrate at each meal.. failure to eat the correct amount will end up with hyper or hypo blood glucose. What you may find is that he needs to have snacks at certain times of the day as most of these intermediate acting insulins do not have a totally flat profile. The rapid fluctuation in his blood glucose suggests he is eating a lot of fast acting carbohydrate and you may have more success control blood glucose by switching to slower release carbohydrates. Your first port of call should definitely be the family or diabetes care team to establish how much carbohydrate he needs to be eating.

 

[ladybird64]

Sorry folks-can I just reiterate my suggestion that the Care Manager is informed of this situation with some urgency.

I note that the OP has accompanied the gent to his Diabetes appts before so it seems to me that he has a reasonable care package in place. It really is important to find out if a learning disabilities nurse is involved because she can get direct access to the clinic as an emergency.

May I also echo what Pneu has said and ask that we don't make sweeping generalisations about what others needs are? I have personal experience of diabetes, learning disabilities and day centres and it has to be understood that individual circumstances come into play.

Of course an appropriate diet is important and I totally agree that carb intake must be watched but total restriction on carbs for someone on insulin?

Not to be recommended.

:shock: :shock:

 

[Sid Bonkers]

The pie and potatoes is a huge clue as to why! Those are foods a diabetic should never eat. This young man should be eating a good varied protein and fats diet with a total restriction on carbohydrates..

Here we go again :roll: Not every diabetic is an ultra low carber Camilla, not every one can live that way and not every one wants to live that way, and a total restriction of carbs would be impossible anyway, no one even the lowest of the lowest low carber eats no carbohydrates what so ever. It may be your opinion that low carbing >30g carbs per day is the only way but I can assure you that it is not. So this type of advise especially when this thread refers to a gentleman with learning difficulties is no help what so ever IMHO.

 

[catherinecherub]

Reading through this thread, it might be that whoever cares for this gent at home has not had access to enough education as to how to manage his diabetes if he has high blood sugars at the start of his day at the Care Centre.
I also wonder if his right to choose the foods he likes, both at home and at the Care Centre as opposed to the foods that will benefit his diabetes are a problem?
It certainly needs professional input a.s.a.p.

 

[Grazer]

The pie and potatoes is a huge clue as to why! Those are foods a diabetic should never eat. This young man should be eating a good varied protein and fats diet with a total restriction on carbohydrates. Is he not seeing a doctor? Levels of 20mm are totally unacceptable and will result for sure in terrible complications for him. If diet cannot control his bg levels then medication is urgently required.

Hi Camilla,. I know you mean well, but this is the second recent post where you replied about a type 1 on insulin with your normal info on low carbs. You got some stick on the other post too. The fact is we need to be careful about advising people on low carb without understanding their insulin needs the way a type 1 might. That's why on this thread I asked for type 1 input rather than giving dietary advice myself. This guy is obviously unbable to understand the impact of carbs and insulin himself as are his poor day carers who shouldn't be expected to. So advice on cutting out carbs doesn't help. He needs proffessional help.

 

[noblehead]

Daggy,

Along with the other posters I suggest you get help from his diabetes care team.

 

[iHs]

I also suggest phoning DUK and speaking to one of the advisors about how to work out the carbohydrate content of most everyday foods. DUK are fairly good at this and will be willing to send out info.

Accu chek also do a Carbohydrate Awareness Guide listing all the common foods in 10g amounts.

Lastly, the Carbs and Cals book will show loads of different meals served up on a dinner plate listing the carb content.