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Helpless

Discussion in 'Type 2 Diabetes' started by Paxydolphin, Jun 16, 2019.

  1. Paxydolphin

    Paxydolphin · Newbie

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    Hi
    My dad has type 2 diabetes for about 20 years. Just went with him for his followup. The doctor told us that his kidney function has worsen. I do not know the reading but I think he is a stage 4. The doctor said because of this he has to stop metformin and up his glyclazide dosage to 2 tablets a day. He was asked to start insulin but my dad refused. He has bleeding in his eyes as well. Just had a 6 vessel heart bypass in Jan and a colon cancer surgery in Feb.

    His before breakfast reading is 8.4 today.

    Can I know how long does it take for a stage 4 to deteriorate to end stage kidney disease?

    What can we do? Can a change in diet help at this point?

    I have not much understanding of the disease. I know of someone who had amputations because of diabetes but yet he does not need to go on insulin. My dads feet is okay. Can someone explain how diabetes work? Thanks
     
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  2. Mike D

    Mike D Type 2 · Expert

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    Only his doctor can advise you. We simply cannot, ethically or professionally. I'd urge you also discuss this with your father
     
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  3. pavlosn

    pavlosn Type 2 · Well-Known Member

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    Hi

    We feel your pain.

    However Mike is right in that it would be irresponsible for us to advise on your dad's situation as we are not medical professionals and your dad unfortunately faces a number of health issues beyond just suffering from diabetes.

    You really need to discuss your questions with your dad's doctor.

    I believe you also need to discuss with your dad his reasons for refusing insulin against his doctors advise. Is it because he has medical concerns for this or does he think that there is a stigma attached? Many t2 diabetics find that they have to go on insulin in order to manage their condition. If that is what is needed then that is what is needed.

    You may find the following general information interesting by way of introduction to diabetes and kidney disease

    Source: https://www.kidney.org/atoz/content/Diabetes-and-Kidney-Disease-Stages1-4


    Quote

    Diabetes and Kidney Disease (Stages 1-4)

    What is diabetes?

    Diabetes happens when your body does not make enough insulin or cannot use insulin properly. Insulin is a hormone. It controls how much sugar is in your blood. A high level of sugar in your blood can cause problems in many parts of your body, including your heart, kidneys, eyes, and brain. Over time, this can lead to kidney disease and kidney failure.
    There are two main types of diabetes. Type 1 diabetes generally begins when people are young. In this case, the body does not make enough insulin. Type 2 diabetes is usually found in adults over 40, but is becoming more common in younger people. It is usually associated with being overweight and tends to run in families. In type 2 diabetes, the body makes insulin, but cannot use it well.

    What is chronic kidney disease (CKD)?

    Your kidneys are important because they keep the rest of your body in balance. They:

    Remove waste products from the body

    Balance the body’s fluids

    Help keep blood pressure under control

    Keep bones healthy

    Help make red blood cells.

    When you have kidney disease, it means that the kidneys have been damaged. Kidneys can get damaged from a disease like diabetes. Once your kidneys are damaged, they cannot filter your blood nor do other jobs as well as they should.

    How does diabetes affect my body?

    When diabetes is not well controlled, the sugar level in your blood goes up. This is called hyperglycemia. Hyperglycemia (high blood sugar) can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet, nerves.

    How does diabetes cause damage to my kidneys?

    Diabetes can harm the kidneys by causing damage to:

    Blood vessels inside your kidneys. The filtering units of the kidney are filled with tiny blood vessels. Over time, high sugar levels in the blood can cause these vessels to become narrow and clogged. Without enough blood, the kidneys become damaged and albumin (a type of protein) passes through these filters and ends up in the urine where it should not be.

    Nerves in your body. Diabetes can also cause damage to the nerves in your body. Nerves carry messages between your brain and all other parts of your body, including your bladder. They let your brain know when your bladder is full. But if the nerves of the bladder are damaged, you may not be able to feel when your bladder is full. The pressure from a full bladder can damage your kidneys.

    Urinary tract. If urine stays in your bladder for a long time, you may get a urinary tract infection. This is because of bacteria. Bacteria are tiny organisms like germs that can cause disease. They grow rapidly in urine with a high sugar level. Most often these infections affect the bladder, but they can sometimes spread to the kidneys.

    How do I know if I have kidney damage?

    Most people with early kidney damage do not have symptoms. The best way to find early kidney damage is to have a urine test once a year. This test checks for very small amounts of protein in the urine called albuminuria. It helps show kidney damage at an early stage in people with diabetes. Not everyone with kidney disease gets kidney failure. With the right treatment, you can prevent kidney disease from getting worse.

    If I have diabetes and kidney damage, what should I do?

    Your healthcare provider will create a treatment plan for you. You may also need to see a kidney doctor (called a "nephrologist"). A dietitian may be helpful too. The following things can help your kidneys work better and last longer:

    Controlling your blood sugar
    The best way to prevent or slow kidney damage is to keep your blood sugar well controlled. This is usually done with diet, exercise, and, if needed, insulin or hypoglycemic pills (to lower your blood sugar level).

    Controlling high blood pressure
    High blood pressure can increase your chances of getting kidney failure. Ask your doctor what your blood pressure target should be.

    Protecting kidney function by taking ACE inhibitors or ARBs
    Your doctor may have you take high blood pressure medicines (called ACE inhibitors or ARBs) even if your blood pressure is normal. Research suggests that these medicines can slow the loss of kidney function in all people with diabetes—even those with normal blood pressure.

    Limiting how much protein you eat
    People with diabetes and kidney disease should eat enough protein for good health, but avoid overeating it. Research suggests that eating less protein can slow kidney damage. You should talk to your doctor about this. If you need to go on a low-protein diet, you must plan this with a dietitian who specializes in kidney disease. Do not go on this type of diet without talking to a dietitian so that you have a healthy approach to dietary changes.

    Promptly reporting to your doctor any difficulty passing urine
    Early treatment for urinary tract infections is important. Some signs of urinary infection could be: frequent need to urinate, burning or pain with urination, cloudy or blood-spotted urine, or a strong odor to your urine.

    Limiting the amount of salt in your diet to help control high blood pressure and reduce body swelling.

    Not using medicines that may damage the kidneys especially NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen and naproxen. Check with your doctor before taking any herbal supplements because some can harm the kidneys.

    Keeping cholesterol and lipid levels under control. This will help prevent further damage to larger blood vessels, such as those in the brain and heart.

    End quote

    I wish you and your dad the best

    Regards

    Pavlos
     
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  4. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    Honestly, I don't know. Normally I'd say go for it, but when there's already extensive kidney damage, they won't like the moderate amounts of protein that go with the Low Carb/High Fat diet. It could make a damaged kidney that much worse. And upping the fats after multiple bypasses... You could both read Dr. Jason Fung's The Diabetes Code and maybe pick up some tips there, but you really want to go with the specialists on this... Books and websites are nice when there's nothing else to consider, but this is too much to go doctoring with on your own. Your dad could try cutting out bread (or anything made with grain, really), corn, cereals, fruit (save for berries in moderation), potatoes, rice.... But with the gliclazide that will make him go hypo, and you want to avoid that. Does your dad have a meter? Just get as much information as you can, and discuss that with the specialists before implementing anything.

    Good luck, and wishing your dad well!
    Jo
    PS: Diabetes Type 2 means your body put out a whole lot of insulin to deal with the glucose in the blood, so much so you've become insensitive to it. So you need more and more to get the same effect as it would've given a few years earlier. The thing that makes bloodglucose spike are carbs. Practically all carbs, not just sugar, but starches too. Hence the spuds and bread etc being a problem: it all gets turned to glucose once ingested, and your dad can't process it back out. It just keeps on floating around in his bloodstream, doing damage to arteries, eyes, kidneys.... That's the really short, simplified version. Again, Dr. Jason Fung's book will give you more information.
     
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    #4 JoKalsbeek, Jun 16, 2019 at 6:59 AM
    Last edited: Jun 16, 2019
  5. Winnie53

    Winnie53 Type 2 · Well-Known Member

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    @Paxydolphin my friend is going through this too. She has stage 4 CKD. We've spent the last two years looking at her options. Here's what we've learned so far...

    Damage to the kidneys is not reversible. You'll find videos on YouTube.com saying otherwise. It's not true. But, with the right diet, lab results will improve somewhat. :)

    The challenge is accommodating the loss of kidney function by making changes to the diet to reduce demands on the kidneys. Doing so sometimes stablizes kidney function, sometimes slows further loss of kidney function. Additionally, there are protein supplements specifically designed for Stage 3, 4, and 5 CKD. They are described in these two books:

    Coping With Kidney Disease: A Twelve Step Program To Help You Avoid Dialysis by MacKenzie Walser, MD, Professor, John Hopkins University School of Medicine (2004). You can read reviews on the book here - (some of his patients wrote reviews too)... https://www.amazon.com/gp/product/0471274232/ref=ppx_yo_dt_b_asin_title_o08_s00?ie=UTF8&psc=1 Dr. Walser, a nephrologist, passed away sometime after publication of the book, but he helped many, many patients with CKD. This book was written for CKD patients, and it provides lots of helpful information on what's happening to your father.

    The second book was published this year by a former patient of Dr. Walser who dug into the medical research and summarized it. It's more of a reference, but also helpful. His name is Lee Hull. Stopping Kidney Disease: A Science Based Treatment Plan To Use Your Doctor, Drugs, Diet and Exercise To Slow or Stop the Progression of Incurable Kidney Disease: A Science Based Diet and Treatment Plan To Slow or Stop the Progression of Kidney and Heart Disease. Improve your GFR and Get Measurable Results in 90 Days or Less by Lee Hull (2019). You can learn more about the book here... https://www.amazon.com/gp/product/0692901159/ref=ppx_yo_dt_b_asin_title_o09_s00?ie=UTF8&psc=1

    Lee Hull has one more book that will be published in the next month or so, a meal planning, recipe and cookbook for kidney patients. Keep checking back for it. Not sure, but I think it will be a Kindle book. If you go to his website, you can sign up to receive emails from him.

    My friend and I found both books very useful, and bought an extra copy of both books for her nephrologist. Just this past week, my friend spoke with Lee Hull by phone, and he was very generous and kind in answering her questions. He lives in the US in Texas.

    You and your father have been through a lot. When my friend was diagnosed with CKD we both scrambled to learn everything we could. Please know you have time to learn about this condition and possibly delay dialysis further down the road. Kidney transplant also may be an option. My friend, like your father, has type 2 diabetes. Plant based protein is best for stage 4 and 5 CKD. That's the reason some patients seek out the plant based protein supplements specifically created for stage 3, 4, and 5 CKD patients. When you read the books, you'll know more than most nephrologists in how to delay transitioning to dialysis as long as possible.

    Hope you find this information helpful.

    Edited to add: You will find a lot of cookbooks for CKD. I bought a couple but the information in them conflicted with one another. I encourage you to start with the books listed above before buying other cookbooks. By doing so, I think you'll be less confused and more grounded in the most up to date information about CKD.
     
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    #5 Winnie53, Jun 16, 2019 at 7:26 AM
    Last edited: Jun 16, 2019
  6. Winnie53

    Winnie53 Type 2 · Well-Known Member

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  7. Winnie53

    Winnie53 Type 2 · Well-Known Member

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  8. DCUKMod

    DCUKMod I reversed my Type 2 · Expert
    Staff Member Administrator

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    Paxydolphin - This link I am attaching is usually posted to new members here, as it contains valuable iformation for people beginning their diabetes journeys, however, I hope it could also be very useful to you, in learning how to hwlp your Dad cope with the position he finds himself in.

    Your Dad has had an awful lot to cope with in recent times - with his bypass and cancer surperies, so he may just be feeling rather overwhelmed by it all. If he is feeling down about his health, it could well be worthwhile seeing if his GP can provide any support.

    Newly diagnosed: what you should know. http://www.diabetes.co.uk/forum/threads/basic-information-for-newly-diagnosed-diabetics.26870/
     
  9. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Hi, so sorry to hear of your father's medical problems, do you know what his control has been like over the years, his diet and how old he is ?
     
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  10. Winnie53

    Winnie53 Type 2 · Well-Known Member

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    @Paxydolphin the other book by Lee Hull released and is available now. I just checked and both books are available in the UK too. Here's the link to the new book...

    Stopping Kidney Disease Food Guide: A recipe, nutrition and meal planning guide to treat the factors driving the progression of incurable kidney disease by Lee Hull (2019)
    https://www.amazon.co.uk/Stopping-K...swatch_0?_encoding=UTF8&qid=1560790637&sr=8-2

    I've ordered it and should receive it in a week or so. It's available in paperback and kindle.
     
  11. Paxydolphin

    Paxydolphin · Newbie

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    He is 70. He is always feeling hungry and thus always eats bread, biscuits, rice, noodles. He told me if he eats lesser he would have gastric again.
    His reading today is 9.4 before breakfast.
     
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  12. Robinredbreast

    Robinredbreast Type 1 · Oracle

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    Hi I can't really speak for your father's health and diet, but 'eating less and having gastric again' might be an excuse to eat what he wants?
    Have you looked at Google for links to help him with weight loss or just changing his eating habits,as this would make him feel so much better and in control too. He really should speak to his GP about Insulin and his refusal for not taking it. He seems to be burying his head in the sand.
    Good luck and all the best.
     
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  13. Paxydolphin

    Paxydolphin · Newbie

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    Today his sugar level is 10 plus . He told me he had a small portion of rice for dinner and 3 diabetic friendly sugar free choc chip cookies. What can he eat or snack safely? Thanks
     
  14. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    The thing with "sugar free" and "diabetic friendly" cookies... They're still made with flour, and thus, carbs.And those turn to glucose once ingested. It's marketing, not actually diabetic-safe. And rice is carby too. He really has to find alternatives. Like cheese, olives, extra dark chocolate... Cauliflower rice is a good alternative to actual rice too.

    https://www.dietdoctor.com/low-carb/snacks Maybe this'll help?
     
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  15. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    He can snack on Cheese, nuts, sunflower seeds, Pine nuts etc. Even carrot sticks would be better than the high carb garbage he is currently eating.
    Note: Anything labelled Diabetic or diabetic friendly is basically poison to diabetics because it is just substituting 'sugar' with other carbs. Anything labelled 'Low Carb' is probably OK - though you have to consider just how high in Carbs the normal version is.
     
  16. Paxydolphin

    Paxydolphin · Newbie

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    He had salad for dinner yest. There was kale, chicken breast, curried cauliflower rice and broccoli. His reading was 10.2 today. Even controlling diet doesnt help anymore?
     
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  17. Winnie53

    Winnie53 Type 2 · Well-Known Member

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    It takes some of us a month or more to bring glucose levels down despite eating only 40 to 50 carbs a day. It did for me. I used graph paper to track every glucose result over an 8 week period. That kept me going. My glucose levels were all over the place, but I slowly began to see a downward trend. That was a good dinner for your father. Well done. Track his glucose levels. Watch for the downward trend. :)

    Edited to add for me: 10.2 mmol/l is 183.6 mg/dl in the US.

    The low carb meal you prepared provided protein and fiber. That will help. I've never made or eaten curry. Does it have fat in it? I believe fat will slow down the processing of the carbs and will help curb the cravings. Fat doesn't effect glucose levels very much.

    Coming off refined starches and sugars causes withdrawal symptoms including intense cravings at times. It's not an easy thing to do but gets better with time. Including fat with all meals/snacks will help. Actually all meals/snacks should include protein, a healthy fat, with a small portion of carbs from whole foods, not refined.
     
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    #17 Winnie53, Jun 25, 2019 at 2:13 AM
    Last edited: Jun 25, 2019
  18. ianf0ster

    ianf0ster Type 2 · Well-Known Member

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    Hi Paxydolphin,
    You don't mention what his other meals were during the day, but it is possible that he might have gone a little too low carb considering his medication.

    As @JoKalsbeek said"... Your dad could try cutting out bread (or anything made with grain, really), corn, cereals, fruit (save for berries in moderation), potatoes, rice.... But with the gliclazide that will make him go hypo, and you want to avoid that."

    What happens if he goes hypo is that the liver will 'think' he is in danger of death and so will dump stored glucose into the bloodstream. If this happen overnight there will be no/little muscular movement to use it up and so there will be a higher BG reading in the morning. Though a somewhat raised BG in the morning is quite normal for many diabetics, including me - it is called 'the Dawn Effect'. In my case it has always dropped back into a good range when tested 2hrs after a low carb breakfast.

    - At what relative time are you measuring in the morning? Is it before breakfast, soon after he gets up? - If so, the numbers can vary quite a lot depending on how low his BG got down to overnight and if he had a disturbed sleep because both of these can increase 'the Dawn effect'.

    The 'fasting' BG levels are the hardest to get down, so as @Winnie53 said, track his glucose levels and look for a trend.
     
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  19. Winnie53

    Winnie53 Type 2 · Well-Known Member

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    ianf0ster has identified a potential problem. Here in the US, physicians like Eric Westman, M.D., who have been using the low carb ketogenic diet to reverse diabetes for a decade or more, typically cuts the diabetes medications and anti-hypertension medications in half prior to starting the diet.

    This however needs to be done on an individual basis, particularly in your father's case because of his other health issues. As your father continues on the diet, he needs to work with his doctor on a strategy to lower the medications as his glucose levels begin to come down because the diabetes medications can cause his glucose level to drop uncomfortably low, which is referred to as a hypo or hypoglycemic episode, and his anti-hypertension medication cam cause a dramatic drop in blood pressure. We don't want him to become light headed or dizzy and fall, or lose consciousness.
     
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