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Is this advice counter productive?

S

Saramel

Active Member
Messages
33
Location
Portsmouth
Type of diabetes
Treatment type
Tablets (oral)
My DM is 76 and started insulin approximately 2 years ago as her blood sugars were quite high on Metformin and her kidneys were being quite badly compromised. Just under a year ago she started Slimming World to lose some weight and within a very short time had to cut her doses of insulin significantly as her blood sugars got much better. This morning she had a consultation with the Diabetic nurse who told her that her HbA1c levels were too low at 6. My Mum says that her fasting blood sugars are never lower than 5 each morning and go up to 7 after breakfast. She tests often and has never been hypoglycaemic so she was surprised when the Diabetic Nurse told her off stating she should be keeping her blood sugars at around 10.
My Mum is so upset by this as she has worked hard at getting the weight off, reducing her blood sugars and staving off dialysis which was looking inevitable a year ago. My knee jerk reaction is to dismiss the Diabetic Nurse's advice without a second thought but it does occur to me that there might be a good reason for the advice. Please can anyone help?
 
Sorry that I can't give you any sound advice as I am not an insulin user but my insticts are the same as yours. An improvement (or lessening deterioration) of kidney function, good bg levels, weight loss and using a little less insulin - it all sounds good to me whereas numbers to aim for being a ten does indeed sound counter intuitive. Having said this, it is best to get the views of those T2s who use insulin.
I'm sorry to hear that the DNs advice has upset the lady, this is unprofessional and shouldn't happen. Try to accompany her to future appointments. Best wishes.
 
It would be kind to just say the advice is rubbish, as this is a public forum that's as far as I can go. A HbA1c of 6 is great and very close to normalised. Blood sugars of around 10 are not good and puts one closer to all of the potential complications of diabetes which kickin around 7.8 mmol. Your Mum has done extremely well and if she posted her change of numbers on this site, she would be inundated with rightful praise. It would be wise for her to follow the advice on this site. There are ways of improving HbA1c and blood glucose numbers even further, even probably getting rid of insulin if you want to investigate further.
 
Saramel said:
My DM is 76 and started insulin approximately 2 years ago as her blood sugars were quite high on Metformin and her kidneys were being quite badly compromised. Just under a year ago she started Slimming World to lose some weight and within a very short time had to cut her doses of insulin significantly as her blood sugars got much better. This morning she had a consultation with the Diabetic nurse who told her that her HbA1c levels were too low at 6. My Mum says that her fasting blood sugars are never lower than 5 each morning and go up to 7 after breakfast. She tests often and has never been hypoglycaemic so she was surprised when the Diabetic Nurse told her off stating she should be keeping her blood sugars at around 10.
My Mum is so upset by this as she has worked hard at getting the weight off, reducing her blood sugars and staving off dialysis which was looking inevitable a year ago. My knee jerk reaction is to dismiss the Diabetic Nurse's advice without a second thought but it does occur to me that there might be a good reason for the advice. Please can anyone help?
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Saramel - Many health care professionals fear that running a very tight HbA1c must mean the individual is having lots of hypos. That may be quite true for some, but not for all, if some I take note of what some members of this site report. I do (take note).

There is also sometimes a concern that if someone using insulin starts striving for very tight control indeed, they might impact, negatively on their ability to recognise a hypo when it arises. Lack of hypo awareness is very undesirable, for obvious reasons.

Clearly, I have no idea the context in which your Mum's nurse made that comment, but you mention your Mum has never had a hypo? Perhaps, and of course this can only be speculation on my part, the nurse is concerned your Mum doesn't recognise when she goes low. Just a thought.

Personally? Personally, if it were my numbers, I would find an ideal number of 10 a bit difficult to take on board, but that would be for myself. I can't tell you or your Mum how t feel about it.

And finally, a huge well done to your Mum in doing the hard yards to avoid dialysis. That's quite an achievement.
 
Well done, mum! DN's, what do they know, right? (Seriously. Your mom should be proud and not fussed about the telling-off!)
 
Saramel said:
My DM is 76 and started insulin approximately 2 years ago as her blood sugars were quite high on Metformin and her kidneys were being quite badly compromised. Just under a year ago she started Slimming World to lose some weight and within a very short time had to cut her doses of insulin significantly as her blood sugars got much better. This morning she had a consultation with the Diabetic nurse who told her that her HbA1c levels were too low at 6. My Mum says that her fasting blood sugars are never lower than 5 each morning and go up to 7 after breakfast. She tests often and has never been hypoglycaemic so she was surprised when the Diabetic Nurse told her off stating she should be keeping her blood sugars at around 10.
My Mum is so upset by this as she has worked hard at getting the weight off, reducing her blood sugars and staving off dialysis which was looking inevitable a year ago. My knee jerk reaction is to dismiss the Diabetic Nurse's advice without a second thought but it does occur to me that there might be a good reason for the advice. Please can anyone help?
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I had similar at my last review. I’m diet controlled and my latest hba1c is 35 which I was told was very good but they don’t want me to reduce it any further!
 
Saramel said:
My DM is 76 and started insulin approximately 2 years ago as her blood sugars were quite high on Metformin and her kidneys were being quite badly compromised. Just under a year ago she started Slimming World to lose some weight and within a very short time had to cut her doses of insulin significantly as her blood sugars got much better. This morning she had a consultation with the Diabetic nurse who told her that her HbA1c levels were too low at 6. My Mum says that her fasting blood sugars are never lower than 5 each morning and go up to 7 after breakfast. She tests often and has never been hypoglycaemic so she was surprised when the Diabetic Nurse told her off stating she should be keeping her blood sugars at around 10.
My Mum is so upset by this as she has worked hard at getting the weight off, reducing her blood sugars and staving off dialysis which was looking inevitable a year ago. My knee jerk reaction is to dismiss the Diabetic Nurse's advice without a second thought but it does occur to me that there might be a good reason for the advice. Please can anyone help?
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Hi Saramel, so in effect then, the DN is saying your Mum should put the weight back on and increase her insulin doses, because that is the only way your Mum will be able to get back up to readings of 10!!!!! What utter nonsense, your Mum is probably at her fittest from her diabetes perspective. Obviously we don't know of anything else that may affect your Mum's treatment but an average reading of 6 is perfect as far as I am concerned. I suspect the DNs 'advice' is based on the NICE guidelines that say someone in their 70's can run higher sugars! In some cases maybe but if your Mum is fit & healthy then I would say it is far more important that she stays that way. (Also, tell your Mum that at 76 NO ONE can tell her off!!).
 
Saramel said:
My DM is 76 and started insulin approximately 2 years ago as her blood sugars were quite high on Metformin and her kidneys were being quite badly compromised. Just under a year ago she started Slimming World to lose some weight and within a very short time had to cut her doses of insulin significantly as her blood sugars got much better. This morning she had a consultation with the Diabetic nurse who told her that her HbA1c levels were too low at 6. My Mum says that her fasting blood sugars are never lower than 5 each morning and go up to 7 after breakfast. She tests often and has never been hypoglycaemic so she was surprised when the Diabetic Nurse told her off stating she should be keeping her blood sugars at around 10.
My Mum is so upset by this as she has worked hard at getting the weight off, reducing her blood sugars and staving off dialysis which was looking inevitable a year ago. My knee jerk reaction is to dismiss the Diabetic Nurse's advice without a second thought but it does occur to me that there might be a good reason for the advice. Please can anyone help?
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It's the fear she might be having hypos, ut she seems to be fine as she is.
 
I'm type one and have a similar conversation with my GP and nurse each year. He's of the belief that with an HB1AC of 5.3 I must be having hypos overnight. Even CGM results aren't enough to convince him.

My annual review, usually every 13 months by the time reminders, appointments and the stars align, came in January.
After a good christmas, this year showed a slight rise to 6 and he was over the moon. Of course, we'll have the same discussion next year when it's back down around 5.

I would say that 6 is better than 10 with respect to complications and she should just smile and carry on as she's doing!
Well done to her.
 
Thank you for all your replies. Apparently my Aunt has been told the same thing and it is because of the insulin. However, my Mum has bounced back a bit now from her doldrums and is going to suggest that if her blood sugar levels are too low, she doesn't take the insulin and tries something else. They were particularly worried about her driving apparently but she says she always tests before she drives (which is rare these days) and she feels she never goes far or out long enough to experience a low before she's home again. Driving a mile to the newspaper shop and back or the 500 yards to her sisters should be safe as long as she tests first.
 
HCP’s do worry that insulin treated patients will get hypos if their treatment and Glycaemic control are too tight ie hba1c too low. Sometimes hypo awareness can be poor and may occur overnight without the person being aware. That said T2D much more rarely causes hypos than T1. If a T2 person cuts back significantly on carbs and calories then not uncommonly treatments need revised and maybe even stopped. Assuming the new diet becomes the norm and regular testing is undertaken it would be possible to review the Insulin. As always this is best done with your HCP who knows your case and not on advice in the forum. But it may well be worth the question. You say already that her dose had been cut so there is a precedent.........
 
Saramel said:
Thank you for all your replies. Apparently my Aunt has been told the same thing and it is because of the insulin. However, my Mum has bounced back a bit now from her doldrums and is going to suggest that if her blood sugar levels are too low, she doesn't take the insulin and tries something else. They were particularly worried about her driving apparently but she says she always tests before she drives (which is rare these days) and she feels she never goes far or out long enough to experience a low before she's home again. Driving a mile to the newspaper shop and back or the 500 yards to her sisters should be safe as long as she tests first.
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Low glucose while driving is a real concern for those on insulin.

Years ago my dad had a serious car accident which required spinal surgery. He was supposed to have gone to a nearby foot massage center but was found it a totally different neighbourhood. Unfortunately that was just the beginning of numerous hypo episodes, disorientation and memory loss that we never truly understood at that time.
 
Sounds like your mum has worked hard and done very well so I can understand her upset. Would she agree to you accompanying her to an appointment so that you could establish the full picture and discuss the situation from all perspectives? Best wishes.
 
Just wanted to update you as my Mum had good news today. She had another HbA1c done and the diabetic nurse reviewed her again. The DN has decided that they are going to significantly cut back on her insulin and she is only to take it if her blood sugars start to rise again. On that basis they are happy if her blood sugars are around 5-6 in the morning. My Mum was absolutely delighted.
 
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