Metformin stopped by Hospital, 3 months later re-admitted with v high blood sugar treated with insulin

[Debs B]

Hi there,
Im posting on behalf of my Aunt who has a number of medical issues, 1 being Type 2 diabetes previously treated by Metformin tablets. Another is vascular dementia and she has capacity but memory and confusion problems sometimes.
in June she was admitted to Hospital with other issues and during this stay her Metformin was stopped due to some issues with kidney function.
her GP or the hospital never prescribed an alternative and I wasnt heavily involved with her then so didnt really find all this out then.
Last week she had a fall at her assisted living complex and paramedics discovered her blood sugars were extremely high (around 30 i think) she was admitted for 5 or 6 days and treated with insulin. she has come out recently and has been receiving visits from district nurses and having insulin injections based on her blood sugar levels.
Unfortunately I cant get to read discharge letter or speak to her GP yet. we have an obvious problem that no action was taken by relevant people in regards to treatment of her diabetes.
can anyone please advise on their experience or knowledge if they think she has now entered a new phase in her diabetes journey and looks like she will be insulin dependant now on?
i was hoping the insulin in hospital and last couple of days might have been to get things under control and TEMPORARY.
Any info or advice greatly received. thanks

 

[AloeSvea]

I'm very moved by your post @Debs B. Your Aunt is very lucky to have such a wonderful niece looking out for her. My mother has vascular dementia, and I do a lot of medical-issues care-giving of her, and the ongoing things like her hearing issues, her eyes, her angina, and so on, involve a lot of 'overseeing'. (My mother would kill me actually if she knew I was writing this, still being as independent as she can be considering.) So I can understand what you are experiencing, by way of helping out your Aunt.

The only thing I can say is - yes, you would need to go the GP with her, or even better - the senior person's specialist (or whatever it is called in your neck of the woods - these things change all the time). The only way to get definitive responses about a loved one's diagnoses or treatments, especially when there are memory issues involved. My mother is fiercely independent, but she still understands that a loved one on hand with a good working memory is worth their weight in gold! The medical professionals will definitely put you and your aunt 'in the picture' about her diabetes treatment.

But saying that, reading what you have written it does seem like entering a new phase in her diabetes journey is what has happened, especially considering the change in her kidney function - which is a really big one on a diabetes journey for sure.

 

[Oldvatr]

Metformin cannot be used in patients having weak kidney function due to it increasing lactic acid buildup. I have had mine stopped now. Having said that, Metformin will have virtually no impact on bgl levels as high as your aunt is suffering at the moment. (at max dose the effect on blood sugar is only a couple of points at best). It may be that because of the confusion issues, insulin treatment by a carer may be the better solution for her. The route back from 30+ levels is not easy even if the pancreas is working, What you don;t know at the moment is if your aunt is suffering from insulin deficiency due to pancreas, or insulin resistance. There is a blood test that can determine the amount of insulin she is able to produce herself (called the vc-peptide test) and this should be made available given the hospital admission. It may be the hospital consultant needs to prescribe this since GP's generally seem unable to provide this test.

 

[Debs B]

Metformin cannot be used in patients having weak kidney function due to it increasing lactic acid buildup. I have had mine stopped now. Having said that, Metformin will have virtually no impact on bgl levels as high as your aunt is suffering at the moment. (at max dose the effect on blood sugar is only a couple of points at best). It may be that because of the confusion issues, insulin treatment by a carer may be the better solution for her. The route back from 30+ levels is not easy even if the pancreas is working, What you don;t know at the moment is if your aunt is suffering from insulin deficiency due to pancreas, or insulin resistance. There is a blood test that can determine the amount of insulin she is able to produce herself (called the vc-peptide test) and this should be made available given the hospital admission. It may be the hospital consultant needs to prescribe this since GP's generally seem unable to provide this test.

Thanks for this info. I will try and find out about the resistancy or deficiency question. hopefully discharge letter might help also. does it affect the treatment then?
Ive just realised i made a typo and she was in hospital for 5 or 6 days not 56!!

 

[Deleted member 559951]

Metformin cannot be used in patients having weak kidney function due to it increasing lactic acid buildup. I have had mine stopped now. Having said that, Metformin will have virtually no impact on bgl levels as high as your aunt is suffering at the moment. (at max dose the effect on blood sugar is only a couple of points at best). It may be that because of the confusion issues, insulin treatment by a carer may be the better solution for her. The route back from 30+ levels is not easy even if the pancreas is working, What you don;t know at the moment is if your aunt is suffering from insulin deficiency due to pancreas, or insulin resistance. There is a blood test that can determine the amount of insulin she is able to produce herself (called the vc-peptide test) and this should be made available given the hospital admission. It may be the hospital consultant needs to prescribe this since GP's generally seem unable to provide this test.

I could be totally wrong here but is there any benefit in a c-peptide in this case? With a (I assume) poor renal function it limits the OHAs that are appropriate and BCG of >30mmols suggests endogenous insulin production may be limited.

 

[Oldvatr]

I could be totally wrong here but is there any benefit in a c-peptide in this case? With a (I assume) poor renal function it limits the OHAs that are appropriate and BCG of >30mmols suggests endogenous insulin production may be limited.

Insulin treatment is already in place since discharge from hospital, and the OP question was Is it a permanent requirement for the future, or is there an alternative. I would suggest that the HCP's in charge will call for a c-pep before agreeing to any altenative treatment. As one who has come back from the 30+ brink myself, that level of blood sugar is not proof of insulin deficiency. My concern is that any alternative therapy will probably require HCP or carer oversight to a greater degree to cover the confusion issue that is a co-condition in this case.

 

[Deleted member 559951]

Insulin treatment is already in place since discharge from hospital, and the OP question was Is it a permanent requirement for the future, or is there an alternative. I would suggest that the HCP's in charge will call for a c-pep before agreeing to any altenative treatment. As one who has come back from the 30+ brink myself, that level of blood sugar is not proof of insulin deficiency. My concern is that any alternative therapy will probably require HCP or carer oversight to a greater degree to cover the confusion issue that is a co-condition in this case.

It's important to note the difference between (I assume) yourself who's relatively younger and in decent health in comparison to the OP's aunt though. For the latter it isn't about tight glycaemic control, more preventing her from being symptomatic.

I'm also thinking that alternatives might not be appropriate depending on the patient's eGFR. Depending on the renal function a lot of OHAs will be contraindicated whilst something like a DPP-4 might not be effective enough at controlling blood sugars that for whatever reason are running at >30mmols.

It'd be interesting to know what insulin the OPs aunt is prescribed.