MODY in the Old

[Bob Marshall]

My wife is 66. She has suffered from diabetes since she was 18. She was eventually diagnosed with MODY in 2009,when she was 53 and prescribed glymepiride. Since then her health has declined (stroke in 2016, heart attack in 2019), she has put on weight and needs to take insulin in addition to the glymepiride.
I cannot persuade her to take any exercise.
I try to provide low fat, low sugar food but I have no idea what diet is appropriate for weight loss for her type of diabetes.
She is reluctant to try a low carb diet and she panics if her blood sugar falls below 8 (even overnight).
Any advice?

 

[boggle]

Hey Bob, currently there are 14 known types of MODY. Do you know which type she has? Some types act differently from others.

 

[Bob Marshall]

My wife has "MODY 3", which is the most common type.
Mutations to the HNF1alpha gene, responds to sulphonylurea (this includes glymepiride)

 

[boggle]

Hey Bob, so I heard that MODY 1 & 3 account for about 70% of all MODY cases. You probably know most of this but for anyone else: MODY 3 is supposedly similar to type 1 diabetes. Apparently it is treatable with sulfonylureas for decades, but eventually most will need insulin. I am wondering if it's worth testing to see if your wife is still producing any of her own insulin? If not then maybe she can stop taking her sulfonylurea. It sounds like LADA but with an extremely long honeymoon period, maybe someone with LADA can share thoughts on this.

Why does she panic with bg lower than 8? Does she experience large drops of a night? Does she have a CGM? If she can reduce her carbs she might be able to reduce her doses and get off the rollercoaster a bit. Has she any thoughts of joining the forum?

 

[EllieM]

Welcome to the forums @Bob Marshall

As a long term T1 I struggle with my weight and have issues with insulin resistance (T2 father) and low carb definitely helps me.

I've had periods of hypo unawareness and consequent hypo fear and I have to say that a cgm makes all the difference. I second the suggestion that you push your team to give her a cgm (or self fund if it's feasible). Aiming for a permanent bg above 8 sounds like a recipe for not feeling that well to me, as I'm guessing that means she spends a lot of her time in the teens. (Though that's assuming she's similar to a T1, which she may not be.)

And I have always been naturally extremely sedentary (I was always the last to be picked in any school sports activity) but I have to say that taking more exercise (which I started to do when I was about 50) massively helps both my health and my state of mind (and my blood sugars). It doesn't have to be formal exercise, just going for a short walk would be better than nothing.

I also second @boggle 's suggestion that you see if she wants to join the forum.

Good luck to you both.

 

[Bob Marshall]

CGM? I assume you mean Continuous Glucose Monitor.
No she does not have one.
She is producing insulin. She is on 4mg of Glymepiride (quite a high dose) which promotes insulin production. She only takes 8 units of insulin per day.
I think she panics about low blood sugar because it is difficult to recognise when her blood sugar is low.
I would like her to get diet advice but no one will give it. I will try to ask the consultant when we see him in August.

 

[EllieM]

CGM? I assume you mean Continuous Glucose Monitor.

Yes, sorry, I do.

 

[onnecar]

Just to clarify. You can still use insulin if you are still producing insulin, lots of type 2 are taking it. It backs up your own declining insulin supply, especially if other meds don't work or are not tolerated.