New to insulin

[Solaire]

My husband is the diabetic, but doesn't do internet, so down to me
he has been diagnosed with T2 over 15 years now. In all his life (now 79) he has never weighed more than 12.5 stone, never got an ounce of fat, but diabetes runs in the family ....Put on metformin and glimiperide over the years there were times when he was losing weight and twice doctors have tried to adjust dosage .... I found out about metformin and how it takes away the appetite and we both went to see the doctor. He discussed going on to a low level of long acting insulin which we thought might be a good thing ... one week later he was rushed into hospital with high glucose readings and infections, one of which the hospital said was a urine infection, and something to do with high ketones.... hospital got in touch with our GP and they actually started him on low dose insulin (2 units) with a sort of loaded pen with a big dial on top .... this has actually got his figures down to a reasonable level .... he is also a permanent steroid patient so know that they do interfere with glucose levels .... now almost 2 weeks of tablets and insulin he is getting really good figures on getting up, followed by the insulin ... but it seems the late afternoon to night sugars are rising despite being careful as usual on what he eats .... but he has certainly got an appetite back which is good .... he drinks plenty of water and occasionally will have a small zero coke, or even a Peroni beer which is a non sugar one (so not really beer is it) .... he is also often tired, yes I know he was ill in hospital and this could be quite normal or expected .... once a day he will enjoy a coffee made with milk ... someone told us milk is bad for diabetics but I never heard that in all these years, plus it goes on morning cereal ... sorry for long message, but this has me quite worried .... on an evening he might have a small handful of plain nuts, or some fruit ... his weight actually dropped past few years from 12 stone down to 9.7 stone when weighed in hospital, so he is very thin and quite difficult to administer the morning insulin because just skin and bone, but the nurse in hospital said that was ok ... thank you to all who have read all this x

 

[JoKalsbeek]

My husband is the diabetic, but doesn't do internet, so down to me
he has been diagnosed with T2 over 15 years now. In all his life (now 79) he has never weighed more than 12.5 stone, never got an ounce of fat, but diabetes runs in the family ....Put on metformin and glimiperide over the years there were times when he was losing weight and twice doctors have tried to adjust dosage .... I found out about metformin and how it takes away the appetite and we both went to see the doctor. He discussed going on to a low level of long acting insulin which we thought might be a good thing ... one week later he was rushed into hospital with high glucose readings and infections, one of which the hospital said was a urine infection, and something to do with high ketones.... hospital got in touch with our GP and they actually started him on low dose insulin (2 units) with a sort of loaded pen with a big dial on top .... this has actually got his figures down to a reasonable level .... he is also a permanent steroid patient so know that they do interfere with glucose levels .... now almost 2 weeks of tablets and insulin he is getting really good figures on getting up, followed by the insulin ... but it seems the late afternoon to night sugars are rising despite being careful as usual on what he eats .... but he has certainly got an appetite back which is good .... he drinks plenty of water and occasionally will have a small zero coke, or even a Peroni beer which is a non sugar one (so not really beer is it) .... he is also often tired, yes I know he was ill in hospital and this could be quite normal or expected .... once a day he will enjoy a coffee made with milk ... someone told us milk is bad for diabetics but I never heard that in all these years, plus it goes on morning cereal ... sorry for long message, but this has me quite worried .... on an evening he might have a small handful of plain nuts, or some fruit ... his weight actually dropped past few years from 12 stone down to 9.7 stone when weighed in hospital, so he is very thin and quite difficult to administer the morning insulin because just skin and bone, but the nurse in hospital said that was ok ... thank you to all who have read all this x

How sure are you he's a type 2? There are a lot of indications for a possible type 1 variant here. Was he ever tested? (C-peptide and GAD tests). In adults, T2 is assumed as the tests are expensive, they don't get done unless there is reason to. Your husband's weight and apparent ketoacidosis should've triggered that line of inquiry, methinks. But who am I.

In any case, it's not sugars, it's carbs we deal with. So there might be no sugar added into the beer, but the carbohydrates in there will turn to glucose once ingested. Same goes for fruit, cereals etc... So can you tell us exactly what he is eating and drinking, to maybe help explain the rise in the afternoon? Mind you, i really, really think you should find out whether he is truly a T2, because there's a bunch of red flags all over the place... And if he is using insulin, and might move from a fixed dose to carb counting at some point, you'll have to know how his body reacts to certain foods/drinks.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help explain things some, but don't do anything drastic. I don't quite understand what stones are, being dutch, but I have a feeling he's quite underweight. That's more of a T1 thing than a T2 thing, as are high ketones in combination with high blood sugars. The difference? A type 2 is insensitive to their own insulin. We make plenty, our body just lost the ability to use it effectively. A T1 however, stops making insulin over a period of time. It can be quite fast, which is usually the case in children, but some adults have what is called a "honeymoon period", where the insulin output grinds slowly to a halt, as their immune system kills off rather vital bits of pancreas. Can be weeks, or even years. But then there's no more insulin to be had, and injections will be required. A T2 won't go into ketoacidosis unless a whole lot of things work against you (like steroid use, indeed), but a T1 runs a much higher risk of it. So you really need to know what's going on. T1 or T2. Not to alarm you or anything, just want to stress.... Find out. Don't ask for these tests, demand them. Your husband is already on insulin so he'll be alright either way, most likely.... But it is something to look into, because they're just not the same condition and there's certain things that need more attention in one than the other.

Hugs,
Jo

 

[Solaire]

How sure are you he's a type 2? There are a lot of indications for a possible type 1 variant here. Was he ever tested? (C-peptide and GAD tests). In adults, T2 is assumed as the tests are expensive, they don't get done unless there is reason to. Your husband's weight and apparent ketoacidosis should've triggered that line of inquiry, methinks. But who am I.

In any case, it's not sugars, it's carbs we deal with. So there might be no sugar added into the beer, but the carbohydrates in there will turn to glucose once ingested. Same goes for fruit, cereals etc... So can you tell us exactly what he is eating and drinking, to maybe help explain the rise in the afternoon? Mind you, i really, really think you should find out whether he is truly a T2, because there's a bunch of red flags all over the place... And if he is using insulin, and might move from a fixed dose to carb counting at some point, you'll have to know how his body reacts to certain foods/drinks.

https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html might help explain things some, but don't do anything drastic. I don't quite understand what stones are, being dutch, but I have a feeling he's quite underweight. That's more of a T1 thing than a T2 thing, as are high ketones in combination with high blood sugars. The difference? A type 2 is insensitive to their own insulin. We make plenty, our body just lost the ability to use it effectively. A T1 however, stops making insulin over a period of time. It can be quite fast, which is usually the case in children, but some adults have what is called a "honeymoon period", where the insulin output grinds slowly to a halt, as their immune system kills off rather vital bits of pancreas. Can be weeks, or even years. But then there's no more insulin to be had, and injections will be required. A T2 won't go into ketoacidosis unless a whole lot of things work against you (like steroid use, indeed), but a T1 runs a much higher risk of it. So you really need to know what's going on. T1 or T2. Not to alarm you or anything, just want to stress.... Find out. Don't ask for these tests, demand them. Your husband is already on insulin so he'll be alright either way, most likely.... But it is something to look into, because they're just not the same condition and there's certain things that need more attention in one than the other.

Hugs,
Jo

Thanks for your reply .... he was checked properly 15+ years ago when first diagnosed. Definately type 2 .... and I have read where quite a few type 2s after being treated with tablets actually need to be on low dose insulin in later years ...... the weight loss is down to metformin ... the first time was a few years back and I pointed out to the doctor how fast he was losing weight so she adjusted his dosage then ..... took quite a while to get some weight back .... 12 stone relates to around 76kgs ...... but had a lot of spinal and joint problems over the years ....yes he is steroid dependant from the 1970s so cannot get off them now .... and yes they do interfere with glucose reading etc ....we eat healthily enough and have learned lots of the years as most of us do .... I usually check for any heavy carbs, but we are used to proper old fashioned meals .... meat and veg .... luckily he has never had a sweet tooth, so that helps, but not a regular salad lover .... I checked out the different carbs of fruit and know which ones are very low .... but our doctors changed a few years back, and this one wanted to see if he could get his glucose figures down a bit, so upped the metformin .... down went the little bit of weight and loss of appetite .... I did explain to the doc about the weight loss with metformin, so he halved the regular dose to long lasting one twice a day plus glimiperide ..... but he recently had a very severe chest infection and took really bad when we had to get the ambulance ... in hospital it was found he also had a urine infection which can be serious for older folk especially and also if they are diabetic .... the hospital started the 2 units of insulation and it made a big difference ... and they explained about ketones which are even found in non diabetics, and they were high at the time ....and they gave him antibiotics and extra steroids ‍♀‍ which of course didn't help the blood sugars .... I am keeping a spread sheet and will take to the doctor when we next see him , plus a list of questions

 

[JoKalsbeek]

Thanks for your reply .... he was checked properly 15+ years ago when first diagnosed. Definately type 2 .... and I have read where quite a few type 2s after being treated with tablets actually need to be on low dose insulin in later years ...... the weight loss is down to metformin ... the first time was a few years back and I pointed out to the doctor how fast he was losing weight so she adjusted his dosage then ..... took quite a while to get some weight back .... 12 stone relates to around 76kgs ...... but had a lot of spinal and joint problems over the years ....yes he is steroid dependant from the 1970s so cannot get off them now .... and yes they do interfere with glucose reading etc ....we eat healthily enough and have learned lots of the years as most of us do .... I usually check for any heavy carbs, but we are used to proper old fashioned meals .... meat and veg .... luckily he has never had a sweet tooth, so that helps, but not a regular salad lover .... I checked out the different carbs of fruit and know which ones are very low .... but our doctors changed a few years back, and this one wanted to see if he could get his glucose figures down a bit, so upped the metformin .... down went the little bit of weight and loss of appetite .... I did explain to the doc about the weight loss with metformin, so he halved the regular dose to long lasting one twice a day plus glimiperide ..... but he recently had a very severe chest infection and took really bad when we had to get the ambulance ... in hospital it was found he also had a urine infection which can be serious for older folk especially and also if they are diabetic .... the hospital started the 2 units of insulation and it made a big difference ... and they explained about ketones which are even found in non diabetics, and they were high at the time ....and they gave him antibiotics and extra steroids ‍♀‍ which of course didn't help the blood sugars .... I am keeping a spread sheet and will take to the doctor when we next see him , plus a list of questions

The two of you have been to the wars eh. I'm so sorry. But it does look like you've got a proper grasp of this thing. If you are aiming for weight gain, try upping the fats and protein, if you haven't already. If his insides are a mess due to the antibiotics, probiotics should help his gut return to normal (so anything he puts in there doesn't fall straight out again). Either from capsules or fermented foods like full fat greek yog or sauerkraut. I'm probably not of much use, but these are the first things I think of.

@Antje77 , you're on insulin... Can you be of more use to these people than I?
Hugs,
Jo