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Over 70 type 1. Very frequent hypos! HELP!

Discussion in 'Type 1 Diabetes' started by Tootybanooty, Nov 29, 2020.

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  1. Tootybanooty

    Tootybanooty · Member

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    Hello, I am hoping for some advice about my father. He is 71 and seems to have totally lost control of his type 1 diabetes and is having REGULAR severe hypos. Many requiring ambulance call out. I’m talking 2/3 severe hypos a week and maybe an ambulance call 1/2 a month.

    At 71, I am concerned that his ability to manage his diabetes is steadily deteriorating. My mother, at 66 is also struggling as she regularly has to intervene and try and force him to eat sugar which she often doesn't have the strength to do. The hypos seem to come on very suddenly and she often has to call my brother who lives 15 minutes away to come and help, this isn't ideal as he is often away with work.

    I believe he spoke to a diabetic nurse a few weeks ago and they advised him to keep monitoring his blood sugar levels. Unfortunately, he isn't doing this effectively. His mood is low and he doesn't respond well when my mother asks him to take a reading. He is quite forgetful and also seems very tired much of the time.

    The family are becoming very concerned and my mother worries about leaving him at the house alone for fear that he will have another severe hypo and either fall and injure himself or slip into a coma.

    I have looked into diabetes in the elderly but there doesn’t seem to be much out there. He went to see the diabetic nurse recently but I don’t know how much he is telling her.

    i just don’t know how feasible it is for this to go I like this and it’s pretty distressing for the family. We’ve not been able to see him as much this year for obvious reasons as he’s high risk but we’re going to have to stage some kind of intervention!
    Any advice greatly appreciated!

    thank you
     
  2. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Tootbanooty, looking back at your posting history, your father was having lots of hypos in 2017. Did things improve for a while, or has it been constant?

    As a T1, your father may be eligible for the Freestyle Libre, which is a blood glucose sensor he would wear on an arm for 2 weeks at a time. It is possible to set it up so that alerts are sent when blood glucose goes low. I wonder if that might help, at least for your Mum to be able to leave him for a while.
     
  3. Tootybanooty

    Tootybanooty · Member

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    It seemed to sort its self out for a while but this year it’s all gone to **** again. But he’s also seeming very much older nowadays and frail.
     
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  4. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    I think if his blood sugars are fluctuating wildly, that won't be helping how he feels.
     
  5. Tootybanooty

    Tootybanooty · Member

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    No it definitely isn’t! Is hard because I’m not there all the time obviously. But his mood is certainly very up and down and he can get quite depressed at times. Would he need to put pressure on the diabetic nurse to get one of those blood sugar machines? Surely they will see his ambulance record?
     
  6. Hopeful34

    Hopeful34 Type 1 · Well-Known Member

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    Is he under the care of a Hospital team that he could ring? If not he could try asking the diabetes nurse, or alternatively you can buy them yourself from Abbott online. They are available on the NHS but not everyone can get them. It's saved me having severe hypo's on a number of occasions, so well worth having.
     
  7. MarkMunday

    MarkMunday Type 1 · Well-Known Member

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    Only insulin makes blood glucose go down. Oher factors can affect the rate at which it happens, but when there are lots of hypos it usually means the insulin dosage is too high. Eating to prevent a drop in blood glucose shouldn't be necessary, especially for elderly and inactive people. Are you able to see any pattern in the hypos? Are they usually at night, between meals or after activity? This would highlight where there might be excess insulin action and how to get it lower. Bear in mind that insulin requirements change all the time and need to be reassessed periodically. Insulin requirements decline as we age and the metabolism slows down.
     
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  8. EllieM

    EllieM Type 1 · Moderator
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    I know someone else recently posted that they were diagnosed T1 at 70ish and qualified for a libre just because of their age. Honestly if he's getting frequent hospitalisation level hypos then his brain is probably currently impaired, so he may not be in a position to advocate for what he needs at the moment.

    The NHS should give him a libre, but you'd be better off converting it to a cgm with alarms that go off when when his bg goes down to eg 5 (mine is set to 4.4 but I suspect he needs more warning) - I believe you need a miaomiao for this.

    Or, if funds permit, and it's very pricy, you could get a dexcom which does this automatically. You could also could self fund the libre (and buy a miaomiao) until the NHS comes up with a libre.

    In any case, as @MarkMunday said, you need to adjust his insulin down appropriately, but you'll need to talk to his team about that.

    Good luck.
     
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  9. Tootybanooty

    Tootybanooty · Member

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    Thank you so much for your responses. We spoke to his team at the hospital today and he is being given a Libre on Friday. He is being given it face to face and my mum and I will both be there. So we will speak to the nurse about the another add ins and always potentially tweaking his insulin.
     
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  10. MissJenniferJones

    MissJenniferJones Type 1 · Member

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    He could easily go into a coma if his bs goes very low. Couldn't your mother do his bs test? I'm assuming he has a meter? It seems likely he is taking too much insulin for his carbohydrate intake - that is the key, getting those things in balance. You say he doesn't have the strength to eat, he absoluteley MUST take in glucose if low. I find the best thing is Lucozade. Just be sure its the full sugar version, not the Sport version. And speak to a consultant re dosage.
     
  11. TypeZero.

    TypeZero. · Well-Known Member

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    Just to point out I am not a medical professional but here are my own opinions.

    If I were having frequent severe hypos then I’d reduce my basal by a good 20% and see if it helps, after all having a severe hypo and dying is worse than being slightly high
     
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  12. asdgfgd

    asdgfgd LADA · Newbie

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    I would guess that since he has been feeling depressed, he may not be eating as he should but still taking the same amount of insulin/meds.
     
  13. Jaylee

    Jaylee Type 1 · Moderator
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    Hi,

    The first port of call really would be looking at what the long acting "basal" insulin is doing & adjust dosage accordingly.
    It's great your father is liaising with his team & the use of a sensor should help immensely.
    Here is a link explaining the principle of basal testing.. https://www.mysugr.com/en/blog/basal-rate-testing/

    Ideally any dosage tweak should be done gradually & adjusting no more than 2U at a time. (Personally 1u can throw it either way.)

    Best wishes.
     
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  14. Chloelox

    Chloelox Type 1 · Well-Known Member

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    Hi,

    I work professionally with the elderly, this may seem like a braise question, but are their any memory issues with either of your parents? I only ask this as a friends grandmother is type 1 and my friend would help with bolus and basal dosages for meals, her grandmother would forget and inject another bolus or basal load as that was her normal routine. She ended up in hospital a lot through double dosages of basal and bolus. With memory issues (which are common in the elderly) we find that the muscle memory can play a part, if your father has been conducting his own injections for a large period of his life, he will worry and inject thinking he has no insulin on board.

    I myself forget I have injected at times, causing my diabetes team to give me a pen that has a timer to tell me when I last injected. Fantastic device as if I’m ever worried about having not injected (say the day has been hectic or I’m overtired) I can check and see that I have.

    other to that, certain medications can cause hypos or make hypos more likely to happen, I hope this helps! Speak to his diabetes team on his behalf or attend an appointment to see that you can get it back under control again. X
     
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  15. Jaylee

    Jaylee Type 1 · Moderator
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    This is a valid point.
    My father had dementia. My mum has Alzthiemers . My dad went through this repetitive routitine of the simple ingrained tasks.
    He could get fretfull for no reason & at other times it seemed like depression.
    Whilst my mother, though her's hasn't progressed in the last 8 years. Almost seems like "covering up" & playing her normal self..
    To be fair, she's a completer finisher on tasks. For instance I'll let her make me a coffee? (She'd make herself a tea.) No problem.
    & is as happy as a bag of weasels.
    But her cognitive wouldn't evaluate the current situation whilst we chat & sup beverage. Then she'd ask if I want a drink..
    Repetition in playing the mother & host.

    It can be easy as an injector to be conditioned by the routine.. After 44 years, I can get the "did I, didn't I?" Moment.
     
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  16. Heathero

    Heathero Type 1 · Well-Known Member

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    As long as management not affected by severe memory prob, dosing twice / not eating .Seems like a (small initial )decrease in Basel insulin needed. If only to decrease severity of Hypos smaller appetite now maybe? Libre would definitely help to read BG . Blood test still needed early morning, and if BG high or low as libre will not read the same)
    Knowing approx when hypos occur should highlight when insulin could be reduced .
     
    #16 Heathero, Dec 13, 2020 at 11:45 AM
    Last edited: Dec 13, 2020
  17. Angusc

    Angusc Type 1 · Well-Known Member

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    you should be able to get a proper CGM from your diabetic team as the sensor will probably cost a lot less than 1 trip to hospital i'd try for a Dexcom 6 or Medtronic guardian 3 as it can alert before low blood sugars. the Dexcom 6 can be shared with up to 10 followers which can alarm other peoples mobile phones for low and high's with it's app
    as 999 callout are very expensive and stay's in hospitals even more so so ask your diabetic team to cost up a bad year in hospital cost's to compare to a proper CGM, and use it to argue that the CGM are cheaper overall, as well fitting NHS guidelines
    a modern insulin pump with a insulin suspend function should stop Hypo's dead as I've not had a hypo for 8+ years since using a Medtronic 640g pump and the new 780g is better as it adjusts insulin dosage dependent on the CGM blood sugars reading's.
    Minimed 780G System pp | Medtronic Diabetes (medtronic-diabetes.co.uk)
    MiniMed™ 640G Insulin Pump System | Medtronic Diabetes (medtronic-diabetes.co.uk)
    Dexcom G6 Continuous Glucose Monitoring (CGM) System | Zero Fingersticks
    there are other's but those are the one's i know about atm
     
    #17 Angusc, Dec 15, 2020 at 11:27 PM
    Last edited: Dec 15, 2020
  18. Heathero

    Heathero Type 1 · Well-Known Member

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    Using new Diabetes management when elderly. May not be something understood / or readily accepted. Hope you can find support from Diabetes care provider locally. Hope things improve for him and you. But changes in management / insulin doses sound urgent. It must be very worrisome for you all.
     
  19. diaBeeGees

    diaBeeGees Type 1 · Member

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    Because he is elderly, which comes with its own drastically unpredictable bodily function changes, taking advice from forum users is probably dangerous, no matter their experience with diabetes.

    This is a seek-actual-medical-advice situation.

    Do not settle for a diabetic nurse in a GP surgery. Demand he is referred to a specialist unit with a consultant, and secure an appointment with said consultant.
     
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  20. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    diaBeeGees, I think you will note there are several suggestions of seeking help from the gentleman's medical team, and indeed, the thread starter confirms they have engaged and are receiving help.

    Many people arrive on our forum at a time of confusion, and oftentimes feelings of abandonment by or a lack of understanding from their mainstream medical teams.

    Visiting a forum such as this does not replace medical support or monitoring, but can be extremely useful. Many find speaking to others living with the same, or similar challenges to their own to help helpful.
     
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