A carer who needs any info that could help

[Jarkey]

Hi folks,
My gran has spent the last 11 weeks at hospital and her blood sugars are still spiking all the way into the mid 20’s. She’s getting out tomorrow and I’m super worried. At her time in hospital she has barely been eating yet sugars are still high, at points having hypos every night. They have put her on loads of variants of insulin and nothing seems to be working. It never used to be like this. She is Type 2 and has always had a problem with overeating, however in the last 6 months her eating habits have rapidly declined and has lost almost 10 stone from it. But her sugars are more out of control than ever. She has various health complications including a cancer diagnoses from last year, could it be the cancer? My family are just at a loss and have no idea what to do, it feels like all the rules of diabetes no longer apply, any help is very appreciated!

 

[Leadinglights]

Hi folks,
My gran has spent the last 11 weeks at hospital and her blood sugars are still spiking all the way into the mid 20’s. She’s getting out tomorrow and I’m super worried. At her time in hospital she has barely been eating yet sugars are still high, at points having hypos every night. They have put her on loads of variants of insulin and nothing seems to be working. It never used to be like this. She is Type 2 and has always had a problem with overeating, however in the last 6 months her eating habits have rapidly declined and has lost almost 10 stone from it. But her sugars are more out of control than ever. She has various health complications including a cancer diagnoses from last year, could it be the cancer? My family are just at a loss and have no idea what to do, it feels like all the rules of diabetes no longer apply, any help is very appreciated!

With the weight loss and high blood glucose this sends up a red flag that she may be Type 1 not Type 2 and that would need a better regime of insulin to take into account of what she eats as well as the glucose that the liver releases even in the absence of food.
Even though doctors dismiss the idea that more mature people an develop Type 1, it is a possibility. A friend was diagnosed Type 1 at nearly 80 when normal meds for Type 2 just did not work.
It is a question that should be asked but I would think it unwise for her to be discharged from hospital unless her blood glucose is more under control.

 

[everydayupsanddowns]

Hi folks,
My gran has spent the last 11 weeks at hospital and her blood sugars are still spiking all the way into the mid 20’s. She’s getting out tomorrow and I’m super worried. At her time in hospital she has barely been eating yet sugars are still high, at points having hypos every night. They have put her on loads of variants of insulin and nothing seems to be working. It never used to be like this. She is Type 2 and has always had a problem with overeating, however in the last 6 months her eating habits have rapidly declined and has lost almost 10 stone from it. But her sugars are more out of control than ever. She has various health complications including a cancer diagnoses from last year, could it be the cancer? My family are just at a loss and have no idea what to do, it feels like all the rules of diabetes no longer apply, any help is very appreciated!

Sorry to hear how difficult your gran has been finding things @Jarkey

I’m slightly confused by

she has barely been eating yet sugars are still high, at points having hypos every night.

Hypos are low blood glucose. Has she been plunging from high to low overnight or did you mean hypers (high) blood glucose?

Has your Gran said why she hasn’t been eating so much recently? Has she intended to lose the weight?

Sorry to hear about her cancer diagnosis. What sort of cancer is it? A significant illness could well be making it harder to manage her blood glucose levels.

Which medication(s) is your Gran on?

 

[Jarkey]

With the weight loss and high blood glucose this sends up a red flag that she may be Type 1 not Type 2 and that would need a better regime of insulin to take into account of what she eats as well as the glucose that the liver releases even in the absence of food.
Even though doctors dismiss the idea that more mature people an develop Type 1, it is a possibility. A friend was diagnosed Type 1 at nearly 80 when normal meds for Type 2 just did not work.
It is a question that should be asked but I would think it unwise for her to be discharged from hospital unless her blood glucose is more under control.

That’s interesting, I’m not actually too clued up on Type 1 but would definitely be worth getting looked in to, thanks!

 

[Leadinglights]

That’s interesting, I’m not actually too clued up on Type 1 but would definitely be worth getting looked in to, thanks!

It is an autoimmune condition so nothing to do with diet but can be triggered by factors like viruses or possibly cancer treatment where people do not produce insulin.
Type 2 is when people do produce insulin and the body does not use it effectively.
The treatment is different in each case.
It would be worth you looking at the Learning zone to find out more about each. The DUK main site will also be useful to you.

 

[Jarkey]

Sorry to hear how difficult your gran has been finding things @Jarkey

I’m slightly confused by



Hypos are low blood glucose. Has she been plunging from high to low overnight or did you mean hypers (high) blood glucose?

Has your Gran said why she hasn’t been eating so much recently? Has she intended to lose the weight?

Sorry to hear about her cancer diagnosis. What sort of cancer is it? A significant illness could well be making it harder to manage her blood glucose levels.

Which medication(s) is your Gran on?

Apologies I did mean hyper. But around midnight it seems to go down as low as 3.

It’s a type of breast cancer but is also paired with things like heart/kidney failure so she’s on meds to help with those along with ones to stop fluid build up etc but don’t remember exact names at the moment. I think in total around 12 tablets a day

 

[Leadinglights]

Are her glucose levels being monitored by finger pricks or does she have a LIbre.
It would help to know what insulin she is taking.

 

[Thebearcametoo]

If she’s showing low in the night and she’s using a sensor then double check with a finger prick. If the sensor isn’t getting enough fluid it can read low when the actual BG is much higher.

It can be tricky to get the insulin dose right and with my mum (type 2, 82 and in a care home) it took them months to slowly get a decent dose as the GP was loathe to do anything too quickly because she didn’t want to increase the likelihood of hypos. When you’re dealing with someone with multiple medical conditions and taking different medications it can be a tricky balance.

The immediate concern is to reduce any hypos she’s having. Highs aren’t great long term but there’s a big difference between an untreated high and partially treated high in terms of safety.

 

[rebrascora]

My guess would be that the night time lows may be compression lows where she lies on the sensor, if that is what they are using to get her readings. If they are finger prick readings then it sounds like they don't have the balance of her insulin anywhere near right. A sensor would be a disc applied to her arm or possibly her tummy? Does she have that?

How long has she been on insulin? Has she just been started on it since being admitted to hospital or was she on it before this admission?

Do you know the names of the insulin(s) she is now on and will be coming home with? It might be a single mixed insulin that she injects twice a day or separate background and meal time insulins. The background (basal insulin) she would take once or twice a day and the meal time (bolus) insulin before each meal and obviously not take that one if she wasn't eating that meal?
A mixed insulin is easier to administer particularly in care home environments etc but is tricky to get the dose right if the patient is not eating much, because it is a set mix of background and meal time insulin and therefore they need to eat a reasonable amount at least twice a day, although ideally 3 meals a day at set times for it to work well and balance things.
Having it as separate background and meal time insulins means you have to inject more often, usually 4 times a day, but if she doesn't feel like eating you can skip a meal or reduce the dose if she just wants a very small amount to eat. It takes more thought and attention but you can get better results with it. You can also do a correction dose using the meal time (fast acting/bolus) insulin if levels are persistently high and not coming down which can be helpful during illness.

I hope they are able to stabilise her levels a bit better before she is released but to be honest many people here would struggle to manage their levels in a hospital regime if they were unable to administer their insulin themselves because the staff don't manage to bring the insulin at the right time to have before meals and taking it after meals often means that levels go very high and stay high and sadly most general nurses really haven't got a clue about how to manage diabetes with insulin and the Diabetes Specialist Nurses (DSNs) who do have the knowledge, don't have the time to supervise those injections several times a day for patients in various wards across the hospital as well as do their clinic duties, so it becomes a bit hotch potch as to when they get insulin and when they eat which is really a crucial part of managing diabetes with insulin. We have had several members of the forum who use insulin and ended up in hospital for a variety of reasons and had to fight to be allowed to keep their insulin so that they could administer it themselves at the right times and in the right dose for the food they were being served and some who were not allowed to keep it and had a near miss with nurses doing the opposite of what was required in emergency situations which could have resulted in a very serious incident or even death so hopefully, once you get your gran home you will be able to balance things better than when she was in hospital with a little support from this forum.

If she hasn't managed her diabetes well through poor diet and over eating over the years then it may just be that her insulin production has been burnt out rather than Type 1, as it is lack of insulin which causes the weight loss, not specifically Type 1 and insulin would be the treatment in either case, so investigating a possible Type 1 diagnosis at this stage may just confuse the issue, if she is being treated with insulin, as that is what she would need if she was Type 1 anyway.
The only difference might be that as a Type 1 she would automatically be eligible for sensors on prescription whereas if she is Type 2 you might have to make a case for her to be prescribed them with no guarantee of a positive result. She would automatically be prescribed finger prick kit to monitor her levels but sensors can be so much more convenient and have low and high alarms. Hopefully at some point in the near future all people with diabetes who are insulin managed will be prescribed them if they want them and will make use of them.

Anyway, those are my thoughts. I hope you are able to get her home with support and manage to stabilise her levels when you all settle into a better regime and understand how it all works. We are her to support you in any way we can, but the more info you have and can give us, the better we can tailor our advice and support.

 

[Jarkey]

My guess would be that the night time lows may be compression lows where she lies on the sensor, if that is what they are using to get her readings. If they are finger prick readings then it sounds like they don't have the balance of her insulin anywhere near right. A sensor would be a disc applied to her arm or possibly her tummy? Does she have that?

How long has she been on insulin? Has she just been started on it since being admitted to hospital or was she on it before this admission?

Do you know the names of the insulin(s) she is now on and will be coming home with? It might be a single mixed insulin that she injects twice a day or separate background and meal time insulins. The background (basal insulin) she would take once or twice a day and the meal time (bolus) insulin before each meal and obviously not take that one if she wasn't eating that meal?
A mixed insulin is easier to administer particularly in care home environments etc but is tricky to get the dose right if the patient is not eating much, because it is a set mix of background and meal time insulin and therefore they need to eat a reasonable amount at least twice a day, although ideally 3 meals a day at set times for it to work well and balance things.
Having it as separate background and meal time insulins means you have to inject more often, usually 4 times a day, but if she doesn't feel like eating you can skip a meal or reduce the dose if she just wants a very small amount to eat. It takes more thought and attention but you can get better results with it. You can also do a correction dose using the meal time (fast acting/bolus) insulin if levels are persistently high and not coming down which can be helpful during illness.

I hope they are able to stabilise her levels a bit better before she is released but to be honest many people here would struggle to manage their levels in a hospital regime if they were unable to administer their insulin themselves because the staff don't manage to bring the insulin at the right time to have before meals and taking it after meals often means that levels go very high and stay high and sadly most general nurses really haven't got a clue about how to manage diabetes with insulin and the Diabetes Specialist Nurses (DSNs) who do have the knowledge, don't have the time to supervise those injections several times a day for patients in various wards across the hospital as well as do their clinic duties, so it becomes a bit hotch potch as to when they get insulin and when they eat which is really a crucial part of managing diabetes with insulin. We have had several members of the forum who use insulin and ended up in hospital for a variety of reasons and had to fight to be allowed to keep their insulin so that they could administer it themselves at the right times and in the right dose for the food they were being served and some who were not allowed to keep it and had a near miss with nurses doing the opposite of what was required in emergency situations which could have resulted in a very serious incident or even death so hopefully, once you get your gran home you will be able to balance things better than when she was in hospital with a little support from this forum.

If she hasn't managed her diabetes well through poor diet and over eating over the years then it may just be that her insulin production has been burnt out rather than Type 1, as it is lack of insulin which causes the weight loss, not specifically Type 1 and insulin would be the treatment in either case, so investigating a possible Type 1 diagnosis at this stage may just confuse the issue, if she is being treated with insulin, as that is what she would need if she was Type 1 anyway.
The only difference might be that as a Type 1 she would automatically be eligible for sensors on prescription whereas if she is Type 2 you might have to make a case for her to be prescribed them with no guarantee of a positive result. She would automatically be prescribed finger prick kit to monitor her levels but sensors can be so much more convenient and have low and high alarms. Hopefully at some point in the near future all people with diabetes who are insulin managed will be prescribed them if they want them and will make use of them.

Anyway, those are my thoughts. I hope you are able to get her home with support and manage to stabilise her levels when you all settle into a better regime and understand how it all works. We are her to support you in any way we can, but the more info you have and can give us, the better we can tailor our advice and support.

Yeah she was brought back today with Humilin M3 which is a 70% isophane/30% soluble split. She’s been diagnosed and taking insulin the last 30 years or so, so not new to taking insulin at all and never really had issues until October time. She used to take it on her own x3 a day but this new one is 15 units before breakfast and 8 before dinner with district nurses coming to administer. But I do agree, she did say she was waiting long times on meds etc so that could have something to do with how it’s balancing. Yeah we get the Libre’s but you may be right as the arm we put it on on Friday is the arm she leans on a bit more so will make sure we put it on the other side.

 

[rebrascora]

The important thing is to double check Libre results with a finger prick if you suspect that the reading is not right. Unfortunately many nurses do not know about compression lows and if they are taking those readings at face value without double checking and then adjusting her doses because they think she is having too much insulin which is supposedly causing hypos, then that will just add to the instability of her levels.
Pleased you have her home and that a District Nurse will be visiting twice daily to do injections. I hope things settle down a bit now she is home and her diabetes becomes more stable and you can tempt her to eat a bit more with some nice home cooked food. Mixed insulin does require her to eat regular meals, so that will be important to help her diabetes management but also for her to recover physical strength.