Advice needed re GP

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sweetbea

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Relationship to Diabetes
Type 2
Hi, I am looking for advice. My husband has had Type 2 for a number of years. Initially treated with Metformin then Empagliflozin was added which while being effective caused a lot of water infections so was then stopped and he was told to try to manage with Metformin and diet. He has been unwell and depressed for the last few months. His blood glucose is varying between 29 and 19. We visited the GP today who told him to phone the mental health team and that once his depression was sorted he would address his sugars and other issues would be looked at. I am worried but unsure on what the best course of action would be. All suggestions would be most welcome.
Thank you
 
Hello @sweetbea and welcome to the forum.
Those are rather high numbers for blood glucose. Does your husband eat foods high in starch or sugar? Having high blood glucose levels can make people feel pretty miserable and also induce problems due to damaged blood vessels. As cutting out problem foods is fairly easy to do I am surprised that your GP hasn't suggested that, as depression is unlikely to be cured overnight where low carbing can start even before the next mealtime.
 
Yes urinary tract infections are a side effect of the empagliflozin and they are notoriously difficult to treat so It is understandable that he was taken off them which means it a more important to look at reducing carbohydrates in his diet to get those dangerously high blood glucose levels down.
I'm afraid the high levels will not be helping his mental health as high glucose affects every cell in the body including the brain so can trigger depression and anxiety.
I think it would be worth going back to the GP and asking if there is another medication that can be added to help.
It would be worth having some ketone urine dip stick as the combination of high glucose and ketones is worrying and would need immediate medical attention.
Would you like to give some examples of the meals he has as people may be able to spot some problem foods which would be worth cutting out.
I post this link for a low carb dietary regime so you can see what you are aiming at for the sort of meals that would be suitable. https://lowcarbfreshwell.com/
 
Seriously? The dr wants to ignore bgl of 29 for what could be weeks or months?

I agree with drummer and leading lights and believe the first step is to assess what his diet is like. Anything like bread, rice, pasta, pastry, potatoes, bananas, cereals (even oats) as well as actual sugar, desserts or fruit juices are the biggest culprits for sending those levels up. Can he start to reduce these items? Increase full fat dairy and veg to compensate for gaps on the plate and to avoid hunger.
 
Hi @sweetbea and welcome to the forum.

I take it your husband is using a hand held meter to get his blood glucose readings. If so when and how often is he testing? Those numbers look particularly high and should be attracting the attention of your GP for urgent further investigation not withstanding the mental health issues. Is there any reason why he/she might think that those readings are not accurate?
 
Hi, yes he is using a handheld device. He usually tests twice a day. We did swap to a new set of test strips which did get lower readings. He also had a bad chest infection a couple of months ago and still has a cough. We have wondered if he has some sort of post viral fatigue or long COVID but how to tell. I did make a formal complaint to our GP practice this morning and he has now had his bloods done so we await results. Thank you so much for your help I was in quite a state yesterday and being able to post on this forum was a help!
 
HSSS said:
Seriously? The dr wants to ignore bgl of 29 for what could be weeks or months?

I agree with drummer and leading lights and believe the first step is to assess what his diet is like. Anything like bread, rice, pasta, pastry, potatoes, bananas, cereals (even oats) as well as actual sugar, desserts or fruit juices are the biggest culprits for sending those levels up. Can he start to reduce these items? Increase full fat dairy and veg to compensate for gaps on the plate and to avoid hunger.
Click to expand...
We have been trying to avoid carbs as much as possible but you are right in that given half a chance he will go for bread! He would live on sandwiches. Usually I cook from scratch because he is also lactose and other foods intolerant. I do do porridge sometimes for breakfast so I'll try and watch the oats. To be honest I find cooking for him difficult. I did try using keto recipes for a couple of months but got stressed out by all the different advice and views and a husband who was not too impressed. Thank you for taking the time to respond it is really appreciated.
 
sweetbea said:
We have been trying to avoid carbs as much as possible but you are right in that given half a chance he will go for bread! He would live on sandwiches. Usually I cook from scratch because he is also lactose and other foods intolerant. I do do porridge sometimes for breakfast so I'll try and watch the oats. To be honest I find cooking for him difficult. I did try using keto recipes for a couple of months but got stressed out by all the different advice and views and a husband who was not too impressed. Thank you for taking the time to respond it is really appreciated.
Click to expand...
It is always going to be tricky when you have various intolerances to contend with but you will have to work with what he can have but just keep the carbs down. There are some lower carb breads in some supermarkets so that might help with the sandwiches or try the open sandwich idea with just one slice of bread and plenty of topping which can still be tasty.
Eggs for breakfast are good options if he can tolerate those with things like bacon, mushrooms, tomatoes or I believe you can get Lactose free yoghurt which he could have with berries.
Keto is probably a bit too extreme so just look for low carb recipes, there are both sweet and savoury ones on the website sugarfreelondoner.
 
Leadinglights said:
Yes urinary tract infections are a side effect of the empagliflozin and they are notoriously difficult to treat so It is understandable that he was taken off them which means it a more important to look at reducing carbohydrates in his diet to get those dangerously high blood glucose levels down.
I'm afraid the high levels will not be helping his mental health as high glucose affects every cell in the body including the brain so can trigger depression and anxiety.
I think it would be worth going back to the GP and asking if there is another medication that can be added to help.
It would be worth having some ketone urine dip stick as the combination of high glucose and ketones is worrying and would need immediate medical attention.
Would you like to give some examples of the meals he has as people may be able to spot some problem foods which would be worth cutting out.
I post this link for a low carb dietary regime so you can see what you are aiming at for the sort of meals that would be suitable. https://lowcarbfreshwell.com/
Click to expand...
Thank you, I did not know that high glucose can trigger depression and anxiety. Where would I get ketone test strips? I usually cook from scratch. I had a go at recipes from the keto diet for a couple of months but found it difficult although I do still do things like chaffles. Yoghurt and berries and banana, eggs with sausages and mushrooms, omelettes are common breakfasts. Steaks, cheese, coleslaw, boiled eggs, sliced meats, chicken, stir fries, casserole ( with dumplings) soups are examples of other foods during the day - not all at once! I do cook veg like kale, carrots and peas but probably not as often as I should. Sometimes he will have a cheese and egg sandwich but once he eats bread he craves it and wants more. I realise typing this that I have rarely made salads recently. He also will have heylo bars sometimes. Thank you for asking this question it has been useful to me already to reflect. Guess I need to have a better relationship with veg and salads as a starter. Any good ideas for cooked veg more than welcome...
 
Leadinglights said:
It is always going to be tricky when you have various intolerances to contend with but you will have to work with what he can have but just keep the carbs down. There are some lower carb breads in some supermarkets so that might help with the sandwiches or try the open sandwich idea with just one slice of bread and plenty of topping which can still be tasty.
Eggs for breakfast are good options if he can tolerate those with things like bacon, mushrooms, tomatoes or I believe you can get Lactose free yoghurt which he could have with berries.
Keto is probably a bit too extreme so just look for low carb recipes, there are both sweet and savoury ones on the website sugarfreelondoner.
Click to expand...
Thanks for that. We do use soy and lactofree yoghurt, milk and cheese which is a godsend. I'll look out for lower carb breads and checkout sugarfreelondoner.
 
sweetbea said:
Thank you, I did not know that high glucose can trigger depression and anxiety. Where would I get ketone test strips? I usually cook from scratch. I had a go at recipes from the keto diet for a couple of months but found it difficult although I do still do things like chaffles. Yoghurt and berries and banana, eggs with sausages and mushrooms, omelettes are common breakfasts. Steaks, cheese, coleslaw, boiled eggs, sliced meats, chicken, stir fries, casserole ( with dumplings) soups are examples of other foods during the day - not all at once! I do cook veg like kale, carrots and peas but probably not as often as I should. Sometimes he will have a cheese and egg sandwich but once he eats bread he craves it and wants more. I realise typing this that I have rarely made salads recently. He also will have heylo bars sometimes. Thank you for asking this question it has been useful to me already to reflect. Guess I need to have a better relationship with veg and salads as a starter. Any good ideas for cooked veg more than welcome...
Click to expand...
Ketone urine strips can be bought at the pharmacy about £5 for 50 I think.
I would ditch the banana as that is very high carb, the other foods sound fine, make sure they are high meat content sausages as they do vary in carbs. Most green veg are fine, the ones to avoid or have only in small portions would be sweet corn, parsnips, potatoes. Salads can have all sorts of things in them, they don't need to be just lettuce, tomatoes and cucumber.
 
When i had a mental health problems my sugars were all over the place also I have found when I have bread it does not feel me up for long so I tend to stick to lots of protein, fats, berries and veg and things like eggs and chicken is what I churn through and feels me up and sugars do not spike.

Small adjustments can make an impact on levels and also enough fluids help.
 
I use the Nutracheck app to look up the carb content of foods. I aim for less than 120g a day- i found that gives me low sugars and is manageable for me and my needs. Others go full keto and have minimal carbs - that wasn't for me.

The carbs and cals book is good as well. It has pictures to help you get portion sizes right so you don't need to weigh as much.

.... remember, any improvement you make will help. Sometimes we need to take baby steps and have a long-term view even though we want a quick fix.

Good luck with everything.
 
@sweetbea I am not sure how lactofree cheese might or might not work, but there are cheese waffles, 'chaffles' which are useful as sandwich or burger substitutes, the same mixture can be used to make wraps in a frying pan if it is thinned down a bit with water.
Concoctions such as sugar free jelly, with yoghurt whipped in then a bag of frozen berries added is a useful dessert as it sets almost at once. I add extra gelatine to make a stiff jelly which holds the fruit and keeps everything firm. I don't always add yoghurt as it works without it, though I tend to add cream when serving.
 
sweetbea said:
Guess I need to have a better relationship with veg and salads as a starter. Any good ideas for cooked veg more than welcome...
Click to expand...

There’s a list of ideas and suggestions from @Pattidevans who used to run an hotel here:

forum.diabetes.org.uk

The A to Z of Vegetables (from DSF)

Kindly shared from the former DSF (diabetes support forum) with permission from @Pattidevans
forum.diabetes.org.uk forum.diabetes.org.uk

I hope you can find some more BG-friendly choices and options that suit you both, and help to bring down your husband’s levels. I am another who has noticed that high BGs for any length of time have a significant and negative impact on my mood, so hopefully improving his glucose levels can form part of helping his depression - which can make many things so much harder.

Has he ever tried techniques like CBT or Mindfulness to help with mood and habitual thinking patterns? There are online resources and books which he can try without having to be ‘officially’ referred or find an elusive appointment slot.
 
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