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Extremely worried for type 1 friend - any help/advice appreciated!

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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.

Moosifer

New Member
Relationship to Diabetes
Type 1
Hi everyone,

It's my first post here so hello to all! 🙂

I'm doing some research for a friend who's a very ill type 1 diabetic, she's so tired, ill and frustrated by this she's finding it hard to help herself, so I really wondered if you guys knew of anywhere that we could go to get advice outside of or as an add on to, the NHS. We're finding them too slow (this has been going on for 4-6 months) and my friend is getting increasingly ill.

Her symptoms are essentially the same as rapid gastric emptying syndrome/gastroparesis - nausea, abdominal cramping, acid reflux, frequent diarrhea (can be 3-5 times in the morning alone), dizziness, fatigue (she was off work for a good 2-3 months, and now is back part time but can only do around 3-4 hours at a push before she feels exhausted).

She hasn't been diagnosed with this syndrome, as there are many similar disorders so it may very well not be this.

Her sugar control has been terrible and erratic (and next to impossible to control with her digestive problems), she suffers from very low sugars (as low as 3 sometimes, quite commonly 4) and also sugar spikes (late teens through to early twenties). It's very rarely stable. I've noticed that she more frequently experiences more lows than highs which I've read can cause diarrhea?

It's hard to follow her sugars as she often will take the right amount of insulin, eat something and it continues to climb higher so she often ends up taking more insulin and then experiencing a crash. She's often at odds wondering what to do in this situation but feels she has to take more insulin in order to bring the sugars back down, and then she crashes.

Her diet is quite poor I think, but I'm not an expert in diabetes or digestive problems so it's hard to say what she should or shouldn't do.

- Breakfast is often crunchy nut cornflakes (this is usually about 9.30 am, 10.00 am although it's not consistent and her eating times can vary).

- Lunch is quite sporadic depending on what she feels she can eat but I often feel she's not eating well enough as there's hardly any fruit or veg (it can be a couple of slices of toast with nutella on, or a sandwich and a packet of crisps). Lunch is usually about 1.30 - 3.00 pm depending on when she manages to get up and how well she's feeling).

- Dinner is often 7.30 - 8.00 pm and seems to be the best meal that she has. She's had to move back with her parents as she's been so unwell she can't be left alone, and when she eats at home it's a good meal and has vegetables, meat, home cooked, often casseroles or something. When she goes back to her house with her husband it's usually pre-prepared bought food.

She seems to be better in the evening than in the mornings and afternoon.

She's been to the doctors and had the following tested for: coeliacs (negative), she's had an endoscopy which has proved negative for any blockages and no recording of damage from acid reflux, no hiatus hernia, nothing abnormal spotted, they've also ruled out ibs. She's still waiting for them to come back to her to arrange a tilt test for gastroparesis.

I know you can't give clinical advice, but I thought that your combined experiences might be able to shed some insight in terms of professionals we could go to or if you could share any experiences of your own?

We're in Devon, so any help or advice you can give would be greatly appreciated as we're all beside ourselves with worry.

Many thanks 🙂
 
Sorry for the quick reply but I'm about to sit an exam. I'm not sure what you mean by a "tilt test" for the gastroparesis. When I had my gastroparesis diagnosed they used a gastric emptying test. Is your friend matching her rapid acting insulin to carbohydrates? This would help to identify if it is gastroparesis. With gastroparesis if you match insulin to carbohydrate for a meal there is a tendency for the BG to go down quite quickly after the meal because the food has not digested but the insulin is working i.e. gastroparesis is delayed gastric emptying not rapid gastric emptying. There is then a tendency for the BG to go up several hours after the meal because the food is being digested late and there is no rapid acting insulin for it. Please ask any questions that you have about gastroparesis and I will try to answer them after my exam.
 
1st things first, have she tried a probiotic to right her tummy problems? If not worth a try as will do no harm.
Then basal test.
http://www.diatribe.us/issues/13/learning-curve.php I know it's aimed at pumpers but same aplies for MDI.
Do not correct blood sugars until at least 2 hours after the first bolus given.
Personally I would not do a correction and then just see what happens ie as in back to normal or not after 4 or 5 hours.
Only change things one at a time.
Timing of bolus is important as well. This needs to coinside with the action of food digesting.
Has your friends cortisol levels been checked? What's her BP like?

As a matter of interest what hospital is your friend attending?
 
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This is just to say I hope your friend gets the help and the answers she needs and feels better soon
 
I'm so sorry your friend is having stomach problems. As AJLaing has said, your friend could have the symptoms of Gastroparesis, as she is showing many of the symptoms. Did her doctor check her over her stomach area, heart, pulse rate etc? Did he prescribe a Gastro resistant tablet like Omeprazole which may of helped and to rule out other conditions? Has she been taking Ibuprophen tablets for a while, as these can cause problems to the stomach.
Whatever she has it does sound very painful and debilitating and I would advise her to go back to her doctors, as she can't keep going on like this, It may just be a simple change in diet and not a chronic condition. I do hope she gets some help and support soon. Best wishes Sheena
 
Hi there - thanks so much for the replies!

The tilt test is what the doctor has said will test her for any abnormalities such as gastroparesis - the gastric emptying test I'm not sure would be relevant to her as she experiences rapid emptying (I've read that it can fluctuate between the two?) more than delayed, although she does get food that just 'sits' in her stomach for quite a while this is less common for her.

As far as I'm aware she hasn't had cortisol levels checked, and I haven't heard this mentioned although I will ask her. I've just been reading a bit on the internet about this and it does sound like a possibility.

She did try having yoghurts to try and help the bacteria in her stomach but it didn't really have any effect on her.

I'll also pass on that test to her - that looks really useful as she doesn't record anything at the moment in terms of bg levels or what she eats.

I'll also mention trying to hold off on correcting injections for 2 hours, as I'm pretty sure she doesn't wait that long.

I do find it bizarre as her doctor referred her to a diabetic nurse who didn't go through with her to check her measurements were correct in terms of how much she was injecting, how often or anything like that - she just told her to try a different injection site and shorter needles. Although I understand that this might be a factor it does seem like basics were missed?

The hospital she had to go to for the specialist was Wonford in Exeter I think, she definitely had her endoscopy there and I think it was the same place.

The biggest thing seems to be motivating her to try different things as she seems very resigned at the moment to this life, I can't even take her out for the afternoon without her getting really ill (yesterday it was feverish, nausea, extreme fatigue, awful bowels) - and we're talking very light non-energy expending activities! :confused:
 
The biggest thing seems to be motivating her to try different things as she seems very resigned at the moment to this life, I can't even take her out for the afternoon without her getting really ill (yesterday it was feverish, nausea, extreme fatigue, awful bowels) - and we're talking very light non-energy expending activities! :confused:

Just an outside thought, does your friend have problems with new places or large open spaces? Might be worth investigation, althouht I could be very wrong.
 
Sorry I forgot to mention that she is on Omeprazole which is controlling her nausea and making things a bit more bearable!

She takes nurofen rather than ibuprofen, and has been warned off taking any ibuprofen so that's not a problem.

Not sure about her bp - she has had times when she gets very light headed and faint and when it's been measured it's been low, however most of the time it seems ok.

Thank you for all your good wishes - it's nice to be able to talk to people who are familiar with diabetic digestive problems and can provide some insight and experience 🙂
 
That's an interesting thought Caroline! She does have tendencies to shut herself away for a period of time and be a bit agoraphobic although not seriously, but as this has been ongoing for some time some of her reaction may be anxiety related in that way - I hadn't thought too much along that line but I see where you're coming from.

She has been under quite a lot of stress in her life over the last year or so and now stress does seem to be quite a major trigger for her.
 
Hi again moosifer I forgot to say that a condition called Idiopathic Gastroparesis could be a possibility, as idiopathic means obscure or an unknown cause.
Please send your friend my best wishes for a proper diagnosis very soon. Sheena
 
That's an interesting thought Caroline! She does have tendencies to shut herself away for a period of time and be a bit agoraphobic although not seriously, but as this has been ongoing for some time some of her reaction may be anxiety related in that way - I hadn't thought too much along that line but I see where you're coming from.

She has been under quite a lot of stress in her life over the last year or so and now stress does seem to be quite a major trigger for her.

It is probably only me or someone like me who'd think of it as I have real problems with new places and many of these 'tummy upsets' are stress related, so anything stressfull might be a cause.
 
I think there's definitely something in the whole anxiety/excitement at doing something as her stomach always plays up when we actually get to go out, and then when she gets back she often has problems and it really exhausts her.

Has anyone found nutrition or dietician experts any good as it'd be nice to be able to track someone down that might be have some insight, as her diet is quite restricted and unpredictable in terms of what she can manage I thought someone like this might be useful?
 
Sorry I forgot to mention that she is on Omeprazole which is controlling her nausea and making things a bit more bearable!
Are you sure about that? I know when I was put on the stuff I ended up with so many emergency visits due to sickness etc.
She takes nurofen rather than ibuprofen, and has been warned off taking any ibuprofen so that's not a problem.

Not sure about her bp - she has had times when she gets very light headed and faint and when it's been measured it's been low, however most of the time it seems ok.
Get a BP measuring machine and see what her BP is like going from sitting to standing and esp when she feels very unwell.
Thank you for all your good wishes - it's nice to be able to talk to people who are familiar with diabetic digestive problems and can provide some insight and experience 🙂

Low BP and a lot of the symptoms you discribe are relevent to Addison's disease, so worth checking it out.
RDE are pretty good on the whole. Make a list of all symptoms though and insist on answers.
Your friend should be carb counting and know what to do with her insulin. This is a basic right for anyone on insulin. So if no course available asked for 1 -1 with a dieticion.
Probiotics can be bought in tablet form to help the tummy you would need to eat a ton of yoghurt to be any good.
 
Hi Sue,

She's found omeprazole to be the most helpful drug she's been given so far so it's the only one she's stuck with. Other than that she's just taking insulin.

I've read a bit about Addisons and you're right - the symptoms do fit very well also, I'm checking with her whether the doctor has checked her cortisol levels. Also I've read that pancreatic enzyme deficiency can occur as well, which also has similar symptoms.

She does count her carbs and know what to do with her insulin, but it has become very confusing with her stomach trouble to know what to do when for instance her sugars aren't coming down after injecting for example.

Can she ask for a 1-1 with a dietician through her GP?

Ah - I never realised that re probiotics, the marketing worked with the yoghurts!
 
Hi Moosifer,
Yes to the 1- 1 also if as your friend is under RDE then this service should also be offered to her. Ask for it 🙂
 
Moosifer hi,
Sorry to hear about all the troubles your friend is having, but with a mate like you in her corner im sure some progression will be made on this.. Does she know you have joined here?
 
Hi. I have not yet had a test to confirm gastroparesis but been told it is very likely and am now on tablets called domperidone to help, I am also on omeprazole. I wouldn't have thought that the omeprazole would help with nausea, they are mainly to protect the stomach, whereas the nausea is helped a lot by the domperidone. If this is a real problem for your friend it would be worth asking to try domperidone as they do make a difference to me when the nausea is really bad.
 
Hi Steff,

That's sweet of you to say - I haven't told her that I joined here but I'll definitely refer the site to her as your suggestions here have been so helpful. Takes a diabetic to know a diabetic I think. 😉

I'm hoping that things will start to progress - it'd be great to see her getting better and enjoying life a bit more.
 
Hi Steff,

That's sweet of you to say - I haven't told her that I joined here but I'll definitely refer the site to her as your suggestions here have been so helpful. Takes a diabetic to know a diabetic I think. 😉

I'm hoping that things will start to progress - it'd be great to see her getting better and enjoying life a bit more.

Certainly Moo the amount of times i have seen people come on here and get more help and advice then they ever would from the NHS or there own GP just shows testiment to how good this forum really is x
 
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