Help for a relative please

[Bean]

My brother in law has come to stay with us for 2-3 months to get his health on track. He is type 2 diabetic. My husband and I are very fit and healthy eaters and we do not know anyone with this condition. He needs to loose some weight and get some regular exercise to build up his stamina.

I am asking for the following help please.

What 3 things would be the most important things my bil should know about his condition?
He has a slow release injection each morning and a tablet as well.

Is his weight relevant?

What 3 things should I be reading up about to help me understand type 2 as I am doing all the cooking?
Already confused about low carb, high fat and recipes online for diabetics that include carbs?
Thank you

 

[Ljc]

Hell @Bean . Welcome to the forum. A little more info will help us to give you the best advise.
Am I right in thinking that the slow release injection is insulin (Basal) a background insulin ? It’s name would be best
What tablets is your brother In law on. The reason I ask is that depending on the medications it may not be wise to lower the carbohydrates drastically as it could cause hypo’s (low blood glucose)
How was your BIL diagnosed
How long ago was he diagnosed.

Losing weight can help improve diabetes control.
Some exercise if able helps, but it sounds like your BIL may not feel or be well enough to do much, a gentle walk taken regularly is good and will help.
Foods/drinks that are considered healthy nowadays may not be.

Basically, we have no problems with protein in any form and providing their are no medical problems that require a low fat diet we are fine with good fats so dairy is ok, the high fat bit of the Low carb high fat (LCHF) is a bit of a misnomer as it is really normal amounts, some foods that are made to be low fat rather than naturally so are higher in carbs than the full fat version, this is done to make then taste better and or to improve there texture.

I hope this helps.

Do you think your BIL would come here

 

[Drummer]

It would help to know if your bil requires the medication because he is on the wrong diet, due to poor advice, or if he would be dependant on the medication no matter what.
I appreciate that it might be impossible to tell, but a lucky type two requires no medication and gets normal numbers by eating protein and fat and low carb veges and salads.
Once I was seeing normal numbers I found the energy and inclination to go out more and went for walks, also used the trampoline in the garden, but for some time anything which required exertion made my heart pound rather alarmingly. It was a good few months before the strength returned to my muscles.
Regular testing of blood glucose, particularly after meals might be something to encourage if your bil isn't doing that - so often the advice is to test before eating like a type one - that's like looking at the speedometer only when stationary, for a type two.

 

[everydayupsanddowns]

Hello @Bean

Welcome to the forum.

Diabetes can be a bit of a conundrum! Does your BIL use a BG monitor to check his blood glucose levels?

As @Ljc says, depending on what medication he is using, you may need to exercise a little caution in any dietary changes, but a framework of before-meal and after-meal BG checks can help to show how he is responding to the food he is eating. Generally people here check immediately before and then either 1 hour or 2 hours after eating. This is often the time when BG has reached it's highest point in a person with t2. The idea is to find the baseline (before the meal) and then check the peak BG. The numbers themselves are less important initially than the difference between the two. Ideally a meal would only raise hos BG by 3-4 mmol/L.

If foods/meals are causing big 'spikes' in BG then it's a question of moderating or changing the type of carbohydrate eaten. Reducing by a proportion initially rather than removing entirely.

If making dietary changes and reducing carb intake (even quite gradually) alongside increasin activity your BIL will have to be aware of the risk of low blood glucose (hypoglycaemia) and carry fast acting carbohydrate with him at all times - along with his BG meter to be able to check if he feels any of the common symptoms (shaking, trembling, sweating, tingling lips, distorted vision, anxiety, extreme hunger).

He probably knows all of this already, but it's best to err on the safe side!

 

[Bean]

Thank you everyone who has replied here. @Ljc @everydayupsanddowns I have tried to answer as many questions as I am able below.

He uses a strip to monitor his blood but says he will bring a machine back when he goes home this weekend. Ill be sure to check what this is and how it works. I have noted your suggestion about getting baseline checks before and after meals and will discuss this with him.
Diagnosis was November 2007 - assume blood test but records I have access to do not state how was diagnosis was made but he has been very very over weight in the past.
Current weight is 94.2kg (weighed by me) and at 6ft 2" seems an ok weight
Injection meds Lantus - daily in the morning.
Tablets are for non-diabetes related issues.

We are encouraging him to get out each day to walk our dog who is 12 and quiet small so doesnt need loads of walking.

I think I will keep with the healthy home cooked food we currently eat as he doesn't need to loose any weight but I'll need to read up about fast acting carbs that I can have around. He doesn't eat between the meals I cook but I can tell he is more than read for his meals when he starts to eat and I'll have to work at getting him to recognise when he is flagging.

 

[everydayupsanddowns]

Injection meds Lantus - daily in the morning.
Tablets are for non-diabetes related issues.

Ah Ok... that helps a lot.

Lantus is a long-acting insulin, which stays active at a more or less constant level over 24 hours, depending on dose. So this is providing a little ‘background support’ to the insulin secreted by his own pancreas.

Any injected insulin does have the potential to reduce blood glucose to levels below which the body and brain can cope (hypoglycaemia), but Lantus is quite gentle and consistent, with a little bump of extra action around 5 hours, but generally flat, so provided your BIL keeps some carbohydrate as part of his diet, he should gradually see a reduction on BGs, particularly if weight is lost and/or activity increased.

it is important to check his BG if he feels a bit wobbly (extreme hunger, dizziness, sweating for no reason, flickering vision, trouble concentrating, anxious, tingling lips etc) because these are symptoms of low blood glucose, but can occur at healthy BG if the body is used to generally high levels.

If a fingerstick check shows levels below 4.0, you should give 15g of fast acting glucose - approx 190ml of Lucozade or full sugar drink, 3 or 4 glucose tabs, 3 jelly babies, or similar - and recheck in 15 minutes. It’s known as the ‘15 rule’, 15g and check again in 15 minutes.

Once above 4.0 he may need a biscuit or piece of toast to prevent a second dip towards hypoglycaemia later.

Hope that helps

 

[Bean]

We have just been talking more about his symptoms and he has said he has numb and tingling fingers and feet. He says walking feels very odd as his feet feel as if they have 'holes' in them. also he gets flickering vision and feels as if his face is sweating when it isn't.
I will encourage him to check his bloods during the day and also keep some of these foods available for him. I wasn't sure if these types of foods would be the correct thing to do. I think I need to keep encouraging him to check in with himself rather than just go for a walk when he isn't feeling 100%. Thank you all again this is so helpful.

 

[ianf0ster]

We have just been talking more about his symptoms and he has said he has numb and tingling fingers and feet. He says walking feels very odd as his feet feel as if they have 'holes' in them. also he gets flickering vision and feels as if his face is sweating when it isn't.
I will encourage him to check his bloods during the day and also keep some of these foods available for him. I wasn't sure if these types of foods would be the correct thing to do. I think I need to keep encouraging him to check in with himself rather than just go for a walk when he isn't feeling 100%. Thank you all again this is so helpful.

I'm sorry to hear that. Those symptoms sound like his Blood Glucose has been too high for long enough to start medical problems- though people have halted or even reversed thode symptoms by going on a Lower Carbohydrate 'Way Of Eating'.
I call it a Way Of Eating because it doesn't need to include counting Calories - just cutting down on carbs.

You say that you yourself eat a healthily - so did I for over 10yrs and it was that which caused my Type 2 Diabetes! My GP told me to cut down on Saturated Fat, and Meat and instead eat 5 a Day of fruit & veg, legumes and whole grains. But the advice was practically guaranteed to give me Type 2 Diabetes since all of those things I was told to eat more of contain Carbs and the meat, fat and dairy that I had previously been eating didn't. So instead of being healthier I was diagnosed with Type 2 Diabetes without ever having been overweight. - I was/am Thin Outside, Fat Inside. But going to a Lower Carb way of eating (real foods like eggs, nuts, avocado, fatty fish, fatty cuts of meat, cheese, cream), cutting out al tropical fruit, grains, potato and other root vegetables has got me back on the right track.