Help required for mum - overwhelmed

[happydaffy]

Hi everyone

I have just discovered this forum after googling for help for my mum (type 2 on insulin).

I woke up this morning to a frantic message from my brother who said my Mum had a reading of 35 and has had 3 consecutive readings of 25. She was also sick yesterday. She has been hospitalised in the past with DKA.

I phoned my parents house at 5am to see how she was as I am worried it could be DKA again and I'm aware time is of the essence with it. He said they had both been sleeping but she was fine. I should be leaving for work soon but I feel I should go over there and see how she is?

Her diabetes is not well managed and my dad seems unable to cope. They pay for private carers to go in the morning to make sure she's up as she used to get up very late, if at all, and miss doses. This is what put her in hospital the last time.

Social work told us they couldn't help as she had my dad and she didn't fit the "critical" criteria. She was very poorly for a long time but once my brother and me intervened things seemed to get better until now.

We have found it difficult to get the help she needs as the health care providers all seem to work separately from each other and it was a constant battle trying to get the right help from the right people. This went on for over 2 years as we tried to get her the help she needed. Things got back onto an even keel and she improved along with her management of her diabetes.

Coronavirus hasn't helped as me and brother haven't been able to visit so we hadn't realised how bad it had gotten again and have probably taken our eye off the ball.

My brother took the most to do with her diabetes and readings as the last time she became unwell I found it difficult to cope and became unwell with the stress. However, I am geographically closer so it makes more sense for me advocate for her.

I am looking for advice on what to do right now with her current situation and high readings and also what to do going forward. Who do I need to speak to and what do I need to know? I can contact her GP and diabetic clinic. We are in Scotland if that makes a difference.

I need a plan and would be so grateful if someone could help me out as I feel a bit overwhelmed.

 

[SB2015]

Immediate care
First and foremost DKA needs hospital care, and is a possibility with her BG so high for so long.
Does she have ketone test strips for blood or urine? Whilst I know that this may not be the same for T2, (can you advise @Toucan or @Docb ) if I am above 14 I would not sleep until I have my levels back down.

Ongoing care.
It sounds as if you need to contact her diabetes team. Is she managed at the hospital or at her Practice. Do you know how she manages her Diabetes. Is she in tablets or on insulin? They can then help you come up with a plan. Could you then work on this with your Dad, even if it means a phone call each day to talk him through it.

General advice
The high blood glucose levels are due to the body not producing/using enough insulin to match the glucose in the blood. The glucose is coming from ANY carbohydrates eaten, not just sugars. To bring the levels down a change in diet is needed. This could be simple swaps from root veg to their green veg, reductions in portion sizes. I am sure that some others with more experience of T2 will be able to give other ideas.

For now it is the possible DKA that needs to be addressed.
With levels that high she is likely to have ketones.
If she has ketones this is an emergency.

 

[grovesy]

Immediate care
First and foremost DKA needs hospital care, and is a possibility with her BG so high for so long.
Does she have ketone test strips for blood or urine? Whilst I know that this may not be the same for T2, (can you advise @Toucan or @Docb ) if I am above 14 I would not sleep until I have my levels back down.

Ongoing care.
It sounds as if you need to contact her diabetes team. Is she managed at the hospital or at her Practice. Do you know how she manages her Diabetes. Is she in tablets or on insulin? They can then help you come up with a plan. Could you then work on this with your Dad, even if it means a phone call each day to talk him through it.

General advice
The high blood glucose levels are due to the body not producing/using enough insulin to match the glucose in the blood. The glucose is coming from ANY carbohydrates eaten, not just sugars. To bring the levels down a change in diet is needed. This could be simple swaps from root veg to their green veg, reductions in portion sizes. I am sure that some others with more experience of T2 will be able to give other ideas.

For now it is the possible DKA that needs to be addressed.
With levels that high she is likely to have ketones.
If she has ketones this is an emergency.

I agree!

 

[Docb]

Absolutely agree that something needs to be done. Those readings, a previous DKA and your dad struggling to cope must be worrying for you and should ring warning bells in the care system.

I would contact the surgery as a matter of urgency, tell them what is going on. If they suggest contacting the diabetes clinic then contact them.

You need to contact who ever is providing the care services - start with your local authority and make sure they understand your concerns.

Your dad is a carer, because your mum needs somebody around all the time to keep her safe. I do not know what the system is in Scotland but in England he would be referred to carer support services. They would do a carers assessment which would work out what your dad can do and help to sort out the external carers. As I have said in other threads, carer services can be bit of a post code lottery, but if they are good then they can be an effective resource.

There are a couple of thoughts. Hope you get somewhere quickly. Let us know how you get on.

 

[happydaffy]

Thanks for your replies.

I am not long back from my Mum's after making sure she is okay and getting all the info I need to progress i.e. medication etc. I have spoken to her GP and I'm waiting for a call back from the diabetic clinic.

Her average 30 day reading is 20.9 with avg past 7 days is 27.2. She has told me her insulin is 204 units per day over 3 doses however this seems a lot so hopefully the clinic will be able to clear this up when I get a chance to speak to them.

As I left she was going to give my Dad a urine sample for him to take to the doctors surgery to test for ketones so I am waiting to hear the result of that.

The issues are 2 fold - she isn't compliant with taking her readings or insulin and also her diet is extremely unhealthy. She has deep-rooted issues with food and has done throughout her life, changing this is nigh on impossible. It's a losing battle.

 

[pm133]

Thanks for your replies.

I am not long back from my Mum's after making sure she is okay and getting all the info I need to progress i.e. medication etc. I have spoken to her GP and I'm waiting for a call back from the diabetic clinic.

Her average 30 day reading is 20.9 with avg past 7 days is 27.2. She has told me her insulin is 204 units per day over 3 doses however this seems a lot so hopefully the clinic will be able to clear this up when I get a chance to speak to them.

As I left she was going to give my Dad a urine sample for him to take to the doctors surgery to test for ketones so I am waiting to hear the result of that.

The issues are 2 fold - she isn't compliant with taking her readings or insulin and also her diet is extremely unhealthy. She has deep-rooted issues with food and has done throughout her life, changing this is nigh on impossible. It's a losing battle.

You might be able to buy some ketone test strips for your mum's meter (if it supports them) at your local chemist. That will give you a feel for where her levels are. Might save you a wait.

 

[grovesy]

You might be able to buy some ketone test strips for your mum's meter (if it supports them) at your local chemist. That will give you a feel for where her levels are. Might save you a wait.

Be aware keytone strips for glucose meters are quite expensive, the ones for Freestyle Libre Reader are at least £14 for 10 and that is on Amazon.
Good luck.

 

[pm133]

Be aware keytone strips for glucose meters are quite expensive, the ones for Freestyle Libre Reader are at least £14 for 10 and that is on Amazon.
Good luck.

That is absolutely scandalous.
We are very lucky in Scotland to be able to get those on free prescription.

 

[grovesy]

That is absolutely scandalous.
We are very lucky in Scotland to be able to get those on free prescription.

I am Type 2 so I don't get test strips on prescription either.

 

[trophywench]

When you have a normal renal threshold, ketones don't start spilling over into your urine until your BG is at least 11.0. Hence, they are of very limited help.

 

[everydayupsanddowns]

When you have a normal renal threshold, ketones don't start spilling over into your urine until your BG is at least 11.0. Hence, they are of very limited help.

Although perhaps better than nothing?

I don’t regularly keep blood ketones in the house as they are expensive and fairly short-dated... plus I don’t appear to be a very ketotic type person. I have a pot of 50 using strips (£5 over the counter, though I get mine on script).

If I have an illness and see days of high readings it’s reassurance enough for me to have ‘negative’ or ‘trace’ urine strip readings I feel. YDMV, of course.

 

[everydayupsanddowns]

Really sorry to hear about your Mum @happydaffy

Have you been in contact over the weekend? Any news on the ketone test?

 

[happydaffy]

Good news on the keytones - none found although signs of a UTI so another sample to go into tomorrow. They've ordered a prescription of ketone strips for future.

Her readings have been lower since Friday. My Dad says she hasn't been snacking as much and the readings show that.

I spoke the diabetic clinic and they weren't much help and referred me back to her GP.

She's on Humalog Mix50, 204 units a day over 3 doses.

 

[everydayupsanddowns]

She's on Humalog Mix50, 204 units a day over 3 doses

It’s unusual to be on mixed 3x a day. do you think it would be easier to be on a basal:bolus regime where insulin was taken with meals (or snacks!) with a separate 24 hour background dose?

That’s the system @Ljc uses very effectively.

Though I am aware your Mum has difficulties with keeping up with doses