long term type 2 -very stubborn high blood sugars

[Norfolklou]

Hi, my husband has been type 2 diabetic for 20 years now, originally he was just on medication but for the last few years has also been on lantus and nova rapid insulin injections.
The last few months his blood sugars and HbA1C have been very high which have resulted in reoccurring UTI and antibiotics. Fingers crossed clear at the moment when saw urologist this week, but has an enlarged prostrate which they wont touch until his readings are lowered.
My concern is he has lost a lot of weight, has night sweats and Nocturia, which deeply disturbs his sleep and despite healthy eating or having little appetite still has very high sugars.
We have always found our diabetic clinic to be very good but recently they say just up the units a little which clearly is not working! His Urologist had sent an urgent letter to the diabetic clinic stating this is not good enough and requires urgent attention, does anyone else have any similar experience-so worried-please advise. Kind Regards Lou

 

[rebrascora]

Hi and welcome

So sorry that you are feeling unsupported by your diabetic clinic at the moment. If your husband's BG levels and HbA1c are very high then it would make sense to increase his insulin doses and/or consider his diet.

Do you understand what the 2 different insulin's are for and how they work?

The Lantus is a basal insulin and is there to mop up the glucose his liver trickles out day and night when there is no food in his system to provide glucose. It should keep his levels stable and in range if he skips a meal (and doesn't use NovoRapid) Getting the dose of this insulin right is really important. It is the foundation to good diabetes management.

The NovoRapid is used to deal with the carbohydrates in his food. Is he on fixed doses or do you count the amount of carbohydrate in his meals and adjust his doses?

How much of each insulin is he on and how much have you increased them and over what sort of time period? Also what sort of BG readings is he getting and when do you take his readings and what was his last HbA1c?

Sorry to ask so many questions, but it is relevant to help us understand what is going on.

As regards diet, a lot of changes in advice have happened in the past 20 years so it may be that whilst you consider his diet healthy, it may not be for a Type 2 diabetic. The thing to understand is that all carbohydrates break down into glucose in the digestive system and get absorbed into the blood stream causing our BG levels to rise. So, not just sugar in all it's forms, but fruits, which contain natural sugars and even milk and particularly starchy carbs like bread and pasta and rice and other grains (even healthy oats) and breakfast cereals are usually high in starches and sugars and starchy root veg like potatoes. I am not saying that he shouldn't eat any of these foods but carefully reducing the portion size of these in his meals and filling up with leafy green veg and protein and low carb vegetables will make a big difference to his BG levels because you are no longer putting more glucose into his system than it can cope with.
Substitutes that many of us use are mashed cauliflower instead of mashed potato. Add a dollop of cream cheese and a good sprinkle of grated cheese on the top and it works great with sausages or gammon or topping for cottage/shepherds/fish pie. Cauliflower can also be grated and used instead of rice or couscous. Courgettes can be spiralized and used instead of spaghetti, roasted butternut squash or celeriac or swede works well instead of potatoes. I've made celeriac chips before I they are pretty good. There are some lower carb breads available if you look closely at labels but I avoid bread as it really causes me BG upheaval. If it helps you to get your head around it, a medium slice of wholemeal bread is about 15g carbs which is the same as 3 teaspoons of sugar, so your average 2 slice sandwich is the equivalent of 6 teaspoons of sugar..... a teaspoon of sugar being about 5g carbs. It will take your body a little bit longer to break down the bread but not much. Again, not saying he shouldn't eat bread, but reducing portion size and frequency will help. The thing which can make the biggest difference is a low carb breakfast. Many of us have Natural creamy Greek style yoghurt with a few berries (rasps, strawberries etc as these are the lowest carb fruits) and mixed seeds.... or eggs however he likes them, with or without bacon and sausage and mushrooms but go steady on the fried bread, beans, toast, hash browns etc. Personally I like an omelette with whatever filling I have that needs using up from the fridge, usually involving mushrooms and onions and cheese.
If you can start to reduce his BG levels at the start of the day with a lower carb breakfast then you stand more chance of managing his levels better for the rest of the day.

Those are my thoughts anyway but if you can supply us with more information as I have asked, we will hopefully be able to give more specific advice.
If you would like to give us an idea of what your husband currently eats, we might be able to suggest different things which he could try to reduce the amount of carbs and help to bring his levels down...... always bearing in mind that any dietary changes need to me slow and steady because he is using insulin.

 

[Norfolklou]

Hi and welcome

So sorry that you are feeling unsupported by your diabetic clinic at the moment. If your husband's BG levels and HbA1c are very high then it would make sense to increase his insulin doses and/or consider his diet.

Do you understand what the 2 different insulin's are for and how they work?

The Lantus is a basal insulin and is there to mop up the glucose his liver trickles out day and night when there is no food in his system to provide glucose. It should keep his levels stable and in range if he skips a meal (and doesn't use NovoRapid) Getting the dose of this insulin right is really important. It is the foundation to good diabetes management.

The NovoRapid is used to deal with the carbohydrates in his food. Is he on fixed doses or do you count the amount of carbohydrate in his meals and adjust his doses?

How much of each insulin is he on and how much have you increased them and over what sort of time period? Also what sort of BG readings is he getting and when do you take his readings and what was his last HbA1c?

Sorry to ask so many questions, but it is relevant to help us understand what is going on.

As regards diet, a lot of changes in advice have happened in the past 20 years so it may be that whilst you consider his diet healthy, it may not be for a Type 2 diabetic. The thing to understand is that all carbohydrates break down into glucose in the digestive system and get absorbed into the blood stream causing our BG levels to rise. So, not just sugar in all it's forms, but fruits, which contain natural sugars and even milk and particularly starchy carbs like bread and pasta and rice and other grains (even healthy oats) and breakfast cereals are usually high in starches and sugars and starchy root veg like potatoes. I am not saying that he shouldn't eat any of these foods but carefully reducing the portion size of these in his meals and filling up with leafy green veg and protein and low carb vegetables will make a big difference to his BG levels because you are no longer putting more glucose into his system than it can cope with.
Substitutes that many of us use are mashed cauliflower instead of mashed potato. Add a dollop of cream cheese and a good sprinkle of grated cheese on the top and it works great with sausages or gammon or topping for cottage/shepherds/fish pie. Cauliflower can also be grated and used instead of rice or couscous. Courgettes can be spiralized and used instead of spaghetti, roasted butternut squash or celeriac or swede works well instead of potatoes. I've made celeriac chips before I they are pretty good. There are some lower carb breads available if you look closely at labels but I avoid bread as it really causes me BG upheaval. If it helps you to get your head around it, a medium slice of wholemeal bread is about 15g carbs which is the same as 3 teaspoons of sugar, so your average 2 slice sandwich is the equivalent of 6 teaspoons of sugar..... a teaspoon of sugar being about 5g carbs. It will take your body a little bit longer to break down the bread but not much. Again, not saying he shouldn't eat bread, but reducing portion size and frequency will help. The thing which can make the biggest difference is a low carb breakfast. Many of us have Natural creamy Greek style yoghurt with a few berries (rasps, strawberries etc as these are the lowest carb fruits) and mixed seeds.... or eggs however he likes them, with or without bacon and sausage and mushrooms but go steady on the fried bread, beans, toast, hash browns etc. Personally I like an omelette with whatever filling I have that needs using up from the fridge, usually involving mushrooms and onions and cheese.
If you can start to reduce his BG levels at the start of the day with a lower carb breakfast then you stand more chance of managing his levels better for the rest of the day.

Those are my thoughts anyway but if you can supply us with more information as I have asked, we will hopefully be able to give more specific advice.
If you would like to give us an idea of what your husband currently eats, we might be able to suggest different things which he could try to reduce the amount of carbs and help to bring his levels down...... always bearing in mind that any dietary changes need to me slow and steady because he is using insulin.

thankyou this has been very helpful, gosh its a mine field isn,t it !! yes unfortunately he likes his bread and rice - I will get some more information from him and get back to you. How do you get on with the libra monitor and are the strips expensive? Many thanks

 

[rebrascora]

Libre is absolutely life changing. It doesn't have strips. The sensor is applied to the back of your upper arm once a fortnight and you then just scan it with a reader or a mobile phone with the appropriate app installed. You do still need to finger prick occasionally to double check low (hypo) or high readings before you correct them and it isn't always as reliable as we would like but the customer services are very good at replacing faulty ones. It is expensive but the way I look at it is that I should be more prepared to invest in my health than in anything else. I used birthday money from family to fund my first two and after that it was money that I might have spent on clothes or luxuries like a trip away etc. Thankfully I now get them on prescription and I am incredibly grateful for that as I know not everyone does and it took quite a while for it to happen.
The sensors are approx. £50 each and last 14 days. Can't remember how much the reader was but if you have an iphone or other compatible phone you can download the free app and use that to scan the sensor and get your readings.

 

[Bruce Stephens]

Can't remember how much the reader was

It's the same, I think. £50. But they're still temporarily unavailable.

 

[Inka]

Welcome @Norfolklou 🙂 You say your husband’s blood sugars are very high - what numbers is he getting? Does he take the same amount of Novorapid for each meal or does he vary it according to what he’s about to eat?