Mum constantly high bs

[Suzysheep]

Hi,
my mum is a type 1 diabetic. She has developed vascular dementia and is now being looked after in a nursing home.
her diabetes has been described as brittle, and her blood sugar tends to spike randomly. It’s constantly above 20 on her libra freestyle, no matter what she has or hasn’t eaten, and it’s always 2/3 in the morning.

what are some of the long term consequences of being too high. ?

thanks for any advice or information in advance!

 

[Inka]

Hi @Suzysheep Are the Libre readings being checked with a fingerprick test? Libre can be inaccurate at the higher and lower ends of the scale, eg it might read 17 when someone’s 13.

The risks of high sugar are DKA if it’s very high, complications from uncontrolled diabetes, and just generally feeling rough, maybe with urinary symptoms, tiredness, brain fog.

Is she on medication that could be affecting her blood sugar? What insulins does she take?

 

[Suzysheep]

Hi Inka
thanks for your reply .
they don’t tend to do a finger prick test unless it’s saying high on the monitor. She can get quite combative and not let them inject or test, so it’s best not to constantly upset her.

im sorry but I’m not sure what insulins she is on now, as she’s been through a few this last year trying to stabilise her somewhat ( had a few nasty DKA episodes) .. l think the medication she is on, she has taken for years without a problem, nothing has changed recently.

 

[Inka]

If they’re doing some checking, that’s fine. I quite understand why they don’t want to upset her. Are her meals being carb-counted for her? Is she eating ‘extras’ that are pushing her blood sugar up? I do know that often there’s a fair bit of sweet stuff around and it can be hard to stop people eating it when they shouldn’t. If that’s the case, maybe making or buying some low carb treats for her would work?

 

[Pumper_Sue]

they don’t tend to do a finger prick test unless it’s saying high on the monitor. She can get quite combative and not let them inject or test, so it’s best not to constantly upset her.

So does this mean your mum is not having the required insulin for the food she eats? I wonder if they are not giving her insulin as an easy way out thus the high numbers.

 

[rebrascora]

Sorry to hear that your Mam's levels are not stable and much too high. It must be very worrying.

I would guess that they have put her onto a mixed insulin to make things easier both for her and themselves, so probably just 2 injections a day rather than 4 or 5. I would be expressing concern that her levels were in the 20s and ask if her insulin regime can be reviewed and possibly adjusted, but I can understand them not wanting her to hypo. That said, if I read your post correctly, it sounds like her levels are hypo in the morning, and therefore her evening dose needs adjusting downwards but perhaps the morning dose needs increasing. It would need a trained diabetes nurse to oversee her results and make those decisions, not the care home staff.

 

[Inka]

I agree @rebrascora It’s also possible they’re correcting highs and causing her to go low overnight. If it were my mum @Suzysheep I’d ask if a DSN (specialist nurse) could look over her results and make some suggestions. There could be something relatively simple they can do which would improve your mum’s results.

I’d also ask about what she’s eating (are they keeping records?). Possibly she’s being given extras without people realising eg biscuits with drinks.

 

[Suzysheep]

If they’re doing some checking, that’s fine. I quite understand why they don’t want to upset her. Are her meals being carb-counted for her? Is she eating ‘extras’ that are pushing her blood sugar up? I do know that often there’s a fair bit of sweet stuff around and it can be hard to stop people eating it when they shouldn’t. If that’s the case, maybe making or buying some low carb treats for her would work?

She actually has a really poor appetite and doesn’t eat much of anything. They started her on fortisip but that made her in the high 20s constantly, so they’ve stopped that. She has lost a lot of weight.

 

[Suzysheep]

So does this mean your mum is not having the required insulin for the food she eats? I wonder if they are not giving her insulin as an easy way out thus the high numbers.

Yes, she gets the right insulin. The diabetic nurse has given them a sliding chart for mums readings and insulin doses.

 

[Suzysheep]

Sorry to hear that your Mam's levels are not stable and much too high. It must be very worrying.

I would guess that they have put her onto a mixed insulin to make things easier both for her and themselves, so probably just 2 injections a day rather than 4 or 5. I would be expressing concern that her levels were in the 20s and ask if her insulin regime can be reviewed and possibly adjusted, but I can understand them not wanting her to hypo. That said, if I read your post correctly, it sounds like her levels are hypo in the morning, and therefore her evening dose needs adjusting downwards but perhaps the morning dose needs increasing. It would need a trained diabetes nurse to oversee her results and make those decisions, not the care home staff.

She is on 4 injections a day. 3 short acting and one long acting for overnight. When she was in hospital after the first time they tried to get her on the 2 injections so she could go home and have the district nurse come in and do it … but she really didn’t respond well to it and ended up back in DKA , falling and breaking her hip.

I have asked the care home to get a diabetic nurse involved, they said that they will consult the gp.

 

[Suzysheep]

I agree @rebrascora It’s also possible they’re correcting highs and causing her to go low overnight. If it were my mum @Suzysheep I’d ask if a DSN (specialist nurse) could look over her results and make some suggestions. There could be something relatively simple they can do which would improve your mum’s results.

I’d also ask about what she’s eating (are they keeping records?). Possibly she’s being given extras without people realising eg biscuits with drinks.

They keep records of what she eats and drinks. She could possibly be eating biscuits on the sly…