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Mums diabetes

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mumsdaughter

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Type 2
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She/Her
Hi all. My mum had been type 2 for 20 on metformin. Unfortunately she took a bad turn and nearly died in April. She is now insulin dependent type 2. Having a really hard time getting her diabetes under control. Everytime she went into the hospital (messed up her insulin a cpl of times kidney infection another time) they increased her insulin. Now that she's out I just can't get her on an even footing. She takes her insulin around 0830 then has breakfast. If she dosent have lunch by 12, hypo. She's now taking hypos even after lunch. 2nd dose of insulin around 4 usually give her a sandwich straight after to keep her going until dinner at 6. If dinner is later than 6, hypo. The nurses just keep saying she needs to snack in between but she's being monitored for a heart problem and is meant to be losing weight (she's put weight on with the constant snacking and increase in carbs to keep her from a hypo) anyone any ideas. I feel like all they ever do is increase her insulin and tell me to give her more "snacks" she snacks on fruit, cakes yogurts toast etc but she takes hypos regardless. 4 hypos in 48hrs and all the nurse said was not to leave her without a snack for so long 2.5 hrs (she went for a nap as the previous nights hypo left her exhausted) and she hadn't slept well. It also takes her ages to recover from the hypos. About an hour for her bloods to come up then she's exhausted for hrs.
 
Which insulin is she on? What are her doses? And does she have a sensor or are you reliant on finger pricks?
 
If she's having that many hypos and having to eat loads of snacks just to try and stay level, then her insulin doses are too high. If you could tell us a bit about what insulin she's on and what doses at what times, that will give us a better idea of what's happening. We aren’t doctors and can’t tell you exactly what to do, but we could give you a list of questions to ask the doctor or possibly some things to try.
 
Welcome to the forum. I am a fairly newly diagnosed type 2 so cannot offer practical advice. I know my best friends husband who became diabetic in his forties now in his early 70s also uses insulin but also has a permanent monitor. There are some remarkable knowledgeable and helpful type 1s here. I see since I first read your post you have a reply from a parent of a type one who will be knowledgeable about coping. I lost weight when first diagnosed by going low carb but your Mum maybe on other medicine that makes it inappropriate. What age group is she and has her mobility been affected by her conditions. Generally insulin would allow her to vary her food more but heart problems will carry their own restrictions.

I was diagnosed in July having requested a test on discovering they weren't bothering to test the annual blood I gave. Obviously Mums situation improving will benefit you. Noone in my family is diabetic but it can run in families so given my experience I would suggest you ask for a test for yourself.

I hope you get some great answers and are able to improve things for yourself and your Mum.
 
She's on humulim m3 kwik pen (eli lilly) finger prick monitoring. They've got her on 50 in the morning and 14 at night. Around 0830 in the morning and 4 pm. She's still on 1 metformin tablet at 6 pm too. This is all new to both of us. I've had to take leave from work to look after her it was all too much for her. I'm learning as I go but some of the nurses seem to gate keep info.
 
HI @mumsdaughter and welcome to the forum - sorry to hear about your mum's troubles but great that she has a loving daughter to support her - from what you have said it sounds as if her insulin dosage is too high (particularly the morning dose) - however this is one for her healthcare team to be made aware of, so they can adjust them as they see fit - I adjust my insulin doses on a daily basis but have had the correct education (and experience) to do so - with your mum so relatively new to diagnosis though I would try and speak to her Diabetes Team and tell them of your concerns so they can suggest the adjustments - if you have any other questions, don't hesitate to ask - good luck and I'm glad you found us - we're all here to help if we can
 
mashedupmatt said:
HI @mumsdaughter and welcome to the forum - sorry to hear about your mum's troubles but great that she has a loving daughter to support her - from what you have said it sounds as if her insulin dosage is too high (particularly the morning dose) - however this is one for her healthcare team to be made aware of, so they can adjust them as they see fit - I adjust my insulin doses on a daily basis but have had the correct education (and experience) to do so - with your mum so relatively new to diagnosis though I would try and speak to her Diabetes Team and tell them of your concerns so they can suggest the adjustments - if you have any other questions, don't hesitate to ask - good luck and I'm glad you found us - we're all here to help if we can
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Thanks I've been saying her morning dose was too high but each time I was getting them to agree to ask the dbn to lower it she ended up in hospital for something and they'd increase it. And so it would all start again when she'd come out ( her bf would take cakes etc into the hospital and they would let her have them) emails have been sent in but I don't hold out much hope as they only record the levels she is at when they test her (not like I can leave her at a dangerous level for them to see it themselves) I just don't know how to get them to adjust things. If I keep giving her "snacks" every 1-2 hrs her levels on paper will appear fine but really it's not. I'm still asking every cpl of days to see the diabetic nurse but she's too busy and the nurses just email her.
 
mumsdaughter said:
Thanks I've been saying her morning dose was too high but each time I was getting them to agree to ask the dbn to lower it she ended up in hospital for something and they'd increase it. And so it would all start again when she'd come out ( her bf would take cakes etc into the hospital and they would let her have them) emails have been sent in but I don't hold out much hope as they only record the levels she is at when they test her (not like I can leave her at a dangerous level for them to see it themselves) I just don't know how to get them to adjust things. If I keep giving her "snacks" every 1-2 hrs her levels on paper will appear fine but really it's not. I'm still asking every cpl of days to see the diabetic nurse but she's too busy and the nurses just email her.
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How frustrating - I know very little about Humulin I must confess so I've done a little bit of research - See the chart below - Humulin is classed as an "Intermediate" Insulin so takes 1-2 hours to work, and is at it's peak after 4-12 hours - the lows your mum is experiencing seem to happen between these times so it would clearly suggest that the dosage is too high - does she experience any lows overnight?
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Not really at night. Sometimes happens in late evening ( usually om days when she eats early say 4pm and has a light snack later, found it better to give a snack at 4 dinner around 6/7) but not during the night. She's usually In the low teens in the morning. And that's normal for her it's more a shock when she's single digits.
 
Good that she's not having overnight hypos as that can be dangerous - but she shouldn't be forced into eating snacks to get her out of hypo territory throughout the day - definitely needs a review with her diabetes team as for me it doesn't look like the twice daily intermediate insulin is working (and certainly not the dosages) - but that's for them to decide (I'm not a doctor or DSN!) - Unfortunately you will have to perservere with trying to get them to review her situation/medication (if necessary) - Unfortunately Diabetes specialists all over the country are under a lot of pressure with an increasing number of patients (With all types of Diabetes) but keep trying to get through to them, because it is important to get it right, and not just for your mum, for you too! Wishing you both all the best of luck, and keep us posted
 
Thanks everyone. Good to know I'm on the right track as the nurses just make me feel like I'm in the wrong for not feeding her a loaf of bread everyday to keep her levels up. Thanks for the info Matt the graph was helpful to see how the different insulin behave ( up until mum came out of hospital the first time I had no idea so many different insulin existed or what they done). I'm reading through some posts and realising I really need to get a cook book geared toward insulin as the one I have is for type 2 and avoiding carbs ‍♀️
 
mumsdaughter said:
She's on humulim m3 kwik pen (eli lilly) finger prick monitoring. They've got her on 50 in the morning and 14 at night. Around 0830 in the morning and 4 pm. She's still on 1 metformin tablet at 6 pm too. This is all new to both of us. I've had to take leave from work to look after her it was all too much for her. I'm learning as I go but some of the nurses seem to gate keep info.
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I’ve used mixed insulin before. You’re quite right that the slower morning part will kick in around noon or before and that’s when your mum needs to eat. What I don’t understand is why she’s taking the second dose at 4pm rather than at 6pm before her evening meal @mumsdaughter
 
mashedupmatt said:
How frustrating - I know very little about Humulin I must confess so I've done a little bit of research - See the chart below - Humulin is classed as an "Intermediate" Insulin so takes 1-2 hours to work, and is at it's peak after 4-12 hours - the lows your mum is experiencing seem to happen between these times so it would clearly suggest that the dosage is too high - does she experience any lows overnight?
View attachment 32803
Click to expand...

What you need is a mixed insulin graph @mashedupmatt That just shows the duration of action of different insulins not the particular pattern of mixed twice daily insulin.
 
That's the latest the nurses will come and if I don't let them monitor the afternoon dose they "wouldn't see the need for the morning visit" they are the only link we have with the diabetic nurse. Last time when the nurses stopped we couldn't get to see the diabetic nurse (I'm seriously thinking she's AI and not human) and mum ended up backnin hospital. It appears they need to decide when she is fit to administer unaided then they will only attend in the am.
 
mumsdaughter said:
That's the latest the nurses will come and if I don't let them monitor the afternoon dose they "wouldn't see the need for the morning visit" they are the only link we have with the diabetic nurse. Last time when the nurses stopped we couldn't get to see the diabetic nurse (I'm seriously thinking she's AI and not human) and mum ended up backnin hospital. It appears they need to decide when she is fit to administer unaided then they will only attend in the am.
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That’s makes it more difficult then. Your mum needs to eat her evening meal within 30mins approx of her evening injection. The reason for this is that her injection contains a quick insulin that works fast to reduce the glucose spike from her evening meal (and a slow insulin to control her blood sugar overnight). That’s why she’s going hypo after her evening injection probably.

The morning injection contains a fast insulin to deal with her breakfast and a slower one to deal with her lunch. I hope that explanation helps. Mixed insulin requires a pretty fixed schedule of meal times. It also requires meals that are similar in carbs - a similar breakfast, lunch and evening meal each day at the same times.
 
As soon as the nurses drop the afternoon visit I'm going to move her insulin to 6pm because it's a pain at 4. She ends up feeling sick after her 6pm meds if she dosent have something more substantial and obviously 2 meals is too much for her to eat and when I tried dinner at 4 she went into hypos at around 8 (snack at 6 with meds) evening hypos are rare and more connected with her not eating the carbs at dinner ( she's got picky with food)
 
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