New to Forum but not new to Diabetes!

[Old&Slow]

Hi, asking for my 85-year old husband (does not use internet). He's been T2 for probably 10 years, gradually getting harder to treat. Currently taking 4 x 80mg Gliclazide (2 morning & 2 evening), and 38 insulin at night. (Also 1 x 10mg Enalapril, 20mg Atorvastatin and 2 x 5mg Apixaban).
He lost plenty of weight with the original Metformin but rarely dared to leave the house (needed to be near the loo!) but it was too restrictive and medication was changed. Insulin was introduced 18 months ago and has gradually increased to 38.
Blood glucose readings vary between 6.4 to 11 over the last week, mostly around 8 to 10. He tries to eat the right food and keep off the carbs but, as he says, I've reached 85 and cannot eat what I want. Where's the pleasure in life now?!
His most annoying problem though is recurring thrush. Been using Canestan off and on for years. Any ideas on what else he can use or do please? It is spoiling his daily life and he gets very down. Thank you.

 

[Inka]

Welcome @Old&Slow 🙂 I’m wondering how often your husband tests his blood sugar? Is it possible he’s going high some time over the day or night without realising? That could cause recurrent thrush.

There are also tablets called fluconazole (by mouth) that can treat thrush. However, I’d try to find a cause first.

 

[Old&Slow]

Welcome @Old&Slow 🙂 I’m wondering how often your husband tests his blood sugar? Is it possible he’s going high some time over the day or night without realising? That could cause recurrent thrush.

There are also tablets called fluconazole (by mouth) that can treat thrush. However, I’d try to find a cause first.

Thank you. We test each morning on waking, before food. (I say "we" because he doesn't like the needles to test or administer insulin so I have to do it!)

 

[rebrascora]

Hi and welcome.

So sorry to hear that your husband is struggling both with managing his diabetes well and also persistent thrush which is no fun.
Are those BG readings before meal tests?

Have you discussed increasing his insulin a little more with his nurse/GP to perhaps bring them down a bit further. I know health care professionals worry about low BG levels (hypos) especially as we get older because the risk of a fall becomes higher, but high levels causing thrush is also not an ideal situation, so it is about finding a better balance.

As regards food, the NHS dietary advice is sometimes not as helpful or effective with Type 2 as you might hope and for many of us it doesn't go far enough in reducing carbohydrates but reinforces a low fat diet whereas many of us find that less carbs and more protein and natural fat makes it enjoyable and

sustainable and enables us to manage our diabetes well. For instance, the NHS recommend porridge or shredded wheat for breakfast whereas those are still quite high carb foods and eaten without sugar or something sweet like fruit, are a bit grim in my opinion. Whereas bacon and eggs and mushrooms are very low carb and will hardly impact his BG levels at all... but need to go easy on bread/toast/hash browns/baked beans.. Not that I am recommending that he has bacon and eggs every morning but it is an option to try out and perhaps alternate it with a couple of other choices. Full fat (creamy) Greek natural yoghurt with nuts and seeds and a few berries (which are the lowest carb fruits) is a popular low carb breakfast choice. The low fat yoghurts tend to be quite sour but the full fat creamy ones are yummy and the fat helps to keep us satisfied and feeling full until lunchtime. Or perhaps a couple of scrambled eggs on a single slice of toast or I love an omelette with cheese and mushrooms and maybe ham or chicken or onions and peppers etc and I have it with a big dollop of cheese coleslaw (full fat, not low fat). We have one member who has steak or chops and mushrooms for breakfast sometimes. I had black pudding, mushrooms and pickled beetroot the other day.
If you would like to tell us the sort of things your husband typically eats and drinks for breakfast, lunch and evening meal and any snacks we could perhaps make other suggestions.

The advantage of eating full fat products is that they help to keep you feeling full because they take longer to digest and that stops you wanting to snack between meals and helps to stabilize your BG levels whilst providing slow release energy. I can sometimes get by on just one, but usually 2 meals a day by eating more fat and less carbs and I don't get hungry or crave sweet stuff like I used to, which is such a relief because I was a sugar addict pre-diagnosis..

I am however very aware that your husband is on insulin, so the type of insulin is important if you can let us know, because if it is a mixed insulin and he changes his diet too much his current dose could become too much and he could end up hypo. Lowering your carbohydrate intake can be a very powerful tool, so it would be important to make changes slowly and steadily. That also helps for your tastes to change too so that you rely less on sweet stuff and start to enjoy savoury and even tart things more.

Anyway, I just wanted to say that I can sympathize with your husband's situation and can understand how miserable he must feel and I imagine it has knocked his confidence to go out socially what with the Metformin and now the persistent thrush making him feel uncomfortable. I can also understand how he wants some pleasure out of food and perhaps the idea of a fry up for breakfast (or maybe brunch) might be something that would give him a treat without impacting his BG levels.

 

[Leadinglights]

Recurrent thrush is an indication that his blood glucose is high enough for the excess to be excreted in urine as the thrush is a yeast infection and yeast thrive in a sugary environment.
As he is on quite a cocktail of medication which is not managing to keep his level down then maybe a different insulin regime is now needed.
Consultation with his diabetic nurse or GP to find an approach that would give him the ability to eat what he enjoys and that might be a basal and bolus regime.

 

[Inka]

Thank you. We test each morning on waking, before food. (I say "we" because he doesn't like the needles to test or administer insulin so I have to do it!)

Ok, well it might be worth testing at some other times too in order to see if he’s going high unnoticed. He doesn’t have to do lots of additional tests all in one day. He can spread them out over a few days to build up a picture eg test at bedtime/middle of the night/2hrs after each meal - just to see if there are higher levels that would explain the thrush.

He certainly should be able to eat a little more variety (unless there are other reasons he can’t). Do you know the name of the insulin he takes (full name inc any numbers or letters)? There are lots of different types and regimes, and it might be another regime would help the thrush and also allow him to eat a bit more of what he fancies.

 

[Old&Slow]

Ok, well it might be worth testing at some other times too in order to see if he’s going high unnoticed. He doesn’t have to do lots of additional tests all in one day. He can spread them out over a few days to build up a picture eg test at bedtime/middle of the night/2hrs after each meal - just to see if there are higher levels that would explain the thrush.

He certainly should be able to eat a little more variety (unless there are other reasons he can’t). Do you know the name of the insulin he takes (full name inc any numbers or letters)? There are lots of different types and regimes, and it might be another regime would help the thrush and also allow him to eat a bit more of what he fancies.

His insulin is Lantus SoloStar glARGine. 100 units/ml and his injections are 38.
We'll vary or increase the daily tests. Maybe need to adjust his diet a bit too - after reading post above from rebrascora.

 

[Old&Slow]

Hi and welcome.

So sorry to hear that your husband is struggling both with managing his diabetes well and also persistent thrush which is no fun.
Are those BG readings before meal tests?

Have you discussed increasing his insulin a little more with his nurse/GP to perhaps bring them down a bit further. I know health care professionals worry about low BG levels (hypos) especially as we get older because the risk of a fall becomes higher, but high levels causing thrush is also not an ideal situation, so it is about finding a better balance.

As regards food, the NHS dietary advice is sometimes not as helpful or effective with Type 2 as you might hope and for many of us it doesn't go far enough in reducing carbohydrates but reinforces a low fat diet whereas many of us find that less carbs and more protein and natural fat makes it enjoyable and

sustainable and enables us to manage our diabetes well. For instance, the NHS recommend porridge or shredded wheat for breakfast whereas those are still quite high carb foods and eaten without sugar or something sweet like fruit, are a bit grim in my opinion. Whereas bacon and eggs and mushrooms are very low carb and will hardly impact his BG levels at all... but need to go easy on bread/toast/hash browns/baked beans.. Not that I am recommending that he has bacon and eggs every morning but it is an option to try out and perhaps alternate it with a couple of other choices. Full fat (creamy) Greek natural yoghurt with nuts and seeds and a few berries (which are the lowest carb fruits) is a popular low carb breakfast choice. The low fat yoghurts tend to be quite sour but the full fat creamy ones are yummy and the fat helps to keep us satisfied and feeling full until lunchtime. Or perhaps a couple of scrambled eggs on a single slice of toast or I love an omelette with cheese and mushrooms and maybe ham or chicken or onions and peppers etc and I have it with a big dollop of cheese coleslaw (full fat, not low fat). We have one member who has steak or chops and mushrooms for breakfast sometimes. I had black pudding, mushrooms and pickled beetroot the other day.
If you would like to tell us the sort of things your husband typically eats and drinks for breakfast, lunch and evening meal and any snacks we could perhaps make other suggestions.

The advantage of eating full fat products is that they help to keep you feeling full because they take longer to digest and that stops you wanting to snack between meals and helps to stabilize your BG levels whilst providing slow release energy. I can sometimes get by on just one, but usually 2 meals a day by eating more fat and less carbs and I don't get hungry or crave sweet stuff like I used to, which is such a relief because I was a sugar addict pre-diagnosis..

I am however very aware that your husband is on insulin, so the type of insulin is important if you can let us know, because if it is a mixed insulin and he changes his diet too much his current dose could become too much and he could end up hypo. Lowering your carbohydrate intake can be a very powerful tool, so it would be important to make changes slowly and steadily. That also helps for your tastes to change too so that you rely less on sweet stuff and start to enjoy savoury and even tart things more.

Anyway, I just wanted to say that I can sympathize with your husband's situation and can understand how miserable he must feel and I imagine it has knocked his confidence to go out socially what with the Metformin and now the persistent thrush making him feel uncomfortable. I can also understand how he wants some pleasure out of food and perhaps the idea of a fry up for breakfast (or maybe brunch) might be something that would give him a treat without impacting his BG levels.

Thank you, lots of info. I'll have to re-read this.
Currently he does have 1 weatabix for breakfast with home stewed fruit (damsons, rhubarb, mixed berries and sometimes plums, adding only a little Canderel, he likes it 'sharp'). His lunches are likely to be bacon and egg and tomatoes on 1 piece of toast (he'd like 2) or home made soups. He does love bread, baked beans, and natural Yogurt, pickled things, but also lots of unsuitable things.
I've answered the type of Insulin below. Thank you for advice and suggestions which I'll discuss with him.

 

[rebrascora]

Sounds like his diet isn't too desperate from what you describe other than the treats he has. I think in the circumstances adding a bolus insulin into the mix as the others have suggested might be the best option IF you can persuade your nurse or doctor, but it will involve more injections.... probably 3 more, one for each meal and probably a bit more testing, but the payoff is that he can have his treats. It is however a little more complicated than just injecting a set amount of insulin once a day and needs a bit of thinking and calculating for the meal time (bolus) insulin. We can help to support you with that and there is an online learning facility which you can do in short sections in order to help you get your head around it.

I think the thing is for you and your husband to have options and make a decision as to what might be best for him or you both if you are involved in testing and injecting.
Obviously without the meal time insulin, his treats are going to push his levels too high and thrush is the result. Finding alternative lower carb treats might be something to explore, particularly if you or he enjoy baking. You need some slightly different ingredients for low carb baking but we have one member who was having low carb chocolate cake for breakfast the other day.... all perfectly healthy and diabetes friendly. There are also low carb breads you can make yourself but again special ingredients (particularly flour as normal wheat flour is high in carbs) are needed. Once you get set up though and into a routine of baking low carb it seems that there is almost nothing you can't recreate. @NotWorriedAtAll is an inspiration in finding ingredients and working out recipes so that she can enjoy all her favourite treat foods all day long if she wants using lower carb ingredients.

Alterrnatievely, you could try to persuade your nurse/GP to add in a bolus insulin to inject before meals.....

Or possibly a third option would be a mixed insulin which would mean just 2 injections a day and would give him a little more cover for treats with meals without being too onerous a task, counting carbs and adjusting doses. Mixed insulin is a mix of the type of long acting insulin he is taking now with some meal time (faster acting) insulin mixed into it at a set ratio. This means that you need to have quite a set regime of injecting and eating at regular times and having similar sized meals to balance the insulin. It is now considered an old fashioned system but it works well for many people so don't discount it as a potentially good option unless you have a very varied routine and skip meals occasionally or eat at all hours of the day and night like I do 🙄.

If there is anything you don't understand about these options, please feel free to ask. Insulin therapy is quite complicated and finding what is right for you in your particular situation is what counts, rather than what suits other people.

 

[Inka]

His insulin is Lantus SoloStar glARGine. 100 units/ml and his injections are 38.
We'll vary or increase the daily tests. Maybe need to adjust his diet a bit too - after reading post above from rebrascora.

Lantus is a background/slow-acting insulin. It might be that he needs a fast-acting insulin to help with his meals. He shouldn’t have to cut out all carbs, and what you’ve described him eating isn’t excessive. As well as controlling the diabetes, he needs to be able to eat enough to nourish him and, yes, allow him to enjoy his food.

The blood sugar results you’ve listed aren’t bad at all but I do wonder if he’s creeping higher at other times. It would be sensible to check before you speak to his GP. The recommended blood sugar for older adults are usually slightly higher than for young adults just to ensure safety - and that’s a good thing.

If you discover his blood sugar is pretty much fine, then it would be worth speaking to his GP about the thrush. Sometimes there can be a rarer form of thrush and the usual creams and tablets aren’t so effective against it.

 

[Old&Slow]

Sounds like his diet isn't too desperate from what you describe other than the treats he has. I think in the circumstances adding a bolus insulin into the mix as the others have suggested might be the best option IF you can persuade your nurse or doctor, but it will involve more injections.... probably 3 more, one for each meal and probably a bit more testing, but the payoff is that he can have his treats. It is however a little more complicated than just injecting a set amount of insulin once a day and needs a bit of thinking and calculating for the meal time (bolus) insulin. We can help to support you with that and there is an online learning facility which you can do in short sections in order to help you get your head around it.

I think the thing is for you and your husband to have options and make a decision as to what might be best for him or you both if you are involved in testing and injecting.
Obviously without the meal time insulin, his treats are going to push his levels too high and thrush is the result. Finding alternative lower carb treats might be something to explore, particularly if you or he enjoy baking. You need some slightly different ingredients for low carb baking but we have one member who was having low carb chocolate cake for breakfast the other day.... all perfectly healthy and diabetes friendly. There are also low carb breads you can make yourself but again special ingredients (particularly flour as normal wheat flour is high in carbs) are needed. Once you get set up though and into a routine of baking low carb it seems that there is almost nothing you can't recreate. @NotWorriedAtAll is an inspiration in finding ingredients and working out recipes so that she can enjoy all her favourite treat foods all day long if she wants using lower carb ingredients.

Alterrnatievely, you could try to persuade your nurse/GP to add in a bolus insulin to inject before meals.....

Or possibly a third option would be a mixed insulin which would mean just 2 injections a day and would give him a little more cover for treats with meals without being too onerous a task, counting carbs and adjusting doses. Mixed insulin is a mix of the type of long acting insulin he is taking now with some meal time (faster acting) insulin mixed into it at a set ratio. This means that you need to have quite a set regime of injecting and eating at regular times and having similar sized meals to balance the insulin. It is now considered an old fashioned system but it works well for many people so don't discount it as a potentially good option unless you have a very varied routine and skip meals occasionally or eat at all hours of the day and night like I do 🙄.

If there is anything you don't understand about these options, please feel free to ask. Insulin therapy is quite complicated and finding what is right for you in your particular situation is what counts, rather than what suits other people.

Wow, there's a lot of stuff we didn't know here. Maybe our GP practice is a bit of a backwater and we need to ask a bit more.

 

[Old&Slow]

Lantus is a background/slow-acting insulin. It might be that he needs a fast-acting insulin to help with his meals. He shouldn’t have to cut out all carbs, and what you’ve described him eating isn’t excessive. As well as controlling the diabetes, he needs to be able to eat enough to nourish him and, yes, allow him to enjoy his food.

The blood sugar results you’ve listed aren’t bad at all but I do wonder if he’s creeping higher at other times. It would be sensible to check before you speak to his GP. The recommended blood sugar for older adults are usually slightly higher than for young adults just to ensure safety - and that’s a good thing.

If you discover his blood sugar is pretty much fine, then it would be worth speaking to his GP about the thrush. Sometimes there can be a rarer form of thrush and the usual creams and tablets aren’t so effective against it.

Didn't realise there were different sorts of insulin for a start, so ignorant here. Thank you.

 

[SB2015]

Welcome to the forum @Old&Slow

There are a variety of options for insulins, and it is a case of finding what suits your husband (and you) in managing his condition. Some additional information about his levels between meals would be useful when making decisions about any changes. Thrush thrives on high glucose levels so a change to insulin, possibly by adding in a meal time bolus (quick acting insulin) could help. That way he may also be able to have more flexibility in what he can eat.

It is amazing how much you can find out by tapping into the the knowledge of others living with the condition. As you have found there is a wealth of experience on here. Keep the questions coming. Nothing is considered silly on here. Just ask.

 

[everydayupsanddowns]

Welcome to the forum @Old&Slow

Bear in mind that running levels slightly higher is often the recommendation as people with diabetes get older. The levels you’ve quoted seem fairly reasonable - though as others have said recurring thrush can be associated with high glucose levels.

Can you remember his most recent HbA1c result? That will give an indication of his overall levels over the past 3-4 months.