Newly Diagnosed Type? ……..Confused.com

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GaynaChick

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Hi all
These forums are very interesting and useful, but just leads to more questions. My Brother (45) was admitted to hospital last about 2 weeks ago with a stroke ( has not seen a doctor for years despite having thirst and peeing regularly for last couple of months I found out) . In the ambulance his sugar level was 33.6! His HbA1c level is 40. He is being treated for Type 1 diabetes but not diagnosed Type 1 ( whatever that means) on 1000mg a day Metformin and 2 shots of 70/30 insulin a day. He is now testing 4 times a day, and they seem to be back down to normal levels, he is finding it hard as he is now absolutely paranoid about what to eat and drink. I am cooking most of his meals and buying things that are low sugar, there seems to be different advice for type 1 and type 2? He is off to see the diabetic nurse on Tuesday so maybe will get some answers and hoping to get a CGM as I know he finds it difficult testing with hist stoke affected hand. Also when discharged as well as the kwikpen he was also given a novo rapid & lantus solostar I don’t know if they do anything different or are just different makes?? I see people on video injecting different things depending on what they eat? Sorry I sound very naive but a whole new world
 
@GaynaChick There are indeed different protocols for type 1 and 2, and it is not just the sugars which need to be taken into account, starch and sugars make up the carbohydrates, and they can be tricky if you buy things with sugar alcohols, aka polyols, but don't worry - there are lots of people using insulin who can probably give you all the gen on how to manage with the ones you have been given.
You'll be fine in no time.
 
GaynaChick said:
Also when discharged as well as the kwikpen he was also given a novo rapid & lantus solostar I don’t know if they do anything different or are just different makes
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Almost all of us (who don't use a pump) use two kinds of insulin: a long acting slow insulin (basal insulin) and a short, fast acting insulin (bolus). Lantus is a slow acting insulin and Novorapid is fast acting.

We inject basal insulin once (or twice, depending on the specific basal insulin) a day and it's intended to cover the regular glucose that the liver produces constantly (so the intent is that we stay roughly steady with that day and night, presuming we're not eating anything), and the fast acting one covers what we eat, so we inject a suitable quantity before eating.

70/30 mixed insulin is just a mixture of the two. It's a bit simpler but is less flexible. It can still be OK for people who're OK eating regularly to match what's required for the insulin.

Ideally we'd be able to tell you how much basal insulin to use and how much bolus (depending on what meal he's planning on having). Unfortunately that varies wildly from person to person, so we just can't (even if the forum rules let us).

I'm guessing they intend you to keep using the 70/30 insulin (with whatever doses they give you, along with some (minimal) advice on food) until you've been seen by your local hospital diabetes team who'll be able to start teaching him (or you both) about how to manage it long term.
 
What seems at odds is the result of the HbA1C test which is an average of the previous 3 months and to be as low as 40mmol/mol would indicate a normal level but when they tested in the ambulance and at hospital which would have been a spot test and the result was 33mmol/l suggests that whatever had raised his blood glucose was very recent. That might be something to ask about at the appointment.
You need to get good information about a treatment plan moving forward both insulin regime, hypo treatment and diet being on the mixed insulin usually it is necessary to eat meals with a fixed amount of carbohydrates.
Indeed Type 1 and Type 2 are very different conditions and are managed in different ways so be careful when you read about what other people do and make sure it is appropriate for your brother's situation.
 
Welcome @GaynaChick It looks like they’ve given him Humulin 70/30 - is that right? This is a mixed insulin and consists of mainly slow-acting insulin (70%) and some fast-acting insulin (30%). People with Type 2 are often given this whereas Type 1s usually have the two insulins (fast and slow) separately so each kind of insulin can be adjusted separately. Perhaps the plan is to stabilise your brother’s blood glucose and then move him on to the Lantus (slow) and Novorapid (fast, used before meals). He could ask at his appointment.

Yes, the Novorapid would allow him to count the carbs in the meal he was about to eat and then calculate the appropriate dose of Novorapid. This allows for more flexibility. Also, it means that meals can be missed (just don’t take the Novorapid) and meal times can vary, whereas on the mixed insulin (Humulin 70/30) meal times have to be regular.

The recommended diet for people with Type 1 diabetes is pretty much the same healthy diet recommended for everyone, but while your brother is on the more inflexible mixed insulin, he’ll probably have to limit his carbs a little and will need to eat similar amounts of carbs for each meal each day.
 
GaynaChick said:
He is being treated for Type 1 diabetes but not diagnosed Type 1 ( whatever that means) on 1000mg a day Metformin and 2 shots of 70/30 insulin a day. He is now testing 4 times a day, and they seem to be back down to normal levels, he is finding it hard as he is now absolutely paranoid about what to eat and drink.
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If he is back down to normal levels then whatever he has been eating for the past few days would seem to be fine. The danger in making too many changes to diet right now would be that the dose of insulin might be too much relative to carbohydrate intake. While blood glucose levels are good I would suggest waiting to learn more and get medical advice before making any drastic changes to diet.
 
Thanks for all this insightful information it is really helpful and makes sense, I think when he was in the hospital we were just too overwhelmed and did not ask the right questions. This information now allows me to formulate questions for the diabetics nurse on Tuesday.

Yes he is on Humlin 20 units in the morning and 18 at night. What you say about doers makes sense as they have said to test inject and then eat.

When I was looking at his discharge notes and noticed the H1 level was only 40 I was suprised too given it was such a high reading on going to hospital so that will defo be one of my questions
 
GaynaChick said:
When I was looking at his discharge notes and noticed the H1 level was only 40 I was suprised too given it was such a high reading on going to hospital so that will defo be one of my questions
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There is a concept called surgical diabetes, which is where blood glucose can rise when the body is under severe stress, such as immediately after surgery. I would guess that a stroke might count. A very high blood glucose reading along with a low HbA1c would suggest a sudden onset of diabetes, which would perhaps suggest Type 1, but I would guess (and this is pure amateur speculation) that the stoke happening immediately before the blood glucose readings makes diagnosis more complicated. This may be why he's being treated as if he has Type 1 but not yet been formally diagnosed.
 
GaynaChick said:
I think when he was in the hospital we were just too overwhelmed and did not ask the right questions.
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Which is extremely common (nearly universal), so don't be at all worried. HbA1c is (kind of) an average over three months and Type 1 diabetes can happen very quickly so it's not impossible to have both a normal HbA1c and to have dangerously high blood glucose.
 
Bruce Stephens said:
Which is extremely common (nearly universal), so don't be at all worried. HbA1c is (kind of) an average over three months and Type 1 diabetes can happen very quickly so it's not impossible to have both a normal HbA1c and to have dangerously high blood glucose.
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I would agree, but it sounds like he has had high BG levels for some time since he has had the thirst and toilet visits for a couple of months prior to the stroke, so I am wondering if it is an HbA1c of 140 and it has possibly been misread (or incorrectly recorded) as that would be the sort of level you would be looking at with BG in the 30s.
 
Next time you see the docs have a pen and paper on hand, its so easy to foget things or misremember otherwise, also, you can make a list of your questions and ensure you get answers!
 
rebrascora said:
I would agree, but it sounds like he has had high BG levels for some time since he has had the thirst and toilet visits for a couple of months prior to the stroke, so I am wondering if it is an HbA1c of 140 and it has possibly been misread (or incorrectly recorded) as that would be the sort of level you would be looking at with BG in the 30s.
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You were correct, after visiting the diabetic nurse today the A1C level taken in A&E is 145! So that must have been an old reading! Still awaiting confirmation of which type but just got to stick with the 70/30 and general healthy eating, being mindful of carbs as seem to be working a blood sugars in single figures.

I was interested to learn that under 5 is hypo. As the hospital said 4 or under don’t inject but the nurse today said under 5, treat as hypo and when sugars are up then inject and eat. All a learning curve

Thanks for all you advice and knowledge really helpful
 
GaynaChick said:
I was interested to learn that under 5 is hypo. As the hospital said 4 or under don’t inject but the nurse today said under 5, treat as hypo and when sugars are up then inject and eat.
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It is common to treat anything under 5 as if a hypo. This is not because it is a hypo but in order to avoid getting to hypo level (below 4). This may be more important with a mixed insulin because you cannot control the amount of fast acting insulin (more likely to reduce BG) like you can with separate insulins. It is another area where the inflexibility of mixed insulin could be a problem for some.
The other thing to consider is that we can cause damage to small blood cells if we reduce our BG too fast. This is why it is important to follow the advice for you (or your brother) when first diagnosed rather than following the generic advice for those of us who have had diabetes for many years.

As you say, it is all a learning curve and, if he wants, your brother may still be learning more about diabetes and the way it affects his body for years to come, especially as treatment options improve.
 
Good to hear his levels are starting to improve and it sounds like you feel a bit happier about his diet. I am guessing a combination of very high blood glucose levels and associated high blood pressure which often goes hand in hand with high BG levels will likely have caused his stoke, so hopefully once you get his BG levels more stable he, should be less at risk of a repeat event.

Diabetes is a very complicated and confusing condition and often you find that just when you think you have it sussed, the goal posts move and you have to start finding a new strategy to win the game. It keeps you on your toes that is for sure!
 
GaynaChick said:
You were correct, after visiting the diabetic nurse today the A1C level taken in A&E is 145! So that must have been an old reading! Still awaiting confirmation of which type but just got to stick with the 70/30 and general healthy eating, being mindful of carbs as seem to be working a blood sugars in single figures.
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Hope you get confirmation soon. As others have said, mixed insulin isn’t recommended for T1s any longer, except in a few circumstances. Bit it sounds like you are both getting on OK with it for the time being.
 
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