Questions about starting injections for my Dad

[leafgreen]

Hello, first time caller here... glad to find this community!
I'm trying to look after my Dad (and Mum) who are in their mid 70's/early 80's. My Dad has had diabetes for a long time, and already has symptoms like tiredness, neuropathy, poor circulation and retinopathy. He currently takes Metformin (1,500mg a day) and is very careful with his (low carb) diet, but his average blood sugar readings seem to be 10-12. Just one Hob-Nob seems to send his blood sugar high! I know my Dad has been recommended to go on insulin at least twice, but he has refused. My Mum is intimidated by insulin because she believes that she would have to manage doing blood sugar measurements, handle fiddly devices, set doses and give the injections.

The problem is that I live a long way away (a plane flight) and so I can't practically help day-to-day, but if I knew more about a next step is that they could cope with, I think I could help my Mum figure it out.

Thanks for reading this far!
My questions are:

* Are getting readings between 6-18, averaging about 12 while on Metformin a sign of a problem? How bad is that?
* If so, what is the next step for better control? Insulin, or the other meds I've read about like Trulicity?
* Is there an option that would be easier for my Mum to manage for my Dad? I think I understand that long/intermediate acting insulin is just 1-2 injections a day, without variable dosing. Is that right? How is it complicated is it to handle?
* Is a once-a-week auto injection (like Trulicity or other meds) going to help? Is it available on the NHS?
* If my Dad moved to insulin, how would his quality of life improve? Is it realistic to tell him that he'd be allowed to have a little more of the food he likes, or is that the wrong way to think of it?
* If my Dad started insulin and just couldn't tolerate the injections, could he return to oral meds (Metformin) without being worse off? That might persuade him to give it a try...

I'd be SO grateful for your thoughts and experiences. I'm trying to work out how best to help my Dad and I'm confused by all the info on the internet. Thank you!

 

[Elenka_HM]

Hello and welcome to the forum!
An average of 12 sounds high, but that's something you (or your parents) should discuss with the medical team, as well as the appropriate treatment.

About injections, I am grateful for the insulin pens we have nowadays, I personally find them easy to use and imagine it was all more complicated years ago with syringes and all that. The nurse would train your parents on how to do the injections, and the needles for pens are tiny, so not so intimidating as I would first think.

From what I've read, yes, there is the option of doing fixed doses of insulin once or twice a day. Maybe it doesn't allow so much freedom with food as carb counting would, but it saves your parents some maths. They would have to weigh the pros and cons. But then again, first they should hear what the healthcare professionals recommend for his case.

I hope someone with more experience give you more replies soon. Take care.

 

[Lucyr]

Hi and welcome. It sounds like a difficult and stressful situation for you.

I’d say that it’s fairly unusual to go from metformin to insulin, without trying the hundreds of other medications available first. It does sometimes happen that people go from metformin to insulin, usually when there are other concerning symptoms like fast weight loss.

In your parents situation, it sounds like trying some extra tablets as well as the metformin, and some dietary changes, would be worth asking about. Monitoring blood sugar if he’s able to would be useful too.

Does your dad have any appointments coming up or is he able to book one to discuss next steps?

 

[leafgreen]

Hello and welcome to the forum!
An average of 12 sounds high, but that's something you (or your parents) should discuss with the medical team, as well as the appropriate treatment.

About injections, I am grateful for the insulin pens we have nowadays, I personally find them easy to use and imagine it was all more complicated years ago with syringes and all that. The nurse would train your parents on how to do the injections, and the needles for pens are tiny, so not so intimidating as I would first think.

From what I've read, yes, there is the option of doing fixed doses of insulin once or twice a day. Maybe it doesn't allow so much freedom with food as carb counting would, but it saves your parents some maths. They would have to weigh the pros and cons. But then again, first they should hear what the healthcare professionals recommend for his case.

I hope someone with more experience give you more replies soon. Take care.

Thank you!

 

[helli]

My Mum is intimidated by insulin because she believes that she would have to manage doing blood sugar measurements, handle fiddly devices, set doses and give the injections.

The insulin regime for type 2 can be different for those of us with Type 1 but I understand it is possible for a fixed daily dose. This may be a long acting insulin or a mixed insulin (combination of long and short acting).
The insulin pens may be a bit fiddly if you have arthritis but the most common ones are prefilled (I usually steer away from these due to the waste but understand the simplicity) and you just need to attach a needle, dial up the dose and inject.
I assume your parents are currently doing blood sugar measurements so this shouldn't change much. Although it could be useful to look at the Libre which reduces the number of finger pricks greatly.

 

[leafgreen]

Hi and welcome. It sounds like a difficult and stressful situation for you.

I’d say that it’s fairly unusual to go from metformin to insulin, without trying the hundreds of other medications available first. It does sometimes happen that people go from metformin to insulin, usually when there are other concerning symptoms like fast weight loss.

In your parents situation, it sounds like trying some extra tablets as well as the metformin, and some dietary changes, would be worth asking about. Monitoring blood sugar if he’s able to would be useful too.

Does your dad have any appointments coming up or is he able to book one to discuss next steps?

Thank you! I wasn't aware of other tablets to try first. I don't get to be in the doctors meetings so I don't know what has been discussed, but if I can give my Dad some ideas of what to ask about he might have a better conversation.

 

[Drummer]

A hobnob is a biscuit - so eating one is going to elevate blood glucose, just like any other high carb food.
You could put it to your father than he might reduce his blood glucose levels by eating fewer carbohydrates, and there to be less need for medication.
I am 70 and manage my type 2 with diet alone, ignoring all the 'eat healthy carbs' I had for decades, and I am stronger and healthier than for some time when I was being nattered at about cholesterol.
Now my cholesterol is down, so is my weight, energy and fitness up, mind sharper, and when I had Covid the week I should have gone for my booster shot, it was basically a bad cold.

 

[Leadinglights]

Metformin works by helping the body use the insulin it is producing more effectively usually in association with a reduced carbohydrate diet. Other medications will encourage the body to produce more insulin assuming the pancreas is able to do so and there are others as well.
Are you able to post the sort of meals he has as it maybe some tweaks to his diet may help.
Also if he is able to have a daily walk will help as well.
Does he need to lose any weight, if so that will help as well.
Sometimes people think they are eating a healthy diet but that may not be so if diabetes is in the mix.

 

[Inka]

My Mum is intimidated by insulin because she believes that she would have to manage doing blood sugar measurements, handle fiddly devices, set doses and give the injections.

It’s possible to have a simple, basic insulin regime using fixed doses. Obviously, it’s less flexible and, depending on the insulin(s) used, can need rigid meal timings but that last thing might not be a problem for your parents. There are a variety of insulin options.

The insulin pens ‘fiddliness’ depends on manual dexterity. Most have a button to press at the end but you can also get at least one that has a side ‘slide’ that you flick with your finger. A number of people find this easier when injecting. Setting the dose is a matter of turning the ‘dial’ to the correct number so is pretty easy.

Ideally, your parents would be able to see and hold an insulin pen before your dad was prescribed it. They might find they’re a pleasant surprise. Do you know why your dad refused insulin?

 

[leafgreen]

My Mum is intimidated by insulin because she believes that she would have to manage doing blood sugar measurements, handle fiddly devices, set doses and give the injections.

It’s possible to have a simple, basic insulin regime using fixed doses. Obviously, it’s less flexible and, depending on the insulin(s) used, can need rigid meal timings but that last thing might not be a problem for your parents. There are a variety of insulin options.

The insulin pens ‘fiddliness’ depends on manual dexterity. Most have a button to press at the end but you can also get at least one that has a side ‘slide’ that you flick with your finger. A number of people find this easier when injecting. Setting the dose is a matter of turning the ‘dial’ to the correct number so is pretty easy.

Ideally, your parents would be able to see and hold an insulin pen before your dad was prescribed it. They might find they’re a pleasant surprise. Do you know why your dad refused insulin?

I couldn't exactly say, but I guess a combination of intimidated by handling the injections (he's quite shaky and his vision isn't great) and just not wanting more compromises in his life. I'm trying to get a sense of injecting insulin really might improve his overall quality of life, once he's over the initial learning curve.

 

[Inka]

I have Type 1 so have no choice about insulin, but I think if I was an older Type 2, my main concern would be any potential risk of hypos. Once I was sure I had a slightly moderated dose that avoided those as much as possible, I’d be ok. I don’t know much about the other Type 2 drugs, but personally I’d prefer insulin to those if I was Type 2.

Insulin should give better and more precise control of your dad’s blood sugars. As he already has some complications that’s important, I’d feel.

 

[Leadinglights]

I couldn't exactly say, but I guess a combination of intimidated by handling the injections (he's quite shaky and his vision isn't great) and just not wanting more compromises in his life. I'm trying to get a sense of injecting insulin really might improve his overall quality of life, once he's over the initial learning curve.

I can see it would be daunting to have to start doing something like that at his age whereas people who have done it for many years will adapt and cope. If he is unsteady there may be devices which are designed to help as he can't be the only one with similar issues.

 

[ianf0ster]

Hi @leafgreen, You say that your father is on a low carb (diet or way of eating) , but your example of having 9.6gms of carbs ( which is almost one half of my normal daily carbs) makes it seem like he never really went low enough carb to improve his diabetes. A hobnob sound like it's a snack rathe than part of a meal and having a low carb way of eating (i.e. not limiting calories) means cutting out snacks (especially those that have carbs - so a chunk of cheese would be OK).

In theory the upper limit of 'Low Carb' is 130gms per day, but the majority of us who used it to get our diabetes into remission had to go down well under 100gms per day even if having achieved that we relaxed the carb limit a bit.

 

[leafgreen]

Hi @leafgreen, You say that your father is on a low carb (diet or way of eating) , but your example of having 9.6gms of carbs ( which is almost one half of my normal daily carbs) makes it seem like he never really went low enough carb to improve his diabetes. A hobnob sound like it's a snack rathe than part of a meal and having a low carb way of eating (i.e. not limiting calories) means cutting out snacks (especially those that have carbs - so a chunk of cheese would be OK).

In theory the upper limit of 'Low Carb' is 130gms per day, but the majority of us who used it to get our diabetes into remission had to go down well under 100gms per day even if having achieved that we relaxed the carb limit a bit.

I think you're probably on to something here. 'low carb' has meant not having sugar in tea, rather than having an actual budget and tracking. Maybe there's more mileage in diet, but sadly that puts more pressure on my Mum. I guess I'm (naively) hoping a simple injection regime might make life simpler and slow/stop his sight loss and neuropathy.

 

[ianf0ster]

Removing sugar from tea has even less effect than cutting down on refined starches like flour, potato, rice. Also avoid sugary (mainly tropical) fruit - the best fruit for Type 2 diabetics are berries: Raspberries, followed by Blackberries & Strawberries, Blueberries aren't quite so good.
Having eggs for Breakfast (any way but with no bread or fruit juice) would have a much bigger effect than just removing sugar from tea.
Like thousands of others, I put my diabetes into remission by basing my meals on meat, fish, eggs, (tofu for a vegan), full-fat dairy (low fat dairy usually has more carbs), nuts and seeds, olives and avocados, low carb veg like cauliflower, broccoli, cabbage, courgette etc. Leafy greens , cucumbers, celery and radishes are also good for bulking up a salad based on meat, fish, cheese or boiled eggs.
For fast food take-aways decent burgers are good - just ask for it in lettuce leaves instead of the bun.

 

[leafgreen]

Thank you all for your answers: One quick follow up question - Who should my Dad talk to to understand his options? His GP, a diabetes nurse? Who should he make an appointment with who can answer our questions about medication choices?

 

[Leadinglights]

Thank you all for your answers: One quick follow up question - Who should my Dad talk to to understand his options? His GP, a diabetes nurse? Who should he make an appointment with who can answer our questions about medication choices?

I think in the first instance he will need to speak to the diabetic nurse or GP and then if needed ask for a referral to a specialist diabetic clinic usually at the hospital.
It may depend on where he lives, but there are some good clinics at some hospitals.

 

[Inka]

Thank you all for your answers: One quick follow up question - Who should my Dad talk to to understand his options? His GP, a diabetes nurse? Who should he make an appointment with who can answer our questions about medication choices?

If there’s a diabetes nurse at his GP surgery, he should speak to them initially. Make sure he has a list of questions and concerns to take with him. Also, suggest he takes a pen and paper to write things down. This can be really helpful to look back on after the appointment.

 

[leafgreen]

If there’s a diabetes nurse at his GP surgery, he should speak to them initially. Make sure he has a list of questions and concerns to take with him. Also, suggest he takes a pen and paper to write things down. This can be really helpful to look back on after the appointment.

Thank you. I'll contact them tomorrow.!