Some advice needed for mumsy!

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Dazz

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Relationship to Diabetes
Type 2
Hi all,

Hope all of you are well!

I'm here on behalf of my mum. She was recently diagnosed with Type 2 Diabetes. We think it lay undiagnosed for a considerable time and she became very poorly and was admitted into hospital. She also has multiple myeloma but that is currently under control and she is on no treatment for this.

After being in hospital for 2 nights (one night on a trolley in a corridor!!!) and receiving insulin by drip, she was sent home with Metformin and a Humulin M3 pen. So, here goes with my questions...

1. She was told to take the Metformin twice a day with meals and the Humulin twice a day, 40 after food. However, the piece of paper that came with the prescription said once a day for the Humulin. We have rung the hospital to clarify and they are very slow getting back (not their fault, poor souls are under considerable pressure at the moment). Does this advice sound right? Mum and dad are getting on and find it all a bit confusing, so any advice would help them stress out less!

2. Mum has been out of hospital for about a week and a half. She seemed to get instantly better while on the drip fed insulin but, since returning home she has felt less energised and fairly weak. How long should it take for her sugar levels to regulate with the medication regime she is on? One doctor said it could take 3/4 weeks for her to really feel the benefit and another said it should be way quicker. Any ideas on this?

All this conflicting advice is causing my folks a lot of stress as well as implementing the new care she needs to monitor her diabetes, which Im sure some of you guys can identify with maybe after you were diagnosed.

Sorry if I have rambled on, but with the NHS in the state that it is at the moment, we are finding it hard to get any solid advice...that's why I came to you guys...the experts!

Thanks for your time and hope you all have a great day.
 
Hi @Dazz, I don’t think anyone can give you a definitive answer on this so you really need to get a response from the hospital. Humulin M3 is a mixed insulin of long and rapid acting insulin. I believe it should be taken twice daily about 30 minutes before breakfast and again 30 minutes before an evening meal. But sorry, no idea if 40 units for each dose is correct for your mother as this would have been calculated by the hospital as a starting dose so you really need to check with them.

Metformin should definitely be taken with or just after food to minimise any stomach problems taking it.

The normal course is to gradually reduce high blood glucose levels, a sudden drop would not feel good as the body gets used to a higher level of glucose so a quick drop would cause some “false hypo” type of symptoms. I would tend to go with at least a week of taking the insulin to start feeling better, more energy, etc.

Sorry I can’t offer any more advice - did you get an information leaflet about the Humulin at all? If not there is one here : https://wiltshirehealthandcare.nhs.uk/wp-content/uploads/sites/8/2022/04/Humulin_m3_patient_booklet.pdf

Good luck, hopefully you will hear back from the hospital soon!
 
It's unclear what the "40" refers to but as per the booklet & above, Humulin should be taken before meals, not after. No one here can advise on the dose though.

She should also have been given a glucose meter to monitor her levels, as the prescribed dose may well need adjustment. Generally glucose levels are reduced slowly by increasing insulin every three days or so. But reading from the meter are essential for this & should be advised by the hospital.

The hospital should have sent a discharge letter to the GP. It may be an idea to call them & see if they can clarify the dose.
 
Sorry, that was supposed to read 40 mins after food...my daft sausage fingers typing!

She has been testing blood sugar and they do seem to be coming down. When she was first admitted, it was 27 which I believe is particularly high.

I'm just hoping she starts to feel a little better soon. I think this diagnosis has bought on a lot of anxiety and depression.

Thanks so much for you answers guys, really appreciated x
 
RBZ5416 said:
It's unclear what the "40" refers to but as per the booklet & above, Humulin should be taken before meals, not after. No one here can advise on the dose though.

She should also have been given a glucose meter to monitor her levels, as the prescribed dose may well need adjustment. Generally glucose levels are reduced slowly by increasing insulin every three days or so. But reading from the meter are essential for this & should be advised by the hospital.

The hospital should have sent a discharge letter to the GP. It may be an idea to call them & see if they can clarify the dose.
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That's the thing, the hospital seem fairly hard to get anything out of at the moment.
 
Dazz said:
That's the thing, the hospital seem fairly hard to get anything out of at the moment.
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Which is why I suggested that the GP should have a discharge letter, which should detail the meds & dose.
Dazz said:
Sorry, that was supposed to read 40 mins after food
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It does rather sound that she's taking it at the wrong time then.
 
Sorry to hear about your mum’s diagnosis @Dazz I wouldn’t take any insulin until the dose and number of doses has been clarified. Humulin is usually taken twice a day but occasionally just once. Insulin is a potentially dangerous medication so it’s crucial to check all the details, and double-check if necessary.

Also, make sure your mum has plenty of hypo treatments like Dextro tablets, jelly babies, full sugar Coke, etc.
 
Inka said:
Sorry to hear about your mum’s diagnosis @Dazz I wouldn’t take any insulin until the dose and number of doses has been clarified. Humulin is usually taken twice a day but occasionally just once. Insulin is a potentially dangerous medication so it’s crucial to check all the details, and double-check if necessary.

Also, make sure your mum has plenty of hypo treatments like Dextro tablets, jelly babies, full sugar Coke, etc.
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Thanks. She is due to see a nurse on the 16th, which to my mind, is way too far away. My dad is currently monitoring and logging her blood sugar. But on her Humulin pen it says twice a day, but on the issuing paperwork it says once.

Still no word from the hospital, so I dare say I will have to ring to get clarification.

Thank you again so much for your responses. It's all very stressful to see her so anxious about it all x
 
You could try calling 111 or 111 online if you are worried and explain the confusion with discrepancy between the two instructions.
I think they have access to your medical record so may be able to clarify for you.
 
RBZ5416 said:
Unfortunately they don't, see Myth 1.

www.nwas.nhs.uk

NHS 111 – top ten myth-busters - NWAS - North West Ambulance Service

We get asked many questions about how our NNS 111 service works and have put together a list of ten myth-busters to help with knowing how it can assist you.
www.nwas.nhs.uk www.nwas.nhs.uk
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I’m sure the call handlers you speak to firstly won’t be able to, but if they refer you on, and say, a duty doctor calls you back, I’m sure the doctor can look at them, otherwise they’d be diagnosing you in the dark.
 
Robin said:
I’m sure the call handlers you speak to firstly won’t be able to, but if they refer you on, and say, a duty doctor calls you back, I’m sure the doctor can look at them, otherwise they’d be diagnosing you in the dark.
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Maybe, seems like the systems were opened up during the height of the pandemic, no idea if they still are. On reflection, I vaguely recall being asked to make my records available across different platforms some time back.

www.bmj.com

Patient records can be shared across practices and with 111 after NHS relaxes rules

GPs will now be able to access records for patients registered at other practices during the coronavirus epidemic in a major relaxation of current rules. The move will allow appointments to be shared across practices, and NHS 111 staff will also have access to records to let them book direct...
www.bmj.com www.bmj.com

Maybe 111 have made that statement to just discourage people calling them for test results & the like when they can't get through to their GP?
 
Personally, taking insulin dosing advice from a locum GP responding to a 111 call scares the Heebee Geebies out of me. I wouldn't trust my own GPs to give me dosing advice and they are all excellent and I know them well but diabetes is not their field of expertise and particularly insulin usage and dosage, which is complicated. If there is a diabetes trained practice nurse at your GP surgery, they should be able to help, but you really should be getting clarity from the hospital staff.
I wonder if your hospital have a diabetes helpline that you can ring. The hospital switchboard should be able to put you through to it if they have one. It is usually an answering machine where you leave a message and they get back to you within 1 or 2 working days.

As others have said Humulin M3 is a mixed insulin which would generally be prescribed to be taken morning and evening before a meal, because part of the mix is a fast acting insulin which works on the food you are about to eat. The slower release insulin in the mix is to cover the release of glucose from your liver which trickles out day and night. It would be unusual circumstances where it was just prescribed once a day, but there may be something unusual about your Mum's particular situation for them to suggest that. I would suggest it may be best to err on the side of caution and just take it once a day in the morning until you get clarification. Half a dose is better than none and should keep her safe but probably still a bit high. If she was to take double what they prescribed and it dropped her very low, that would be much more serious.
 
If your mum doesn’t know how much insulin to take and when, and is feeling unwell, then she needs to go back to hospital or at least call 111
 
Hi all,

Many thanks for the responses.

A little update.

So, my Dad actually went into the hospital and got clarification that the Humulin should be taken twice a day and the 500 mg Metformin the same. When she first went into hospital she was suffering from a water infection as well, which could explain the brain fog and confusion she has been experiencing. they gave her antibiotics but only had 3 days worth.
So her GP has issued here with some more. The GP said the Metformin should be 4 tablets a day but we are ignoring that.

I think she is on 6 mg on the Humulin pen which, one nurse at the hospital said is very low. Mum has also got in a tizwoz about what she should be eating. She has always eaten fairly well but after this has become obsessed with not eating sugar. The hospital also advised this is wrong and she should eat normally so they can get a reading of what the insulin is doing.

The hospital said that diabetes nurse should of been out to her around 4 days after her discharge but we are still waiting on this. So, in the meantime here sugar readings are coming down to around 8 but she still feels so tired and brain foggy and it is really getting her down.

We are now left in the lurch waiting for the diabetes nurse to get to her.

Hope you are all well at least!!
 
Insulin is described in units not mg so it’s best to say dose is 6 units

It is a low dose, she doesn’t need to avoid sugar on insulin. She needs to eat a normal balanced diet and the dose will be adjusted to match that.

As it’s a mixed insulin it’s best to eat fairly similar amounts each day. If she was to have a large jacket potato with beans one day (high carb) and a salad the next (low carb) then blood sugars will be more erratic as the mixed insulin only covers a set amount of carbs.
 
Lucyr said:
Insulin is described in units not mg so it’s best to say dose is 6 units

It is a low dose, she doesn’t need to avoid sugar on insulin. She needs to eat a normal balanced diet and the dose will be adjusted to match that.

As it’s a mixed insulin it’s best to eat fairly similar amounts each day. If she was to have a large jacket potato with beans one day (high carb) and a salad the next (low carb) then blood sugars will be more erratic as the mixed insulin only covers a set amount of carbs.
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Thanks for the reply. The doctor at the hospital said it will take 3-4 weeks for her to start to feel more energetic and less brain foggy and tired. Is this right or should it be quicker? I know it's different for every person but, as a general rule?
 
Hopefully once the UTI has cleared up she should see some improvement in the brainfog. It is common in elderly people to suffer confusion, get hallucinations with UTIs.
I hope you get some clarity from the diabetic nurse.
 
Well the 3-4 weeks 'ish' is a deliberately conservative estimate since every single human body in the world will react a bit differently - we are all definitely different! Also where usual logic seems to indicate to most people that when something is higher than is wanted, so when you're cooking dinner and something is boiling instead of simmering, you turn the heat under the saucepan down, obviously - so why on earth don't you just start off on a high dose of insulin and then reduce it? The reason why is a very good one - if you do that there's a great danger that both fine nerves here there and everywhere in the body and the eyesight, which is very quickly noticeable to the person and affects them quite a lot, can easily be adversely affected and THAT then takes time to recover again. Hence instead of doing that it has been recognised by the medical profession for a long while now that it's far better to start off with small doses and gradually adjust them one way or the other until the right balance is achieved.

Patience is a virtue when it comes to all things diabetes - and that goes for the nearest and dearest of the patient as well as him/her!
 
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