Type 2 advice for my Father please!

[Cordyline]

Hi, I'm new to the forum and shamelessly here just for advice if possible....

My Father (aged 73) has recently found himself in hospital, then a nursing home as an NHS rehabilitation patient, after a series of falls at home (not an irregular occurrence generally, but seem to have put him off his feet this time). After he had been in rehab a week I opened a hospital letter stating he had hyperglycaemia while in hospital and is now on Linagliptin.

Previously he has been on metformin, and gliclazide but these were stopped and his condition was 'diet managed'. He made no major dietary concessions, but has a limited diet anyway and I have successfully discouraged consumption of sugar in drinks, chocolate, sweets and excessive amounts of fruit juice. He does have other health complications and takes a cocktail of other medications.

Blood glucose levels are being monitored at the nursing home, but, after around 2 weeks on the new medication, are constantly around 16 in the afternoon before his evening meal. Might be too simple to ask, but is this ok? Should Linagliptin reduce his blood glucose gradually?

I think I want to know if it sounds as though the high level is being correctly monitored and managed, or whether I should be making a fuss and expecting more medical intervention...

Thanks in advance for any advice or comments

 

[Northerner]

Hi Cordyline, welcome to the forum 🙂 Sorry to hear about your father's problems 16 is on the high side, but a lot will depend also on how much his current situation is contributing to the high levels - stress and trauma can cause an increase in levels. Also, some medications or health conditions can make the control of blood sugar levels more difficult - steroids, for example. Do you know what his fasting/waking levels are like? Reducing sugary items is good, but it's important also to monitor total carboydrates consumed, as all carbs - bread, rice, pasta, potatoes etc. - will raise blood sugar levels, so it would be worth knowing if his diet involves much in the way of non-sugary carbs. I'm guessing they don't want to put him on insulin and perhaps took him off gliclizide due to the risk of hypoglycaemia (low blood sugars), which would increase his risk of falls.

I'm not personally familiar with linagliptin or the mechanism by which it works, although I know we have other members on that or similar medication, so hopefully they will be along to share their experiences.

 

[Cordyline]

Thanks very much for your reply Northerner. I'm finding the situation rather grey and trying to see if I should be making some noise, so you've helped me start putting things into context.

Certainly the events that led up to his hospitalisation were stressful and traumatic, so it does make sense that those may have had an impact in his body's management of blood sugar.

I'm not sure about waking levels, but will ask when I visit this week. What you say about Gliclazide causing low blood sugar and possible falls does ring a bell

I am a little concerned about his institution diet. At home he ate porridge, a frozen Wiltshire farm foods meal for lunch (yes, processed but fairly nutritionally balanced), then either a tin of soup, or scrambled eggs and beans for tea - note, no bread! In the nursing home, and hospital previous to that, he seems to have sandwiches and biscuits daily, toast for breakfast and I'm not sure about the main meal, but I'm sure potatoes will often feature. The only concession they seem to have made to the high level is to stop the slice of cake at lunchtime, possibly only when someone remembers!

If anyone can give advice on how soon the level may be expected to come down on Linagliptin that would be really helpful..

 

[Northerner]

It does sound like diet may be playing a part then, sounds a lot like a lot of hospital diets with barely any concession to diabetes except maybe a slight reduction in sugar. When I was diagnosed I was in for 8 days and the only thing not deemed 'suitable' for diabetics was treacle sponge and custard! 😱 Small amounts of carbs should be OK, but if possible there should be more emphasis on elements like, for example, more of other veg and less potato.

I found the following explanation about the medication:

"Gliptins don't usually have many side effects. They work by preventing incretin being broken down. Incretin is a hormone which regulates digestion, reduces the amount of glucose released from the liver into the blood stream. And it stimulates the pancreas to produce more insulin in response to blood sugar rise after a meal. So it's a useful hormone and the longer it hangs around the better. The gliptins prevent it being broken down so quickly so you get a longer action from it."

My understanding of that is that it should act more or less immediately, rather than being something that you 'build up' in your system over weeks, like metformin, before you experience the effect.

Hard to say how much the stress and trauma might still be contributing, I'm afraid it's a complex situation with no clear answers, and the medication is a bit of a blunt instrument in comparison to injected insulin, but once more or less recovered things ought to settle down 🙂