What to expect after diagnosis?

[nottheplan]

My husband had a heart attack a couple of weeks ago and was diagnosed as diabetic while he was in hospital recovering. It has all been an emotional time with lots to take on board.

I'm looking for some advice on what to expect after diagnosis. Husband was seen by a diabetes nurse in hospital but there hasn't been any contact since or any idea of what happens next. They weren't able to tell him what type of diabetes he has. So he's been sent home on insulin twice a day but it feels without any ongoing support or much advice beyond keeping blood sugar below 10 and adjusting insulin if needed.

What would normally happen next in these situations?

Thanks!

 

[everydayupsanddowns]

Welcome to the forum @nottheplan

Sorry to hear about your husband.

Hope he is recovering well from his heart attack, and that you are getting good rehab support.

Approaches to diabetes care seem to vary a bit from area to area and practice to practice. Some have very forward thinking GPs and nurses and will encourage a proactive management style (including self monitoring to see how different foods affect you) and providing lots of support and information... while others rely on a tired single sheet of paper (if that!) and leave people feeling rather cut adrift.

I hope you get the former 🙂

You might find this guide helpful to the annual checks you should expect

Diabetes health checks (annual review)

Diabetes can cause other health problems that can become serious if not picked up and monitored or treated in the early stages. So regular diabetes health checks – sometimes called your yearly or annual review – are part of your routine NHS treatment. What diabetes health checks should I be...

www.diabetes.org.uk

Let us know how you are getting on, and keep asking questions 🙂

 

[nottheplan]

Thanks . Good to know about those 15 checks.

 

[Northerner]

My husband had a heart attack a couple of weeks ago and was diagnosed as diabetic while he was in hospital recovering. It has all been an emotional time with lots to take on board.

I'm looking for some advice on what to expect after diagnosis. Husband was seen by a diabetes nurse in hospital but there hasn't been any contact since or any idea of what happens next. They weren't able to tell him what type of diabetes he has. So he's been sent home on insulin twice a day but it feels without any ongoing support or much advice beyond keeping blood sugar below 10 and adjusting insulin if needed.

What would normally happen next in these situations?

Thanks!

Hi, I'm surprised that he has been left to his own devices given that he is on insulin. What have his levels been like, and has he had to make much adjustment to his insulin doses? I would get in touch with your GP to find out how you can make contact with someone who can offer him support and advice, either by telephone or email (given the times we are in). When I was diagnosed and sent home on insulin I had regular contact with a diabetes specialist nurse (DSN) who advised and encouraged me over the early weeks, and even though times may have changed and practices vary, you should at least have similar access. If he had just been put on tablets then it would have perhaps been less important, but still worrying for you and your husband not knowing.

I hope his recovery is going well, please ask if there is anything you are unsure of - no question is considered 'silly'! 🙂

 

[nottheplan]

Thanks for the reply. Yes, I was expecting some kind of Covid appropriate telephone support but he doesn't even seem to have a phone number for the diabetes team. I'll suggest he talks to his GP - they didn't seem to say much last week, but that have been because they spoke more about cardiac rehab.

He increased his evening insulin slightly but then his blood levels went down so I think he is now back at the insulin amounts they suggested in hospital. His blood sugar levels first thing in the morning are down to 6-9 and I think the same before dinner which are the two times he was told to take them.

It is lovely to have a space where any question is ok. 🙂

Thanks

Sarah

 

[Northerner]

Thanks for the reply. Yes, I was expecting some kind of Covid appropriate telephone support but he doesn't even seem to have a phone number for the diabetes team. I'll suggest he talks to his GP - they didn't seem to say much last week, but that have been because they spoke more about cardiac rehab.

He increased his evening insulin slightly but then his blood levels went down so I think he is now back at the insulin amounts they suggested in hospital. His blood sugar levels first thing in the morning are down to 6-9 and I think the same before dinner which are the two times he was told to take them.

It is lovely to have a space where any question is ok. 🙂

Thanks

Sarah

When I was diagnosed they also suspected I had had a heart attack and that did seem much more important than the diabetes! In my case they finally concluded I hadn't had a heart attack, but that was after 3 months of tests and having to take a variety of tablets. In your husband's case it is obviously more serious, so appropriate that they are concerned about his rehab. I suspect that there is much more expertise and resources available to deal with that than with insulin-controlled diabetes (whether Type 1 or 2), so that may be an issue. It may also be that the fact he is on insulin has slipped through the net, so I would definitely contact the GP to find out what the situation is. If he is Type 2 there may be an assumption that he is just on some straightforward tablets e.g. metformin and, if so, this need correcting so he receives appropriate care 🙂

His numbers sound good 🙂 Have you been told how to recognise and treat a low blood sugar level (known as a 'hypo')? This is very important to know as it can be potentially dangerous. It may be that, as he recovers from his heart attack and his body is no longer having to work so hard to heal him, that his insulin requirements will change so he needs less. You need to be alert to this. A hypo can be recognised by a variety of symptoms - feeling shaky or light-headed, tingling, blurred vision, difficulty concentrating etc. There may be any combination of these, or some different ones, so the important thing to do is to test the blood sugar and make sure it is above 4.0 mmol/l. If below that he needs to eat or drink something sweet, not too much, and this will raise his levels and the symptoms should disappear - check blood again after 10-15 minutes. I usually have 3 jelly babies as a guide, which is about 15g of sugar. I hope this doesn't worry you, but felt it important to know if you haven't been told 🙂

 

[everydayupsanddowns]

Hello again @nottheplan

Like @Northerner I am a bit concerned about the lack of information your husband has been given - I’d missed the reference to insulin in your initial post, and that does make the lack of clarity about ongoing support much more pressing.

Thankfully it sounds like your husband’s levels are being fairly cooperative, but you do need much more support and followup than you seem to have at the moment.

I hope you can get in contact with his Drs and clarify what happens next. In the meantime, do call NHS111 if there are any pressing concerns, or speak to the Diabetes UK Helpline (9-6 Mon-Fri) on the number at the top of the page.

Let us know how you get on 🙂

 

[nottheplan]

Thanks for the responses and pointers. It is good to know I'm not being a worrying wife in wanting more information and support.

He did have hypos explained but good to have the reminder as I'm finding there's so much to remember at the moment.

I think I have three questions at the moment - happy to wait and ask someone next week, but if you have any pointers, that would be great too.

1. He's on humulin (is that the right spelling?) 30. The nurse in hospital told him to take it after food but everything I've read says it should be taken before. Is there any reason for that difference?

2. He's also really struggling to get blood out. The lance is on the longest and he warms his hands and has tried different sides of the nail and squeezed it and left it and shaken it, but this morning it took him seven attempts. Anything else he could try?!

3. I'm also confused about when we need to tell DVLA. I know he's been told he can't drive for a month but after that do we have to tell them immediately or not of it is within the first three months?

Thanks for listening!

 

[zuludog]

You should also inform your car insurance company
It shouldn't affect your premium, but you do need to let them know

 

[Ljc]

I would inform the dvla now as I believe but not sure (as I had stoped driving before I went into meds that could cause hypo’s ) that they temporarily withdraw your licence as they require a few moths of self testing .

It can take a while to get the grip of getting enough blood to appear, when I started self testing, I was ahead of the game as part of my old job was pricking peoples thumbs to check their iron level.
It helps if you use a sort of rolling squeeze, if necessary release to allow the area to fill up with blood again , it will change back to its normal colour and plump up in a second or two, then squeeze again.
You should find This blog helpful

 

[everydayupsanddowns]

1. He's on humulin (is that the right spelling?) 30. The nurse in hospital told him to take it after food but everything I've read says it should be taken before. Is there any reason for that difference?

Many HCPs err on the side of caution when initiating insulin treatment, as sudden and severe hypos can be distressing, and dangerous.

Humulin 30 would be a mixed insulin I think, with a combination, of Humulin I (intermediate acting) and a more rapid acting insulin.

Mixed insulins suit some people really well (especially if they have a regular routine and/or are also producing their own insulin to ‘make up the difference’), but they aren’t very flexible and can’t be adjusted easily if they aren’t working at a particular time of day.

When I was started on mixed insulin (waaaaay back) i was told to take it before meals, so if you would like to try this I would ask his GP/nurse if there were any reasons they don’t advise it in your situation. 🙂

 

[trophywench]

It's a mixture of Humulin I (the I standing for 'intermediate') and Humulin S (S for soluble - ie a faster acting but not instant) insulins. It's intended to be and is, 'gently does it' in its action.

 

[Amity Island]

Thanks for the responses and pointers. It is good to know I'm not being a worrying wife in wanting more information and support.

He did have hypos explained but good to have the reminder as I'm finding there's so much to remember at the moment.

I think I have three questions at the moment - happy to wait and ask someone next week, but if you have any pointers, that would be great too.

1. He's on humulin (is that the right spelling?) 30. The nurse in hospital told him to take it after food but everything I've read says it should be taken before. Is there any reason for that difference?

2. He's also really struggling to get blood out. The lance is on the longest and he warms his hands and has tried different sides of the nail and squeezed it and left it and shaken it, but this morning it took him seven attempts. Anything else he could try?!

3. I'm also confused about when we need to tell DVLA. I know he's been told he can't drive for a month but after that do we have to tell them immediately or not of it is within the first three months?

Thanks for listening!

Hi,
Sorry to hear about your husband and it must be a worrying time for you both, allthough in part, a time to be relieved too.

I'd like to add a few things to try and help.

Firstly, to me at least, it sounds like you need more support and direction from the diabetes team.

Regarding humalin30, I believe this is the same/similar mixed insulin that I was started on which was ok, it kept things simple in terms of sticking to a regular meal plan and it was taken before meals. As I was diagnosed as type 1 diabetic (I don't know what your husbands type is yet so this may be irrelevant) I soon found it a bit too restrictive and moved onto two types of insulin, one called a basal (taken once a day at same time, usually either in the morning or evening) which should keep blood sugar ticking over at the same steady levels day and night and a bolus insulin taken for meals. Your husband is currently on a mixed insulin which provides both background (basal) insulin and enough to allow for carbs at mealtimes.

Getting blood out of fingers is easier from the pad than the side, but can be more painful. But needs must.

DVLA yes, once someone is on insulin they need to inform DVLA.

Regarding low blood sugar, if this happens, as they've mentioned, some glucose/sugar (10-20g?) needs to be eaten/drank to pick blood sugar back up. It's worth mentioning that it's not always a one treatment and done, sometimes if someone has taken too much insulin or too much excercise, blood sugars can continue to fall even after taking some glucose, so certainly in the early days until one knows more personally how things go, re-test blood sugars again in 30mins to check blood sugar isn't still falling.

 

[silentsquirrel]

I would inform the dvla now as I believe but not sure (as I had stoped driving before I went into meds that could cause hypo’s ) that they temporarily withdraw your licence as they require a few moths of self testing .

I think the 3 months of readings only applies to HGV or PSV licences, not applicable to car drivers. I would inform them now.

 

[Robin]

I would inform the dvla now as I believe but not sure (as I had stoped driving before I went into meds that could cause hypo’s ) that they temporarily withdraw your licence as they require a few moths of self testing .

I think being told not to drive for a month will be more to do with the heart attack. My husband was told not to drive for a month after a retinal artery occlusion, which is treated the same as a TIA. When I informed the DVLA I was allowed to go on driving while they made their inquiries, and then got my three year licence in due course. I think you have to tell them unless you know that you are only going to be on insulin temporarily (under three months) which at the moment, I assume you don’t know.

Diabetes and driving

You may need to tell DVLA if you have diabetes, depending on the treatment you're getting

www.gov.uk

 

[Ditto]

Hello and welcome to the forum @nottheplan 🙂