she does drink coffee, but she also does drink coffee in the mornings and after lunch and it didn’t have any effect on her blood sugar. Also, there are days when she doesn’t drink anything caffeinated yet her blood sugar still does rise.
My Mother was on Tresiba before her surgery and it did a great job, I was very surprised. I gave her 20 units of Tresiba last night but then at 3 am, her blood sugar was 81. Good thing I checked otherwise she would have woken up with a hypo. I guess I will have to see what her blood sugar will be later on in the evening to decided whether to continue with 20 units and a bedtime snack or another approach such as the one you suggested( twice per day).
I will def look into this, thank you for the suggestion
You haven’t mentioned whether your mother uses a CGM so I’m thinking she does not. The right dose of Tresiba is very good about usually holding a steady line through the night. I’m wondering if your mom would’ve gone hypo as you feared or simply skipped along in the 81 +/- 10 for the balance of the night. Did your 3 a.m. carb correction lead to a good wake-up number?
You are a admirable daughter to help your mother this way, a true labor of love!
I’m sorry I had not realized your mother had Whipple surgery. This surgery can dramatically affect digestion and cause gastroparesis. And according to one source:
After a Whipple procedure, the most common complication is delayed gastric emptying, a condition in which the stomach takes too long to empty its contents.
As I mentioned before, you bring this up right away with your doctor to get a proper diagnosis. There are medications that can help. Also for some eating small meals during the day helps as well as avoiding high fat and high fiber meals. For some liquid meals help and enzymes can aid digestions.
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+1.
I spoke to Mom’s Endo about Gastroparesis and he insisted it may very well be that. Had you not brought it up, I highly doubt her Endo would have known what’s going on. All he kept telling me was to increase the Basal, without even realizing that increasing the basal would have not worked. Mom has an appointment for next week to get an exam done, which will confirm whether it is indeed Gastroparesis or not. Thanks!
Thank you Terry!
i do everything I possibly can to make her life easier lol even if it means me going crazy for a short while 
, she is my world!
Thank you West,
Loveeee my mom, she is the best! I have spoken so much about my mom, lol I almost feel like uploading a picture of her and I.
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You really should!
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Hi everyone,
Hope this message finds all of you in good health.
Quick update:
My Mom’s PCP suspected Mom has a case of mild Gastroparesis( due to Whipple Surgery). She is schedule for some tests this coming week. HOWEVER, I did some reading around and a couple of forums have mentioned that Dr. Bernstein suggests taking Papaya Enzymes. Turns out, I actually had a huge bottle at home of the one he had suggested( belongs to my grandmother). My mom took 1 after each meal since the last two days and LO BEHOLD- the highest spike she has had was 150-162. Still high but not as high as close to 300 as she has been having.
I really hope this just isn’t a temporary fix and doesn’t cause any long term issues down the road. Will update everyone within a week and with the results of her tests.
Thank you so much for all of your help, your support means so much to me. I’d be so lost without all of you!
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Awesome news!
I am not sure if it is due to the papaya enzyme, or just to surgery recovery. But either way, let’s hope it keeps on getting better. I am so glad for you and your mom!
Please let us know of progress!
If this is a typical event, why not bolus at 0630 to prevent the spike? Bolus is for spikes, so I don’t think basal should be a consideration in this event.
The reason why is because mom tends to have dinner around 8, 9. So her endo
said to not " stack " before her dinner bolus. Let’s say if I give her 4
units to bring her blood sugar down at 7 pm and then she’ decides to have
dinner at 8 or 9- she’ll have to bolus again. If she had a cgm/insulin
pump- it would have made things easier to monitor but she doesn’t. Nor does
her endo want to write a rx for it.
We might have become a bit obsessive about control - but this wouldn’t stop us at all. In fact, we sometimes inject twice in a meal, particularly at a restaurant.
Lately we have become pretty aggressive about correcting early. We used to go - let’s wait another 15 minutes and see if it has peaked. Now it’s more - let’s inject right now, we’ll take carbs if it peaks in the next 20 minutes. It takes so long for insulin to act, and it is so fast for carbs to work is how we see it now:-) Maybe we went too far that way…
Update*** so now Mom is waking up with high numbers - 170-200. Overnight -250 ish. After meals since yesterday -240 ish. Will increase basal but…
I knew the papaya enzyme thing was a bit too good to be true. It worked for a few days but since yesterday, mom’s blood sugar has started to go out of control…again. What’s worse is her health insurance made an error on their part and now mom will be without insurance till mid April. I don’t mind paying for Dr.visits and her meds full priced but in all honesty, some of them are extremely pricey. Oh and her Endo’s next available appt is march 18th. No point in going to her Pcp as he’s clueless beyond belief. Lol, Just when I thought mom’s starting to get better post whipple surgery, she’s started to get worse.
Oh and she’s starting to lose weight again, assuming from the high blood sugar /malabsorption of nutrients …she’s at 97 lbs now.
Whipple surgery really did a number on her overall health, didn’t it ?
Ow Jeez. Is there any way to work this further? This is the last thing you’d need to worry about right now.
That seems reasonable since she used to be on a higher basal before her surgery
It sure did - and on yours too, with all this waking up in the middle of the night and worrying about her all day long:(
Is there any way you can get some administrative help somewhere to help you work through the insurance snafu?
Are you still able to work through your classes (or did I misunderstand)?
Now for a short family story. My young son (he is T1D now), when he was really young, maybe 2-3 years old, was always cold -he has always been pretty thin. So, when we were going skiing, he would put his cold hands under my arms or against my abdomen while in the car, in order to get warm. One day, he did that with my wife, who is skinnier and never very warm, and got no heat off of her at all. He turned to her, full of pity for the poor woman, and announced sadly: “Mama, your warm is broken!” So, @Tinsyl, you keep a little bit of your warm for yourself, y’hear?
Sending good feelings your way - your friend Michel.
Hi West,
I really am at wits end. It seems that her Endo is just driving me even more crazy along with her health insurance company. I left a message with one of the higher up’s from her Health insurance to try to give me a cal( no call back), I tried calling all day- funny how every single rep is giving me an entirely diff answer. Interesting isn’t it? I just got off the phone with Mom’s Endo but that convo in itself was a huge waste of my time. I took a break from Ph.D research for now and will return back in Summer. Luckily, the company I work for was able to allow me to work from home- however by March, I’ll have to start working at the Office again. Mom’s Endo suggested I change her ratio but I did earlier and again at 7 pm, her blood sugar went up to 252! 2 hours was 162 3 hours, 252.
Thank you so much for sharing the story about you, your wife and your son. Your son sounds like an absolute sweetheart! Sometimes, us caretakers get so wrapped up in making sure our loved ones are feeling okay, that we end up forgetting to take care of ourselves which is what I’m somewhat going through at the moment, lol.
It’s tough but I’m trying to " keep a little bit of warm for myself" haha, thanks for being so supportive Michel!
So, @Tinsyl, with my son, we have to change basal rate and carb ratios every few weeks - it needs constant adjustment, because kids change a lot while adults change a bit less. You mom has gone through this difficult surgery and her body is trying to heal, so it will definitely be a difficult target to solve because it will change even faster. A pump has more adjustments than MDI and the ramp up is harder, so balancing her is probably easier with MDI first. Later you can check what to do with a pump.
What I do with my son is that the first thing I adjust is the basal rate. If he gets many lows that are not within 5 hours of a meal, I adjust the basal rate down until he gets few such lows. Then I adjust the carb ratio, and I deal with peaks if any.
So, for your mom, if she is high most of the time, then you need to keep on increasing the basal. When she starts getting low more than 5 hours after a meal, you went too high. That sets the basal (at least for that period - it will change later I am sure). If she high once or twice during the day, then possibly your basal is set (ideally, once the basal is set, she would not be high - but after Whipple who knows what her body is doing).
Once your basal is newly set, then, if you still have a peak around 7pm, you need to start treating the peak with bolus insulin. For that you need to know her correction factor - ie the # of mg/dl that she goes down (over 3-5 hours) for 1 unit of bolus insulin. If you don’t know you can test for it (I can explain to you how).
Treating a peak that is not a meal will probably need less bolus insulin than when you deal with a peak following a meal btw.
Do you want to talk on the phone and discuss the tuning MO? I have done that many times for my boy, not always very well - so we can discuss it if you want.
Possibly you have too much on your plate, what with your needing to learn how to deal with your mom’s new diabetes circumstances, your job, the insurance company, stress etc. There are often ombudsmen witjh insurance companies to be patients’ advocates, or administrative agencies that can help you. or, possibly, you could pay someone a few hundred dollars to do it for you?
I saw you are trying to get her on a pump and on CGM. There is quite learning curve with each, as well as some difficulties to surmount. Possibly, going one step after another may be easier? Imho, a CGM may be a better first step than a pump between the two. You might want to ask what people here think.
A CGM will help you diagnose better what is going on, which is a problem for your mom right now.
I don’t mean to say that you can’t manage without a CGM, of course - you can totally do that. The one point I am making is that, between a pump and a CGM, I would likely get a CGM first. But, with all the issues your mom is facing, adding more complexity to her management may not automatically be the best direction, of course.
It took me forever to finish mine:-) I was sailing sailboats to make a living, and I did not really want to stop. At one point, my wife had to put down an ultimatum and made it clear I had to start earning a living for real. Without her, I probably would still be a sailing bum… It is great to have such a flexible company to work for as yours is.
He is a devildog with a great heart. He will make a good sicentist, I think, curious and inquisitive. But mostly he is kind and compassionate - what I like best about him.
DO THAT!!
Again, I’d be happy to discuss MO options on the phone if you’d like.