I've been a diabetic for almost 30 years, on insulin for 1 year. This will be a bit long, so thanks for your patience!
My father has been here since April on an extended visit. His BG was spiking really high, into 300s and 400s. He is taking 50 units of Levemir per day. I called his GP ( he has never seen an endo)and asked them to start him on Humalog pre meals and they said start with 4 units and no more than 7.
I was able to get him an appointment with a nurse practitioner at my endo office. His A1C was 10 and his fasting that morning was 468. Yikes!! I've been trying to get him to change his eating habits while here and we had a bit of a blow up a little while ago because he told me he had taken his second Humalog shot for the day and had barely eaten anything yet today. I think he said a half cup of yogurt and some almond meal cookies I baked.
Help!!!! I cannot make him understand the importance of balanced meals no matter what I do. The big issue here is that the humalog so far has not taken his daytime numbers down and only since a few days ago has it started getting his fasting into the mid 100s. This morning is the first time it has not been over 200 after "breakfast", but he did take that extra shot with not enough food.
He will be going back home soon and I'm fearful he will start getting lows and not having any supervision. He spends a lot of time with no one else around him. He says he's never had lows before and I'm afraid he doesn't understand how dangerous it could be especially since he spends a lot of time napping. I feel like I have to go into his room and wake him up every so often to make sure he's not in a coma.
I just don't know what to do right now because if I tell him today not to eat something at a certain time, he takes it to mean all the time and vice versa.
I'm not type 2 so I don't really know much if anything about dosing for that but maybe he needs more basal if his fasting was that high? It sounds like an emergency with those high numbers. I thought many type 2 also took much higher doses for meals too, but I may be wrong about that. I think he needs to get to an endo asap. Hopefully someone else will have more info for you. Has he had hypos while on levemir alone?
Most people calculate the fast acting dose according to how many carbs they eat with fat/protein taken into consideration also and then the dose is figured out from the carb/insulin ratio. Has he tried to figure that out or did the cde give him advice on that?
He has only been on the fast acting for a little over a month and I recall having an adjustment period to get things straight. I always calculated my current BG and then added to whatever carbs I eat to figure out my fast acting dose.
My biggest issue is that I can't get him to understand how he's really supposed to eat. Too many years of too many people giving him the wrong information on how diabetics should eat and not realizing he has to do things different with insulin instead of oral meds. He's been on insulin for at least 4 years, so that's not new, just the fast acting.
Maybe try getting him some books on low carb eating as well as some links for the online info and talk with him about what you eat? A lot of pwd who are type 2 can really benefit from very low carb but that may not be feasible for him. I wonder if another appointment with a cde who can give him a set schedule of when/what to eat and how much insulin to take might help? I do pretty much what he does. I don't try to lower my bg most of the time to eat if it's higher, but not too high, because it ends up stacking insulin when I do eat and then I can drop very rapidly, I calculate my food and the correction for the bg all together and most of the time it works well for me.
I guess if the fast acting was helping lower his fasting bg then the food etc. is an issue and the fast acting is combining with basal to help keep him lower. I think that is really what happens with everyone in some form who is on both insulins. But I still wonder if higher basal might help too? I don't know, just my thoughts.
I would also try to get the cde to discuss lows. Unfortunately he may have to experience one that is scary to understand he needs to pay attention to this.
I gave him my "Think like a pancreas" book and another on insulin, but he seems to be lacking the concentration to get what it's talking about. He's also on some other medications so he's a little befuddled sometimes, LOL. I'm starting to think I need to make a gigantic chart with some food choices and do one of those "pick one from each column" type thing.
Yes, it is probably the high bg too, when my bg goes above 150 I really start to find it hard to concentrate on things and think logically most of the time, above 200 forget it. And other meds won't help. I think a chart sounds like a great idea for him :) I know how frustrating it must be, but eventually hopefully it will sink in.
You really don't say how old you dad is or anything about his living situation. From what you are saying I suspect he is getting up there in years and lives alone. Unfortunately he may need stronger and consistent guidance throughout the day. Is it possible to get him to hire someone to come in once a day for a couple of hours to organize his day? They could lay out medication and makes sure he takes it. The could get all his meals planned and ready and makes sure he has been doing things like checking his blood sugar and bolusing for meals and corrections.
Another possibility is to employ one of the nutrition services that will actually deliver meals to you, there are now low carb versions of these.
ps. And I sympathize with your comment about getting befuddled about rules, my aunt was told not to drink so much water because of her edema, so she stopped drinking any water ended up dehydrated and in the hospital.
I apologize if I'm taking this further than you want to go. I've dealt a lot with elderly parents over the last few years, also. What bsc is saying seems more important. It sounds like your dad isn't processing information very effectively. If he lives alone and is on other medications that sometimes leave him befuddled, it's not a safe situation, even without diabetes. Help that comes in every day has helped the situation for my own parents, tremendously. It wasn't easy to make the transition at the beginning. My parents had a lot of opposition to the idea, but it has made things much, much smoother and safer since then.
Brian, my dad is 74 and doesn't live by himself. My mom still works full time and mostly at night, so she is not home evenings and sleeps during the day. My oldest brother is temporarily living at home, but he is only there every other 7 days. I have another brother who is there in the evenings. My dad also occasionally stays at my aunt's house but she works during the day. That leaves him alone for a fair amount of time to feed himself and look after his medications. He takes pain meds and in the past has taken too many and so now he has to be given his meds in the morning and the rest put away so he has no access to them.
My mom cooks but does not cook a diabetic diet. My brother does cook but he has too much focus on high protein and no carbs which I think has contributed to his numbers being so off. My dad had been used to eating a lot of sandwiches that were basically bread and meat. At least now he understands to add lettuce and tomatoes or eat it with a salad of greens. He has had a serious lack of fiber in his diet.
Thanks Marty! Any suggestions are helpful. He was having a home health nurse come in, but I don't know the full details of that and I know it was limited.
Yesterday was just a very frustrating day because he just wouldn't listen to what I was saying and he was also very irritated with me. I know it's hard trying to unlearn all the things that take a life time to learn, but I want him to be healthier.
The biggest problem is that he has never seen an endo. One doc started him on insulin after he was hospitalized for high numbers and then another just kept up the prescription. The started him on insulin and never adjusted the dose or had him keep a log to find out what the dose should be. That was years ago!! I found him a doc for when he gets back home, but it will depend on others to get him there.
Being on this site for several years, I've learned that there are many different types of diets that people eat successfully. Have you asked your father what he wants to eat, and work from there? He may be more compliant if he feels his tastes are taken into account. And with the very high numbers you list, I suspect he needs a lot more insulin. He needs a good doctor to work through that. Before carb counting, we used an exchange system. For instance, you might get 1 protein serving, one fruit serving and 2 bread servings for lunch. That might possibly be easier for him than carb counting. Maybe a colorful chart might help him make better selections.
Good luck. Your dad is lucky to have you so concerned for him.
I am cooking everything and anything possible that he likes to eat. It's portion control we are having issues with or when he's eating at 6 in the morning before anyone else is up. I cook a healthy breakfast each day but when he eats a super large bowl of bran cereal, that starts his day going high right away. Yes he needs a good doc and hopefully he will see one when he gets home, but not sure if he will be able to follow what they say.
