So my Dad's been diagnosed with Diabetes...

[LaydeeBug]

and I was wondering if anyone here knows anything about Type 2 diabetes (he is not overweight)

I checked the Health Forums for the r s t l n e er's and there wasn't a forum pertaining to it (I considered the weight management one, but he isn't, so I am asking here)

How often should I make him check his levels? He was Rx'ed insulin this time (He was diagnosed about 7 years ago, but it went away with nutrition (I started cooking for him) Now it's back (he stopped checking his sugar levels when the doctor told him it wasn't detectable anymore and gave him an "atta-boy&quot

Does anyone on DU struggle with Diabetes? Or, like me, have a family member who does?

[alfie]

1. You need to contact a professional

Managing diabetes with insulin is a lot more complicated than managing it with diet. Your doctor should have given you very specific instructions about checking his sugar levels etc. There should be someone in his office or at the nearest hospital that could help you. I am a retired nurse, am very hesitant to give any advice, but for sure I would say check his glucose level before you give him an injection of insulin to be sure his level hasn't dropped too low. But you really need to get with a diabetic educator.

[loli phabay]

11. yup he needs to get to the diabetes clinic and talk to the councillors

[Baitball Blogger]

2. My dad was just diagnosed.

He should connect with a specialist to get good nutrition information. Especially with the holiday season coming up he needs to study up on what he can't and can eat.

Carbohydrates, for example, turn into sugar and that can affect his sugar levels.

[ChazII]

3. I found this site useful when

my dad was diagnosed with diabetes. The second link has recipes for all categories of food and even adjusts for number of servings.

http://www.dlife.com/

http://www.dlife.com/diabetes/diabetic-recipes/

edited to add second link

[LaydeeBug]

5. Thank you for this. Thank you very much

He is pretending he can manage this just with nutrition, but I am not so sure.

[ChazII]

8. Like you, I became my dad's

caretaker and I knew nothing about nutrition and diabetes. That second link was very helpful as it gave the amount for the number of servings. If the recipe called to serve 6, it can be adjusted for a single serving or whatever number you need or want. I also appreciated that it covered snacks.

[LaydeeBug]

9. YES!!! Snacks. He loves grapes and they are high carb

I know how to do a low carb diet and to keep his carbs down, but insulin confuses me to no end.

And he won't remember anything they told him because he thinks he can get this gone with diet. He had already dismissed it in his head before he was out of their office, I am sure. I wasn't there. That won't happen again.

[enough]

4. I had an official diagnosis of Type 2 diabetes for a while (about 2 years).

A low carb diet and lots of exercise changed the numbers and changed the diagnosis. One thing I learned is that so-called "resistance" exercise has a particularly clear effect on blood sugar. First read that in the New York Times health section. I got into weight-lifting (in a structured class) and I still do it without fail, but only once a week because I really enjoy other types of exercise more. I lift lighter weights in other classes, but consider the basic weightlifting to be the foundation of it all.

I'm about to turn 70, female.

[LaydeeBug]

6. This post just might win the internet. I've been "at" him to exercise. He will like hearing

that he needs strength training, not so much cardio (he *hates* cardio with a passion)

[IDemo]

7. I'll have 50 years with Type 1 next Spring

If his doctor has not already referred him to a registered dietician, he might want to pursue it. They can offer some very valuable advice on dietary factors that can make a big difference in blood glucose control and overall health.

And test, test, test! As much as many folks hate the finger sticks and test their blood glucose levels only once or twice daily, keeping a sharp eye on changes that occur throughout the day (and night) will help greatly in adjusting carb intake and insulin dosages.

Taking the initiative to own the control of your diabetes will keep it from owning you. Best of luck to your dad!

[LaydeeBug]

10. How often should I make him test? 5x a day? 4?

He doesn't complain too much about the finger pricking, but he REALLY complains when I ask him what his level is.

How high is high?

[IDemo]

13. These are questions best answered by his doctor

I know what levels have become the 'comfort zone' for me, generally somewhat lower than most. And I test many times daily, often 8 times or more. If you get everything under good, stable control, you really shouldn't have to test that much, but it's become a habit with me. I will take just a unit or two of Humalog (rapid-acting insulin) if a meal has taken my BG levels over a certain amount.

There is a huge amount of information on the web from some good sources, but again, I'd make sure his doctor has dialed in his diet and dosages before relying on any adjustments based on internet info.

[LaydeeBug]

14. I agree, but all of this is very informative nonetheless. nt

[Yo_Mama]

15. What's most important is STABLE, but you do not want his blood sugars to exceed 170 or 180

at their peak. But unless you have checked his curves, you don't even know how to find the peak. Some diabetics will peak in an hour, and some in three hours after a meal.

Above 180 his organs are probably getting damaged. But good diabetic control really consists of flattening the peak to valleys on a normal day. This is very important, especially for older people who may have heart problems! When blood sugar rises and falls too much it can affect circulation.

A lot of older people who are diagnosed with diabetes mellitus have some degree of cardiovascular disease, and that should be a consideration. I truly think you need professional medical help in doing this. I cannot stress that enough.

Just until you get that:
You need to find his natural peaks and lows. This usually occur around three in the afternoon and 3 in the morning. You need to know if he can sense when his blood sugar is getting low, because not all people can.

So try testing three days in a row at 2:30, 3:00 & 3:30 to see what his average is. The doctor who prescribed the insulin should have told him how low he wanted the lows to be. This is important because in many older people the higher blood sugars are partly compensatory, and if that compensation is very important (such as for heart function), a low that would be fine for a younger person could be dangerous to an older person.

If he's having trouble sleeping in the early AM, or he wakes up with a jolt or his morning numbers are very high, you need to check around 3 AM to see if he's going low then. These are some of the symptoms of hypoglycemia.
http://www.diabeticcareservices.com/diabetes-education/hypoglycemia-and-hyperglycemia-and-the-elderly

The problem is that many older people don't get them in the same way or are not very aware of them. Also check for reduced peripheral circulation when he's at his lows. If the feet or the hands feel colder than normal, you've got a problem. Also look for abnormal dampness of the feet.

Then you need to find his peak. To do that, test before a lunch or dinner, and then start testing every half hour after the meal UNTIL HIS BLOOD SUGAR HAS RISEN, and THEN KEEP CHECKING UNTIL HIS BLOOD SUGAR HAS FALLEN FOR TWO SUCCESSIVE READINGS.

The reason you do that is because one of the signs of insulin overdose is that the blood sugar will "seesaw" when it should be rising, which means that the blood sugar is being pulled down so fast that the body then compensates by raising the blood sugar. That always indicates the need for medication readjustment.

Once you find the natural low and the natural peak after the meal, you should check with his doctor and ask if that low is too low. And if your father doesn't feel good at that low, it probably is too low. If there is too large a difference between the fasting and the peak after the meal, he needs a different regime. For older people I try to keep the fasting/post-prandial at no more than 40 points. So if his blood sugar before eating dinner was 110, the peak after should be around 150. 155 would be okay. 160 not so good. 170 definitely not. That needs a change in meal or a change in medication or a change in exercise or a change in non-diabetes medication.

Once you know all that, check in the morning fasting every morning. For most Type IIs, that is about the high for the day. If it's very high suspect that his sugar is going too low at around 3 AM, and check it.

The morning reading try to keep around 130-140, unless he has significant heart disease, in which case it may need to be higher. A doctor can help you decide.

Then check at least before lunch, at the expected peak after lunch, before dinner and at the expected peak after dinner. You may need to check before bed if his peak to valley change is pretty broad, because he may need a snack before bed.

If you find that his morning blood sugar isn't about the high of the day or close to it, and his average blood sugar tends to ratchet up throughout the day, it's not a good sign and he needs to go back to the doctor.

And if his doctor doesn't understand why you are asking these questions, your dad needs a new doctor. Best of luck and you are a great daughter.

[LaydeeBug]

17. OMG! Thank you for this. For each and every word.

His sugar levels tend to be a bit high (170-180 is our goal).

Whether or not he is upset greatly effects the level and asking him to check makes him upset. He's all 'old school' like that. He won't ask for help, and he will scream at you when you try. It's ok. There will be an adjustment while we figure this out.

You have been a great help. He is saying that they didn't tell him anything other than he should be aiming for a sugar level between 170 and 180. He has no idea whether or when to take insulin or how much and no one told him.

I respect everyone telling me to ask a pro, and I will, but the pros weren't much help this time around, and I hate to see him worried and confused.

[Yo_Mama]

12. If he's on varying doses of insulin he needs to test at least 4 times daily

but it really needs to come with the whole package - dietary, nutrition, education and exercise.

If people don't know what they are doing, especially with insulin resistance, they may see a high number and misinterpret it.

Your dad really needs to get instruction on how to manage this from someone knowledgeable. Also exercise programs can hugely change some Type II's numbers, so there is a lot you need to know.

If he's thin and he increases his muscle mass, even with pancreatic insufficiency his numbers may drop to near normal without insulin. The important part is the muscle/fat ratio.

I think you either need another doctor or an NP or a diabetes educator to get settled into this with some degree of confidence and safety, and you do not have that. Also, if you are the primary caretaker, you need that education too. And you have to have someone knowledgeable to call when something goes wrong. Illness and stress can change insulin dosage a LOT.

Diabetics can be very healthy indeed, but only if they know what they are doing and how to handle the whole package, and he may have other medical conditions that interact, so this is not something to take lightly and I think you need professional help.

[RebelOne]

16. All the women on my mother's side of the family

had Type II diabetes in their later years, including my mother and two sisters. One sister died of kidney cancer at the age of 57. My other sister is 66 and found out last year she had diabetes. I am 74 and suspect that I may have it, but have not yet been to a doctor.

[LaydeeBug]

18. Best to you, I hope you are well and don't develop it.

This is all very confusing.