# New here, need help for my mum



## jdv (Jan 27, 2018)

Hi everyone,

I hope you're in good health and well.

I need help and advice in how I can help my mum.

She's 80 and has had Type 2 since 1998 as well as chronic arthritis and the pain that comes with that. When she feels arthritis pain, that increases her blood glucose levels. She describes the pain at times like a hook in her leg and tissues and nerves being pulled and twisted. She takes 2 x paracetamol 500mg to manage pain. Codeine causes her other issues and also unable to take ibuprofen.

She was on 1mg Glimepiride three times a day and Metformin 500 three times day. She was also prescribed Metformin 850 and to take that instead of the 500 if the glucose readings were higher.

Mum also suffers from high blood pressure for which she is currently on 2.5mg Bisoprolol and 5mg Felodipine, taken once in the morning. She also has been diagnosed with heart failure (lower two compartments stiffer than they should be)

Mum's gone though a rough patch with being in Hospital twice since November 2017, once for the High blood pressure and breathing issues where she was in for 6 days. The hospital changed her BP medication (2.5mg Bisprolol in the morning instead of 1.25mg, and one 2.5mg Ramipril at night instead of her previous 1.25mg Ramipril three times a day). They also introduced two new medications to be taken in the morning with the Bisoprolol : 20mg Furosemide (diuretic to help with heart failure) and 2.5mg Indapamide (help with BP and also diuretic). They also informed mum of heart failure and that two compartments were stiffer.

On December 20 2017 mum went to hospital with sepsis (one hour late to emergency and the doctor said she would have died), treated with Gentamicin and Amoxiclav IV. While she was treated for sepsis, the doctors in the hospital stopped Furosemide, Indapamide and the Ramipril as mum's kidney function was impaired and also indications of low blood sodium levels (121/122). While still recovering in hospital, she caught flu there and was on Tamiflu for 5 days and then finally discharged on 8 Jan 2018 as mum had a strong desire to come home (sadly, a patient in the next room died the night before), the doctor on the day (Monday 8 Jan 2018) said there was nothing more they could do in terms of treatment and was concerned about mum catching something else from being in hospital as she already caught flu. He said any other issues mum's GP can help with. On the discharge notes, the hospital also asked for the GP to check sodium levels and kidney function in two weeks (from 8th Jan) which hasn't happened yet.

On 9th Jan 2018 mum still had a chesty cough and wasn't feeling well on 10 Jan 2018. I was concerned with what happened with sepsis and infections. I called mums GO to ask for a visit as I believed it was an emergency. A nurse visited instead in the afternoon and she was diagnosed with a secondary chest infection, she said "we have a short window to knock this out [alternate would be hospitalization]" and was given antibiotics for 7 days (Clarithomycin 10ml twice a day) and Prednisolone (30mg once a day) for 5 days to help easy airways and breathing. The Prednisolone after two days spiked mums glucose into the 24 mmol range on her blood test unit. I called 111 and an on call doctor came (who also said he was a diabetic specialist), he said it's due to Prednisolone and advised mum to just take Metformin 850 three times a day and also warned if it went "HI" then to call 111 or go to emergency.

The following day (Sunday 14 Jan 2018) mum's glucose read "HI" (over 27.9mmol for the Xceed unit) and it wasn't dropping and hours of tests. This was also the last day of taking Prednisolone. I called 111 and they advised me to take her to emergency at the hospital which I did at 01:30. At the hospital her glucose read 21.8 and 22 using Blood Gas Analysis. On mum's test unit it showed 27 mmol so that's the first time we realised that there was a fault variance (5 in this case) with that unit (Optium Xceed). We contacted Abbott, the manufacturer and they said they would send a free replacement unit but would take a few days (Optium Neo). We left the hospital at 05:30.

Last week (16 Jan 2018) the district nurse came to visit mum for a general check up. Mum was testing her glucose at the time on the old unit (Xceed) as the replacement had not arrived. Her fasting glucose at that time (due to having increased Metformin 850, Glimepiride and not eating enough the night before, the after effects of the Prednisolone incident) showed 3.9 mmol.

The district nurse saw this and said it's near normal, not to worry. I told her that the unit has a fault and not to 100% rely on this single value, what happened at hospital with the high glucose, mum not eating enough last night and I asked her if she could check with her unit. She said she didn't have one with her.

The district nurse did not test mum's blood glucose herself with her test unit, then she left and reported that 3.9 mmol value (taken in the Xceed faulty unit) to a diabetic specialist nurse who then called my mum the next day (17 Jan 2018) and said she is writing to mum's GP to recommend they stop Glimepiride as they're concerned about mum going into Hypo.

[Mum's history to date, she's never gone hypo (we keep a record of readings). That 3.9mmol value from one unit, and also mum not eating well the night before, taking Glimepiride and Metformin 850 three times due to the side effects of Prednisolone dropped mum's glucose on that day.]

I spoke to the diabetic nurse and mentioned that the 3.9 mmol is from a single reading from a unit that is faulty (old Xceed), I explained what mum has just gone through recently with the glucose going "HI", she said she wasn't aware of the Prednisolone and what had happened. She mentioned mum's kidney function wasn't good, I told her about what happened in November, the introduction of Furosemide and Indapamide and how the hospital doctors stopped them as they were causing kidney and low sodium levels and also about the Sepsis and the pain she gets in relation to her arthritis

The diabetic nurse has never met mum, or known her history of what's happened in relation to her high blood pressure, heart failure and diabetes and how all of those are in interplay.

Mum's GP called on Friday 19 January and informed mum that her HbA1c levels have been relatively OK over the last few months. Mum told her it's because she's been managing her diabetes, measuring and taking Glimepiride and 500 or 850 Metformin depending on her glucose levels. Mum mentioned about her arthritis pain increasing her glucose and that being the reason for 850 or 500 Metformin in addition with Glimepiride. The GP still proceeded and stopped mum's test strips and Glimepiride - all without any test period to assess how this will impact mum.

The GP and diabetic nurse say a district nurse will come this (w/c 29 Jan) coming week (or next - w/c 5th Feb) to take blood for the HBA1c and then again in three months - and then decide if any changes need to be made.

Mum's other conditions all have a interplay with her glucose and vice versa. Mum has stopped Glimepiride from the afternoon of Thursday 25 Jan 2018. She is now only taking Metformin 500 three times a day. Her blood pressure has gone up as a result and her glucose levels seem high. She's feeling tired, blurred vision, dizzy, has felt minor suffocation at times.These are results I've gathered through my own monitoring:

27/01/18   09:26   BP: 163/93   Glucose: 10.2 mmol***
*** Fasting glucose is high. High BP, concerns with the heart failure condition and overall health

26/01/18   23:46   BP: 158/88   Glucose: 12.6 mmol**
** This was 3 hours after eating and taking Metformin 500

26/01/18   19:24   BP: 142/78   Glucose: 9.5 mmol
26/01/18   08:08   BP: 147/82   Glucose: 7.8 mmol
25/01/18   19:40   BP: 153/90   Glucose: 9.3 mmol

25/01/18   13:05   BP: 121/73   Glucose: 7.7 mmol*
*Glimepiride 1mg and Metformin 500 was taken in the morning with food at 07:25 - the last time Glimepiride was taken.

Glimepiride seemed to be having an affect on her lower her glucose and also a lowering effect on her blood pressure.

My concern is how her glucose is higher and the effect on her blood pressure and all of that affecting her heart failure condition and overall health. When she was in Hospital in November and the cardiologist performed tests, that was with Glimepiride being taken and the effect that also had. Now that's been removed and I can see an increase in her BP and also her glucose levels 9+mmol, it causes me to question mums treatment and recent immediate change by her GP.

Waiting for three months to check HbA1c, in that time if mum continues to have high levels of glucose and high BP then that will affect her overall health, cause longer term damage to organs and cause other conditions. Mum's glucose test strips have also been stopped with this change the GP and diabetic nurse have made so mum hasn't a mid term (3 month) way to track changes in her glucose.

She's in a delicate state with what she has been through of late and a change like this without the tools, resource and support to self monitor her blood glucose from her GP seems dangerous.

Thanks for any help and advice,
Jay


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## trophywench (Jan 27, 2018)

I agree entirely with the desire to test her BG - because she has so many other concurrent health issues it strikes me as a particularly cruel thing of the GP to have done to such an elderly lady who has been using the meter as sensibly as she always has to the extent that the thing is now part of her personal 'support and security network'.  I am actually very surprised he doesn't understand this, in this day and age.  Yes - all the CCGs have cracked down on test strip prescribing in an effort to save money and ALL GP surgeries have had to consider this for all their diabetic patients BUT there have always been exceptions to the rule where there's good reason for the patient to use them - so you do need to try and get the decision changed.

You would find it useful I think to ring Diabetes UK's Helpline because they are very helpful with these sorts of problems.

I haven't any personal experience of mum's other issues, but one thing I noted was the diuretic and the low sodium.  I always have sodium at the lower end of normal (and it's a very narrow  normal range for serum sodium so needs watching like a hawk) so I'm appalled the GP hasn't taken steps to retest it despite being told by the hospital to do so.  If sodium is low or on the low side - then a diuretic is absolutely contra-indicated.  Hence when I was tried on Felodipine to control BP and my ankles both swelled to double size inside a week I took myself off them and got an emergency GP appointment to try something else instead.

It's a very fine balance between different drugs for different things, and now especially for more elderly folk they try to only prescribe those particular drugs that actually really DO something helpful for the urgent things rather than just adding another and another to the pot ad infinitum - so that's kind of what has been happening - but it also sounds to me like the Glimipride was stopped far too soon - if mum had been 3.9 after every meal all day - well yes! - but not one 'rogue' test on an 'iffy' meter.

What a nightmare for you - and thank goodness your mum has someone prepared to fight her battles for her if she can't any more.

Ring that number on Monday - tel: 0345 123 2399


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## Northerner (Jan 27, 2018)

Hi Jay,

Welcome to the forum  Very sorry to hear about all your Mum has been through, it must be a very worrying period for you all  I'm not qualified to give medical advice, but I would question her GP's knowledge of the treatments she has been given. As far as I know metformin is not a medication that has an 'instant' effect on the system, it is something that 'builds up' or takes time to 'establish' in the body before becoming effective. As such, varying the dose on a day-by-day basis depending on fingerprick blood glucose readings doesn't really make sense. The glimepiride, on the other hand, does have a much shorter-term effect. I also think that the withdrawal of the test strips is wrong. This may save a little money, but not if your Mum has blood sugar 'spikes' that you don't have the facility to test for. I suspect it may also make you and your Mum anxious about not knowing what may be happening 

I'd agree with Jenny - contact the Diabetes UK helpline, they are better placed to give you guidance on any possible actions you might take to improve you Mum's situation. Details here:

https://www.diabetes.org.uk/How_we_help/Helpline


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## HOBIE (Jan 28, 2018)

Welcome JDY


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## pav (Jan 28, 2018)

Welcome JDY, Your mum has been through a lot and you are there to support her.

I agree with with Jenny and Alan above it's worth contacting the diabetes helpline to see what advice they can offer.

Going o my own experiences, varying the amount metormin depending on what her levels are does not work as it's a more long term medication that helps with the levels and takes a while to build up it's help. When I have forgotten to take it, there is no noticeable difference in my readings.

I have also found like yourself the professionals don't appear to believe a low reading can be a result of a faulty test strip or meter. I had one test that showed 1.6 followed the correct reading a few seconds later, which they noted the 1.6 reading on the system and not the correct reading.

I always have a spare meter, which i found most meter suppliers will send you for free as a precaution if you have a faulty one or like me keep one at home and take one out with me, might depend on what meds you are on as things keep changing, or from your GP depending on what meter they support. I have had two meters supplied by both the GP and the meter suppliers over the years.


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## jdv (Jan 29, 2018)

Thank you Jenny, Alan, Hobie, Pav for the amazing support and advice. It's so great to know there is a supportive community.

Just to update, I've been monitoring mums levels over the weekend and her blood pressure has gone up (highest being 163/94 - not good when she has heart failure condition) and also glucose seems high levels (highest being 13.3 with a KET(ones) flash warning on the meter, haven't checked keytones as have no keytone strips) that was last night, 3hr 40m after food and taking Metformin. 

I'm going to call the Diabates Helpline for advice on the best way to proceed.

Thank you all dearly  <3
Jay


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