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Posted 10/14/2015 3:32 PM (GMT 0)
Hello! Once again I am seeking advice for my 83 year old Mother. She recently was diagnosed with 2 blood clots and while she was hospitalized and then in PT for 21 days she was put on insulin. For some history, she was diagnosed in 1997 with diabetes and was on medication until 2011 when she developed ulcerative colitis. Her dr. took her off diabetic medication since her A1C had been so very good for a very long time. Only with this last illness was it discovered her blood sugar had skyrocketed. She has been on lantus since her hospitalization in August. Her insurance won't pay for lantus so she will now begin Januvia and Levimir Flextouch. I just learned lantus should not be used past 28 days -Yikes! I did not know that except for googling! Hope I have not done her harm in continuing to use it. Is Januvia fast acting or slow acting like lantus? I will be at work, she will be home alone and I am concerned beginning the new medication without my being able to monitor her. She has slight dementia and, to be honest, I don't think she will be able to recognize it if she were to experience low blood sugar! I can wait until Saturday and Sunday to give the new medication to her so I can monitor her closely but that means she will miss a few doses. I'm sure you experienced people will have some questions for me so that you can help me out. Tell me what they are and I will respond. I really appreciate your help.

Post Edited (RollTideFan) : 10/14/2015 4:02:05 PM (GMT-6)

Posted 10/14/2015 3:47 PM (GMT 0)
Hello again. Gosh, I'm sorry about your mom's setback. I cannot answer the question about lantus and Januvia because I've never been on them, so I would have to direct your questions back to the doctor. However - we have a couple of members here on insulin and I hope they will post suggestions/answers to your questions.

An endocrinologist would be a specialist in diabetes and meds taken for this in case that is an option for your mom. If you can help with her eating plan, that would be an excellent way for your to help her lower her blood sugar to keep it near normal. Eliminating heavy carbs in the diet will do this: cut way back on bread, potatoes, anything made with flour and, of course, sugar.

I wish I could help you more!
Posted 10/14/2015 4:52 PM (GMT 0)
Lanie, thank you! I have been making sure her diet has limited carbs and sugar. Her numbers have been steadily coming down from where they were so she is making progress, just not where we want to be yet!
Posted 10/14/2015 7:55 PM (GMT 0)
Hi RollTideFan:

That is sad what your Mom has been going through. If she has some Dementia, she is probably frustrated and confused. I am experiencing this with my Mom although she does not have Diabetes. I so wish as People age, that they would improve in health not the opposite. What a dream! That is wonderful that you are able to look after your Mom. I know inside that she appreciates it, at least half of the time.

You did nothing wrong by using the Lantus after 28 days. I am a Type 1 and I was on Lantus for a few years along with many other Type 1's and Type 2's. The manufacturer put 28 days limit on it since that is as long as their study was. Understandably, they do not want to be sued for putting Diabetics in any possible harms way. We have proven over and over that it still works well up to 35 days and with some people a little longer. It does lose it's potency. It is good that you check your Mom's blood glucose to make sure her numbers are in the preferred range or as close as possible. It takes time and sometimes her BG will go out of whack for many reasons or it's sometimes a mystery. Do not expect perfection all of the time or you will defeat your efforts. Just carry on and consult her Endo when you feel that you need to.

I think you would be right to try the Levemir on Saturday and Sunday. She is more at risk to have a hypoglycemic event in the beginning weeks since she will be taking Januvia while taking another medication(Levemir) that also lowers blood sugar. Januvia is for Type 2's only and usually goes along with diet and exercise. Her Endo probably lowered her Levemir dosage for this reason. It is trial and error for a while.

Just know that you are doing a difficult but above average "job" in caring for your Mom AND working away from home. Hopefully you have someone to help you with her care. Make sure that you do something for yourself at least weekly for your enjoyment and to destress, so you will continue to be in good condition for you and her.
Posted 10/14/2015 10:01 PM (GMT 0)
Thank you for your kind words and advice, msOuchie! I believe waiting until the weekend so I can monitor her more closely will be the right thing to do. She came home on Labor Day weekend so this lantus is well past 35 days! Insulin is new to me so I'm learning as I go. Just realized we don't have needles for the flex touch! Dr. Only prescribed the pen and not the needles! They called in the needle prescription today and pharmacy will have them in by tomorrow!
Posted 10/15/2015 12:22 AM (GMT 0)
I'm so glad msOuchie responded! Maybe Will can pop in, too, with some advice.

RollTide, you're doing great taking care of your mom! Bless your heart! I hope you can find the answers to all your questions here. (Of course, your primary source for information should be her doctor or the pharmacist, but we have knowledgeable members here who can also help.)
Posted 10/15/2015 6:50 AM (GMT 0)
YW! I'm happy to be of some help to you RollTideFan. Diabetes is a continuing learning experience. I'll have had Type 1 for 54 years in December and I'm still learning new things about it. That's probably because some of the treatments and ways of management change every so often. There is also more to learn for Diabetics who use insulin and their caregivers.

Whew! I'm glad that you noticed that there were no needles and that you will be able to pick up the needles for the Flextouch today. Did you have 2 insulin cartridges or did he have to prescribe your Mom another one also?

How high was your Mom's BG that her Dr. decided to put her on Insulin? He must be a pretty good Dr. since some Drs. refuse to put Type 2's on Insulin. Those Drs., People with Diabetes(PWD) should run away from, FAST.
Posted 10/17/2015 1:13 AM (GMT 0)
msOuchie, Mom's BS has been running between 150-188 most days. It started out at 305 when she was admitted to the hospital. I did not know they put her on insulin until she got to the rehab facility! They were only giving her 10 units of lantus once a day and in the evenings it was usually in the upper 200's. They never did increase the units while she was there.

Once she got home and her stress level dropped and I put her on a good diet her numbers have been steadily dropping. A couple of times she forgot and ate a banana shortly before I tested her and it was 271 and another time company brought her some chocolate chip cookies and it was 226. That's the only two times since labor day weekend it was that high

Recently before breakfast it was as low as 106 and 133. This afternoon it was 133 so I decided not to give her this new insulin tonight. I just picked up the needles today because the pharmacy had to order them. I'll give her the Januvia in the morning for the first time followed by her breakfast. Hoping it won't make it go low quickly. She loves her cherrios and yogurt for breakfast so those carbs should keep it from dropping. I'll be monitoring her throughout the day.

She had a follow up with one of the doctors attending to her during her ICU stay yesterday. They are repeating a blood test that was "slightly elevated" for a tumor on her pancreas back in August. I am praying it is back to normal. These doctors seem to think the blood clots had to be due to a tumor. She has ulcerative colitis and one of the doctors said even that could have elevated this test. I am pretty worried about that and praying that this test is normal. She has enough issues including severe osteoarthritis of the knees. Sure don't want another major illness on top of all this she is currently going through. I have to say she is tough as nails! Nothing gets her down or discouraged and she rarely complains of any pain! She has certainly been blessed thus far and I hope she has many years of good health to come.
Posted 10/17/2015 7:41 AM (GMT 0)
Hello:

Good that her numbers are coming down steadily. Soon she will be in the preferred range. Everyone knows that it can be difficult /impossible to stay in that range all the time. I see why he started her on Insulin. Numbers over 140 are considered high. Some feel that up to 160 is okay. I am in that group of People. It is common for many Diabetics to go higher but hopefully they come back down shortly after. Low BG numbers are 75 and less. Did your Mom’s Endo mention what her A1c(blood glucose average for a 3 month period) was when he got her test results back?

Gee, I understand how you would be worried about the tumor on her pancreas and you are right, she has enough going on, as is. She is in my prayers and thoughts and the best results to her.

Diabetes is cruel! As you probably know, sugary cereals like Cheerios is not a good food choice for someone with Diabetes. They raise the blood sugar high. Some Diabetics do eat them and other sugary foods but they use an appropriate amount of fast acting Insulin(Humalog, Novolog or Apidra) about 15 minutes before they eat their food. Check to see what your Mom’s number is 1 – 2 hours after eating Cheerios. Januvia works on high blood glucose and works less on low blood glucose numbers. Hopefully, Januvia and Lantus will work good together for your Mom.

Sometimes I get hooked on one meal and don’t change for a while. Like 3 tablespoons cottage cheese, bacon, a slice of toast and a low carb fruit yogurt(5 - 7gm). Plus coffee. Lanie is wonderful to share good meal choices. Here are some low carb snacks for your Mom to eat when she gets hungry in between.

•
• Celery with tuna salad inside
• Celery with cream cheese inside
• Hard boiled eggs
• Deviled eggs
• Dill pickles and cheddar cheese
• 1/4 cup berries with 1/3 cup cottage cheese
• A handful of nuts
• Sunflower and pumpkin seeds
• Cheese sticks
• Sugar-free Jello, alone or with cottage cheese.
• Cheese with a few apple slices
• Plain or low carb yogurt with berries.
• Salmon and cream cheese on cucumber slices
• Romaine lettuce leaves rolled up with luncheon meat or tuna, etc inside.
• Raw veggies with low carb dip
• Pork rinds
• Ricotta cheese with blueberries and/ or strawberries
• Canned mushrooms, cheese cubes

*Please let us know how the use of the Januvia works with your Mom. Good Luck to you both!!
Posted 10/17/2015 11:57 AM (GMT 0)
MsOuchie, what great ideas! With your permission, I think that list should be part of our stickies at the top of our forum!

A questions about pork rinds: I've never eaten them although I'm living in an area where they are very popular. Is this skin? What about cholesterol? I have to admit I have never been tempted to try them. What are they like?

Thank you so much for your informative posts for RollTideFan!
Posted 10/17/2015 4:20 PM (GMT 0)
Roll Tide Fan, you may want to ask her doctor about any in-home services available to her, also. In many states there is a state department of aging that can provide periodic nursing visits, or more frequent visits when someone starts on a new medication. Sometimes we older folks are more amenable to a professional monitoring us than our children.
Posted 10/17/2015 9:34 PM (GMT 0)
Thank you but you didn't have to ask my permission for that Lanie. I researched and found most of them on the net, so they don't belong to me. There are thousands more, I'm sure. Others could add more too.

Yes, pork rinds are the fatty skin which shrinks and becomes more airy and puffy. I looked up about the cholesterol and (lol!) got three different answers. We will presume that they may raise a person's cholesterol if they eat them too often or too much each time. Moderation! I only eat a handful once a month. We all like them. They are crunchy and taste good to us. Ours have a shiny smooth surface unlike photos that I've seen on the net.
Posted 10/17/2015 9:43 PM (GMT 0)
That's an excellent idea Judy2! If RollTideFan's Mom doesn't have the help and care while her Daughter is at work, then she certainly is due for it especially with the Dementia. My Mom has a habit of turning on the stove coils to the max, puts a pan with something in it on the coils and goes away to do something else and forgets about the pots. Scary!
Posted 10/20/2015 11:01 PM (GMT 0)
Hi Ladies! Sorry I have not responded recently, been very busy with work and out of town commitments.

Just got a call this afternoon saying Moms ca9-19 levels are still elevated. I don't know what the number is but the nurse that called and the doctor the other day both mentioned seeing an oncologist after the ct scan. I am petrified. Mom does not know how serious this could be. I am praying for good ct scan results. A nurse will call me soon (?) whenever that it is and set up the ct appointment. I hope we are not dealing with cancer. Mom has ulcerative colitis and, although it is in remission, one dr. at the hospital said that could run up the numbers on this test. Or, it could be pancreatic cancer! I would appreciate your prayers on her behalf.

Mom has qualified for some services through the Medicaid Disability Waiver program. She has home health coming once a week to check her vitals since she came home from the rehab facility. She also has a helper come twice a week prior to this recent illness to help her bathe, fix food, and wash clothes but they have now approved for this worker to come 5 days a week. That is so much help to me, not just because she feeds her, washes her clothes, cleans and provides daily companionship but I know she is there a few hours a day checking on her and that really relieves my stress level. Mom is very independent and while she has slight dementia and troubles with short-term memory, she has never done anything that could cause harm to herself. She is also in NO pain except for her knees. The home health nurse has recorded 0 pain level on her for the past 6 weeks. She has no stomach pain either so it is had for me to believe she has cancer. I am praying for healing in Jesus name! Thanks for letting me vent. This has been a very rough afternoon!
Posted 10/20/2015 11:22 PM (GMT 0)
I am so glad your mom has all these services. I'm sure you have been worried and concerned about her, trying to make sure her needs are taken care of and is comfortable. And you need to take care of yourself as well!

Sending prayers for your mom!
Posted 10/30/2015 1:29 PM (GMT 0)
Hi everyone! It's been such a busy time lately I have not had time to update. Mom's CT scan showed NO CANCER. She has a fatty liver, probably due to diabetes, surely not from her diet and she rarely eats meat! CT also showed diverticulosis but other than that, she is in the clear for pancreatic cancer, We are so thankful and blessed.

We are still having issues getting her BS numbers where we want. It's been running around 160 after fasting overnight to 180 in the evening. We had an appointment with her Dr. yesterday and he said double her Januvia and then add a unit or 2 in the evening of the Levemir if it's still high. We will go back again in a month so he can see the record of her numbers I am keeping. I told him about her cherrios breakfast, no added sugar, the heart healthy kind and he said if that is what she want, they let her have it. Her helper cooks for her mon-fri and feeds her nothing but vegetables. Even though I know carbs are an issue, I am buying sugar free cookies, cakes so she can have some things she likes! After all, she is 83 and sometimes I think she should just splurge!

Anyway, I am so thankful her CT scan was good, you can't imagine what was running through my mind waiting on results. She is feeling good and we will still take our annual Thanksgiving trip to the Smoky Mountains next month. God is good. I hope you are all doing well!
Posted 10/30/2015 3:47 PM (GMT 0)
Hi again! I'm so glad your mom's scans came back negative for cancer. I'm sure that's a relief. If she likes her Cherrios for breakfast, then let her have them. I'm with your doctor on this because of her age. And for the other meals, I would not eat potatoes but the other vegetables would be great. I hope she's eating some kind of meat or chicken or fish?

And do keep a record of her food and blood sugar. I'm not a big fan of sugar-free cookies and cake because it's also the flour that raises blood sugar but if she can really eat them in moderation, then fine. Keep in mind that those, as well as potatoes, and bread (or anything made with flour) will keep blood sugar high so don't be surprised at high readings.

I hope she can continue feeling well. I love the Smoky Mountains! We're at the other end of the state of Tennessee unfortunately but that whole area around Knoxville and Chattanooga is beautiful in the fall!
Posted 4/4/2016 9:08 PM (GMT 0)
Hi again! I'm back seeking more good advice! My mom's blood sugar is creeping back up. We just had an appointment in mid-March. Her A1C number is now down to 8 (started at over 10 back in September!). Her doctor just had heart surgery and he has a CRNP working in the mornings while he is out. She changed mom from 100mg of Januvia to 100/110 Janumet. Since she switched to the new meds on March 16th I haven't liked mom's BS numbers. She is also on Levemir flex pen. Saturday her readings were 173 morning and 213 evening. Both readings taken before eating. Sunday morning it was 191. I was scared to check it last night but and it was 192! I switched her back to Januvia yesterday. This morning her BS was 175. I just checked it when I got off work and it was 309. I can't get anyone at the doctor's office to answer. She also had complete blood work done, she is not complaining of any aches or pains. I have no clue what is making it rise like this. I gave her 28 units of levemir and won't let her eat until a couple hours and I will check it again. I guess I worry about another blood clot but she is not exhibiting any signs that I can tell. Should I wait a couple days or go on to the local med center? Any advice will be greatly appreciated! TIA
Posted 4/4/2016 10:46 PM (GMT 0)
You're right. Her numbers are too high. I cannot tell you what to do about the diabetes medication. I just know her blood sugar needs to be lower. The only thing under a patient's total control is what food is eaten - and we've gone over that so I trust that she's not eating a lot of bread, cereal, cookies, cake, pasta.

As for the medication, maybe it's time to get another doctor. However, if she is on other medication like steroids or diuretics, those can raise blood sugar. If it were up to me, I'd look for another doctor because no one should be happy with those blood sugar results.

I wish I could help more!
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