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Has anybody tried swapping dinner and breakfast/lunch to reduce the fasting numbers?
I'm trying to reduce the morning fasting numbers which are stubbornly in the 180-220 mg/dL. She is a 90-year old diabetic whose fed a large dinner and a smaller breakfast/lunch at mid-day. She has a swallowing disorder which makes the larger meal about 2-3 hours long. I'm giving her about 1-2 hours to clear her mouth of food and move her last food intake away from bedtime. I'm also trying to shift her sleep/wake cycle so she goes to bed by 9 pm.
I have my doubts that the doctor's order to increase her Metformin to 3 tablets will work without all three of the lifestyle changes since the increase from 1 to 2 has had no effect over the last two weeks.
Last edited by lchoro; 12-29-2018 at 08:49 AM..
Reason: added length of time to last sentence
I would give the increased metformin dose a chance to work before doing all that to her. Does she take insulin? How many carbs does she eat in a day?
Personally, what I eat has very little effect on my fasting sugar the next day. The metformin itself keeps my fasting sugar down.
We went to 1 under doctor's instructions because she lost weight.
I changed her diet several times and she has gained some of the weight back. I'm targeting 1200-1500 calories per day.
As a result, I recently reinstated her base dosage of 2 Metformin tablets. I haven't noticed a change from 1 tablet over 3 weeks.
She is consuming two or three Carnation Breakfasts with whole milk daily. That alone will provide up to 120 carbs.
A lot of the foods that puree well contain rice, noodles, or bread stuffing.
Some of the changes have desired benefits that overlap with the need to prevent aspiration pneumonia. I have some suspicion that some small amount of food is still ingested overnight and keeps the blood sugar elevated.
She will oversleep which throws off the schedule. Then we have two meals that aren't far apart. You either have one big meal followed by a small one before the end of the day, or the regular situation.
I read some things that the change can drop fasting numbers by 20 percent which would put her in the desired level.
We went to 1 under doctor's instructions because she lost weight.
I changed her diet several times and she has gained some of the weight back. I'm targeting 1200-1500 calories per day.
As a result, I recently reinstated her base dosage of 2 Metformin tablets. I haven't noticed a change from 1 tablet over 3 weeks.
She is consuming two or three Carnation Breakfasts with whole milk daily. That alone will provide up to 120 carbs.
A lot of the foods that puree well contain rice, noodles, or bread stuffing.
Some of the changes have desired benefits that overlap with the need to prevent aspiration pneumonia. I have some suspicion that some small amount of food is still ingested overnight and keeps the blood sugar elevated.
She will oversleep which throws off the schedule. Then we have two meals that aren't far apart. You either have one big meal followed by a small one before the end of the day, or the regular situation.
I read some things that the change can drop fasting numbers by 20 percent which would put her in the desired level.
I assume she is not using insulin but just the metformin? If someone is not producing enough insulin, the metformin may not bring it down enough on it's own. You may need a 2nd medication, the doctor should know this. You should also not be feeding refined carbs such as rice, noodles and bread to diabetics especially when you don't have good control which is what it sounds like. White flower products and rice will spike worse than sugar itself, just so you know. The milk is also full of sugar. Try testing her blood sugar two hours after a meal to see what the number is like. You should be at 140 or below, ideally closer to 100, if it's not you don't have proper control. If this is the case you should mention it to the doctor so he can adjust the treatment. You need to pay closer attention to carbs. As far as fasting numbers, if you don't have proper control, the number will never go down.
She is consuming two or three Carnation Breakfasts with whole milk daily. That alone will provide up to 120 carbs.
A lot of the foods that puree well contain rice, noodles, or bread stuffing.
.
She is being given a lot of carbs every day with those foods. Maybe try to cut her carbs down to help her out.
I'm wondering, if at age 90, I would be concerned with my blood sugar readings. It's a slow disease, and at that age there isn't a lot of time left. I'd rather enjoy my last days on earth than spend it fretting over carbs. But I don't know her, and you do.
I assume she is not using insulin but just the metformin? If someone is not producing enough insulin, the metformin may not bring it down enough on it's own. You may need a 2nd medication, the doctor should know this. You should also not be feeding refined carbs such as rice, noodles and bread to diabetics especially when you don't have good control which is what it sounds like. White flower products and rice will spike worse than sugar itself, just so you know. The milk is also full of sugar. Try testing her blood sugar two hours after a meal to see what the number is like. You should be at 140 or below, ideally closer to 100, if it's not you don't have proper control. If this is the case you should mention it to the doctor so he can adjust the treatment. You need to pay closer attention to carbs. As far as fasting numbers, if you don't have proper control, the number will never go down.
The carb figures for the puree meals range between 30 and 50g. I may limit the supplement drinks to two since each of them have 40g carbs. When I provide fish twice a week, it is negligible. She has been historically around 140-160 for fasting numbers with 6.3 A1c.
One thing that I forgot was that I hadn't been sanitizing the test site during these three weeks. She is also incontinent.
The doctor will go by whatever the protocol dictates. It is up to me to figure out what to do and get the numbers aligned with the treatment. This medical system really is severely lacking in the educational component. It is just an assembly line format.
Quote:
Originally Posted by oldgardener
She is being given a lot of carbs every day with those foods. Maybe try to cut her carbs down to help her out.
I'm wondering, if at age 90, I would be concerned with my blood sugar readings. It's a slow disease, and at that age there isn't a lot of time left. I'd rather enjoy my last days on earth than spend it fretting over carbs. But I don't know her, and you do.
I'm not sure that the additional Metformin will work, and I would like to make it possible to keep any side-effects to a minimum. The earlier wake times are beneficial to being available for family visits.
I assume she is not using insulin but just the metformin? If someone is not producing enough insulin, the metformin may not bring it down enough on it's own. You may need a 2nd medication, the doctor should know this. You should also not be feeding refined carbs such as rice, noodles and bread to diabetics especially when you don't have good control which is what it sounds like. White flower products and rice will spike worse than sugar itself, just so you know. The milk is also full of sugar. Try testing her blood sugar two hours after a meal to see what the number is like. You should be at 140 or below, ideally closer to 100, if it's not you don't have proper control. If this is the case you should mention it to the doctor so he can adjust the treatment. You need to pay closer attention to carbs. As far as fasting numbers, if you don't have proper control, the number will never go down.
The guidelines differ by age. Here is the most recent guideline for A1c.
She is being given a lot of carbs every day with those foods. Maybe try to cut her carbs down to help her out.
I'm wondering, if at age 90, I would be concerned with my blood sugar readings. It's a slow disease, and at that age there isn't a lot of time left. I'd rather enjoy my last days on earth than spend it fretting over carbs. But I don't know her, and you do.
That's not fair, OG-- you're using your brains and that puts that doc at a disadvantage. He only has his cookbook.
Three problems with having DM (1) accelerated hardening of the arteries-- a long term consideration. At age 90, this pt doesn't have a long term to consider.
(B) Dehydration. As long as the pt can be given adequate fluids, this is easy to prevent...and [3] ketoacidosis-- not a problem in Type II.
At age 90, it's a good bet this pt has decreased renal function (elevated creat & BUN, a relative contraindication for metformin) and metformin must be used with caution. Keeping her BS< 200 is good enough and getting aggressive to get it that low probably isn't warranted. Sometimes you just gotta give into MotherNature. Primum non nocere.
The carb figures for the puree meals range between 30 and 50g. I may limit the supplement drinks to two since each of them have 40g carbs. When I provide fish twice a week, it is negligible. She has been historically around 140-160 for fasting numbers with 6.3 A1c.
What is the objective here? If it's to keep her numbers as close as possible to normal, those carb numbers are way out of bounds. Those numbers would be fine if she was using insulin but metformin alone will not do it. If I understand correctly, you are the caretaker? If it's to keep her A1C normal, the 6.3 is not super high but not normal either, it is a bit elevated.
Quote:
Originally Posted by lchoro
The guidelines differ by age. Here is the most recent guideline for A1c.
The link was broken, apparently, it requires a login?
As far as A1C, the consensus is to keep it under 6. The pt is 90 so longevity may not too much of a concern, she may be fine as is. The fasting number, it is not as important as you think. The A1C is more important, it is an average over 90 days. A 6.3 A1C converts to 134 which is somewhat consistent with the fasting numbers. Many diabetics wake up with a high fasting number, it's nothing to be overly worried about. It's just one point in time, the overall numbers are more important.
What is the objective here? If it's to keep her numbers as close as possible to normal, those carb numbers are way out of bounds. Those numbers would be fine if she was using insulin but metformin alone will not do it. If I understand correctly, you are the caretaker? If it's to keep her A1C normal, the 6.3 is not super high but not normal either, it is a bit elevated.
As far as A1C, the consensus is to keep it under 6. The pt is 90 so longevity may not too much of a concern, she may be fine as is. The fasting number, it is not as important as you think. The A1C is more important, it is an average over 90 days. A 6.3 A1C converts to 134 which is somewhat consistent with the fasting numbers. Many diabetics wake up with a high fasting number, it's nothing to be overly worried about. It's just one point in time, the overall numbers are more important.
I believe the link had new guidelines of A1c of 7 for very elderly patients and 8 for those in frail condition. The ceiling of 200 for the fasting glucose set by the doctor falls under the second category.
The two nutritional supplement drinks keep her base caloric intake to about 700. The target I've set for daily calories is around 1450 at her weight. If she eats 75 percent of the food, the target has been reached. So the carb intake is going to be the 2 drinks plus 75 percent of the carbs for the solid food. I expect that it's around 150g total since the fish is served about 25 percent of the time.
I am getting the numbers below 200 so far, but not by much.
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