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Sunday, March 9, 2014
Quality Health Care and You - Diabetes
Giant Cell Arteritous and Diabetes in 81 yr
My father has had mini strokes and now has giant cell arteritous. He was on diabetic medicines forimat and amirille or glimapride. They have put him on 60 mg of predisone a day 3 at 7a.m. and 3 at 12.00 a.m. two amirille a day half as soon as blood sugar rises above 81 and 1 at noon and half at super at 5 he get 15 units of the levemir flex pen. Morning can be below 20 and evening can be above 500 We have him at home and trying to keep him there. This is a guessing game and we have little or no help. He has mild alzhimers and my mother has beginning parkinsons.
Any sugestions on how to keep his blood sugar around 200 to 300? We are watching what he eats giving him snacks and regular meals and boost and hard boiled egg before bed. We have been doing this for a month now and nothing seems to help. The morning lows are really scary. Signed desperate and tired.
First and foremost, we need to fix his low blood sugars. Having wide swings in blood sugars for an elderly person at home is dangerous. You should seek the advice of an endocrinologist to better manage his medications. The Glimepiride should be discontinued, Levemir should be continued and mealtime insulin (Novolog, Humalog, Apidra) should be initiated. The goal for his blood sugars should be <140mg/dl. You may want to consider getting a visiting nurse or temporary 'rehab' placement for additional assistance in controlling his numbers now that he is on Prednisone.
It's also important to evaluate his kidney and liver functions to make sure he is tolerating the medications appropriately.
You should also seek the help of a diabetes educator/dietitian to address meal planning and carb counting. Having consistent amounts of carbohydrate at meals will help prevent the wide swings in blood sugars as well. What is nice about carb counting is that any food can be incorporated into a meal plan. For your father, you may want to aim for 45-60g per meal.
For breakfast he could have 1 slice of toast with peanut butter (15g), 1c milk (15g) and ½ banana (15g)
For lunch a sandwich with 2 slices of bread (30g), salad (0g), and a small cookie (15g)
For dinner a grilled chicken breast (0g), salad (0g), small dinner roll (15g), 2/3c rice (30g) and sugar free jello (0g)
Looking at the total carbohydrate line on a food product's nutrition label will tell you how many grams of carbohydrate are in one serving of the food (the serving size is listed on the top of the label). It is wise to measure out his foods to be sure the portion sizes are accurate. Again, a dietitian can help make a personalized meal plan for your father.
Connie A Gottfried, MPH, RD, LD, CDE
Case Western Reserve University