[panda692]

Hi,
New to this forum and would be interested to hear from anyone else who has similar issues. Here is our story.

My husband for whom I am the carer was diagnosed with type 11 Diabetes in April 2005 aged 60. He maintained good control of his sugar levels with diet.

He was diagnosed with Parkinson's Disease in June 2006 and after some months of adjusting to medication his motor symptoms settled well although he has non motor problems with insomnia ,daytime sleepiness and balance difficulties.

In January 2007, following his 6 month review he was given Metformin by the Diabetes nurse 500mg x2 daily. He began to feel very ill so we contacted the surgery and were told to cut down to one. Eventually following further review with D Nurse he got back on to full dose. In April, another D nurse prescribed aspirin and he was so ill that he went back to her and it was changed to Enteric Coated aspirin. Things got worse so he visited his GP who prescribed Omeprazole which he admitted to my husband should have been given at the outset with the Metformin.
This settled things a little but in June another D nurse increased the Metformin again to 850mg x2 daily.

Last Monday, after 24 hours of violent Diarrhroea &, Vomiting and acute abdominal pain my husband was admitted to hospital via A&E. Tests so far have failed to indicate any other cause that an adverse drug reaction. I have seen this written on his hospital notes with a ? as further tests are pending. The metformin has been stopped and his blood sugars have remained within acceptable limits.

I am a retired chartered Physiotherapist and have been concerned about his medication for some time. Discussion with one of the GP's on Monday ended in a consensus that aspirin was uneccessary, especially as my husband is already protected against high BP by Ace inhibitors and statins.

I know that nurse colleagues who specialise have good training but they are not doctors and we have suffered a loss of confidence over this. Failure to take on board the whole medication picture could potentially have very serious results.

My poor husband has been extrememly ill, needed Morphine for the pain and suffered the indignity of catheterisation and all the other necessary procedures needed in such a situation.

I am hoping that once it is established that the drugs are the cause, which seems highly likely, that some sort of investigation will take place.

This has been a frightening and distressing experience. Fortunately I am a HPC and knew to get swift help. We have always received such wonderful treatment in the past and I hope that the equilibrium will be restored.

[dgrilli]

Why all that medication?

Why not just inject insulin or get him on a Pump and forget about all the harsh side effects?

Sounds like the man has been through enough.

Some jst don't tolerate the meds and others the meds just plain don't work.

[panda692]

Thanks for the reply,

He isn't bad enough or insulin dependent. From now on we will do it our way. Monitor urine sugars 2 x daily and take Metformin as needed.

Kind regards,

Panda.

[Harold]

Monitoring urine sugars will only show levels over 10 (180). He needs better control by monitoring blood glucose levels with a meter and trying for levels below 7.7 (140).

[shockme]

Originally Posted by dgrilli

Why all that medication?

Why not just inject insulin or get him on a Pump and forget about all the harsh side effects?

Sounds like the man has been through enough.

Some jst don't tolerate the meds and others the meds just plain don't work.

we type 2's have insulin resistance...need a med to deal w/that issue ...trish

[panda692]

Thank you so much for all the help. We are looking to get a blood glucose testing set to self monitor and take Metformin as required.

Kind regards,

Panda.

[princesslinda]

Originally Posted by Harold

Monitoring urine sugars will only show levels over 10 (180). He needs better control by monitoring blood glucose levels with a meter and trying for levels below 7.7 (140).

I agree with Harold....regular testing is vital to good control, esp. those 2 hr after first bite of food tests...this is the best way to learn how certain foods affect blood sugar and to help make the smartest food decisions.

[moorejames]

Originally Posted by panda692

Thank you so much for all the help. We are looking to get a blood glucose testing set to self monitor and take Metformin as required.

Kind regards,

Panda.

You can't really take Metformin "as required" it has to build up in your system generally and can take weeks to reach its full effectiveness, so just popping one now and then like an aspirin probably isn't going to do much good.

I'd talk to his doctor about alternative medications.

I've been struggling for a year now to find a dose and timing with metformin that I can live with. The intestinal issues can be severe... I'd switch to something else, but for someone in good control, it's probably the best med out there, if you can tolerate it.

jim

[Rebecca]

One Very common issue with Type 2 diabetes mellitus aka NIDDM, is insulin resistance.
With oral hypoglycemics, one will have to increase the amount of medication to keep sugars under control. Some have not only increase the amount of the oral hypoglycemics, but also add different ones to the original ones, eventually leading to insulin use.
Regarding the pump. It looks like this person is from Suffolk which is in the United Kingdom (UK). Where pumps are very rare to get not only prescribed but paid for. With the research I have done for type 1's in the UK, there is only about 500 such people in the UK with pumps. Never is a type 2 on a pump.
Oh. and Orals will NOT work for a type 1. unless metformin in conjunction with insulin, either injected or pumped (it is a medication thats target cells are hepatocytes, which makes the liver not do glycogenisis as often as it would in normality. Your liver pumps out glucose, as it is the storage facility for extra glucose in addition to fat deposits throughout the body).
Diarrhea and vomiting are very common side effects of metformin (glucophage), in either IR or ER. Most (99%) orals do have some side effects, just like the side effect of insulin is hypoglycemia (and some are allergic to the preservitive that is use to make insulin shelf fridge stable for several months to a couple of years.. some use a very minute amout of phenol as the preservitive).
Nurses. There are Nursing staff that DO know as much as some physicians and some that know more than some physicians. Nurse practioners or even Physician assistants here in the states, are wonderful in my own opinion. They do know medicine. Nurse practioners, are required to go through the normal 4 years of nursing and get their bachlors of nursing (BSN), and then are required to work as a nurse for 10 or so years, before applying for their masters degree (MSN's are nurse practioners), and then they need to do clinical residency to learn their specialty. PA's or Physician Assistants, go through the normal 4 years of uni in undergrad (just like medicine), and then they go through a very intense 2 years of PA education at a grad school that has a physician assistant programme, instead of 4 year Medical school or Osteopathic medical school. Then they also have to do clinical residency, just like a MD or DO would have to do.
My life would be so much worse if it was not for the nurse practioners and physician assitants, as I am a physician. I am not being biased, but saying the fact.
Things might be different in other countries other than the states (USA), but still they are needed, and do what they need to do to help us.
In some type 2's medications can be used off and on, but most require some kind of medication at all times.
And blood glucose testing. Well that is the prefered method of testing, as urine glucose only shows what your sugars were several hours prior, and blood glucose, well that is what you are currently at.
And there is now medical documentations, that Type 2's on orals, really don't need to check their sugar levels, unless they feel "off", which I totally disagree with. I will continue to suggest to my type 2 patients (I am a paediatric endocrinologist fellow, and therefore, I treat people 18 and under, and I have 11 type 2 diabetic patients) to test 2-3 times a day, and more so with intense exercize to make sure that they do not go extreamly low. And yes, I do have a couple of patients on both the orals and insulin with their type 2 diabetes. (I have close to 250 patients).
Best thing would to do is get a second or third opinion.
Good Luck to you, and your husband, Panda692

[panda692]

Once again many thanks all of you and Rebecca for such a detailed account.

Now that my husband is safely home and feeling much better the dust has settled and we have had a chance to consider the events of the past few days.

Upon reflection it would appear that the culprit was the aspirin which he has now stopped. Prior to that he was beginning to tolerate the Metformin well, so hopefully everything will settle down and he will continue to take it and monitor his situation.

We have learned from this forum about the Diastix only recording a reading of 10 or over and also other useful information.

Thanks again,

Panda.

[Tucker]

Originally Posted by shockme

we type 2's have insulin resistance...need a med to deal w/that issue ...trish

Don't need meds when the insulin is shot directly into muscle.