please help urgent..

mishraji
By mishraji Latest Reply 2012-04-16 18:57:07 -0500
Started 2012-04-06 14:05:41 -0500

my dad is dibetic since 1985 type 2 .for past three months he was living alone and skipped some medication also .4 days earlier his urine and stool stopped .after he consulted to doctor where sugar level got tested to be at 460 after that insulin was given.before this he never used insulin.now he is too weak and whatever he eats he vomits .he is using insulin before breakfast.lunch.dinner .still sugar level remaining high around 250 gets down sometimes and gets up sometime..


19 replies

Harlen
Harlen 2012-04-06 18:49:51 -0500 Report

He needs to go back to the Doc this is something that will take time to get a grip on .
Best wishes
Harlen

Caroltoo
Caroltoo 2012-04-06 15:46:16 -0500 Report

Your dad has been diabetic for almost 20 years and has now had some significant change in how his illness presents itself. You mention he consulted with a doctor who started him on insulin which he had not used before. His blood glucose level is still high.

Can you take him back to the doctor again? He may be weak because of continuingly high blood glucose or from not being able to keep anything on his stomach. He may need a change in medication. He may have something else happening with his health. This is potentially serious, but needs the expertise of a doctor. Please take him back and go with him, if you can, so that you also know more about his situation and how you can help him in the future.

mishraji
mishraji 2012-04-08 14:32:24 -0500 Report

thank you sir..i took him to hospital and his medication is going on.it seems to be HHNS .he is not showing any significant improvement and blood sugar remains high. So shall i continue with the same medication or go for different doctor.
medication going..
amryl
tonact
taxim o
monotrate
cameffer
resourse diebetic powder
pan40

no ketones detected in urine.
hba1c test result 9.7

Caroltoo
Caroltoo 2012-04-08 15:40:18 -0500 Report

Hi, mishraji,

Glad to hear you were able to get your father to the hospital and get treatment. HHNS sounds very serious and could take his life, if left untreated, so you will need to be very watchful and proactive for your dad's health.

From what I've read here, it sounds like there is usually an underlying infection or illness that also needs treatment, as well as the diabetes (high BG readings). Another developing issue is the possibility of dehydration, keep him drinking lots of fluids, even if he does not want them. I would surely continue medications as prescribed and look for a doctor who will see him for on-going treatment rather than just the occasional hospital emergy visit.

I wish you both the very best. You have a challenging job to care for your dad.
Carol

Here's some information that may help you make some of these decisions:

DESCRIPTION OF HHNS AND HOW IT OCCURS:
Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes, but it occurs more often in people with type 2. HHNS is usually brought on by something else, such as an illness or infection.

In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You make lots of urine at first, and you have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may be very thirsty. Even if you are not thirsty, you need to drink liquids. If you don't drink enough liquids at this point, you can get dehydrated.

If HHNS continues, the severe dehydration will lead to seizures, coma and eventually death. HHNS may take days or even weeks to develop. Know the warning signs of HHNS.

What are the warning signs?
•Blood sugar level over 600 mg/dl
•Dry, parched mouth
•Extreme thirst (although this may gradually disappear)
•Warm, dry skin that does not sweat
•High fever (over 101 degrees Fahrenheit, for example)
•Sleepiness or confusion
•Loss of vision
•Hallucinations (seeing or hearing things that are not there)
•Weakness on one side of the body
•If you have any of these symptoms, call someone on your health care team.

How can I avoid it?

The best way to avoid HHNS is to check your blood sugar regularly. Many people check their blood sugar several times a day, such as before or after meals. Talk with your health care team about when to check and what the numbers mean. You should also talk with your health care team about your target blood sugar range and when to call if your blood sugars are too high, or too low and not in your target range. When you are sick, you will check your blood sugar more often, and drink a glass of liquid (alcohol-free and caffeine-free) every hour. Work with your team to develop your own sick day plan.
http://www.diabetes.org/living-with-diabetes/...

2ND ARTICLE: TREATMENT
TREATMENT of hyperglycaemic hyperosmolar non-ketotic syndrome.
Levine SN, Sanson TH
Source: Department of Medicine, Louisiana State University Medical Center, Shreveport.

Abstract
Hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS) is a life-threatening complication of uncontrolled diabetes mellitus. This syndrome is characterised by severe hyperglycaemia, a marked increase in serum osmolality, and clinical evidence of dehydration without significant accumulation of ketoacids. HHNS is typically observed in elderly patients with non-insulin-dependent diabetes mellitus, although it may rarely be a complication in younger patients with insulin-dependent diabetes, or those without diabetes following severe burns, parenteral hyperalimentation, peritoneal dialysis, or haemodialysis. Patients receiving certain drugs including diuretics, corticosteroids, beta-blockers, phenytoin, and diazoxide are at increased risk of developing this syndrome. Patients usually present with a prolonged phase of osmotic diuresis leading to severe depletion of both the intracellular and extracellular fluid volumes. Losses of water exceed those of sodium, resulting in hypertonic dehydration. Therefore, correction of the syndrome will ultimately require administration of hypotonic fluids. Patients presenting with HHNS also have significant depletion of potassium and other electrolytes that will need to be replaced. The principal goal at the outset of therapy must be restoration of the intravascular volume to assure adequate perfusion of vital organs. It remains controversial whether 0.9% or 0.45% NaCl should be the initial fluid infused intravenously. We prefer to administer 0.9% NaCl until the vital signs have stabilised and then substitute 0.45% NaCl. 10 to 15 units of regular human insulin should be injected as a bolus, followed by a continuous infusion of approximately 0.1 U/kg/h. Once the blood glucose approaches 13.9 to 16.7 mmol/L (250 to 300) mg/dl, 5% dextrose should be added to the intravenous fluids and the rate of insulin infusion reduced. Following recovery many patients presenting with HHNS will not require long term insulin therapy and can be managed effectively with diet or oral agents. Precipitating causes of HHNS must be identified and treated simultaneously with correction of the metabolic abnormalities. Appropriate management of precipitating illnesses will limit the high mortality associated with HHNS. This review discusses the current state of knowledge concerning the pathogenesis of HHNS, the clinical features of the disorder, and a systematic approach to treatment.
http://www.ncbi.nlm.nih.gov/pubmed/2680438

Caroltoo
Caroltoo 2012-04-08 16:58:50 -0500 Report

Here's some more information, mishraji.

Diabetic coma — also known as hyperglycemic hyperosmolar nonketotic syndrome — is a serious complication that can happen to a person with type 2 diabetes who is ill or stressed. Diabetic coma occurs when the blood sugar gets too high and the body becomes severely dehydrated. Unlike ketoacidosis, which typically occurs in people with type 1 diabetes and produces similar symptoms, no ketones are formed in diabetic coma. So rarely is there an acid build up in the blood. Ketoacidosis rarely occurs in people with type 2 diabetes.

The CDC reports that diabetic coma occurs most often among people who are older than 60. This may be because older people often have an altered sense of being thirsty and are more likely to become dehydrated. Most sufferers have a history of diabetes, but for some, the disease is undiagnosed or untreated.

In most cases, there is a history of excess thirst and urination for weeks prior to diagnosis. Excess urination and extreme elevations of blood sugar levels lead to dehydration throughout the body, including cells becoming dehydrated. The severe loss of body water can lead to shock, coma, and death. Death rates can be as high as 50%.

People who are especially at risk include those who are chronically ill or disabled.

Is Your Type 2 Diabetes Under Control?

What Causes Diabetic Coma?

Causes of diabetic coma can include:
Infection
Heart attack
Kidney failure
Medicines (diuretics, heart medication, or steroids)
Illness
Bleeding ulcer
Blood clot
Uncontrolled blood sugar

What Are the Early Symptoms of Diabetic Coma?

Early symptoms that may lead to diabetic coma if not treated include:
Increased thirst
Increased urination
Weakness
Drowsiness
Altered mental state
Headache
Restlessness
Inability to speak
Paralysis

If you have any of these symptoms, test your blood sugar and call your doctor if your blood sugar is high. Diabetic coma typically occurs when blood sugar reaches 600 mg/dL (milligrams per deciliter) or more.

How Is Diabetic Coma Treated?

Once early symptoms of a diabetic coma are noticed, treatment typically requires intravenous fluids as ordered by your doctor and may require insulin. It can lead to death if left untreated.

How Can Diabetic Coma Be Prevented?

Diabetic coma can be prevented by the following:
Check your blood sugar regularly, as recommended by your health care provider.
Check your blood sugar every four hours when you are sick.
Take special care of yourself when you are sick.
http://diabetes.webmd.com/hyperglycemic-hyper...

mishraji
mishraji 2012-04-09 01:34:06 -0500 Report

thanks for your help

my dad age is 65 years and he has got some older age behaviour as anger,confusion,forgeting things .So when i try to give him water or food he gets very angry as he feels thirst or hunger less than usual.He had only 2 peice of bread and some rice in two days.Should i forcefully feed him.He has become very weak unable to walk on self or to stand for while without support.Perticularly in nights he doesnt sleep well and get more confused.as he told me to switch on light which was already switched on.

what should i do?

Caroltoo
Caroltoo 2012-04-09 02:55:19 -0500 Report

You are very welcome, Mishraji. I hope it helps.

I've been thinking about food that might be easy to eat. One of the easiest and most soothing foods might be a chicken and lentil stew. The broth is fluid and helps with dehydration, the chicken is the protein which helps with blood sugar, lentils do also and have fiber. Any other vegetables that you put in it would be fine also.

I live in Hawaii and need to go to bed soon cause it's getting late. I'll check back here tomorrow morning, so please keep me updated. I'm concerned about you and your dad.

Caroltoo
Caroltoo 2012-04-09 02:10:40 -0500 Report

mishragi,

Your dad sounds like he may have Alzheimer's or other form of dementia. That is the confusion, anger, frustration, forgetting often seen in our older family members. If so, it would explain some of his behavior in forgetting to take his medication that led to the high blood glucose levels that caused the HHNS. My husband has this disease, so I am quite familiar with it. Confusion in the night (more than the daytime) is also a symptom of Alzheimer's.

Is he blind or partially blind? Loss of sight can be one of the after effects of high blood glucose like he has had.

Does he have a fever? How high?

Bread and white rice are two of the foods which will make his blood glucose go up high. Here in the US, we would use protein and fibrous foods to decrease his blood glucose. I don't know what your diet is like, so I'm going to just guess. Could you give him an egg cooked soft so its not hard to chew? Do you have some cooked beans or lentils that you could mash up and give him? These would give him some protein (egg) and protein and fiber (lentils and beans).

It doesn't have to be a lot of food, just enough to give him some nourishment. For a very sick man, some bread and rice may be the right amount. I'd just use different choices of food because of the effect of bread and rice on blood glucose.

Water is very important to prevent dehydration. It is probably even more important than food right now. A few sips every few minutes might be easier than having him drink a glass/cup at one time. Try to explain to him that he needs water so that he will not get very much more sick!

Try to stay calm. This has to be frightening to you. He has his own fears and confusion. You can help him stay more calm by being calm yourself and speaking softly, touching gently, doing whatever you can to reassure him that he is safe with you. That you two will do what you need to do to get through this.

What country do you live in? I'm guessing India or Pakistan. We have a couple of families online who live in India. I could contact them to see if they could help you deal with food choices for him because I know Dev mentioned recently that diabetes is treated differently in India than in the US.

Can you get him back to a doctor today? Your doctor should be helping you make these decisions since he knows more about your dad's medical condition than you or I do.

Carol

mishraji
mishraji 2012-04-09 03:30:57 -0500 Report

My dad is admitted in hospital .His food is checked by a dietician first .I asked her about these issues she told me that its okay to have these foods.My dad is a vegeterian and for protein doctors are giving him protein powder with milk which he unable to digest the amount suggested.
I live in india.
Now i am afraid as his sugar level never comes below 220 and reachs 415 level in noon and night even after this muvh medication.

Caroltoo
Caroltoo 2012-04-09 10:58:25 -0500 Report

I'm glad he is admitted because he sounds like he is really sick and this would be the safest and most healing place for him.

I use protein powder with milk also; don't know why I didn't think of that last night. It's a good choice. His sugar does run high, that could be a reaction to whatever infection caused the HHNS in the first place. The bread and rice reminded me of my own childhood. That is what my mother would give me too.

You are a good and caring son to take care of him in this way. How are you doing today? This has to be exhausting because you obviously care very much for him.

mishraji
mishraji 2012-04-09 14:10:53 -0500 Report

Dad was not urinating for 1 day doctors tried to put catheter which resulted in bleeding now they put him in icu.i am now very afraid will he be ok.

red flower lady
red flower lady 2012-04-09 15:51:40 -0500 Report

When bg level gets too high the body/individual reacts in different ways. You can start vomiting, get dry mouth, cracked lips, problems using the bathroom, etc… It will require medical care. It is not unusual to be put in the ICU for a couple of days until the bg gets back to desired range. Basically, your body wants to start shutting down, but the insulin will help, and since his levels were not getting below 250, he'll probably need to keep using insulin daily. Don't panick, the worst should be over. I know this from experience and not just trying to make you feel better.

Go ahead and cry, you have earned it and it will help you to release some of the fear and stress.

mishraji
mishraji 2012-04-09 19:47:45 -0500 Report

they have put catheter directly in urine bladder.there seems to be internal organ injury because of which bleeding happened.
doctors says he is stable .Buy never says in how much time he will be ok.

Caroltoo
Caroltoo 2012-04-09 22:10:33 -0500 Report

Cathetization can be very painful, especially the Foley catheters, and sometimes does cause bleeding. Once in and stabilized, he will begin to be more comfortable because there is so much less pressure.

I'm so glad to hear that he is now stabilized! It will take some time, mishraji, before he will be well. One other person who is familiar with HHNS said it's frequently several days in ICU because it really is serious. Being stable is encouraging!

How are you doing?

Caroltoo
Caroltoo 2012-04-09 14:46:34 -0500 Report

Oh, mishraji, when we fear we are loosing someone we love, it is so hard. Weep, perhaps in the shedding of tears for your beloved dad you will find some solace. You are doing all you can for him. Share your love with him, so he knows he is cherished as parent and as friend.

You have gone deep within yourself these last few days to find the strength to be there with him and comfort him, even when he, in his fear, may have lashed back at you. If he is awake and can talk with you, it may be healing for both of you to share some good memories of your boyhood and your relationship with your dad.

Both of our cultures are deeply rooted in faith, though different faith. Draw the strength that you can from your beliefs. Hope and pray for his recovery, but also use the time to make peace with the possibility that you may loose him. The end of life comes to each of us and none of us know when that will happen. Cherish these days and moments with him; you hold him close to your heart in that way.

mishraji
mishraji 2012-04-16 18:37:36 -0500 Report

Now my dad seems to be good.His sugar level is normal and ocassionally goes up once before bed.Only problem he is left with is he has some less sodium level .and swelling in hands and legs which has also reduced.
hopefully he will leave from hospital tommorow.

Caroltoo
Caroltoo 2012-04-16 18:57:07 -0500 Report

I am so happy for you! It's wonderful to hear this. Such a good outcome after such a scary experience.

Will you take him to live with you (or come stay with him)? I guess what I'm really asking is if there will be someone to be with him?

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