Dad with dementia diagnosed with diabetes and treatment issues. Any advice?

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Dad with dementia diagnosed with diabetes and treatment issues. Any advice?

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My dad is 84 and was just diagnosed with type II diabetes. He is in a memory care. His NP put him on metformin. His fasting glucose is 120 and his A1C is 6.3.
He loves to eat so we agreed to giving him Metformin so we don’t have to change his diet. The metformin is giving him a lot of diarrhea. He was also prescribed immodium to take when the diarrhea occurs. He’s in bed today because of the diarrhea.
I messaged his NP to discuss alternative medicine, but has anyone else had something similar and decided not to treat? His numbers are still pretty low, and I’m worried about the constant diarrhea being a quality of life issue (and possibly a skin irritant even with diaper cream). He’s in the next to last stage of Alzheimer’s- wheelchair bound and incontinence but still talks a fair amount.

Alzheimer's & Dementia Diabetes Incontinence Medications

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as to the metformin ask for a slow release I'm on that and have only had 3 bouts since taking it. also the body will need time to adjust sorry cant help with other issues tho

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also with a count of 6.3 why is he on it anyway

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Courage726: Let your father enjoy the time that he has left. Alzheimer's is a horrible disease. The poor man is suffering as a result of a side effect of the Metformin. Prayers sent for this most difficult of times.

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My advice: Read and trust the answer by "notgoodenough". By those standards (from the ADA), your dad doesn't need Metformin or any other diabetes medication. His A1C and fasting glucose levels easily meet those standards. Seeing an endocrinologist may be a good idea if his numbers fall outside the standards. Metformin causes diarrhea on its own and when it's in a combination medication (Janumet, Kombiglyze to name two). You're correct to worry about skin problems from diarrhea. Also read articles from reputable sources about the side effects of metformin.

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My personal opinion. Say no to metformin or any meds for diabetes at this point. Don't understand why he's on metformin at 6.3??
Quality of life isn't continual diarrhea.
Thanks for being Dad's advocate !🥰

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Is there really even a point in monitoring diabetes in a person with such late stage Alzheimer’s? Besides selling more Metformin I mean? It kind of seems cruel to me but idk.

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I agree, my father had diabetes for at least 30 years, (runs in his side of the family, men only), later in life they pushed and pushed him to go the injection route, I was totally against it.

He finally gave in at age 82, he hated doing it, it made him a nervous wreck.

He died at age 84, after he started the injections, his body just broke down, I feel that the injections had something to do with it. He was just too old for this change.

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I have mixed feelings about treating. given the advancement of the Alzheimer's and the problems he is having.
And it might be that he may actually be better monitored and cared for in Skilled Nursing rather than Memory Care for the very reasons that I mentioned in my comment to "Chris101" below.

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Thanks! I’m looking for a SNF
now

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I do not know why doctors do not tell people this...BUT Metformin has to be started very slowly, this is why he has diarrhea.

I would either stop the Metformin for a day or two to stop the diarrhea or reduce it to 1/2 of a 500 mg tablet only once a day for 3 days, then 1-500 mg tablet for 3 days, then if he is suppose to take more than that, split it between breakfast and dinner. And make sure with those 2 meals he has some carbs.

You also have to be careful of low bloodsugars. If his hands and legs start shaking - he may feel it before you see it. Test him then give him protein and carbs. (Peanut Butter on Graham Crackers are pretty good) You can also keep Glucose Tablets on hand if he can chew or they have Glucose gel that you can put on his gums. If his bloodsugars gets to low he could go into a coma so keep an eye on this closely. Also if it is low he may be unresponsive to you even though conscious so this is when you need the gel. You can buy the tablets and gel at any pharmacy.

I have been a Type 2 Diabetic for the last 19 years, and my daughter has been a Type 1 Diabetic for the last 24 years (since she was 10). I was prescribed Metformin and it also gave me diarrhea. I stopped it until that cleared up then restarted it very slowly. They also tried to put me on Janumet (Metformin mixed with another med). This gave me a UTI so be careful of all the meds!

Good Luck!

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Since he is in Memory Care expecting staff to see leg shaking or hand shaking is going to be difficult. Then to get an aide to get to the nurses station and inform a nurse as to the shaking it might be an hour before he gets anything in the way of glucose.

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My mother always said she loved to eat "like a dirty hog". Her words, not mine. She dieted her whole life but pushed food on others to watch their enjoyment of it that she prevented herself from experiencing. After she went into AL, she started eating desserts and gaining weight. After she had to segue into Memory Care when her dementia got worse, I'd BRING her bags of chocolate and junk foods weekly. If her blood sugar spiked, who cared? Her one enjoyment in LIFE that was left was food. Far be it for me or her PCP to say she should be on another diet to extend her pitiful quality of life, or that she should take meds to cause diarrhea! I did nothing whatsoever to extend her life and instead prayed for God to have mercy and take her sooner rather than later. She died 1 month 2 days past her 95th birthday.

The facility your dad is in is run by idiots for making a med mistake of that magnitude. I'd take him off Metformin completely and bring him a bag of chocolate truffles. But that's me. Let him leave this earth with a smile on his face in the last phase of AD, cruel as it is, and enjoy himself a bit. No PT, no nothin. Nobody's fixing this.

Best of luck to you.

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We did take him off. He’s on a no concentrated sugar diet, so sugar free dessert, but I will still bring him some occasional treats. He loves fried chicken and I bring him some once or twice a month.

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This is a known side effect. My MIL had the same thing (except we weren’t convinced she actually had T2D, we wondered if the chemotherapy had messed with her blood sugar). She went on hospice soon after going home from the hospital so they took her off the metformin at her request. I completely understand why you are considering not treating.

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Diabetes starts with A1c at 6.5. Talk with his doctor about his side effects with Metformin.

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Actually, the acceptable levels in the elderly are somewhat higher.

"For those without other major comorbidities, an A1C goal of 7–7.5% and a fasting glucose target range of 6.5–7.5 mmol/L (117–135 mg/dL) are recommended, whereas for frail older adults and those with multisystem disease, an A1C goal of 7.6–8.5% and a fasting glucose target range of 7.6–9.0 mmol/L (137–162 mg/dL) are recommended to minimize the risk of hypoglycemia and metabolic decompensation."

Source: American Diabetes Association Diabetes Spectrum August 31, 2018

If the OP and/or dad want to manage this chronic condition from this point on, their best bet is really an endocrinologist. But to have the facility dad is in to mistakenly triple the dosage of the medication is gross negligence at the very least. If it had been a different medication for diabetes, like insulin or a sulfonylurea which can dangerously lower someone's blood sugar, dad might have had some serious - and possibly fatal - problems.

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Courage: Here's my mother's experience. She has had Type 2 diabetes for years as well as dementia (she's 86). Her A1c used to be fairly high and she was on insulin as well as Metformin and other diabetes meds for years. As her dementia progressed she lost lots of weight, and was gradually removed from all her diabetes meds except Metformin.

She is now in home hospice care, later stage dementia, wheelchair bound and incontinent like your dad, but still somewhat "with it" as she still knows us and talks.

Her last A1c was low 6s and fasting glucose last time I checked 125. I believe the weight loss brought her glucose way down from where it was. It was as high as 11 several years ago. Her doctor first lowered her Metformin to 1 pill once per day (from twice) and just this week took her off it entirely. She said that at this stage she felt it was better to keep the glucose a little higher and that we are not playing the long term game now, but keeping Mom as comfortable as possible for her last years.

But I do remember from my own experience with Metformin, it can upset your stomach but you eventually get over it, especially if the dose is started low and raised gradually. It wasn't an option not to treat my diabetes since I am younger (62 is young, right!?) but so far my mom is doing just fine without any diabetes treatment.

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62 is very young!

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My mother was on metformin for many years but when they had to increase her dose she had the same problem. Her doctor switched her over to jiardiance and the diarrhea cleared up. Her BG does run high but she will be 92 in a week. Her doctor isn’t that worried about the high values since that is more likely to cause long term damage whereas low causes life threatening acute problems.
The one problem I have had with her is that she wouldn’t monitor her levels since she hated doing the blood sticks. To get around that problem I got her a free style libre which only has to be changed every two weeks. It does have a tiny needle on it but several times we have put it on with out her even noticing that we had already done it. We haven’t turned off the alarm for when she is either too high or too low so she complains about it yelling at her and it makes her feel like she isn’t doing something right but it helps us know her high range. We actually don’t worry about the highs, which are mostly under 300, most of the time but right now she has a laceration on her leg and she has understood the need to keep it lower to help the healing process. Since she sees how much cutting out the sugary treats can help she has been complying. I know that once it has healed she will be back to her ice cream and coffee flavoring syrups but at least she is seeing what affects her diet has.
As others have said it sounds like your father isn’t at a level where he needs meds to control it. He probably will need them at some point but there are many options out there.

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Your dads A1C seems good and so is his fasting blood count. Metformin has other benefits than helping with the management of sugar in blood.
I have diabetes type 11 and was able to monitor with diet. After 10 years, my doctor put me on Metformin stating it would protect my kidney and heart. My A1C was 7.9 so I was agreeable. I had no side effects.
Have your dad’s doctor do a blood test to determine blood sugars. If he is talking any antibiotic or steroids, they can raise his levels. Losing even 5-10 pounds make a difference. I went from 150 to 115 fasting blood sugar. Also, the dosage of Metformin may be to high.
Hope this helps.

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Yes I have been there. Metformin is the worst. He will get over the diarrhea in time as the body learns to tolerate it. ( maybe 6 mos or more) But metformin damaged my kidneys. His sugar levels are good at 6.3. But I strongly urge a change in diet just because He can eat crap and you can counteract it with meds does not mean it is a good thing. Personally I became vegetarian and try to exercise. Exercise is key to burning off sugar. And finally I switched my med to gliperide and stomach issues are gone. I will never do metformin again!

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I assume he is on the extended release (ER) type of metforman? And also his body might get used to it after 1 month? But I went years with it and was fine, and Then all of a sudden it was a big problem. I was told sometimes that happens.

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In our household we also had problems with metformin. Donot let the doctor discourage you with changing the medicine. There are many alternatives that work better than metformin

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We took him off and he is on a no concentrated sugar diet.

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120 fasting and 6.3 A1c why is he on any drugs? I question this decision, makes no sense to me.

Why add to his misery? What is NP trying to accomplish he has Alzheimer's and other medical issues, there is no way I would agree to this.

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His fasting glucose is 120 without the metformin? If so, he doesnt need to be on meds and like another poster mentioned - older patients can have a higher A1C.....its a bigger risk if dad goes too low and he falls or faints......if he does need the metformin - the Extended Release version has less diarhea impact - what dosage is he on? My mom was a type 2 diabetic but her fasting numbers were in the 400s without meds - eventually i got rid of all her diabetes meds and switched to insulin and that was easier to manage and she was able to eat what she wanted at 91 - she just died last month and it was a heartbreaking journey till the end.

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Sending you love and support regarding the passing of your mom. Thanks for the info you shares. We did stop the metformin.

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I am a geriatric provider myself

With his dementia and relatively low Hg A 1 C, he doesnt need to be treated for the Diabetes
The target A1 C for older adults, specially nursing home and dementia u it residents is as high as 8 or even 9 %

pls discuss this with his NP and ask her to d/ c the metformin

giving Imodium for metformin induced diarrhea is ridiculous prescribing cascade

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Thank you! We stopped the metformin.

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Personally I would not treat diabetes when in memory care unless the blood sugars were high enough to cause coma! Diarrhea and dementia is miserable for everyone. These drugs are harsh {retired health care professional speaking}. Perhaps start hospice to stop the meds. Ps look at research an a1c of 7 is very acceptable for the elderly!
Good Luck.

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We stopped the metformin. Thank you! Hopefully The diarrhea stops soon when it is out of his system

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This is just a finger-in-the-dike suggestion, but you might try asking to change from immodium to lomotil (diphenoxylate + atropine). I have irritable bowel syndrome, usually with constipation, but occasionally with diarrhea. Immodium has never positively affected me, but lomotil always does. Unlike immodium, lomotil does require a prescription and is classified as a Schedule 4 (lowest level of abuse liability) narcotic. As far as I know, it has no real abuse liability, However, it may be that the NP in your father's state cannot prescribe any scheduled drugs, and that is why she prescribed immodium. This is another reason to have a physician involved, although probably an internist would be more than adequate.

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Update: the facility was
giving him the prescribed daily dose of Metformin three times a day
instead of once a day. It has been fixed now but I feel furious. He is still in bed (day four) with diarrhea.

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awful mistake

i don't know if this helps you (every case is different), but i do know some elderly people who were suddenly (just like your dad) diagnosed with diabetes II. they decided not to take ANY medicine against diabetes, because:
1. the numbers were not that bad
2. they have other diseases, and they preferred not to extend their life by taking medicine against diabetes
3. their overall health is actually very good
4. they eat very healthily and enjoy food; they enjoy life

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Since the med is giving him the runs, I would discontinue it ASAP. If it were my mom (she's 80), I would not give her meds that made her life even more horrible than it already is with mid level dementia. I would also not try to control her eating to keep her numbers low because she would hate it. I would consider getting a hospice evaluation or at least palliative care as that can shift the way he is treated.

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He’s got palliative care now. I messaged them today for their advice too.

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Can’t think that “He loves to eat” should be part of a diagnosis/treatment protocol, but on the other hand it also seems to me that nobody will be making progress with someone at the level of dementia where he seems to be.

I would feel much more confident in your situation with a consult with a geriatric endocrinologist AND his facility’s dietary manager.

Dietary management may be very helpful.

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I am with NGE here. This should not be overseen by a Nurse Practioner. I would see an Endocrinologist especially since this is new. Like SP said, it maybe controlled by diet. If he is heavy, weight loss can bring it under control. Exercise is important to.

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Dad is wheelchair bound, so he probably doesn't get enough exercise. See if the MC has a program for patients like this. I bought my parents videos to do seated exercise (years ago). Some residential facilities have "classes" to exercise to music. Dad may not be able to follow but it may be fun and it might help his BG.

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Is this a recent diagnosis for your dad?

Is there any way you could find an endocrinologist to have a telehealth appointment with you and dad to discuss his blood sugar numbers and his current medication? I'm sure the NP is doing what the recommended treatment says to do, but it might be in your dad's case for his general overall health, age and life expectancy his numbers pre-metFormin were fine. An endocrinologist would have a better idea about treatment options for your dad's condition.

The older someone gets, the more dangerous hypoglycemia becomes, which, I'm sure, is why metFormin has been prescribed, because it rarely causes dangerously low blood sugar levels. The down side is the digestive issues it can cause. Maybe dad doesn't need to be on such a high dosage in order to keep his levels in acceptable territory.

Good luck!

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I’ll see if I can find one, thanks for this idea!

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Those side effects are terrible. Type 2 diabetes can be reversed or helped by eating a low carb diet. Reducing the carbs and sugar will lower that A1C number dramatically.

The other alternative is he is 84 with dementia. Let him enjoy his life and food and don't worry about his type 2 diabetes.

My two options are far better than his staying stuck in bed because of his diarhea.

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Dad with dementia diagnosed with diabetes and treatment issues. Any advice?

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