Diabetes and oropharyngeal cancer

Hi. There have been a few patients here with diabetes but it seemed more of a problem when they had to have meal replacement drinks like Fortisips and Ensures. The dieticians are well versed in treating diabetics alongside chemotherapy and radiotherapy. What is his team suggesting and what treatment is planned? 

Hes on palliative care with no treatment just pain management. The GP looks after his care at the moment and because he has had 2 hypos last week they have decided to take away the insulin and leave the tablet medication without consulting my dad or myself. It would be easier for him to stay on insulin and take away the tablets instead but im wondering if anyone would do that.

Jane

Hi again Jane

I'm sure that his GP taking away the insulin is trying to avoid hypos. I would have a chat with the practice and try to explain. Sorry to read that your dad is so ill. How are you? It must be hard for you too. 

Hi Dani,

Yes I totally get taking away the insulin is to prevent hypos as its like the standard practice for diabetes because its the 3rd line treatment so makes total sense in that regard. I just feel like this decision did not have the cancer taken into account if that makes sense? I mean is it just me or would it be common sense to take away oral medication instead of an injection when someone has pain in their mouth? Not to mention the GP did not consult my dad or me when he made this change and the district nurses told us about it on Saturday morning. Insulin can cause hypos but so can the other 3 medications he is on and hes on the highest doses of each med. 7 diabetic tablets my dad has to take in the morning. I mean really!

I'm doing better than I was the last couple of weeks. The GP prescribed my dad a pain patch 3x the dose of morphine he was on and it totally sedated him. Thanks to our MacMillan nurse it was sorted out as I feel she really listens and helps us when nobody else will listen. I was in hysterics seeing my dad in such an awful state and having to go against a doctor at the practice.

So now im feeling like will palliative care just think im trying to control things again with an illness im not trained in or does it make sense to anyone else. I guess they're the only ones to tell me if im right or wrong but im so anxious about saying I don't agree with what a GP has done again in the space of a month.

Palliative care did say it was great I stepped in about the patch as this sort of thing should not have happened. So I don't know why I feel so worried.

Jane

7? I can see why you are worried. Can you get back to his Macmillan nurse? Is there hospice care locally? He could go there to get his medication tweaked then go home more comfortably? 

If your dad is understandably finding it hard to eat has the hospital considered placing a feeding tube? 

Janey123456 said:

will palliative care just think im trying to control things again with an illness im not trained in or does it make sense to anyone else.

No. Palliative care involves the carer as well as the palliative team and they need the feedback. 

You are worried because you are losing your dad in pain and that is right. Keep up the fight for him, get in touch with his CNS again

Hu Jane.  It’s only  human nature for you to be worried about your dear dad. Sounds like Danis thoughts are certainly  worth exploring hospice care for a few days to sort his meds out. Ask your cancer nurse about a nasal feeding tube all his medication can go through that relieve then in his mouth. Sending hugs 

Hazelx

I've spoken to palliative care today and the nurse said she totally understands where I'm coming from and it makes complete sense what I'm saying, which is great. Downside is they aren't able to change diabetic medication without a GP or diabetic specialist. So, tomorrow im going to get back onto the GP as he still hasn't gotten back to me and I've also sent an email to the "type 2 diabetic hub" to speak to a specialist if the GP doesn't agree.

However, I now have more evidence to put to the GP today about how these medications are effecting my dads appetite as a side effect. Today the carers were late, which meant his medication was given late. But because the medication was given late my dad started feeling hungry just before lunch time and managed a whole tin of soup and some maderia cake! Whereas every other day when the medication is given at 10.30, he doesn't feel like eating until 6pm. So the carers being late was annoying, but it totally reiterated my theory of these tablets have somewhat of an effect on his appetite. Don't get me wrong i know the cancer will effect it too but its given me more push to get this looked into.

Thanks for all of your advice. If the GP doesn't get in touch or the specialist by the end of the week, I will see what the MacMillan nurse can do to help.

Hi

I have a friend on metformin. Even the diabetic nurses joke that it's a great drug to make you lose weight. So persevere and let us know how you get on. 

Spoke to diabetic specialist nurse today. She said "it doesn't make you lose weight". I'm like what? This was after I skimmed over the Notification of your reply while I was in work. Just thought to myself....and your the specialist? I'm in for a tough ride here!

Locum gp phoned. Told him exactly what I thought and that I am fuming at everything. I've researched everything and he can't convince me otherwise. He said he will go and speak to practice partners and get back to me although he was sticking up for their decisions kind of but also saying he knows what I'm saying.

1 hour later. Calls me back. We've had a meeting and maybe you're right. Well who knew? Gp is coming out on Tuesday to speak with us and gliclazide is to be stopped immediately as his blood sugar was 5.7 then 4.1 7 hours later today. Bloods being taken tomorrow.

What a stressful week this has been.

Jane…. Well done. Your perseverance has paid off. Wish your dad all the very best and I hope he gets some food  into him now. 
Thank you so much for updating me. You deserve a medal.