How to deal with constant hunger in a diabetic, hypertense, and with renal insufficiency patient?

[ellistoryteller]

Hello, I am new in this community and I am seeking some advice for my mom, who is 65 years old, has been diabetic since 2006 and a diagnosed hypertense since 2008. Due to her not taking care of herself, in 2018 they diagnosed her with renal insufficiency. She is on pioglitazone, bezafibrate, telmisartan, and erythropoietin. She, unfortunately, is obese, and her hunger is becoming a real problem for us. She sneaks to the kitchen to eat in the middle of the night and is constantly complaining that she never feels full, and is always experiencing hunger. She often feels nauseous due to this constant hunger. We don't know how to deal with this anymore, because it is becoming increasingly more and more difficult to find things she wants to eat and that don't worsen any of her conditions. She can't ingest sodium or a lot of protein, whole bread, sugar, or very processed foods (she has a couple of allergies and her skin rashes). I am aware that most of this could have been prevented by us taking care of her before things escalated this much, but in our house, we all (my mom, my aunt, me) have chronic issues we deal with, and we all kind of take care of ourselves, but this worsened before we had the chance to prevent it properly, and now we can only find a way to take care of her as best as we can. What can we do to deal with this? Is there something she can eat and that make her feel satistisfied and not harm her? The doctor told her to stick to her diet and avoid eating otherwise, but I don't know if there is a way to make things easier on her and on us.

[Hidden]

At 65 you probably won't be able to make her do anything. You can sign her up for a virtual Kidney Smart class held by DaVita at davita.com

She will find out what she must do to slow the progression of CKD.

I've had Type 2 Diabetes for 20 years with the last five years under control and in the last three years, it has been under control without meds.

I also have HBP and for the last year, it has been under control with medication.

When I was diagnosed three years ago with CKD, my GFR was 32. Since then I have averaged 52 with my GFR and am active, healthy, and trying to stay off dialysis for as long as possible.

If your mother watches the class and isn't willing to make the lifestyle changes she must, as well as begin an approved exercise regimen, to help her lose weight and slow the progression of CKD you don't have many options, and frankly, neither does she.

Have her complete an Advanced Medical Directive and a Living Will.

Best of luck.

[DarbyWills]

You should have her test her blood sugar at those times because her incessant hunger could mean her glucose is high. When your body is not metabolizing sugar because not enough insulin is there to work your body craves food. .also, Low blood sugar causes it too but you'd also see anxiety and sweating prompting an urge to eat as well. Ask her doctor to prescribe for her a continuous glucose monitor. Either Dexcom or Abbott make them here in the US. Clearly your family member needs to see the immediate effects of what and how much she is eating and how that in turn affects her blood glucose. Eat a candy bar or drink orange juice or eat rice (high index sugar load foods) and she can watch her blood glucose soar. She cannot manage her diabetes and nor can her doctor without knowing. If she does nothing she will continue to be told to raise her dose, be told she has to inject insulin and will eventually have further deckine in her kidney function and overall health. I wish you luck in transforming her... give her the gift of insight, make her see when she has for awhile been in the dark. Hope this helps!

[Bassetmommer NKF Ambassador]

HI,

Your mother is trapped in a loop. She needs to find a provider that will not just say stop eating. There is so much more to it than that. Has she ever had a mental health check done? I would push to have one and see if therapy will help. Often overeating is a response to depression and other chemical imbalances. There is often a connection to trauma and over eating. Figuring out the cause of the desire, such as stuffing food, is often a substitute of facing the feelings and emotions. It is why we call certain foods comfort food.

Have a medical provider look over her medication. There may be one of those drugs that increases her appetite and changes her ability to feel full. Take a look at the link for the pioglitazone and you will see that one of the side effects is that it can cause weight gain among other serious cardiac issues. Maybe she needs to see an Endocrinologist and get on a different drug. drugs.com/sfx/pioglitazone-...

Get rid of the garbage foods in the house. Get plenty of fresh vegetables and stock the refrigerator with things like carrots and celery and other filling and crunchy foods. Often we grab for something that is simple so having cleaned and prepared veggies to munch will make that choice easier. Package up small amounts of things like lo fat cheese and maybe some crackers in packets that she can take ONE of. Get some apples or small fruits like cherries and grapes and package a cup or so of each so she is not over eating fruit. No sugar applesauce is also good if you buy the small individual cups. Sugar free Jell-O is another good snack idea. Make sure she is eating foods that have fiber to help with the feeling of being full. If she is allowed salad, have one with every meal but make sure the dressing is lo fat and the salad is not swimming in it. Just know that some people do NOT have the ability to feel that feeling of being full. An appointment with a dietician might be the best idea and see what foods would be permissible for her, and let her work with the dietician to create a meal plan that works for her. She needs to own this, not you.

This is the bottom line. She does not want to take care of herself, then there is nothing much you can do to change her habits. This is why speaking with a mental health counselor might be beneficial. Look at how you are reacting to her also. Does she get positive feedback from the family? Any attention for some people, even if it is negative attention, is better than none. So they will act out to get you to focus on their needs. Nagging and being in her face about her food habits is a form of attention. Trust me, it does not help. Food can be as addictive as alcohol. Treat this as a disease that could be helped.

You say she obese. Is she able to move well? Does her life fulfill her? Is she active in other things other than food? Does she participate in meal planning and preparation. Is she lonely? Does she get out of the house? Is she sleeping well? Metabolic issues are way more complicated than someone is just overeating.

[Darlenia]

Oh my. I feel for you. I wonder if she has gastritis or something similar since she never feels full, always feels hungry, and is nauseous? People in this situation often feel a constant internal "gnawing" or starving sensation that can only be relieved by more eating and, if left unattended, leads to nausea. People, as they age, often contract this condition, and it can definitely be exacerbated by medications, etc. I would urge a candid discussion with her primary doctor or someone similar with a broad knowledge of issues that she's facing along with the diabetes and kidney issues.

[dreamwalker1016]

has she had a thyroid test (T3 and T4) to see if her thyroid is underactive? This can cause obesity and feeling like you want to eat everything in sight as well.

[Blackknight1989]

This is a real and common problem with CKD and diabetic patients with other comorbid conditions (such as your mom’s problems) when restricting diet to help with those issues. I know this may sound ridiculous but in some it is due to malnutrition specific to what she is eating. For example, if restricting protein as is often recommended, that can cause the hunger feelings because she isn’t getting enough protein. The remedy according to the NKF KIDGO guidelines is specific protein supplementation. Without enough protein muscle tissue starts to waste and put those by-products in the blood and urine. This both destroys kidney function and causes (sometimes severe) hunger issues. If available please request a RENAL diabetic dietitian referral from your primary care or specialist doctor. There are several studies and articles specific to this available on the web in the US. If interested I can help get you started on the links if needed.

Others have offered other ideas and opinions that have merit. I did not see this specific issue mentioned in those replies so I thought I’d add it. I haven’t researched this issue much but have run across the specifics in other CKD/HBP/Weight Management research.

Just my experience and opinion and shouldn’t be used as medical advice because I am not a doctor or a medical professional.