What to expect with T2 going onto Insulin + dementia symptoms

[MidnightMay]

I would like to understand more about insulin management and how this may then work for my dad who has dementia symptoms and unlikely to be able to self manage, currently carers go twice daily to give medications.

I want to go prepared for the appointment with the diabetes nurse in a few weeks so that I can ask further questions.
They mentioned at the last that moving to insulin was likely if the GP HbA1c result is still near 100. Not seen GP's result but private blood test not long before was 103. He's on max Glicazide, his glucose readings on Libra2 did come down a bit initially but recently high again possibly diet related as he can't moderate portions and is eating a lot of bread and occasionally other unsuitable foods, he has carer visits but unsupervised most of the time. Despite eating a lot he's very slim.

His private blood test also showed vitamin b12, vitamin D deficiency and borderline low iron stores, which I hope to see his GP soon to resolve. It was mentioned in blood test report that Metformin reduces b12 absorption so I wondered if this is known why don't practices check b12 at diabetes annual review or offer regular injections to those on Metformin given even if taking oral supplements may not be helping.

You can have b12 injections, fil has them, 100+ is very high though, is his diet managed? Does he have carers or support?

@LIZS

Currently the carers do 2 short visits Morning and evening but it can be anytime in a 2-3hr window. I'm not sure how carers will be with insulin as have said their current clients all self inject.

In the past dad's mainly refused to let the carers assist with meals or anything else other than the meds. A local relative checks in daily and takes dad shopping etc but frustratingly although they're quite a militant T2 diabetic themselves they don't seem dissuade dad from buying unsuitable choices like I'd do, I've told relative about the bread consumption and that he can't moderate. I can only visit every couple of weeks unless I've had weekly appointments I need to accompany him to and tend to stay overnight or an extra day when I do.

I'll attach 3 days of my cam food monitoring some days are bit better than others really.
Foods not ideal really given limited ability to prep, he has Meals on Wheels hot lunch+ soup delivered daily and I stock fridge with selection of curry/rice ready meals on my visits as diabetic relative told me rice was better option than potato/pasta and were low sugar and longer use by, they all have pretty much same cooking times too. He's reliant on seeing things in the fridge to remember it exists which limited my options tbh he sometimes chooses a ready meal but often defaults to sandwich/toast/soup+ bread etc. I've tried adding vegetables and more healthy things to fill up on in fridge but they just get left to go off.

Do high sugars make you feel more hungry? As I'm surprised at how much he can put away in a short time span.

thats a lot of carbs and probably why he’s so high. If he’s going onto insulin twice a day it’s likely a mixed insulin which will mean he needs to only eat set amounts of carbs at set times, not a constant stream of bread etc. I’d ask what diet plan is needed alongside the insulin, it’s very important to eat the right amount of carbs at the right times on mixed insulin.