Care and feeding of a diabetic

Parent Cafe
1

<p>My father is driving me crazy! This is a 79 year old man that is active and smart, but when it comes to taking care of his diabetes, he becomes stupid or stubborn. As long as I can remember he was labeled diet control diabetic; later he began taking oral medication. About 2 years ago he started on insulin, using one of the pre measured pens. </p>

<p>His blood sugar levels were all over the place and I would nag him about going back to the doctor to see if they could get it under better control. I was upset as he could never get an appointment with his endocrinologist, only the PA. When he would call, the PA would adjust the medication over the phone. When he finally got in for an appointment, the PA changed his meds and gave him a bit more information. I was having trouble understand if my dad just really wasn’t giving enough information to manage the diabetes himself, or if he was being non compliant. While I think it is a little of both, I am seeing now that he just doesn’t take care of himself.</p>

<p>The main problem I see is he doesn’t eat right. He eat good foods, just not enough. He doesn’t like that the insulin has made him gain weight, so that could be part of it, but I also think he just isn’t hungry as often. I know as people age they do not have the appetite they once had (I can not wait for that day for myself!!) Dad sleeps late and then gets up and has a cup of coffee and maybe a piece of toast, along with his morning insulin. If he eats lunch it is not until maybe 3:00, and then he doesn’t really want dinner or only eats a small dinner with his insulin again. Some days he might give himself insulin at meals with no protein. Well guess what happens; he gets low in the evening, around 40-50!</p>

<p>I have told him he needs to eat 3 meals a day with snacks, and have explained he doesn’t have to eat a huge meal, but he needs to eat. My mother is a excellent cook and they love to go out to dinner at good restaurants. He just either doesn’t understand the lows are due to his eating or he doesn’t care. I believe he can adjust his insulin at his meals, bit he doesn’t check his blood except in the morning and at bedtime, so he had no idea what his level is at dinner when he takes his insulin.</p>

<p>Now that I just wrote a book, what I wanted to know is if there is a good book out there for the care and feeding of a diabetic? Maybe he would read it, or maybe I could get my mom to read it. Although, my mother is fed up with him not eating during the day, maybe I can get her afraid enough that she would be more hands on. Again, these are smart, active adults, not frail old people. My dad is always on the computer and know how to research, but I have a feeling he is still in a bit of denial. I told him the other day not to call me when he went into a diabetic coma! He really needs to take care of himself, I don’t know why he has so much trouble with the diabetes, he takes care of all his other health needs.</p>

<p>I am going to check Amazon and the American Diabetes Association to see what they offer in the way of books, but I bet someone here know just the book I need. In order to get my dad and/or mom to read this, I think it needs to be very straight forward, and easy to understand. Maybe it can tell the reader how much of each food group is needed at each meal and with certain amount of insulin. </p>

<p>Thanks in advance for your help.</p>

2

<p>I don’t know of any particular good books. When my husband was first diagnosed with diabetes our doctor sent him to a program with a dietician at the local hospital. It was very useful and informative (not that he follows it much). It might be worth checking to see if there is something like that available locally that your Mom & Dad could go to. I think insurance paid for it.</p>

3

<p>“… (not that he follows it much).”</p>

<p>Sadly, this has been my experience as well. I hope you have better success with this than our family did. With any luck, perhaps early signs of peripheral vascular disease will be a wake up call for your Dad.</p>

4

<p>I agree with the recommendation for your Dad to see at Registered Dietitian. If you Dad’s physician doesn’t have the name of someone he works with, you can go to the American Dietetic Association website (eatright.org) and they have a list of RDs by location and specialty area. Almost all will have experience with diabetics --it’s great if you can also get one who works a lot with the elderly, since there may be other issues there (such as loss of appetite). A couple of sessions with a good dietitian – preferably with both him and your Mom there – could work wonders. Medicare now covers visits with an RD for patients with diabetes (It’s covered as “medical nutrition therapy.”) Good luck to you and your folks.</p>

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<p>I actual know of a dietitian who happens to be diabetic herself, but when I have mentioned to my mother that they go, she hasn’t been interested. I am at the point that I am going to kidnap my father and make him go!! Maybe if Medicare covers it, he will go. I will look into it.</p>

<p>My parents are very capable of taking care of themselves, and they do. But for some reason the diabetes seem to be an issue; maybe more with me than my dad. He just does get that having lows often is causing additional damage to his body. This from a man that has had two major heart attack at a young age and an abdominal aortic aneurysm which he has a stint in that has had to be repaired or replaced twice so far. Still don’t get why he can take care of everything else, except his diabetes; well, he thinks he does take care of it, just not the way I would like him to.</p>

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<p>There are several “Diabetes for Dummies” books including versions for type I and type II. They have cooking for diabetes books in this series as well. They are fairly straightforward. Check them out in person at B&N or Borders.</p>

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<p>As a type one diabetic I can give some basic advise but I have little experience with type II so keep that in mind. Diabetes is a lot harder then it looks like from the outside looking in. It might seem like it is as simple as just doing such and such but the truth is it is a lot more work then that to have good control. What works one day doesn’t necessarily work the next day. This can be very disheartening and makes it hard to care after awhile. It is also a lot easier to push it out of you mind then do the work it takes for good control. The emotional aspects cannot be ignored because they are inwrapped what is happening on the diabetes front. </p>

<p>If he is on insulin it would be great if he and your mother could learn how to carb count. That way he would have a long acting insulin (basal) which takes care of his insulin needs for his day to day and a short acting insulin (bolus) that would take care of food and when he has an out of range blood sugar. This way if his basal is right then he can eat or not eat as he likes and still maintain good control. This method does take a lot of testing so it depends on his motivation. </p>

<p>With type II diabetes you can have extremely good control, if you work at it. So take heart this is very doable. The lows that he is experiencing are because he is either taking to much insulin or getting a lot of exercise or not eating enough for the insulin he is taking. This is why an insulin to carb ratio would help that way he can take insulin for only what he eats and doesn’t have to eat on a schedule for the insulin. Making to insulin work for you not against you. </p>

<p>Clearly this is too much to explain online but I just wanted to give you an idea. One book I have heard recommended a lot online but have never read because I am type I is: The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker. I hear it is a very well written book by a doctor who has type two diabetes herself. I would also recommend: Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin by Gary Scheiner, this is a book I can personally recommend however I can’t remember how much of type II it covers, so I would look into it before buying. </p>

<p>Since your dad is online, there are some great diabetes forums I could recommend that could help you both. You might get better advise and understanding of what it is all about and how you can best help your dad. Your dad could get a much better sense of how to take care of himself and feel that he isn’t alone in this struggle. Having a sense of community can help a lot. PM me if you need some good forums to check out. </p>

<p>I realize that this is a really hard thing to watch and to try and help. I wish you the best of luck and let me know if you have anymore questions or if there is anything I can do and help.</p>

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<p>How long has he had diabetes?</p>

9

<p>He is intelligent and knows what he has to do so it seems he is choosing not to. You can get all bent out of shape but to me it sounds as if he has decided to live the remainder of his life on his terms and not on his sickness’s. They do get stubborn like that.</p>

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<p>“He is intelligent and knows what he has to do so it seems he is choosing not to.” It isn’t so easy to do what he has to do!</p>

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<p>Also check his medication. There is one pill I know of that my father takes which reduces appetite.</p>

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<p>Denial is not just a river in Egypt.</p>

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<p>Pray tell - which pill is this?</p>

14

<p>He doesn’t have a reduced appetite like I see in many elderly, it is more he doesn’t feel the need to eat 3 regular meal and 3 snacks a day. My parents and I have never been breakfast eater, but he will have some toast or cereal with his coffee in the morning. Lunch might end up being cheese and cracker or a sandwich if he makes time for it. His big meal is usually dinner, unless he has gone out for lunch with friends, and then he doesn’t want much for dinner. If I skip dinner because I had a huge lunch it isn’t a bug deal; but he is injecting insulin at dinner time, so for him it is a big deal.</p>

<p>fairyblood-I am familiar with carb counting as my cousin’s daughter has type one. I am sure it would also work for my father and I will ask him about it. His insulin pen is a pre measured with a mixed insulin. I am not sure when he is suppose to change his dosage, but I know he can adjust it. If he doesn’t check his blood before he injects his insulin, I am not sure how he know how much to use. I will look into the books you mentioned as I think I will have a better chance of him reading a book than check in on forums.</p>

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<p>He would need to switch from the premixed to two separate insulin’s to use carb counting but it sounds like it might work better for his lifestyle. </p>

<p>I hope the books will be of some help and that he starts having an easier time at it.</p>

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<p>snowball, I’ve been through it with my dad who passed away 5 years ago. A longtime diabetic, he finally started paying more attention when his eye doctor told him his vision was failing as a result of the diabetes but, at that point, the damage was done. That was a wake up call for him as he was very independent, loved going online to research stocks and other interests and often jumped in the car to visit friends and family rather than pick up the phone. </p>

<p>Unfortunately, the eye doc only restricted his night driving and, six months later, Dad made a left turn onto his street, in broad daylight on a straight road, right in front of an oncoming SUV. He told me in the ER that he didn’t see the other car at all! His Prius did a wonderful job of protecting him, and the other driver walked away, but he wasn’t a regular seatbelt wearer and a broken hip at age 76 led to organ failure, coma, and death within two weeks.</p>

<p>I’d had my suspicions that his eyesight wasn’t quite right - he seemed to drive in the center, or left of center, and had asked me to write out checks for bills he paid and other clerical tasks. I have been kicking myself ever since that I didn’t call his eye doctor myself or just take away his car keys. I live nearby and had asked him, and my mom, to just call me if they needed something from the store or wanted to go someplace but they never wanted to “bother” me. It would have been a huge fight for the car keys, but I can’t shake the feeling that I should have been more aware and taken them from him. I think the change was so gradual that he didn’t really think about it either.</p>

<p>Anyway, don’t know if your dad’s had an eye exam lately but perhaps a discussion with his eye doctor would help. And, if he’s still driving, please watch for small signs of deterioration as they won’t necessarily be obvious to him! Good luck!</p>

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<p>Good suggestion about the eye doctor, and I will check. I think he has been recently as he ordered new glasses a few months ago, but it is worth looking into.</p>

<p>sk8rmom, you dad sounds like mine as far as being independent. I am so sorry you lost your dad, but I am sure you would not have been able to stop him from driving. I think of the hardest thing an adult child has to deal with is getting the keys away from their parents. My FIL is 90 and still drives everyday, yet his children talk about whether he should still be driving. As far as we know he drives well, just too slow. Not one of the 4 children want to discuss it with dad as driving to run an errand is the only activity he does. Otherwise he is in the home and they feel it is good for him to get out and go to the grocery store and drug store a few time a week. I am staying out of this, the children can figure out what they want to do on their own.</p>

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<p>Thanks for condolences, snowball. Please feel free to share our story w/his wife and other kids, even if he isn’t concerned about the possible vision loss. Ask them to make sure he is ALWAYS wearing his seatbelt (sometimes stiffness in shoulders or hands, etc. makes them not want to do this). Also, might see if someone will tag along with him on occasion to quietly observe his driving skills. The field of vision seems to decrease slowly, sometimes peripherally and sometimes dead center. My dad got new glasses, and had lasix surgery in the last few years, but apparently that does not help with this problem. We were so lucky that he didn’t run over a child or injure the other driver!</p>

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<p>Diabetes seems to be a very diffucult disease to manage. My mother in law has it as well as a very close friend of ours. There seem to be so many variables to the sugar monitoring that no wonder they have so many highs and lows.
Both have come dangerously close to passing when sugars got too low, due to a cold or flu like sickness. Just last week, our friend, who unfortunately lives alone went into a coma. Between his mother, sister and us, we have to check on him often when he isn’t answering his phone. He is a great guy, but gets pretty ugly when his sugars are low …and really stubborn about accepting help when it is clear he is in trouble.</p>

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<p>That’s exactly what happens when you have very low blood sugar. You get combative and refuse help. It takes a lot of effort to get a glass of juice in someone with low blood sugar, and it’s amazing how quickly the blood sugar rises after the juice, when the person can think straight.</p>