"Brittle" Diabetes

shel · #1 (**permalink**) 01-04-2009, 09:21 AM

A dear friend, an 80yo woman confined to a wheel chair, has "brittle" Type 2 diabetes. Her blood sugars are all over the place, frpm an ocassional low in the 60s to highs around 400 - usually she's in the 150 - 300 range. I've tried adjusting her diet but that doesn't seem to help much. Any thoughts on how best to control her highs and wild spikes?

Subby · #2 (**permalink**) 01-04-2009, 09:53 AM

Just wanted to say, good on you for helping. I don't have much to say except, any specific details you can give might help answers jump out for people. Do you know what medication? What are her eating habits? Do you see a link between anything and those highs? Do they happen with certain events or certain times of day?

Good luck.

Barberian · #3 (**permalink**) 01-04-2009, 11:00 AM

The only suggestion I have is to keep a log of food, activity, and blood sugars to see if there is a correlation between them. Probably there will be anomalies where you won't see a relation, but it might over a few weeks time show a pattern.

art · #4 (**permalink**) 01-04-2009, 11:42 AM

what medication is she on now?

Seems with swings like that insulin may be called for.

Art

Psycho Penguin · #5 (**permalink**) 01-04-2009, 12:14 PM

I would definitely recommend insulin, since she can't really do too much exercise if she's 80 years old and confined to a wheelchair.

shel · #6 (**permalink**) 01-04-2009, 07:14 PM

Quote:

Originally Posted by Subby

Just wanted to say, good on you for helping. I don't have much to say except, any specific details you can give might help answers jump out for people. Do you know what medication? What are her eating habits? Do you see a link between anything and those highs? Do they happen with certain events or certain times of day?

Good luck.

She takes Humolg three or four times a day with the amount adjusted to her bs readings. At night she takes a long-acting insulin - Lantos? I've got the info in another place, not right here right now. Her eating habits are erratic, but her sugar levels seem almost independent of her meals. I'm trying to control her diet both from the standpoint of ingredients and portion control, but she has a couple of caretakers that aren't looking after her properly. One bought her a bag of potato chips and when I arrived she was scarfing down chips dipped in sour cream. In two sittings she ate more than 1/2 of a large bag. When she sees me, she's on good behavior, in part because she knows I won't accept any cr@p from her and in part because I'm diabetic and in good control of my situation - and she knows I know what I'm talking about.

Unfortunately, I can't control things 24-hours a day. Her family is of little help. I had her bs running @ 85+/- for a few readings and her daughter saw that and decided it was necessary to raise her blood sugar - and this was immediately after I had a long discussion with the daughter about what normal bs is and what to aim for.

I guess I'm frustrated with how she gets treated and how she behaves, but I do want to do the best I can for her.

Here's an anecdote that tells the whole story: we were having dinner one night and her caretaker asked if she wanted a baked potato. My friend asked for a large one, with plenty of butter, and the caretaker was about to give it to her. I walked into the room and my friend said, "No, I'd better only have half of a small potato."

Subby · #7 (**permalink**) 01-06-2009, 08:08 AM

It soulnds like you have uncovered the primary causes of her instability. I wish there was something better I could say, except that... its her choice to make poor decisions when you're not around.

That's not a judgment... it's just the way it works... she has to want to do it, she has to drive it, she has to resist other's lack of vigilance/knowledge about her BG's. From your words it sounds pretty clear she may be rather stuck in her ways (not surprising I suppose at that age anyway?)

The only way I could see you making more progress would be to get the other people around her to modify their behaviour and not do the wrong thing by her/ exert a more positive influence, which from the sounds of it is not a very promising enterprise.

It's small, but I wonder if you might at least try and effect a lower GI trend to her diet. For example, actively give her lower GI bread, see if she will substitute her current brand, introduce her to sweet potatoes instead of normal, get her to try diet sodas if she currently drinks normal, or fruit juices with no added sugar, etc etc. I'm not sure if you could actively get her to try these things and then get it to stick on the shopping list, but it's a suggestion.

shel · #8 (**permalink**) 01-06-2009, 08:41 AM

Quote:

Originally Posted by Subby

The only way I could see you making more progress would be to get the other people around her to modify their behaviour and not do the wrong thing by her/ exert a more positive influence, which from the sounds of it is not a very promising enterprise.

I'm trying, but progress is slow and halting. Everyone's an expert <LOL> and some of her caretakers are truly igorant about nutrition for diabetics, and they also follow June's orders instead of actually taking care of her. However, one of the caretakers has asked me to teach her about diabetic diets and even to prepare a menu and some meal choices for her. Maybe it's a start.

Quote:

It's small, but I wonder if you might at least try and effect a lower GI trend to her diet. For example, actively give her lower GI bread, see if she will substitute her current brand, introduce her to sweet potatoes instead of normal, get her to try diet sodas if she currently drinks normal, or fruit juices with no added sugar, etc etc. I'm not sure if you could actively get her to try these things and then get it to stick on the shopping list, but it's a suggestion.

Actually, I've been giving her a low glycemic bread that she likes, and have been trying to wean her off milk - that's a slow process. We don't drink sodas, and I try to water down any juice that June drinks. Actually, she's pretty good about not drinking sugary drinks like OJ, etc. I never give her white potatoes, but she has a stash of almost twenty pounds that she gets others to make for her. I bought her some sweet potatoes recently - she likes them - she likes many foods that are good for her - but she also likes the junk and the high-carb and high glycemic foods.

I'm trying to be the one who does the shopping so the food in the house can be better controlled. That's starting to show results.

Progress is slow <sigh>

You're right - she has to want to make the changes, but the others who are in her life have to want to help her rather than just serve her whims. There's a clash of egos here - the live-in caretaker doesn't like the visiting caretakers, the visiting caretakers think they know best (because they give June what she wants), and the family thinks June's high blood sugar is just something that has to be lived with. The doctor thinks a bs of 130 is "normal" and acceptable while I'm shooting for bs readings in the mid-eighties and even a bit lower.

She's legally blind because of retinopathy caused by her diabetes which wasn't properly treated or cared for. It's sad - she's slowly killing herself and no one is really willing or able to help. I gave one of her daughters some material about diet and treatment, and while she's read it, and tries harder than the others in June's life to keep June on track, it's still not enough. There's only so much she can do.

Thanks for your suggestions. I just had to vent a little - the situation is so frustrating.