Tactfully getting someone to check their sugars??

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sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/10/2010 9:23 AM (GMT -7)   
Hi...this is my first visit to this forum. I am not diabetic but I hope you can help with my question. My older brother is diabetic...and very bad. His pancreas has completely stopped producing insulin. He is on  a pump and semoline pen. He is fighting a staff infection as well so the dr said his body would be really outta whack. I don't understand all of it...but have been exposed enough to have pretty good knowledge.
 
We all went camping this weekend and he had many times where he just wasn't seeming right so I would ask him to check his sugars. His pat answer is "I'm fine"...when it is obvious to all but him that he is not. It is very scary b'cuz he has so many other health problems, I worry about him falling when he is stumbling around. He swears he has it under control and can see it coming a mile away...but he is soooo wrong. I don't know how to react in the right way. I know it is scary for him too and making him feel bad is the last thing I want to do but I found myself having to be very aggressive and demanding and MAKE him go do it. Only to find out he is at a 51. Do you have any advice on how family can deal with these situations without making the person feel bad? Any advice would be appreciated.

The Watcher
New Member


Date Joined Aug 2010
Total Posts : 16
   Posted 9/10/2010 11:27 AM (GMT -7)   
Well, I can tell you just like a person loosing weight they hate the food police asking them..." Are you sure you can eat that or should you be ""??? I am no longer on any meds for being diabetic because I got my weight and sugar under control by proper food intake. It is very difficult to listen to the excuses so many NON compliant diabetic's use because .....until I got my act together I was one of them . My best friends mom and another friend are BOTH the type of person your dealing with and it can be very unsettling when they won't listen ...if I had any advice for you it would be to offer alternatives like on a trip like that bring proper balanced snacks and eat one with them so you know they are eating and keeping the sugars at balanced levels . You may want to find a diabetic counselor that can further their knowledge because alot of times what they think is the right choices puts them at serious risk . Someone on insulin more than ever REALLY needs to watch their levels ....just lead with love and support and remind them this is why you are helping...not judging ....blessings ...
44 year old female , I have survived three strokes, 2 bouts of cervical cancer, I have fibromyalgia , Degenerative disc disease, arthritis in my hip, neck and both shoulders and my new condition is hypersensitivity pneumonitis, interstitial lung disease, pulmonary fibrosis and wegeners granulamatosis currently taking IMURAN , sulindac, skelaxin

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 9/10/2010 2:21 PM (GMT -7)   
I don't know what to say about your brother.  This is a behavioral problem.  How old is he?  I would say that it's like dealing with a person who's in denial and until he is ready to start acting responsibly, there's no amount of persuading, anger, cajoling, etc. that will convince him he should test and take more control over his diabetes.  And the unfortunate problem is that this can be fatal.  Maybe I don't understand pumps, but don't they automatically read the blood sugar and then deliver the insulin?  Maybe others can jump in here and give you more advice.  Sorry I can't help more.
Lanie

diabetes moderator
diabetes type 2 controlled so far by diet and exercise
very low carb way of eating

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/10/2010 4:52 PM (GMT -7)   
Thanks for the responses. I didn't know if I should ask or not. I just worry about him and how best to help him. At home it is just him and his 15 year old son. I feel so bad for his son since during real bad lows...he gets very aggressive and mean. I know he doesn't mean too but its hard to take that back once you repeatedly hurt someone. I don't get into what he eats...he pretty much eats whatever he wants...and doses based on carbs. I wonder if part of the problem is that he doses before he eats...then he may or may not get the food eaten that he planned and have time for it to break down and do its thing in his system. One of the really bad episodes he told us ahead of time that he was dosing for a brownie. I remembered hearing it...but I really don't sit and keep track of what he is eating. So...when I noticed his get bad so fast it dawned on me that he didn't eat the brownie...but had dosed for it. He was nearly falling out of his chair and it comes on so quick. I am not around him much, but we talk about this stuff on the phone. Seeing it first hand...and having any clue how to help if it suddenly turns too far that he can't help himself. Ambulance oviously...and I wouldn't hesitate. I just wish...who am I kidding...I wish he didn't have to deal with it at all but since thats not going to happen...I just wish it wasn't so extreme. As for the pump...he has to test and then enter readings...then it dispenses it directly into his system. Plus he uses a pen but not sure how that all works.

The healthy snacks...yeah that would be nice but he is so set in his ways. I didn't even bring marshmallows and stuff for smores b'cuz I worried about him. After our last camping trip and his smore feast I figured it was better not to even have them there. Instead he made a 9x13 pan of something he called Torte?? I couldn't eat more than a 1 inch square...it was that sweet. Two layers of brownies with coconut/pecan frosting inbetween. Poked holes and then melted fudge frosting and chopped walnuts and poured over it all. On top of all that was a whole bag of chopped Reeses minitures. This is the brownie I referred to earlier.

The wierd part about all of this is he is more on top of his meds and testing before eating and record keeping than alot of people. His dr calls him the poster child of record keeping. It is just that he may have tested an hour earlier but can be crashing just out of the blue. He hallucinates in the sense that things become intense and vivid...then flashes to angry in a blink. Then to try to get him to check based on what we see becomes the problem. I did talk to him again today and tried to explain to him that where he thinks he can see the signs and knows when he is going outta whack...that is not the case. I wish it were that simple. Sometimes he does know...and knows he needs to drink juice...NOW!! Its the other times that have me really scared.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 9/10/2010 6:55 PM (GMT -7)   
You know sometimes a really smart person can be a dumb bunny.  If he's so careful with his records before meals, then he has to realize he needs to log them after.  His doctor should be asking him how his blood sugar is and he should be looking at his blood sugar meter,  too.  If his doctor had any inkling that there are events as you described, I'm sure he'd talk to your brother very seriously.  What also concerns me is his crashing at home with only his son present.  Does his son know how to handle a situation if his dad passes out?  The other thing is his eating habits.  If he's eating brownies made of all that sugary junk, he's playing with fire.  Sure, sometimes we want to endulge but from what you describe, he goes overboard at times.  If he doesn't want to change habits for himself, then he should think of his son.  So many bad things can happen to your brother with all the flipflopping.  Do you think he would consider coming to HealingWell?
Lanie

diabetes moderator
diabetes type 2 controlled so far by diet and exercise
very low carb way of eating

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 9/11/2010 8:06 AM (GMT -7)   
Some of us can have a much harder time managing Type 1 diabetes than some of our peers. (Not unlike Type 2's as well).

I envy those who can cruise through a day of relatively normal BGLs without the constant mental checks and testing to make sure of BGLs. Some of us can be good enough at keeping our BGLs normal that we can lose our sense of going low/hypo (called hypo unawareness).

Most Type 1's put in a LOT of effort to maintain BGLs and because of such, often feel like they've got a 100% handle on things at all times. This is why it gets tricky to tell a Type 1 that they need to check their sugars - it's perceived as a failing, or lack of control, or your Mother or teacher telling you to do something you know you're supposed to (think furrowed brows and looks of consternation :-) Of course my immediate reaction would be "What do you know!?". "You have no idea what I go through and how dare you try to inform me about something I'm an expert on". It's an automatic defense mechanism.

What I realized early on, and continue to work on, is that I'm not always 100% in-tune with how I feel and can't guess at my BGL. If I want to know I have to test. A heart-to-heart with hubby and family also cleared up a lot of things and we came to some mutual understandings. "What's your blood sugar at?" is the line we all agreed to use, for example. It's "code" for them thinking: "I'm not comfortable with what I'm seeing" and triggers my mind to do 2 things: 1) answer the question and 2) test if necessary. It may just be semantics but, my mind goes to answering the question as opposed to being "told" to do something and feeling defensive and resistant about it.

Maybe telling your Bro exactly how (nervous/anxious) you feel and asking if he would assuage those feelings by explaining his side of things to you. Maybe he's not understanding from where you're coming from? Maybe you're not understanding him? Communication is often the key to understanding where each is coming from and setting up some game plans (code words, etc), can also be agreed on. Worth a try?

BTW, what's a semoline pen? Is it Diabetes related?

Hi Lanie - I WISH insulin pumps automagically tested and dispensed insulin like a real pancreas but, we're not there yet. It still takes the individual to set or program the dispensing of insulin. The carb counting and past, present, future calculations are still required. I think of the pump as a permanently inserted insulin needle with pushing buttons instead of plungers :-)

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/11/2010 8:15 AM (GMT -7)   
Lanie...I don't know if he would or not...I could invite him. I know how much he is at risk and it scares me. He has so many other health problems too that it is hard to keep it all straight. Last night we found out that his dr is running another test on him for Multiple Myeloma. This is the blood/bone? cancer that my father died from. They did blood tests on him for it already b/cuz his bones are so brittle. He cracked 4 ribs in multiple places with his own arm jamming into his side. Something else is going on but they are having a hard time finding out what it all is. I guess the blood test came back negative so we were all relieved but the cancer specialist said that you have to do a 24 hour urine study to get an accurate result. So now we wait and pray again that he does not have that evil disease. As for the dr knowing about his episodes...he says he finally told him this week after seeing how scared we were and how strongly we had to act to get him to see that he was not ok. Maybe a blessing is coming out of all of this if he actually did tell the dr. He is worried that they will take his son, and his license. I am of the believe that you get the proper help so that his son doesnt' have to come home from school one day and find him dead. I have tried to tell him that he would feel so guilty and would probably never get over it. Yes he does know how to do the rescue pen...but I hope for his sake he never has to use it. My brother is getting so bad that I worry that he may not have long to live.

So you should do readings again after you eat?? Is that what you mean?? Do you do your insulin before you eat or after?? He crashes so fast I wish he has a way to let the food start working and then do the insulin. It seems like some of his major ones are cuz the med works before the food...and down he goes. At least when he is above normal he is functioning and can dose and bring it back down...its the too low that really knocks him into the dirt...literally.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/11/2010 8:32 AM (GMT -7)   
Phishbowl...sorry we must have been typing at the same time...I didn't see your post. Yes we have been talking about it. We had pretty open dialog about it all along and he would tell me these stories about bottoming out and how scared his son was...but I haven't seen it first had for a while. Actually I had only seen one episode where he dosed for something and then didn't eat it. He scared me half to death. We had to put honey in his mouth but thankfully he came around.

The Semoline pen, if I am spelling it right is something he used in addition to his insulin product. They have him on some new synthetic stuff if I understand right. It just came out a few months ago but I don't know the name so I call it insulin.

we have talked about it alot over the years and he has told us point blank that if you see me starting to not make sense, seem out of it, or anything that is not normal...tell me to check my sugars. So that is what we do. The problem we ran into is when all the routine things were in place it was getting him to see that he was not fine like he seemed to think. I am glad he finally talked to his dr about the extreme and scary fast drops. Hopefully they can come up with a plan to help him. I wish he had home health to stop in to help him and check on him. thanks again for the great advice and just having a place to ask questions. I love him and am really scared that we may not have him for long.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 9/11/2010 7:14 PM (GMT -7)   
Yes, usually we test about 2 hours after eating.  This is to see what effects the food is having on our blood sugar, of course.  I don't take meds, so Kris (Phishbowl) can answer your questions about testing, etc.  Your brother is lucky to have caring family and I'm sure you're very worried.  He's got to realize he needs a better eating plan.  Treats?  Yes, once in a while and he has to test and be ready for it.  He should carry some glucose gel in case he's really low.  He can buy it at any pharmacy.  I've seen it in Target even.  I hope the problem of the brittle bones is resolved.  I know that's worrisome.
Lanie

diabetes moderator
diabetes type 2 controlled so far by diet and exercise
very low carb way of eating

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/12/2010 8:57 AM (GMT -7)   
Ok...yeah he does test a couple hours after he eats. Heck he pretty much checks evey couple hours all day. It's just that it can change so fast. He sounded pretty good last night when I talked to him. The dr wants to try to come up with a way that will signal him when it is going too low since this also happens while he is sleeping. The thing is...I don't know if that kind of technology exists. I guess we can hope there is something available. As for treats in moderation...he says he tells his dr what he eats...and I know he writes is all down for the dr to see. He said his dr told him that he is so outta whack anyways that fudge and pie are the least of his worries. Who knows...all I know is I am worried. I don't know how long a body can survive the extremes. Thanks again for all your help.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 9/12/2010 10:16 AM (GMT -7)   
Sounds like your Bro would be a good candidate for a CGMS (continuous glucose monitoring system).

They are becoming more and more available to our market, have significantly improved technology (new pumps are starting to include them as options) and are covered in many circumstances by insurance now. If your Bro is already on a pump, he's most the way there in understanding how it works. A CGMS is a device with a canula (like a pump), inserted under the skin. It essentially takes a BGL readings at regular intervals and sounds an alarm when BGLs are too low. I've heard them to be quite invaluable for folks with your Bro's challenges.

Sounds like your Bro is doing all the right things to help find some resolution; his log book being the best place to look for patterns. I understand the frustration of trying to do all the right things only to see you've missed the mark - going high or unexpectedly low. Sometimes the tighter control you try to achieve can cause more problems. I've even taken to stepping back from my control once in a while and usually find that I've got better numbers than when I try to focus too intensely on it.

I hope his doc looks into possible gastroparesis, too. It's not uncommon with Diabetics and could be the cause of his sudden drop in BGLs after food. The remedy is often an adjustment in insulin delivery (when, how much, etc.).

I'm glad to hear he sees a doc (hopefully and Endo) and keeps records of food, meds, etc. I can understand your concerns because you obviously love and care about your Bro but.... (and I'm sorry there's a BUT), the only thing you can do is be supportive and understanding and be encouraged to know that he seems to be doing all the right things and is in a doctor's care. If he and his doc are focussed on finding some resolutions, then I'm sure Bro's situation could at least be improved. I guess I'm just trying to encourage you with hope - it's always there :-)

Cheers,
Kris

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/12/2010 10:41 AM (GMT -7)   
Thanks Kris...yes it does help to hear. I do know they have been trying to get a new pump approved so maybe this is the one. That would make sense when the dr said finding a way to let him know when it is going outta whack. I hope it will get approved. I had never heard of gastroparesis is but I looked it up and will ask him about it. I know he is doing everything he can...and he is just as scared as we are about the extreme rapid changes. He has been fighting infections too say they say that affects how your body uses insulin. I appreciate all the help. I will continue to keep the conversation open with him and will ask about the pump and gastroparesis. Thanks again...have a great day.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/14/2010 3:04 PM (GMT -7)   
Hi...just a quick update. I asked my brother about the new pump. Boy was I suprised to find out that he did get the new fancy pump that is capable of reading your sugars and sounding an alarm when too low. I was confused since he didn't have any alarm going off and it sure should have. He told me that medical assistance won't pay for him to have the sensor and attatchments that go with it...I thought this was the craziest thing I have heard in a while. The sensor is around 900 and not sure what else is involved. His doctor sent an appeal but was still denied. I asked him to have his dr try again since his situation has changes so drastically. Hopefully something can get worked out. I can't believe they would pay for the high tech pump but not let him use it to save his life.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 9/14/2010 6:23 PM (GMT -7)   
That's awesome - about the approval for one of the latest pumps. Hopefully having the doc resubmit another appeal will see the sensors/inserters, etc. approved. Insurance is funny like that. Here in Canada, every province has their own medical programs/insurance and in addition, company benefits can run the full spectrum, too. Some of our provinces cover insulin & the needles but not test strips. Others cover test strips and needles but not all insulin. Then there are some federal programs that allow for various tax deductions. Sometimes I think it's all MEANT to be confusing 'cause it certainly doesn't make logical sense most the time :-)

Most insurance right now looks at a pump as a "delivery device", just like needles and syringes and they look at the CGMS as a "testing device", just like the hand held glucose monitors we all use to check our BGLs. Insurance companies seem to move at a snail's pace when adding new coverages. They were slow to start covering the newer insulin (Levemir), insulin injection pens (no vial & syringe; all in one pen), and they're being just as slow about covering a new type of BGL testing device. I'm encouraged that recently they've started to get much quicker about it but CGMSs are really new player to the game (insurance game).

Keep sending in the appeals - it's often persistence that wins. Many aren't covered till the 3rd or 5th appeal just as a standard practice. There's nothing to lose and everything to gain - hammer away! I've got my fingers crossed :-)

Cheers,
Kris

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/15/2010 7:13 PM (GMT -7)   
Thanks Kris...I hope his dr is persistant. I know he has tried to get him into trials...and other sorts of things so I think he will do a good job for him. I was suprised to find out he has had this pump for months now without being able to use the sensing (life saving) part of it. Oh well...hopefully it will all work out. Thanks for all the great advice.

SmurfyShadow
Veteran Member


Date Joined Dec 2008
Total Posts : 2386
   Posted 9/20/2010 3:53 AM (GMT -7)   
Careful with pumps... You need to be on a STRICT schedule, no flexibility. (Personal Experience). My brother has a pump, supper was only a half hour late and we found him outside unconcious in the backyard lawn. I yelled "Mom better call 911" and she yells to my sister to call 911 and comes running with honey and syrup. I sit with my mom and we work as a team rubbing syrup on the gums and under the tongue. Have to be super careful so there is no choking, but by the time medics come, they are usually either awake, or getting close to it. Unfortunally, out of 8 of us, 4 are diabetic... my poor mother deals with 3 of us going into comas (I'm the one who fights the coma and manages to stay awake).
Don't Care Bout Nuffin No More, Guess I shouldnt even be in this world

sobermommy
Regular Member


Date Joined Aug 2010
Total Posts : 80
   Posted 9/21/2010 8:37 AM (GMT -7)   
Smurfyshadow...oh my gosh...that is so scary. I have seen my brother go down once and with the help of honey we were able to keep him from the coma stage. This whole thing is scary. Thanks for the advice tho. Does the pump dose at certain times so you have to eat at a certain time?? You and your family are in my thoughts and prayers.
Trying to keep my focus...

Fibro, deg/bulg discs in neck, rotator cuff tear, exteme nerve pain in hands after carpal tunnel on both, multiple foot surgeries with pain still, IBS, tension headaches, (Lap band)

Savella, MS contin, Vicoden, claritin, prilosec, flonase, vitamins, calcium
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