Appointment with diabetic nurse / pain management clinic / hip & knee consultant

[donnellysdogs]

If he goes on to insulin they must give him a meter and tell him about dvla requirements to test pre driving and 2 hourly at least.

They also need to find away to get him out of his negativity towards his health. I would be mentioning this at the appt and telling him bluntly that diabetes and injections is not yhe end of the world... Better than losing your sight or legs. This appt is the best place to mention this... Diabetes does not mean dying... It could give him a new lease of life if he let it and accepted it and did something about it.


Loving life

 

[Molly56]

Gliplizide is not the same drug as gliclazide. http://en.wikipedia.org/wiki/Glipizide
Gliclazide is not marketed in the US so that's probably why it's not there. You might find it under diamicron.
It's probably better to talk to a pharmacist, that is their field.

And yes do try to impress on him the necessity of having his foot looked at. If it's open then it can become infected.

http://www.everydayhealth.com/diabetes/type2/treating/tips/treating-a-blister.aspx

@phoenix Thanks for the correction on the gliclazide point....I had obviously jumped to conclusions that I shouldn't have done. Anyway, I plan to take the prescription into the pharmacist when I get round to it and get their opinion on any potential conflicts in medication as they are the experts.....the website was a good starting point though in looking at the different combinations and potential issues.

Will keep an eye on his foot and try my best to encourage him to get it looked at.....I have a feeling that the wound was open and am fully aware myself of the problems that this could lead to if it were to become infected.....but if he won't get it looked at I can do nothing about it. .....so frustrating but what more can I do?

 

[Molly56]

If he goes on to insulin they must give him a meter and tell him about dvla requirements to test pre driving and 2 hourly at least.

They also need to find away to get him out of his negativity towards his health. I would be mentioning this at the appt and telling him bluntly that diabetes and injections is not yhe end of the world... Better than losing your sight or legs. This appt is the best place to mention this... Diabetes does not mean dying... It could give him a new lease of life if he let it and accepted it and did something about it.


Loving life

@donnellysdogs thanks for the words of advice, the appointment with the nurse was a few weeks ago but I have kept this thread going to raise any questions or issues that have arisen from that appointment and since.

His medication was changed (but not to insulin yet) and he was provided with a meter and told to test before driving - evidently the increase in gliclazide to the maximum dose of 320mg per day has the potential to cause hypos and this is the reason he should be testing.

However, I know for a fact that he has completely ignored this advice and has not / will not test before driving as instructed despite my best efforts to explain that is why he was given the meter in the first place.

Am at a loss to know what else I can do - have considered going back myself to speak to the nurse but not sure if that is possible as I am not the patient, but I was there at the appointment with him so perhaps I can just say how worried I am about him not doing what he was instructed to do.

As for the negativity, two phrases stick with me from that appointment .....the first being " I'm not worried about it, why should you be" and the second being words to the effect of "well I have got to die of something".....I had tried my best to mention my concerns to the nurse but if this was his reaction then what else can I do.

I guess the bottom line is that you just can't help some people .....but then again i am not prepared to give up just yet!

 

[donnellysdogs]

The only trouble is that if HCP's know he is not testing (if you mentioned this) before driving, they (i think) may inform dvla that his licence should be revoked for not complying.

Very hard for you. Yes, we all die of something, but why die unecessarily early? It really sounds as if he really does not want to live.

Incidentally, do friends and family sympathise to your partner.. Are they aware he could have improvements to his quality of life if he made changes.

We all know how much you are trying to help him. I read that you been doing more for your happiness and health.. Keep it up, otherwise all your mind and time will be spent on someone that isn't valuing you or your concerns...


Loving life

 

[Brunneria]

One thing that I would do, immediately and without exception, is refuse to get into the car with him as a driver, unless he tests.

If he wants to kill himself, you cannot stop him, but there is no reason why he should take you with him.

And I feel terribly sorry for the other people he may involve in the crash.

 

[Molly56]

The only trouble is that if HCP's know he is not testing (if you mentioned this) before driving, they (i think) may inform dvla that his licence should be revoked for not complying.

Very hard for you. Yes, we all die of something, but why die unecessarily early? It really sounds as if he really does not want to live.

Incidentally, do friends and family sympathise to your partner.. Are they aware he could have improvements to his quality of life if he made changes.

We all know how much you are trying to help him. I read that you been doing more for your happiness and health.. Keep it up, otherwise all your mind and time will be spent on someone that isn't valuing you or your concerns...


Loving life

@donnellysdogs I agree the first bit is tricky and I haven't yet decided what to do - it feels a bit like whistleblowing but do I have a moral responsibility to raise the issue. As someone else rightly pointed out when I mentioned it earlier (either on this thread or one of my others) how would I feel if he had an accident when driving and killed himself.....or how would he feel / I feel if he had an accident when driving and killed someone else. I guess it depends how I approach the nurse and what I say but I do tend to think that raising my concerns would be the right way to go - what they choose to do or are obliged to do will be down to them.

Having just typed that I am now even more confused as to what I should or shouldn't do......will have to sleep on it / give it some thought over the next few days etc ......and not do anything rash that I will regret later.

As far as friends and family sympathising that is a difficult one as they don't know what the real situation is .....I guess in common with a lot of other people problems are not discussed openly and as I always say no-one knows what goes on behind closed doors.

I have a couple of close friends that I discuss this with and use as sounding boards for how to deal with this but choose not to discuss this with members of my immediate family for personal reasons / my own privacy. As for his family I have tried to talk to them about the situation and to make them aware of what is going on but don't think they fully understand - in fact I didn't find them very sympathetic and at one point was made to feel that I was worrying unnecessarily...

Am trying hard to keep myself occupied with other things and not spend all my time on this ...am keeping my work routine and finding leisure projects to keep me occupied...need to do some decorating around the house and some gardening so should provide a welcome distraction and something else to focus on

 

[Molly56]

One thing that I would do, immediately and without exception, is refuse to get into the car with him as a driver, unless he tests.

If he wants to kill himself, you cannot stop him, but there is no reason why he should take you with him.

And I feel terribly sorry for the other people he may involve in the crash.

@Brunneria ....my sentiments exactly.....I always drive on the occasions when we go out in the car together and have taken him off of my car insurance when I renewed it this month so that he can't drive my car.

 

[donnellysdogs]

Just wanted to make sure you are aware that HCP's are obliged to report to dvla if they have any concerns of the drivers ability to drive safely due to a medical condition.
I, like you are considering, would have discussed with the nurse if my partner was not compliant. Like other poster, I would not get into the car with him driving.

Have you actually sat him down and said " why are you wanting to die early or why do you want to get complications when you could still have a wonderful life?" (How did he respond).

Maybe that a bit of reverse psychology is needed which you are doing by getting on and keeping yourself interested in other things and keeping yourself busy will do something to nudge him.. Perhaps even not mentioning anything to him about D at all for a few weeks. Its amazing how activitys and smiles can unnerve persons that are stuck in their routines, as some people do not want to be left out and smiling all the time is certainly a winner for unnerving people when they are trying to be upset or annoyed with you. For example, if he says "i'm not going to test" smile the biggest smile and walk away without saying anything" -it is the opposite to what he is expecting your reaction to be. He'll wonder why you have changed.. And more than likely will follow you to ask why you are smiling....

It does seem that straight talking doesn't work so perhaps opposite talk may. You are going to have to try all angles to find out if any can work with him.



Loving life

 

[Molly56]

Just wanted to make sure you are aware that HCP's are obliged to report to dvla if they have any concerns of the drivers ability to drive safely due to a medical condition.
I, like you are considering, would have discussed with the nurse if my partner was not compliant.

@donnellysdogs Had come to that conclusion myself which is why I haven't done anything about it yet other than talk about it on this thread. Am still thinking about what I should do.

If he wasn't allowed to drive that would be devastating for him as he has driven all of his adult life and is the only means by which he would be able to get out of the house. Also I am concerned that if his license is revoked then he will just carry on driving anyway.

It is certainly a dilemma as to knowing what is the right thing to do.....am assuming the nurse would have an obligation to report if I raised the issue with her or perhaps she could send some info / talk to him to explain importance / explain consequences of not complying before reporting to dvla.

Anything I have said has just been brushed away so it really needs to come from someone else.

 

[Molly56]

A couple of days ago my partner mentioned that his foot hurt and asked me to take a look as he finds it difficult to see / reach his feet due to hip and knee problems. I noticed that on his right heel he had a small sore where his shoes had obviously rubbed and created a blister...
I did mention to him at the time that he should get it looked at by the nurse but he has dismissed this suggestion - he has got an appointment booked with the podiatrist on 14th August but my feelings are that he should get this looked at sooner than that. I also mentioned that he should really be wearing socks with his shoes but once again this advice was dismissed.
Don't know what I can do other than keep an eye on it and keep suggesting that he gets it looked at - but if he won't then I guess any consequences will be down to him.

Have been keeping an eye on foot problem as he has not seen anyone about it...have just taken a picture on my iPad to show him how it seems to be getting worse (it is difficult for him to see as at back of heel so thought this would be a good move)and suggested once again he gets it looked at......sounds like he is going to see if he can see the Podiatrist tomorrow if he can.....will remind him in the morning

 

[Molly56]

Just a quick update and some news that things are starting to move in a more positive direction....

For the last two days he has tested when he got up in the morning and in the evening after his meal....... On the first morning I suggested it would be a good idea to test but then in the evening he did it without me saying anything....and again yesterday....definite progress in my book for someone who said he didn't need to test!
Anyway the readings so far have been 13.6 / 11.8 / 13.2 / 11.2......and yes I know that these are still high but a definite improvement on earlier readings of 15.0 /17.1 and up to 23.2............so it seems we are heading in the right direction......he also told me that he would like to get them down to about 8.0 ....so we now not only test but have a target to aim for too!!!

The fact that he is now prepared to test has eased my mind a little with other matters of concern (ie the driving) but I am still aware that these need to be dealt with too.....is still on my 'to do' list

As for his foot problem he now has an appointment with the podiatrist on Friday....I had phoned them and asked for an urgent appointment - got one for today but they subsequently phoned him and cancelled / rearranged for Friday....my preference would have been to push for asap but I guess Friday is not that far away.....fingers crossed it doesn't get too much worse in the meantime

Am trying to continue to promote eating the right things and buying appropriate food to snack on so some progress there too.

Seems that things are slowly beginning to move in a more positive direction .....just a case of taking it step by step and hoping that nothing happens to upset the progress made so far

 

[Brunneria]

That is really good news.

Sometimes it takes something concrete (sore foot) before we accept there is really something wrong...

I hope he doesn't have an attitude relapse when his foot is better!

 

[Molly56]

That is really good news.

Sometimes it takes something concrete (sore foot) before we accept there is really something wrong...

I hope he doesn't have an attitude relapse when his foot is better!

@Brunneria to be honest I don't think he sees his foot problem as a problem......the fact that he can't see it or feel it means it is not there.

If I had not made the appointment for him he would have let it to his next regular appointment on the 14th.....having read on this forum / website I know that getting this looked at is a matter of urgency as things can develop so quickly.

Hopefully the appointment on Friday won't be cancelled by either party.

The improvement in attitude seems more general rather than relating to his sore foot so hopefully this will continue and we can build on it.....

 

[donnellysdogs]

You are making progress if he setting a target of 8.0 and testing....make sure when he gets to 8.0 that he has heaps and heaps of praise. Just a little imorovement like a blood test without asking deserves a "thanks, I appreciate that!"
Well done you and for foot too.



Loving life

 

[mo53]

Well done. Things are moving. I bet yiu are relieved.

 

[Molly56]

Not quite sure what progress if any is being made at the moment.....

He did test for a few days morning and evening ....the last time was the day before yesterday with readings of 12.2 in the morning and 16.3 in the evening.....have been trying to cook / buy / suggest the right kinds of foods but I did notice the return of the customary bowl of cereal in the evening last night.....I was doing some work in the other room but could hear the clink of a cereal bowl in the kitchen

His foot problem appears to have got worse...he is seeing the podiatrist tomorrow afternoon after the appointment for Tuesday was cancelled / rearranged....it is now almost two weeks since it was first noted so plenty of time for an infection to have set in, it does look rather red and inflamed around the area now. Will await the podiatrist verdict tomorrow.....will probably need antibiotics and numerous return visits to hopefully get it sorted....am hoping it doesn't develop into anything more sinister....especially as we are due to go away on holiday in early October.

Have spoken with pharmacist today when I dropped in his repeat prescription and they can do a review of his medication to see if any of them contradict any of the others......will just involve a five minute appointment / discussion to take details of medical history etc. Think this is well worth doing so will probably arrange for next week sometime. Our local pharmacist is so helpful and always willing to give good service....in fact the prescription was ready and waiting to be handed to me by the time I had walked up to the local supermarket and back

Feel that I am running out of energy at the moment ....with so much to deal with it is starting to get to me a bit....think I need to just back off a bit and allow things to run their course and be there to pick up the pieces when required.....not much else I can do.

Perhaps I will feel differently in a few days time but really need to think of myself and have some 'me time' for a while

 

[Molly56]

His foot problem appears to have got worse...he is seeing the podiatrist tomorrow afternoon after the appointment for Tuesday was cancelled / rearranged....it is now almost two weeks since it was first noted so plenty of time for an infection to have set in, it does look rather red and inflamed around the area now. Will await the podiatrist verdict tomorrow.....will probably need antibiotics and numerous return visits to hopefully get it sorted....am hoping it doesn't develop into anything more sinister....especially as we are due to go away on holiday in early October.

Perhaps I will feel differently in a few days time but really need to think of myself and have some 'me time' for a while

Following his appointment with the podiatrist today it seems that he now has a foot ulcer - am not surprised given the amount of time he has left it without seeing anyone. Will have to wait and see how this develops - was a bit surprised that he wasn't prescribed antibiotics if it is infected but then the podiatrist must know what she is doing.

Follow up appointment is next week on the 14th which was his original appointment date so will have to see what happens then. He doesn't seem bothered by it so I guess on that basis, why should I be?? (but of course, I do worry....it's hard not to)

As for me - have been out today for some retail therapy and lunch with my son at Pizza Express- opted for the salmon salad which was really tasty rather than the pizza - I think all this eating healthy is rubbing off on me so not a bad thing!

Next thing to worry about - my son's A level results next week and whether he gets into his choice of University......fingers crossed for a good result!

 

[donnellysdogs]

Good for you Molly for having good me time with your son (does that make sense). Salmon would have been my option too!

Your partner, well, it's still tough on you. I would actually log yourself at the GP practice as your partners Carer if your partner would agree... You are after all the only person really in the relationship/family/friends that is actually caring for him.
However, I also find it strange that he has an ulcer forming and no antibiotics, but perhaps that's the way things are done. I don't know to be honest. Was he given any other instructions?

I hope your son gets on well with his future plans.



Sent from the Diabetes Forum App

 

[Molly56]

Good for you Molly for having good me time with your son (does that make sense). Salmon would have been my option too!

Your partner, well, it's still tough on you. I would actually log yourself at the GP practice as your partners Carer if your partner would agree... You are after all the only person really in the relationship/family/friends that is actually caring for him.
However, I also find it strange that he has an ulcer forming and no antibiotics, but perhaps that's the way things are done. I don't know to be honest. Was he given any other instructions?

I hope your son gets on well with his future plans.



Sent from the Diabetes Forum App

@donnellysdogs I wasn't there so don't know what other instructions were given....if there were any I very much doubt that he would have remembered them anyway.....or only remembered the ones that he wanted to.

He did tell me that she told him not to wear shoes around the house - I guess this is so that they don't rub on his heel where it is. I have reminded him that he should really be wearing socks but he refuses to do this.

Was surprised too that no antibiotics were given as it clearly needs something to help it heal - don't know what is under the dressing though......but may find out later as it is already coming off....

Would presume that the podiatrist knows that he is diabetic but not the extent of the problem and that his bs levels are so high / out of control....I would assume this is relevant information when dealing with a problem such as this in terms of determining the potential for healing and hence the treatment given.

Can only see it getting worse at the moment but lets hope that I am wrong.

 

[Molly56]

Was just wondering if anyone had any experience of or knew about the healing time for a foot ulcer......I know of course it will depend on many factors including its current condition and treatment given but just wondered if there was some time frame that is to be expected in terms of minimum expected healing time
.
One of my reasons for asking is that we are due to go on holiday abroad for a couple of weeks in early October....have just counted in my diary and that is only about eight weeks away.......could the foot ulcer have got better by then or should I be preparing myself for the scenario that it won't be healed.

We have existing annual travel insurance but I am guessing that this will not be covered by that as it will be a known pre-existing medical condition.

Should we (or my partner as the travel insurance is in his name) be informing them of this now or at least before we travel.

Depending on how the ulcer develops / improves should he get some form of notice/letter from the podiatrist to say that he is fit to travel......and what happens if she advises him that he shouldn't.

Is a difficult situation as he still does not see it as a problem and his view is that nothing will stop him going on holiday.....but just another thing for me to worry about.

I do not attend the podiatrist appointments with him so don't know what has been said....I have suggested that he tells her that we are due to go away but doubt that he has done so ( he certainly won't be asking the questions that I have above)....not being the patient myself I don't know if I can contact them and ask the questions myself or whether they will discuss this with me due to patient confidentiality etc

Any advice would be appreciated, thanks