My dad (again)

[TooManyCrisps]

I've posted about my dad before but am looking for some more advice.

Dad has had T2 since he was in his early 40s, and was put on insulin after about 3 years. He's now late 70s so has been on insulin for over 30 years.

His diet isn't good and he doesn't follow the NHS advice about eating. Fair enough, neither do I as I do LCHF but dad eats lots of carbs usually. Hus blood sugar are always high.

However he has recently had a long period of hospitalisation and illness and has really gone off his food. He's eating relatively little and has lost weight. So now he's earing mainly salads with maybe a piece of ham or a hard boiled egg.

So far so good. But he seems to think that as he's hardly eating anything he doesn't need to take his insulin. The diabetic specialist did change his routine so he's now only injecting once per day (18 units long acting, 14 short). But Dad hates injecting so has now started skipping injections. I went to stay with him last week as mum had to go away for a few days, and one morning he said he hadn't taken his injection as his blood sugar was "only" 21. He knows perfectly well that this is too high.

He's already got very bad diabetic neuropathy in his feet and legs and has now started to lose sensation in his fingers.

Part of me says I should stop nagging him as he's nearly 80 and can done hat he wants. But his Ill health is taking a huge toll on my mum who is very fit and active but getting worn down by this. Also, if he loses sensation in his hands he will be much more dependent, have to stop driving etc.

Any ideas as to how to get through to him?

 

[Brunneria]

Hi,

I am sorry, I don't have any suggestions.

With my own father, I have often felt as though I was banging my head against a brick wall, but his last HbA1c was down a bit, which means he is doing something different - but I wouldn't claim any credit for that. He is the one who makes the decisions on what he eats, and so on.

What I suspect happened, was that last summer he felt very tired and was limited in what he could do in the garden - and he LOVES his garden - which may have given him the motivation he needed to reduce the raised blood glucose. Another motivation may have been him finding driving more challenging, and their car is their lifeline, because of where they live.

So how is that relevant to your father?
Only that until your father finds something that motivates him to change, he won't. No idea what that motivation may be, but it will take him wanting to change before he makes any changes.

Sorry I can't help more. I completely understand how distressing and frustrating it is, to watch the situation unfolding.

 

[KK123]

It is a difficult one. I think I would say to your Dad that if he 'won't' or 'can't' look after himself by missing his injections, you are going to speak with Social Services and arrange for them to come in once a day to give him his injection. They will do this by the way (they were coming in to do my Mum's injections 3 times a day when she couldn't manage any longer). I know your Dad is mentally capable so he may just prefer to start doing it properly rather than have Social Services involved. Perhaps imply to your Dad that it's his age that's muddling him up, that's sure to get a 'I'm alright and I'll do it myself' response.

 

[MikeTurin]

It's possible for him to use a pump?
I have seen some elderly people, that after have been in the hospital, they slowly stated to losing interests and energy, eventually refusing to get hospitalized again.

 

[TooManyCrisps]

Thanks for all your responses. It is very frustrating. He is very capable of giving himself the injections, he's been doing it for 30 years, he just isn't keen so I don't think he would be eligible for care workers or nurses to inject him. He's very stubborn!

He would hate to give up driving so that may be the impetus he needs. My mum drives and they live in a small town where he can get to shops on his scooter, so it wouldn't be a disaster but psychologically it would be a big deal. I might stress that aspect to him.

 

[TooManyCrisps]

And I'll suggest he talks to his DSN about a pump. So thanks for that suggestion

 

[catapillar]

Insulin pumps aren't prescribed tp type 2 diabetics unless there is some other clinical need for them. As your dad is perfectly capable of doing injections there isn't. With a pump you would still need to bolus for every meal, the pump doesn't do it automatically. When using a pump to bolus you need to know the exact carb content of the meal. If your dad is on fixed doses then he's not carb counting and not experienced enough with the carb counting skills that are required to use a pump.

 

[novorapidboi26]

If I was there now I would try and explain to him how the basal/bolus insulin's actually work.....

you always need your basal......and if you eat carbs, you need the bolus......and confirm also that if he is just eating salads, then yeah, no bolus needed, build on that point....

must be hard though.......

but well done to him for going this long, also pat him on the back for that.....

 

[TooManyCrisps]

Thanks. I don't know anything about pumps so that explanation was useful. It doesn't sound like that would be an option.

He doesn't carb count. Before being in hospital he ate quite a lot if carbs - big fan of baked potatoes and wholemeal bread. But he has really gone off food. Mostly eats salads and soup at the moment, without bread. He's also on a fluid restriction so isn't drinking any alcohol whereas before he was very fond of beer. Yet his blood sugars are still high.
I don't live nearby so won't see him again for a few weeks but wil try to talk to him again. I don't know anything about insulin or what bolus really means but he's been doing it for so long he ought to know himself.

 

[novorapidboi26]

Has he been shown how to count carbs and turn it into an insulin dose?

 

[Phoenix55]

There comes a time when you have to step back and offer support to the parent who needs it. My father smoked cigarettes until my brother said that he wanted his Daddy around while he grew up, Dad gave up the cigarettes and took up smoking a pipe He lived to see my brother graduate but not much longer.
Like all drugs he has to give up carbs for himself. He knows the effect that high bg has and is having, I suspect that he also knows that it 'presses your buttons' when he tells you a high reading or that he has not taken his injection. Next time tell him that he already knows what you think about his high blood sugar but it clearly doesn't make any difference to him that both you and your mother want him to be healthy for as long as possible. He is an adult and capable of making his own decisions but they have consequences, and although you are heartbroken by his decision not to take care of himself you need to support your mother and to look after yourself.
He will still try to get a rise out of you, don't ignore him but if he tells you his bg tell him yours, if he says he has missed an injection tell him that you have managed to stay drug free then change the subject to something he enjoys - gardening, whittling, photography. You have made it clear that you still love him but will not continue to argue the same point repeatedly. You have to step back for your own health and for the sake of your mother who needs support too. It is hard, but sometimes you have to let people live their own lives, even though they seem to have pressed the self-destruct button, and you may not be the person who will make him change his ways.