Gaps In My Knowledge.

[DavidGrahamJones]

My 91 year old father is returning home after 7 weeks in hospital (one week because of a UTI and six weeks rehabilitation). It's highlighted several problems including my father's reluctance to see a GP when he's ill and his loss of feeling in the whole of his left leg, possibly something to do with his refusal to have a stent put into a major blood vessel when they did the other leg to help with blood flow to his amputated toe.

What surprised me the most was that after years of thinking he was using an insulin pen, there seems to be different types. My father takes about 45 minutes to inject his insulin and I have never known why. I have a friend who is type I and he doesn't take more than a few minutes. While in hospital he has been telling me that when they inject insulin it's all done in seconds and I can't really understand how what the hospital uses is different to what he has at home.

I've googled insulin pens and watched the video, which seem to be the same as my friend, so I'm wondering what device my father has that takes him so long. I know it's not an old fashioned syringe.

I'm hoping that somebody might be able to let me know if there are different types of pen and if some are better than others.

Also, because his sight has deteriorated he will now have a nurse coming round to the house to make sure he is getting the right amount of insulin as he can't see the numbers on the pen. Does anybody know if there is something to help blind/poor sighted people with using the pen and dialing the correct number. It's very nice that a nurse will visit 3 times a day, just for his injections, but . . . .

 

[NicoleC1971]

I am type 1 and when I used pens and got lazy it took me longer to inject because the needle was blunt! Also if the volume of insulin is large e.g. more than 6 units maybe he is taking his time depressing the button due to muscular weakness. Does he have enough subcutaeneous fat where he is injecting? Never had that problem but I imaginie a gent of 91 will not have plump legs? The abdomen is the best site.
Also it is certainly unusual but is it causing him any distress or problems? Going too fast can also be inefficient since you lose some of the dose.

 

[Robinredbreast]

Here is a link to the RNIB, also phone or email them with your father's medical history, how he is really coping on his own etc to get some useful advice and support. Has he been tested for dementia, not nice I know, but my dear dad had that. Also his GP and Adult Social Services are there too.
All the best.

https://www.rnib.org.uk/eye-health/...d-eye-conditions/managing-diabetes-sight-loss

 

[Engineer88]

Depending on his hearing the clicks might be able to be counted but I suppose it depends how many of those he needs also. It could be a general reluctance to do it also?

 

[Zilsniggy]

My 91 year old father is returning home after 7 weeks in hospital (one week because of a UTI and six weeks rehabilitation). It's highlighted several problems including my father's reluctance to see a GP when he's ill and his loss of feeling in the whole of his left leg, possibly something to do with his refusal to have a stent put into a major blood vessel when they did the other leg to help with blood flow to his amputated toe.

What surprised me the most was that after years of thinking he was using an insulin pen, there seems to be different types. My father takes about 45 minutes to inject his insulin and I have never known why. I have a friend who is type I and he doesn't take more than a few minutes. While in hospital he has been telling me that when they inject insulin it's all done in seconds and I can't really understand how what the hospital uses is different to what he has at home.

I've googled insulin pens and watched the video, which seem to be the same as my friend, so I'm wondering what device my father has that takes him so long. I know it's not an old fashioned syringe.

I'm hoping that somebody might be able to let me know if there are different types of pen and if some are better than others.

Also, because his sight has deteriorated he will now have a nurse coming round to the house to make sure he is getting the right amount of insulin as he can't see the numbers on the pen. Does anybody know if there is something to help blind/poor sighted people with using the pen and dialing the correct number. It's very nice that a nurse will visit 3 times a day, just for his injections, but . . . .

Pens have the click sound to alert those with sight issues, so that they can count the clicks.....10 clicks would be equivalent to 10u insulin, and so forth.

 

[kitedoc]

Hi @DavidGrahamJones, I thought about how I would give myself a pen injection , starting with my eyes closed.
Where is the pen ? Depending where I was, perhaps it is in a special place, e.g. on the bedside table, or in the top shelf of the fridge. Maybe it had been knocked off or fallen from the usual place or accidentally left somewhere and I would have to find it.
Then, is it the right pen ? Hopefully it is a Mix insulin type as trying to tell pens of different insulin apart is tricky when unsighted I would think.
Then I need to be positioned, say on a chair, and ensure a suitable patch of skin is exposed. (I have heard of people injecting through shirts and other garments but it does not sound wise).
IF my hearing is OK I can count the clicks of the pens as I dial up a dose. If my hearing is not good it becomes a bit of a guessing game, and I have been told that too much insulin or too little can be dangerous. Is it my fault if I dither a bit over this ?
Then I have to steel myself to give the injection, make sure I do so firmly and not allow the needle (which I am assured is very thin but also very short), does not become displaced.
I press the plunger down, using my other hand, but the arthritis makes that difficult. I wait, count to 15 as instructed.
Now I pull the needle out, but where is the cap for the needle and pen device?
Yes I feel it on the table, pick it up but how to re cap the needle without getting jabbed? It takes a few goes to do it.
If I could see or see better I might at least be able to use a glucose meter to check my BSL from the pin prick accidents of trying to recap the needle !
I can see quite some minutes going by trying to achieve this procedure !!
Hopefully there are other aides, devices that might make things easier, such as, if I am sight impaired, a magnifying device; a guide that makes recapping of the needle and pen easier etc.

 

[DavidGrahamJones]

Also it is certainly unusual but is it causing him any distress or problems?

Thanks for reply, I can't even say needle without him almost fainting, he's been like that all my life. He says it's because of the way they gave injections in the services and he was at the end of the queue, therefore the needle was blunt. By the way, my father is well known at spinning a yarn and a lot of the problems we have had are because he will tell me, my two brothers and my sister something different.

Does he have enough subcutaeneous fat where he is injecting? Never had that problem but I imaginie a gent of 91 will not have plump legs? The abdomen is the best site.

He was skinny the whole of his life until about the time he was diagnosed type II. He is probably 10 kgs overweight and it is mostly abdominal superfluous adipose tissue.

 

[DavidGrahamJones]

It could be a general reluctance to do it also?

Sounds about right.

 

[DavidGrahamJones]

Here is a link to the RNIB, also phone or email them with your father's medical history, how he is really coping on his own etc to get some useful advice and support. Has he been tested for dementia, not nice I know, but my dear dad had that. Also his GP and Adult Social Services are there too.
All the best.

Thank you for your reply and the link. My father is well supported by family who do everything to help him maintain his independence. He is also getting support in the form of 4 nurses who call to give him his injections and carers who help as well. He complains that the first nurse of the day is calling too early at 08:00. He had always refused to have 4 injections a day and never got up before 10:30. Relying on others means he has to work to their rules. As well as nurses and carers he has had a cleaner for years. We have now discovered that she is buying him bars of fruit and nut, my brother found his stash in the fridge. There is an old chines proverb that comes to mind “He that takes medicine and neglects diet wastes the skills of the physician.”

My father hasn't been tested for dementia, my mother had Vascular Dementia for the last 7 years of her life, the last 3 being in a care home. Doesn't make me an expert, but my dad is pretty much on the ball, crafty old ******. LOL As for his GP, my father hasn't been the best at seeing his GP when he's been ill, so I shouldn't blame his GP for being useless, although my mother's high blood pressure which led to her first stroke was untreated for years. Her medical team in hospital caused quite a stink when they discovered her GP wasn't treating her hypertension.

Cheers

 

[DavidGrahamJones]

I have heard of people injecting through shirts and other garments but it does not sound wise

Thanks for considering what you'd do with your eyes shut. I have a friend who injects, not through the shirt, just undoes a button to expose some skin. My father has Macular Degeneration and his sight is questionable. He is not registered blind and has refused to see an optician for many years. We think they will have given him a proper eye test while in hospital. He gives us different stories of his sight, one minute he can't read what's on his PC, despite recently typing up his memoirs, now available as a book of 150 pages and even more recently writing a history of Waterloo Station. Then he recognises my wife from 30 ft away (he didn't know she was visiting and she came into the ward several seconds after me).

Hopefully there are other aides, devices that might make things easier

Frustratingly my suggestion to get a Freestyle Libre was stonewalled, pretty much like anything I have ever suggested. This is particularly tiring and wearing and one eventually gives up trying to help. Seems he sooner make holes in his fingers. I have a feeling that he could probably get it on prescription, it would certainly make life easier for his 4 nurses.

 

[kitedoc]

Thanks for considering what you'd do with your eyes shut. I have a friend who injects, not through the shirt, just undoes a button to expose some skin. My father has Macular Degeneration and his sight is questionable. He is not registered blind and has refused to see an optician for many years. We think they will have given him a proper eye test while in hospital. He gives us different stories of his sight, one minute he can't read what's on his PC, despite recently typing up his memoirs, now available as a book of 150 pages and even more recently writing a history of Waterloo Station. Then he recognises my wife from 30 ft away (he didn't know she was visiting and she came into the ward several seconds after me).



Frustratingly my suggestion to get a Freestyle Libre was stonewalled, pretty much like anything I have ever suggested. This is particularly tiring and wearing and one eventually gives up trying to help. Seems he sooner make holes in his fingers. I have a feeling that he could probably get it on prescription, it would certainly make life easier for his 4 nurses.

I feel for you. The elderly are set in their ways. As I am sure you know unless something needs definite attention sometimes it is easier to go with the flow, even when it goes against the grain, one's learning, understanding and commonsense.
I recall how my very fair-skinned father hid from the sun for years, even though as a scientist he understood that some sun exposure was good for him. It was only in his last week of life that he decided to have a sun bake or three!