johnrubinstein
Well-Known Member
- Messages
- 83
- Type of diabetes
- Type 2
About 10 days ago my wife received an email from her brother. He had been hospitalised because of a sore on his foot that had become quite infected. Following evaluation, the consultant told him that he was diabetic, that the results pointed to his having been so for a number of years and that he was to undergo an emergency operation. The email then went on to report that the operation had been successful and that he was recovering quite well.
At the time, Josie was in the States, so I hopped in my car and drove to visit him at the hospital. I found him sitting by his bed typing at his laptop away happily while putting final touches on a paper he was submitting for publication.
So, what’s the story I asked him? Oh, came back the cheerful reply (I’m serious, cheerful), he had had had his big toe amputated, they were considering possibly amputating the adjacent one (thankfully, it turned out to be unnecessary), and they’d put him on two different types of insulin. Additionally, they were concerned about high levels of potassium, high blood pressure, and damage to his kidneys.
Being T2 myself, I gently began to engage him in a discussion about diabetes. It soon became clear that after more than a week in hospital no one had broached the subject with him. All he knew was that he would have to inject himself 4 times daily and do something about his diet!
Had he had any other tests I asked: an eye test, a foot examination to test for peripheral neuropathy? Not yet came back the answer.
Coincidentally, as we were talking, a nurse arrived to test his healthy foot for peripheral neuropathy. Problem was, that my brother-in-law’s non-bandaged foot was in a knee length hospital sock which the nurse could not remove because of an identity tag tightly wrapped around his calf.
No problem for this nurse. Out came a biro pen (!) and he proceeded to POKE the foot through the sock. Do you feel this? Yep. How about this? Yep, feel that. And this? Yep feel that.
Didn’t want to confront the nurse with the ridiculous nature of his testing, but did intervene nonetheless. Don’t look down at your foot while he’s testing. You’re not supposed to look I said.
After about an hour of talking about this and that (and doing my best not to overload him with information), I left promising to visit again later on in the week.
And that visit happened yesterday, this time, accompanied by my wife, Josie, who had in the meantime returned from the States.
We walked into his ward to find him sitting in his bedside chair eating lunch. This was his lunch: a large piece of fried fish, a mound of chips, steamed carrots, a whipped cream topped tart and a slice of whole wheat bread.
We settled in around him and chatted while he was happily tucking in. After a while, I observed that this is not what I would be eating having been diagnosed with diabetes. oh, came back the reply, they know what they’re doing (this, after all, was a diabetic ward) and, anyhow, given that the doctor was quite concerned about his potassium levels, he (I.e. my brother-in-law) had requested a low potassium meal. You might call this an LPHC diet: Low Potassium High Carb diet. Quite an innovation.
About half way through his lunch, a nurse arrived to prepare one of his trice-daily insulin injections, which, after having put down his knife and fork he happily injected into his thigh under the watchful eye of the nurse.
I enquired about the timing of the injection: wasn’t he supposed to take the injection before the meal? Oh yes, came back the answer, but since they were late in giving him his morning injection they decided to delay his lunchtime injection. I asked whether there had been any discussion about calibrating the insulin doses in light of what he was eating. My brother-in-law had no idea what I was talking about. After two weeks in the hospital no one had yet sat down with with him and had a thorough and informed discussion about his condition (diabetes, high blood pressure, kidney damage, etc) and management requirements.
Except for this: the previous day he had gone for an eye test during which he was handed a leaflet and book about diabetes. And, John, what do you know! most of the stuff I knew because you told me during your last visit. BTW, he told me that lately he has had some trouble focusing when reading. I would be very surprised if there is no retinopathy.
Finally, as for the insulin, they’re still trying to figure out the daily dose (the, I think, basal insulin - being T2 and not on medication, my knowledge regarding insulin is very basic). They’ve changed the timing of that injection from the evening to the morning since, one morning, his BG tested at a low 3.8. His morning BG now reads between 10 and, on one occasion 20!
Ah yes. One final observation/question. His legs are very swollen and dotted with sores. He tells me that’s because he’s been asked to drink 2 litres of water a day to “flush his kidneys” and that, he was told, the swelling will go down once the kidneys settle. I suspect he’s fibbing. I suspect the swollen legs predate his hospitalisation. He’s being quite parsimonious about the information he’s been giving me in answers to my enquiries - because, I believe, he’s embarrassed about how long he let things go. For example, I can’t get a clear answer out of him regarding any loss of sensation in his feet.
At any rate, quite frightening. A lot of work to be done if quality of care is to be ramped up.
John
At the time, Josie was in the States, so I hopped in my car and drove to visit him at the hospital. I found him sitting by his bed typing at his laptop away happily while putting final touches on a paper he was submitting for publication.
So, what’s the story I asked him? Oh, came back the cheerful reply (I’m serious, cheerful), he had had had his big toe amputated, they were considering possibly amputating the adjacent one (thankfully, it turned out to be unnecessary), and they’d put him on two different types of insulin. Additionally, they were concerned about high levels of potassium, high blood pressure, and damage to his kidneys.
Being T2 myself, I gently began to engage him in a discussion about diabetes. It soon became clear that after more than a week in hospital no one had broached the subject with him. All he knew was that he would have to inject himself 4 times daily and do something about his diet!
Had he had any other tests I asked: an eye test, a foot examination to test for peripheral neuropathy? Not yet came back the answer.
Coincidentally, as we were talking, a nurse arrived to test his healthy foot for peripheral neuropathy. Problem was, that my brother-in-law’s non-bandaged foot was in a knee length hospital sock which the nurse could not remove because of an identity tag tightly wrapped around his calf.
No problem for this nurse. Out came a biro pen (!) and he proceeded to POKE the foot through the sock. Do you feel this? Yep. How about this? Yep, feel that. And this? Yep feel that.
Didn’t want to confront the nurse with the ridiculous nature of his testing, but did intervene nonetheless. Don’t look down at your foot while he’s testing. You’re not supposed to look I said.
After about an hour of talking about this and that (and doing my best not to overload him with information), I left promising to visit again later on in the week.
And that visit happened yesterday, this time, accompanied by my wife, Josie, who had in the meantime returned from the States.
We walked into his ward to find him sitting in his bedside chair eating lunch. This was his lunch: a large piece of fried fish, a mound of chips, steamed carrots, a whipped cream topped tart and a slice of whole wheat bread.
We settled in around him and chatted while he was happily tucking in. After a while, I observed that this is not what I would be eating having been diagnosed with diabetes. oh, came back the reply, they know what they’re doing (this, after all, was a diabetic ward) and, anyhow, given that the doctor was quite concerned about his potassium levels, he (I.e. my brother-in-law) had requested a low potassium meal. You might call this an LPHC diet: Low Potassium High Carb diet. Quite an innovation.
About half way through his lunch, a nurse arrived to prepare one of his trice-daily insulin injections, which, after having put down his knife and fork he happily injected into his thigh under the watchful eye of the nurse.
I enquired about the timing of the injection: wasn’t he supposed to take the injection before the meal? Oh yes, came back the answer, but since they were late in giving him his morning injection they decided to delay his lunchtime injection. I asked whether there had been any discussion about calibrating the insulin doses in light of what he was eating. My brother-in-law had no idea what I was talking about. After two weeks in the hospital no one had yet sat down with with him and had a thorough and informed discussion about his condition (diabetes, high blood pressure, kidney damage, etc) and management requirements.
Except for this: the previous day he had gone for an eye test during which he was handed a leaflet and book about diabetes. And, John, what do you know! most of the stuff I knew because you told me during your last visit. BTW, he told me that lately he has had some trouble focusing when reading. I would be very surprised if there is no retinopathy.
Finally, as for the insulin, they’re still trying to figure out the daily dose (the, I think, basal insulin - being T2 and not on medication, my knowledge regarding insulin is very basic). They’ve changed the timing of that injection from the evening to the morning since, one morning, his BG tested at a low 3.8. His morning BG now reads between 10 and, on one occasion 20!
Ah yes. One final observation/question. His legs are very swollen and dotted with sores. He tells me that’s because he’s been asked to drink 2 litres of water a day to “flush his kidneys” and that, he was told, the swelling will go down once the kidneys settle. I suspect he’s fibbing. I suspect the swollen legs predate his hospitalisation. He’s being quite parsimonious about the information he’s been giving me in answers to my enquiries - because, I believe, he’s embarrassed about how long he let things go. For example, I can’t get a clear answer out of him regarding any loss of sensation in his feet.
At any rate, quite frightening. A lot of work to be done if quality of care is to be ramped up.
John
