Diabetic Father

[EpcotKilterFan]

My 77 year old father has been a diabetic for 15 years. He has really never had it in control. He thinks that he can have what he wants because he was on insulin and pills for the diabetes.

He also has congestive heart failure. Which he would not wear his oxygen. Even at night when the Dr told him that was the only mandatory time. We figured out later that he would turn on the machine, bring up the tubing, but not wear it. He probably figured that if we heard the machine we would not suspect anything.

The past month he has been hospitalized and in a skilled nursing rehab center. On February 11 we had to have the squad take him to the hospital when his blood sugar dropped to 24 and the paramedics pumped him up with glucose and it was 160. We did not take him to the hospital then because we thought that was the problem. He ate a peanut butter sandwich and 16 oz of juice. Half hour after the squad left it dropped to 54. Called them back and they took him in. This happened 3 more times in the ER before they took him to the ICU. He stayed there for 1.5 days. He had an irregular heartbeat and they shocked him twice with the paddles while he was awake. Needless to say, that was NOT fun for him.

Over the next 2.5 weeks after being admitted they had to clear all the fluids off of his body. Lost over 40 pounds of water weight. He still had alot of issues of his blood sugar spiking to 400 then within 12-24 hours drop to below 100. This has gone on for a month. He will have a string of a couple of days that are "normal" then it all goes kerflooie again.

He was in a controlled environment when it comes to food and no snacking. Still his numbers were all over the place. There is no explanation from his Doctor (who I lost faith in a while ago) but his nurse practioners have been pretty good. His office does have a Diabetic educator that we finally got to talk to a few days ago. She is going to try and figure this out. I have faith that she can help us. We won't see her for another 10 days for a work up. But we will send her his readings.

Today he came home from the rehab center. He is strong and looks ok. His blood sugar before lunch 314. Before dinner it was 202. Took insulin at dinner time. Before bed it dropped to 88. He didn't feel right and it took his reading and it was 66 about an hour after the previous reading. We gave him glucose tabs then a bit of leftover pasta. In 15 minutes it was 71. Then 15 minutes later it rose to 84 but he still felt woozy. I gave him half a peanut butter sandwich. Checked it 30 minutes later and it is 93. So it is going up and is feeling better.

We are at wits end as to what is happening. I don't know what is wrong and not sure what we did was right tonight to make it better. A visiting nurse is supposed to come over sometime tomorrow for an evaluation. So maybe she can tell us if we did the right thing.

Sorry it is so long and probably makes no sense, but maybe someone has some words of wisdom to give.

Thanks for listening

Debbie

 

[mommasita]

Sorry Debbie, about what you are going through. I really have no experience whatsoever in this, but I wish nothing but wellness for your farther. I hope they can get it straightened out quickly.

Thoughts and prayers.

 

[Pea-n-Me]

I don't know if they're words of wisdom, but hopefully maybe some of these thoughts may help.

He may need to have his insulin adjusted.

I'd also suggest a meeting with a nutritionist (if he hasn't already), as he's not only got issues with his blood sugar fluctuations, but with his salt and fluid intake as well (which also fall under the nutrition umbrella).

I usually tell my patients (many of whom have the same issues as him) that it's doubly challenging having both diabetes and heart failure, as there are strict guidelines to follow for both in order to maintain health. Following a carb controlled diet, but also one that's low salt and limited fluid makes it difficult, especially when they live alone. You'll probably need to help with oversight, here. (You should be able to find out what the guidelines are on his hospital discharge paperwork.)

People discharged with heart failure after diuresis like he's had (ie 40 lbs of fluid), are instructed to weigh themselves daily and if their weight creeps up more than 2 lbs in 2 days (which is water weight), they're to call their doctor. This means they're retaining fluid in their inner tissues and their heart can't pump it well enough so it accumulates. Salt exacerbates this as where salt goes, fluid goes. They should not be drinking excessive fluids, either. (The fact that it got to 40 lbs means he either didn't know to call or that he didn't want to call, LOL.)

People often don't realize how much sodium they're actually eating. You really need to read labels and watch serving sizes - the salt shaker itself is usually not the issue, it's the salt hidden in most foods. It doesn't take too long in today's world to go over 2000mg/day.

Oftentimes in diabetics, sugars get out of whack when there's an illness or alteration in physiology, like there would be with the many issues he's got going on. To get it all stabilized, it takes a concerted effort on the part of the patient, the family, and all team caregivers working together.

HTH, I know it's not easy. Good luck.

 

[Regina]

Has there been any improvement? It's so scary/frustrating when you're dealing with your parent's health issues. They fight so hard to retain their independence while you're trying your best to make them cooperate with treatments they may disagree with.

I'm so sorry you're going through this. It's a road many of us have been down and it's not an easy one to navigate. Please let us know if things are any better.

 

[EpcotKilterFan]

Thanks for all the support

It is tough to balance his diet. Diabietic diet, low sodium and being aware of his coumadin makes meal planning tough.

He still has been a bit up and down. The visiting nurse has been in a few times as well as the occupational therapist and physical therapist. He will do well then one day is pretty bad.

My mom is here with him. She can't leave him for long periods and it is really taking a toll on her. She is a young 65 recently retired active person and being home and not even able to go out for a few hours is stressing her out. So I deal with that too. I do live with them, and work during the day but by the time I get home he is only up for a few more hours and most of the activity is done.

He needs to take control of his recovery. We are walking that fine line of milking it for all he has and really being sick. I think he may be getting the picture that he can only milk some things so far. Miraculously he was able to make his own lunch yesterday But he tends to forget to take the morning insulin (which he has done for 15 years) and gee it is only on the days the therapists come so when they arrive he does not feel well enough to participate.

He is a gadget person. So I am looking for an inexpensive PDA and I will put in reminders of his meds, eating, blood sugar counts etc so he will get reminders.

But the better news of the day, yesterday afternoon they went to the doctor, and have determined that his feeling woozy is not his blood sugar. It is his low blood pressure! So they took him off of one of the blood pressure meds. We hope that it will help and he will be more sure of himself and he will feel better. This made my mom feel better because she was feeling it was her fault that she was not feeding properly and that was what was causing the problems.

We go and see the diabetic educator on Tuesday and she will help with a meal plan. They filled out a survey of his likes and dislikes and sent that to the nutritionist.

So we make a few steps forward then slide back. I hope that after the nurse and therapist come today that he will feel ok and I can take my mom out for a little bit to get her out of the house. Or I will stay home and send her out to the store.

Sorry so long!! Thanks for being there
Debbie

 

[Regina]

Thanks for the update Debbie. I hope that you were able to give your Mom a break and that you took one for yourself.

I'll be praying that your Dad starts to show improvement. Please don't worry about your updates being long. It's nice to have a board where you can unload some of the stress.

Take care!!

 

[Mackey Mouse]

Debbie, hugs to you... I have been pretty much wrapped up these past few days but saw this this morning and thought....so hard to regulate these all these medications and the sugar part is so scary too. I do hope that once they regulate the blood pressure meds, it will take care of the problem of the wooziness. Sounds like your Mom has the diet back on control and is monitoring that. I am thinking out loud here, is your Dad and Mom happy with the doctor because if all three of you are not, maybe time to find someone else?? JMO, but if my husband did not like his doctor, we would find a new one.. there are enough of them too...

 

[EpcotKilterFan]

Well yet another bump in the road.

Tuesday we went to meet with the Diabetic Educator who is one of the Nurse practitioners in the office. She is WONDERFUL. Very patient and will not take any crap While we were there she explained some things that were beyond the diabetes and also did the coumadin test. She took a small blood sample and came right back in and said that his count was more than twice what it should be! Took him off the coumadin for 2 days and they were going to go for another test this morning to see what the level was.

Yesterday, Dad was dizzy most of the day. Tough time even getting up to go to the bathroom, walk across the room etc. Checked the blood sugar and it was ok. (not great but within acceptable ranges). The nurse practioner called last night to check on him because we had a slight adjustment in the insulin. Told her abut the dizzyness and she said to let him sleep and check again with her in the morning if it did not change.

This morning, he got up and was still very dizzy. His blood sugar was through the roof. Mom gave him his insulin and some food. Still was very dizzy. She called the nurse and was told to just take him to the ER for blood tests.

His BP was 64/24 and it fell again in the ER. So right now they have given him platlets, and a pint of blood. Still waiting on some tests to come back and they may give him a second pint if he needs it. They have taken him off all of his meds and will start all over. He is in the ICU for the night so they can monitor him.

He looks alot better and has some color. There does not seem to be any signs of bleeding. A CT scan was done and an x-ray. So now they are looking at anemia or vitamin deficiency.

My mother is blaming herself that she did something wrong and was not taking care of him the right way. I have told her over and over she did nothing wrong and that she did good by calling for help and getting him to the ER.

So that is my update. We hope to get some answers tomorrow.

Thanks for listening

Debbie

 

[Pea-n-Me]

This is not unusual for this to happen. The management of heart failure requires a lot of medications, many of which can have the untoward effect of lowering the blood pressure. With his being on a diuretic and watching his fluid intake as well, he can also become "intravascularly dry" if that makes sense. Sometimes it does take a while to get the right combination to work. Hang in there.

PS Stress to both your mother and father the importance of not letting him fall - especially while on coumadin. If his BP remains low (which it might, although a little higher would be good, 80's - 90's isn't unusual), he should be careful and take his time going from sitting or lying down, to standing.

 

[EpcotKilterFan]

Well Dad has had a total of 4 units of blood since being admitted. They did not find any blood in the urine or stool. Did another CT and did not find a bleed anywhere.

They had been doing a hemoglobin test several times today and they needed to get to an 8 and they could only get him to a 2. (I think that is the test, I am going by what dad is telling me) Tonight he called and they do not need to give him more blood because the test finally read 8.3. They will do another test overnight as well as in the morning to see if the level remains the same.

So that part is looking up I guess. Still no reason for the problems. So maybe now they might be able to find a cause.

Thanks for the encouraging words

Debbie

 

[travelprincess]

I could have written the first part of the post myself. My father is the same!
I just wanted to give you a hug.

 

[Regina]

Sorry you had another scary episode. I hope that they're able to find what's causing these issues and are able to treat him for it.

 

[EpcotKilterFan]

Thanks everyone. Here is another update:

Since we last met dad had an endoscopy. They determined that he had abrasions in his stomach from aspirin. They ended up giving him another 2 units of blood after the endoscopy (they actually determined that he needed the blood before the procedure, but had to wait). So the diagnosis is too much aspirin... which the Dr's had prescribed for him, and the hospital would give him.

I think it is a perfect storm scenario. He has been on enteric (coated) baby aspirin since 2005. He goes into the hospital this past February, and I think that the hospital and nursing home were not giving him the coated ones. When I was reviewing the counts with the blood Doctor, there was a significant drop after he was first admited and then in the nursing home. When he was discharged, the prescription was for regular baby aspirin. And he was also put on coumadin at this same time. So in my not so educated opinion, I think that a combination of the coumadin and un-coated aspirin exacerbated any small problems he may have had.

So, fast forward to today when he is discharged from the hospital. He was looking good, being stubborn and giving a hard time. So... pretty much NORMAL Mom picked him up. He felt good so she even took him to the barber shop to get a much needed haircut. They came home and a social worker came by for an interview (that is a whole other story for another post) and he did well. I came home at 4:45 (2 1/2 hours after discharge) and he looked like crap! Very gray. I thought to myself... gee if this is what they think is healthy, we need another hospital. So we got to talking and he was a bit out of it and said he was really tired. I figured he had been through alot today and he would be tired. Kept talking to him, and something was not right. I felt his arm and he was cold and clammy. He was disoriented. I was about to take him back and he was very distant. So we called the squad, it was all I could think of to do. They came in and found his blood sugar at 24 and his BP was through the roof. They gave him glucose and some fluids and brought him out of it.

It was again a scary incident. I suspect that it was all of the activity. They had given him 11 units of insulin right before he left. Between that and the activity he crashed.

We are very frustrated and can only hope that this was isolated incident. But it is coming to a point where we can not leave for more than a few minutes.

Thank you all for listening to this long post

Debbie

 

[shancan911]

Debbie,
I'm mostly a lurker here on these boards, although I just wanted to chime in. You and your Dad gave my family some pixie dust 2 Christmas's ago. Your Dad was an elf for the Polar Express trip we took. He stopped by and made sure my DS and Dnephew were taken care of, and enjoying their trip. He looked like he enjoyed the trip as much as the kids. I just wanted to say thanks to the both of you. If I could send some pixie dust your way, I'd drop a truckload off for you. Be blessed as we are in one of the best cities for medical care. I'll pray for you and your Mom, and your family to get through this time. Know that we're here on the boards if you need to talk.