Friday, November 9, 2007

I'm at a loss here

Well, the nutritionist called today (DH saw her last week about his type 2 diabetes). His A1c was 9.9, and his doctor has been threatening him with insulin for the last 2 or 3 years. I don't know if his ex-wife was helping him control it or not (probably not, since his BGs have been high for quite a while). We've only been married 11 months, and I knew absolutely nothing about diabetes when we got married. I've had to learn a lot in a hurry, and I finally convinced him that he needed to watch his carbs, which he's been doing for the last month or so. Not long enough to affect his A1c this last time, but it should affect it and show up by the time he's due for another one. The nutritionist told his doctor that we were starting on low carb, and DH has lost 6 lbs since he last saw his doctor 3 months ago. But she's not going to give us time to see if this works to get his A1c down and control his BGs. She's bound and determined that he will go on insulin, whether he wants to or not. Since we're dealing with the VA, I don't have a clue what they will do if he refuses. I don't know if she'll keep refilling his metformin and glyburide, or if she'll cut him off, or what. He works 25 miles away from home, and he says he can't inject himself. He can handle someone else doing it, but he can't handle doing it himself (and it's like pulling teeth to get him to test, too, he hates sticking his finger, and his doctor told him testing a couple of times a week was fine, WTF! I heard her say that when we saw her last, and I couldn't believe she said that).
So far, he doesn't have any neuropathy, his heart, lungs, and liver are fine, and he's working a job where he's lifting 28 to 42 lb boxes off a conveyor and putting them on pallets. If he gets hired on full time (he's working thru a temp agency now, that way he can work when he wants to), he'll be working 12 hour shifts at night (6 pm to 6 am), which is going to make it a stone cold bitch to figure out when he should test and when he should take his meds. Especially since he'll be working 2 days on, off 2, work 3, off 2, work 2, off 3, repeat sequence. If he's supposed to take his meds at the same time every day, and eat his meals at the same time every day, this second shift schedule is going to screw his diabetes all to hell (and the company really wants to hire him, they asked him today, and he has never put in an application). So I'm thinking we need to make an appointment to see her and get this shit straightened out. I'm not sure she's going to listen to anything we have to say, but I sure as hell don't know what else to do.
If his A1c being this high hasn't had much of an effect on him in the last couple of years, I don't know why the hell she can't wait another couple of months to see if the changes in the way he eats is helping. The only problem he has, and I don't know if it's related to his diabetes or not, is with his eyes. He's had laser surgery on each eye 3 times for excessive watering (something about extra blood vessels that had to be zapped, is what he said, this was before I ever met him), and just about a month ago, he had a cataract removed. He has an eye drop that has to be put in once a day (both eyes) for the pressure (and he's been using it ever since we've been together). It seems like when his BGs are high, so is the pressure in his eyes. But the last time he saw the eye dr., his pressure was down to 15 in both eyes, so I'm thinking the change in the way he eats is lowering his BGs, and therefore lowering the pressure in his eyes. But what the hell do I know, I'm not a doctor. All I know is what I've read from the books that have been recommended and what I've learned from the diabetic lists I signed up for.


  1. Dear Mariellen,
    I am not sure what your husband's dietitian means by "going on insulin" but it might be one injection a day of long-acting insulin.
    I have type 2 and have taken insulin while I was pregnant and nursing, and while it's not the most fun thing in the world, it's not anywhere near as awful as I expected, and I got terrific blood sugar control on it.
    Even with the shift schedule, the insulin might really help.
    To me, the hardest thing about being on insulin is that there is usually some weight gain associated with it (your body is holding onto more of what you take in).
    Controlling blood sugar, blood pressure and cholesterol are among the most important things your husband can do to reduce the risk of stroke and heart attack, not to mention other complications. This isn't just scare tactics, it's based on solid science.
    Really, we type 2s are fortunate to have the choice between insulin and other medications, but the recommendations for patients whose blood sugar isn't well controlled on 2 medications is to start insulin. It's not a sign of failure, it's a chance to prevent serious problems.
    There's a great web site that has plenty of great information from the National Diabetes Education Program. Yes, it's "the government," but it's not sponsored by any pharmaceutical company. You can order free information if you would like -- or just read the materials online.
    I felt better when I was taking insulin and my blood sugar was well controlled than when I was on oral meds and not controlling my blood sugar.
    If you can find some folks who do use insulin and talk with them, you might see what a positive difference it can make. I felt much more in control when pregnancy was making my blood sugars go haywire when I had insulin that I could use and adjust as needed. I would have felt much more helpless if I was trying to just control it with diet and worried about the harm I was doing if that wasn't sufficient.
    I am keeping you and your husband in my thoughts and wish you both great health. You are taking so many positive steps!

  2. Thanks for the information. It helps, especially when DH starts getting stubborn, if I can quote facts for him. I did some more research last night, and he is starting to come around to the fact that insulin might not be as bad as he thinks. He's been checking his BGs, and even with lowering carbs, his BGs are still all over the place. I'm thinking that it's either a progression of the disease, or it's because it was uncontrolled for so many years (part of which I blame on his doctor for telling him he only needed to test a couple of times a week, how in the hell can you control BGs if you don't have any idea what they're doing on a daily basis?). She told him to test after breakfast one day, then 2 days later, test after lunch. Then the next week, test after supper, 2 days later, test before bed. Then the next week, before breakfast, 2 days later before lunch, and so on. To me, unless he was eating exactly the same things all the time, that isn't going to tell him much about his BGs on a daily basis re what he eats. So we got a letter today and have to call and make an appointment to see the nutritionist before he has his knee surgery the beginning of December (doc is afraid of infection and slow healing if his BGs aren't in better control). Again, thanks for your reply, I'll tell him about it when he gets home from work, and maybe he'll feel better about the whole thing.

  3. Mariellen, even if your husband goes on insulin now, he may not need it forever. If I had an A1c as high as his AND had had laser surgery on my eyes I would do whatever it took to make sure I retained my eyesight. One way to increase the odds is to normalize blood sugar. Insulin can do this.

    I think you said you had Dr. Bernstein's book. If so, go back and read the part about using insulin. Dr. B has his patients using a basal insulin like Lantus or Levemir which will keep blood glucose stable around the clock and then adding a bolus insulin like Novolog to cover mealtime carbs. I use this method with Lantus as a basal and Novolog as the bolus and it works for me. If I worked shifts, I would prefer using the bolus insulin over glyburide since the insulin works for the specific meal and I don't get the lows I used to get with glyburide.

    It's possible that just adding the basal insulin will be all your husband needs in addition to the metformin and glyburide he already uses. I inject my basal twice a day since I get better coverage that way but many people are able to do it once a day.

    One more thing, some people are afraid of insulin because they think the injections will hurt. Actually, there is less pain than with testing. When I started, I read a post on Diabetesworld where the poster said she moved the needle around her tummy until she found a place where she couldn't feel it and injected there. I tried this method and it worked. Sometimes I have to look to make sure I've actually put the needle in!

    It sounds like you and your husband are going through difficult times healthwise now but it also sounds like you are taking positive steps to change this.

  4. caprice, that's good to know, that there are spots where you can't feel the injection. He'll just have to experiment until he finds one (I wouldn't have a problem with it, I have numb spots on my stomach from my gallbladder surgery and WLS, where the incision scars are, about an inch on either side of the scars). And I think it's the pain thing that worries him the most, that and that he may have to test more often (he's such a wuss when it comes to things like I love him anyway). We'll get through this and things will get better, they usually do. It's just that at the time, it seems a bit overwhelming. I'm glad I have this blog so I can vent and get feedback from people who have been there or know people who have. It helps, a lot. So thanks.

  5. Mariellen, there's not just one spot where I can't feel the needle but there are lots of places all over my tummy. There aren't that many nerve endings on any person's tummy. One good reason for your husband to do his own injections is that he has control of where the needle goes in.

    Lantus and Humalog come in pens and some people find that emotionally more comfortable than syringes. You just dial the dose and when the short needle is in it just looks like you're holding a large ballpoint pen to your tummy. I'm such a control freak that I prefer the syringes since I can see the amount of insulin I put in the syringe and then see that it has all gone in! Also it's much smaller and I can carry a bottle of insulin and syringes in my test kit so everything is together.

    If your husband is having pain when he tests, check to see if he is testing on the sides of his fingers. There are fewer nerve endings there. Also, after a while a small callus will build up which reduces any pain even further. A large callus isn't good so he should rotate the fingers he tests on so that he is using all his fingers. The lancet device that came with my One Touch meter is has a dial that allows you to adjust the depth that the lancet goes in. Some people find this helps too.

    Your husband isn't alone in his fear of painful needles. I think he will be pleasantly surprised at how painless insulin can be.

  6. caprice - I don't think the VA has the pens for injections. DH's brother-in-law uses insulin, he's also doctoring at the VA and he said he can't get the pen through them. Whatever DH has to use, he'll figure it out after a couple of times and I'm sure he'll be fine, he just hates changing his routines.


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