Newly Diagnosed Diabetic Has Questions
February 6, 2005 2:34 PM Subscribe
My husband was just diagnosed with diabetes. A very incompentent nurse came by. I can get the rest of the informations that he may have missed from the physician...but.....how often should we be doing finger sticks? Three times a day? Can we get by with two? [MI]
More info - he's 72, has mild/moderate Alzheimer's (so he can't stick himself, too frustrating to follow the directions). He's type II, overweight, apathetic, well from ALZ. He used to exercise regularly, but has family history of diabetes.
More info - he's 72, has mild/moderate Alzheimer's (so he can't stick himself, too frustrating to follow the directions). He's type II, overweight, apathetic, well from ALZ. He used to exercise regularly, but has family history of diabetes.
My husband also has type 2 diabetes, and he has always discussed the number of blood tests he should be doing with his doctor, and you should definitely feel free to ask your husband's physician about that, too. It will be different if he needs insulin, and will probably also depend on how easily his blood sugar can be gotten under control.
For my husband, it's varied over time; early on, while he and his doctor were figuring out the best dosage and timing for his medication, he was doing it two hours after every meal ("postprandially") as well as first thing in the morning and just before bed. Now his blood sugar is pretty well under control, and I believe he does it on a rotating schedule -- the full set on Monday, then just after breakfast on Tuesday, after lunch on Wednesday, after dinner Thursday, before bed Friday, first thing in the morning Saturday, and a break on Sunday.
posted by redfoxtail at 2:46 PM on February 6, 2005
For my husband, it's varied over time; early on, while he and his doctor were figuring out the best dosage and timing for his medication, he was doing it two hours after every meal ("postprandially") as well as first thing in the morning and just before bed. Now his blood sugar is pretty well under control, and I believe he does it on a rotating schedule -- the full set on Monday, then just after breakfast on Tuesday, after lunch on Wednesday, after dinner Thursday, before bed Friday, first thing in the morning Saturday, and a break on Sunday.
posted by redfoxtail at 2:46 PM on February 6, 2005
If the nurse gave undue care, please write a letter to the home health agency and voice your concerns. Often times in the field care that is sub par can only be proven with documented experiences from the patients. You will be helping many out if this results in an action that betters the service given to you and others. This is spoken from very inside of the trench.
posted by sled at 3:02 PM on February 6, 2005
posted by sled at 3:02 PM on February 6, 2005
What amandaudoff said - doctor probably needs to get an idea of your husband's level so he can more closely diagnose and prescribe if necessary. Doctor should have printed handouts for general education.
Hubby (you) will be told to eschew the carbs in e.g. breads, pasta, potatoes, and fill up on veggies. (Lots of luck getting him to eat green beans) A young woman of my acquaintance lost 40 pounds by following her father's diabetes diet.
Do not be terribly upset yourself - diabetes is common in aging males. Exercise is helpful; if he is not interested in self-preservation, perhaps you could say that you need to do some walking, but are afraid to go alone ;-) Good luck.
posted by Cranberry at 3:05 PM on February 6, 2005
Hubby (you) will be told to eschew the carbs in e.g. breads, pasta, potatoes, and fill up on veggies. (Lots of luck getting him to eat green beans) A young woman of my acquaintance lost 40 pounds by following her father's diabetes diet.
Do not be terribly upset yourself - diabetes is common in aging males. Exercise is helpful; if he is not interested in self-preservation, perhaps you could say that you need to do some walking, but are afraid to go alone ;-) Good luck.
posted by Cranberry at 3:05 PM on February 6, 2005
When my husband was diagnosed, (also type II, age 58) he began fingersticking 2x per day, about 1/2 hr. after meals. What's important to note: what medications was your husband given (if any) and is he changing his diet (because the medications can only do so much)? Also important to note, what was his initial fasting blood sugar amount? Once you have a benchmark of initial bl. sugar amount, and you're tracking with 2 fingersticks, your husband is taking his meds and adjusting his diet to drastically lowering sugars and fats, you should start to see the numbers come down. A normal range of over 240 ml/dl is cause for concern and necessitates stronger dietary measures and possible medication adjustments. Over 550 means go to the hospital NOW. Normal range is 70 - 120 ml/dl. Your husband should shoot for 150 or under, but my husband cautions that he won't like how he feels at first. The reward comes later, when he starts to get stabilized, can sleep through the night and doesn't need to eat and drink constantly to feel good. Good luck and better health wishes to you both!
posted by Lynsey at 3:13 PM on February 6, 2005
posted by Lynsey at 3:13 PM on February 6, 2005
My mother does it three times a day. Before breakfast, before dinner, and before bedtime.
posted by FunkyHelix at 3:15 PM on February 6, 2005
posted by FunkyHelix at 3:15 PM on February 6, 2005
An adult type 2 diabetic often need not check at all. There's no data that confirms control is better in a non-insulin dependent diabetic.
If your husband is indeed a T2, then a decision to start insulin seems odd, since there are a wealth of drugs that can be given orally prior to reaching that point. Unless he was admitted with ketoacidosis, or some other diabetic crisis.
Some people like to check there BG, so we tell them go ahead, since it seems to assist in their motivation.
Also, what was his initial HgbA1C, and was a C-peptide done, which is an indicator of endogenous insulin production?
As for diet issues, IMO the diabetic educators fill up your head with a raft of advice about counting carbs at a time when your head is already spinning. Most people can benefit tremendously from just taking a half-decent look at there diets and making basic changes they've known would be good for them for years. Eliminate or cut way back on soda, snacks, desserts. Eat off a small plate, cut portions in half. Never eat out for convenience, pack food for lunch instead of going out. It really can be that simple for a lot of people.
What, exactly, did the nurse do, if you don't mind me asking?
posted by docpops at 3:26 PM on February 6, 2005
If your husband is indeed a T2, then a decision to start insulin seems odd, since there are a wealth of drugs that can be given orally prior to reaching that point. Unless he was admitted with ketoacidosis, or some other diabetic crisis.
Some people like to check there BG, so we tell them go ahead, since it seems to assist in their motivation.
Also, what was his initial HgbA1C, and was a C-peptide done, which is an indicator of endogenous insulin production?
As for diet issues, IMO the diabetic educators fill up your head with a raft of advice about counting carbs at a time when your head is already spinning. Most people can benefit tremendously from just taking a half-decent look at there diets and making basic changes they've known would be good for them for years. Eliminate or cut way back on soda, snacks, desserts. Eat off a small plate, cut portions in half. Never eat out for convenience, pack food for lunch instead of going out. It really can be that simple for a lot of people.
What, exactly, did the nurse do, if you don't mind me asking?
posted by docpops at 3:26 PM on February 6, 2005
Longer, better thought-out answer to your question. When a spouse is diagnosed with diabetes, you have to take ownership over it and not let it own you. My husband and I went to nutrition classes, I went with him to his case-manager's appointment and asked a lot of questions of everyone, as well as did lots of online research. I borrowed low-carb and diabetes cookbooks from the library, learned to use half sugar and half-Splenda in baked goods, lowered our fat intake drastically and learned to love fish. (Side benefit, I lost about 12 lbs. on this regime!) The hardest part is getting hubby to go for walks with me, as I like to walk every day. Things to be aware of: even without Alzheimer's, you'll note that your diabetes patient has memory problems, possible numbness in fingers and toes, and he or she will have moments of temper and lash out at you that are not caused by you - that usually means they are running low on blood sugar and need something to eat. There are some good resources here.
posted by Lynsey at 3:33 PM on February 6, 2005
posted by Lynsey at 3:33 PM on February 6, 2005
Everyone has said useful things.
Speaking as a practitioner who occasionally meddles with his patients' blood sugar control, I find that it's very helpful - to me, at least - if a small notebook is used to record the fingerstick data. A good way to organize is by rows and columns: rows being the date, and columns being the time of day that the fingerstick is taken.
Classically - ancient-history medicine - the fingerstick rule has been "Q AC and QHS", which means 'before eating each meal' and 'before bed' - i.e., 4 times a day. I still find this the most useful when I'm trying to see patterns in someone's daily or weekly blood sugar fluctuations; but if insulin isn't being used, it may not be so useful. Running averages such as many modern machines provide are worse than useless to someone like me; they can even be misleading.
Ask your doctor what the fingerstick data is being used for, and how she'd like you to collect it. Then it should become more obvious.
posted by ikkyu2 at 10:18 PM on February 6, 2005
Speaking as a practitioner who occasionally meddles with his patients' blood sugar control, I find that it's very helpful - to me, at least - if a small notebook is used to record the fingerstick data. A good way to organize is by rows and columns: rows being the date, and columns being the time of day that the fingerstick is taken.
Classically - ancient-history medicine - the fingerstick rule has been "Q AC and QHS", which means 'before eating each meal' and 'before bed' - i.e., 4 times a day. I still find this the most useful when I'm trying to see patterns in someone's daily or weekly blood sugar fluctuations; but if insulin isn't being used, it may not be so useful. Running averages such as many modern machines provide are worse than useless to someone like me; they can even be misleading.
Ask your doctor what the fingerstick data is being used for, and how she'd like you to collect it. Then it should become more obvious.
posted by ikkyu2 at 10:18 PM on February 6, 2005
An adult type 2 diabetic often need not check at all. There's no data that confirms control is better in a non-insulin dependent diabetic.
Strictly speaking that just isn't true. The UKPDS concluded that tight glycemic control in Type 2 diabetics does in fact reduce the risk of negative microvascular outcomes.
posted by drpynchon at 10:58 PM on February 6, 2005
Strictly speaking that just isn't true. The UKPDS concluded that tight glycemic control in Type 2 diabetics does in fact reduce the risk of negative microvascular outcomes.
posted by drpynchon at 10:58 PM on February 6, 2005
Depends on how severe the diabetes is, too. My mom's case is very mild, and she's strict about her diet and pretty self-aware of her BS levels, so she actually doesn't bother pricking at all.
Plus, the various devices she had left bruises on her fingertips, and she types for a living, so the use of the tools more seriously affected her than did the disease itself.
posted by majick at 10:59 PM on February 6, 2005
Plus, the various devices she had left bruises on her fingertips, and she types for a living, so the use of the tools more seriously affected her than did the disease itself.
posted by majick at 10:59 PM on February 6, 2005
Response by poster: Thank you all for your input. Here are answers to some of your questions. He is on oral meds. No one has told us what range we should look for other than to call is sugar level goes over 400! The home health nurse was more interested in getting his paper work done than engaging in dialogue. When he showed us how the finger stick gear works (we have already been home from the hospital for 36 hours and done several sticks) he said to use the same needle for not more than day because it will get dull. That using the alcohol swab each time was more important than changing the needle!!!
My job takes me traveling a good part of the month (2-3) nights at a time so I am trying to figure out what kind of help we will need. My husband is unable to remember all the little steps needed to do the stick.
LAG
posted by lag at 5:55 AM on February 7, 2005
My job takes me traveling a good part of the month (2-3) nights at a time so I am trying to figure out what kind of help we will need. My husband is unable to remember all the little steps needed to do the stick.
LAG
posted by lag at 5:55 AM on February 7, 2005
drpynchon,
what I should have said is that frequent finger sticks are not shown to improve long term control. You are correct, of course, that glycemic control has everything to do with long-term complication rate. But regular monitoring of HgbA1C is a more reliable way to do this once a patient is stabilized, assuming they are truly a T2 diabetic. I find BG logs to be useful at certain times, especially when changing therapeutic regimens. Otherwise, I monitor HgbA1C, microalbumin, lipids, etc. every 4-6 months. If patients like to check their values I don't discourage them, but the cost and burden of doing so is frequently not something they want to undertake.
LAG,
I think your situation will only get easier. You may want to ask for a referral to an endocrinologist as a first step to seeking a streamlined way of managing his sugars. At some point I would expect that he will not need to check himself once he is stabilized on a regimen of oral agents, many of which do not cause low values either.
posted by docpops at 8:04 AM on February 7, 2005
what I should have said is that frequent finger sticks are not shown to improve long term control. You are correct, of course, that glycemic control has everything to do with long-term complication rate. But regular monitoring of HgbA1C is a more reliable way to do this once a patient is stabilized, assuming they are truly a T2 diabetic. I find BG logs to be useful at certain times, especially when changing therapeutic regimens. Otherwise, I monitor HgbA1C, microalbumin, lipids, etc. every 4-6 months. If patients like to check their values I don't discourage them, but the cost and burden of doing so is frequently not something they want to undertake.
LAG,
I think your situation will only get easier. You may want to ask for a referral to an endocrinologist as a first step to seeking a streamlined way of managing his sugars. At some point I would expect that he will not need to check himself once he is stabilized on a regimen of oral agents, many of which do not cause low values either.
posted by docpops at 8:04 AM on February 7, 2005
I was diagnosed Type 2 February 2001.
My BG is mostly under control by oral drugs (metformin and glyburide). I say mostly because I can't seem to my food intake under control (damn that sweet tooth anyway).
I'm scheduled to poke my fingertips twice a day - Day A: before breakfast and before dinner, Day B: before lunch and before bedtime. Use one finger per day (or maybe two if you're poking four times a day), that way you're only using each finger once every 10 days (or once every five days). That gives them time to heal. I've never been told to use alcohol before poking. I just wash and dry my hands thoroughly before each poke.
A book I found very helpful is Diabetes for Dummies. Yeah, I know, but it's very simple to read and quite comprehensive.
Good luck, lag. Email address is in my profile.
posted by deborah at 10:53 AM on February 7, 2005
My BG is mostly under control by oral drugs (metformin and glyburide). I say mostly because I can't seem to my food intake under control (damn that sweet tooth anyway).
I'm scheduled to poke my fingertips twice a day - Day A: before breakfast and before dinner, Day B: before lunch and before bedtime. Use one finger per day (or maybe two if you're poking four times a day), that way you're only using each finger once every 10 days (or once every five days). That gives them time to heal. I've never been told to use alcohol before poking. I just wash and dry my hands thoroughly before each poke.
A book I found very helpful is Diabetes for Dummies. Yeah, I know, but it's very simple to read and quite comprehensive.
Good luck, lag. Email address is in my profile.
posted by deborah at 10:53 AM on February 7, 2005
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posted by amandaudoff at 2:46 PM on February 6, 2005