Combatting Diabetic Denial? Please advise...

[Concerned_Daughter]

Hello,

I've come here hoping that you may be able to offer me some advice 🙂 It might be long, so I apologise in advance but please bear with me as I really need your thoughts and advice on this...

My Dad is 67 and was diagnosed with Diabetes Type 2 nine years ago. It took him a while to get himself to the Doctor and when his results came back, he was shocked to be told he has Diabetes. He also had very high blood pressure and cholesterol and the Doctor he had at the time told him he was 6 months away from death at that point, without treatment. He was prescribed Metformin and medication for high blood pressure and cholesterol and he continues to take these 9 years on (although in the 9 years, the dosage has been upped and upped to the point that he is now on the maximum).

The reason I am asking for advice is because, although he didn't appear to be having a hard time accepting this diagnosis, it has been extremely hard work getting him to acknowledge, understand and manage his condition properly ever since. He is my Dad, I love him very much and I want him to be around in good health for as long as possible, so since his diagnosis I have been there supporting him to understand and try to manage his condition sensibly. However, he makes everything such hard work and now 9 years on, his mismanagement is starting to have real consequences to his health. For example, his latest diabetic retinopathy screening reveals that he has now started to show the early stages of this and lumps have started appearing on the palms of his hands, which I am worried are the start of Dupuytren’s Contracture. I can’t help but feel that if he managed his condition properly, he may not have these symptoms yet…

The problem is his attitude to his diet - he wants to continue eating what he wants, when he wants (and often does). He has a sweet tooth and indulges this on a daily basis with various things such as chocolate, biscuits, cake etc. - I have lost count of the times I have explained to him what the excess sugar in his blood is doing to his body but he just refuses to take this in.

A few background pointers to try and reduce the length of this post -

• His blood sugar has always been high, due to the fact that his diet is poor (he won't eat vegetables for example) and he eats too much sugar.
• He has a blood monitor but he refuses to use it because he says the readings it gives 'are not accurate so it is a waste of time'.
• He lies at medical appointments, giving them the impression he is a ‘model patient’ by doing things such as filling out his blood monitor record book with false readings that sit where he should be (between 6-8 mmol/l).
• When he has his HbA1c he will cut down his sugar intake for 12 weeks before the blood test and carry on as normal afterwards, which obviously gives them a false reading.
• He was told last year at his last HbA1c appointment (which he had without warning so could not cut down 12 weeks beforehand) he might have to start injecting insulin if his blood sugar continues to be too high. They think he eats a diabetic diet so can’t understand why his blood sugar is so high…!
• Was diagnosed with Prostate Cancer last year and had a radical prostatectomy. In his pre-op assessment he was told his blood sugar was too high but they went ahead and operated on him anyway because the cancer was quite advanced and at risk of spreading.
• Anaesthetist came to see him post-op and told him they nearly lost him on the operating table due to his blood sugar levels becoming dangerously high during the operation. She told him that had the operation been for anything else, she would not have operated.
• Had radiotherapy following his operation and said he would ‘use it as an excuse for high blood sugar ‘at his next HbA1c appointment.
• Told off by Nurse at his latest HbA1c appointment for having very high blood sugar again. Told he has 8 weeks to lower it, another appointment made where he might have to start injecting insulin.

He is currently on 850mg Metformin x 3, glipizide (not sure of dosage), ramipril (not sure of dosage), statin (not sure of dosage) and an aspirin daily but I don’t think this is managing his condition anymore and I think he needs to move on to insulin injections. He has lost weight and is urinating more, which he has put down to having his prostate removed, but I think it’s his body getting rid of the excess sugar in his blood, which is not turning into fat, hence the weight loss. His blood monitor reading last night was 20 mmol/l.

How can I help him face up to the damage he is doing to himself so that he starts to take his diabetes seriously before it is too late? I (and other well-meaning family members) have all told him how the excess blood in his system is damaging his organs (he has been told his kidney function is already reduced) and how important it is that he monitors his blood sugar levels and eats well. I think for the past 8 years he has managed to somehow ‘get away’ with it and not have too many problems (which in turn reinforces his thinking that he is managing his condition OK) but now I think it is starting to ‘catch up’ with him.

If you have any thoughts, or advice on this I would be very grateful. I am the only person he mildly listens to, so it falls to me to ‘nag’ him about his diabetes but I am feeling like this is dominating my relationship with him

Thank you for reading 🙂

 

[grovesy]

I have read, but have no advice sorry, and with a level of 20 you are correct to assume that is why he is passing more urine and possibly implicated in his weight loss.

 

[Northerner]

Hi Concerned_Daughter, welcome to the forum 🙂

I'm very sorry to hear all this The only person your Dad is fooling is himself, of course. Many of the complications of diabetes only really start to take a hold after a decade or so of poor control. They may appear earlier in some people because they may have been undiagnosed for some years. It's very hard to know what to say when someone is so stubbornly refusing to accept the seriousness of his situation, and this despite the very real warnings he has been given from his operation and the unplanned HbA1c revealing the real truth. I have little doubt that the medics suspect the truth, that he is fabricating results to try and hide the true situation. The crazy thing seems to be that he can eat sensibly for 12 weeks to 'fool' the HbA1c, but then reverts to his bad habits and poor control!

Who cooks for him and does his shopping, does he do it himself? Would it be possible to seek out alternatives to the carbs in his diet that he might enjoy (or not realise that they are better for him).

It's something I find personally hard to understand, I must admit. I was diagnosed aged 49 and right from the very start I have been concerned about the possibility of life-altering complications, so have always done my best to respect my diabetes. The problem, of course, is that you may feel as though you are 'getting away with it', but all the time it is silently damaging you.

It might be a good idea to call the Diabetes UK Careline service - they are trained professionals who I am sure deal with this sort of problem often, so may be able to offer some practical solutions or methods of persuasion. The contact details can be found on the following page:

http://www.diabetes.org.uk/How_we_help/Careline/

 

[Amigo]

Hi Concerned Daughter and how I feel for you in this quest to get your father to see sense and face the consequences of his actions. At first I thought perhaps your dad didn't fully understand the full ramifications of his condition but from what you've described so honestly (and probably painfully), is that he's crafty!

His actions in trying to fool the doctors are quite deliberate and suggest he's in a state of stubborn denial. I've seen it so many times professionally and quite often from people who like control and reject alternative wisdom. And the reality is he's on a slippery slope medically. I wonder in his more considered moments whether he ever recognises that and is prepared to admit it? I'd suggest counselling to try and break the destructive cycle of denial but he doesn't sound like he'd go. It must weigh heavily on you because you seem to be close. In your situation I'd be tempted to write him a letter describing how disappointed you are that his love of sweets and cakes is more important than being around for you and his family. Brutal but that's maybe the wake up call he needs. It's then up to him and it's clear nagging won't help so maybe a plea to the father in him might help.

It's amazing how many people feel the fight with diabetes is like an external battle and that they can outwit the 'enemy'. His logic is totally scewed and the only enemy is himself and his own insistence on ignoring medical advice.

I wish you well and you're a very caring daughter who deserves a dad who is prepared to take the chance he has to stick around for you. I have cancer as well as diabetes and will do anything and everything I need to be around for my children.

Warm regards,

Amigo

 

[stephknits]

I really feel for you concerned daughter. That is a lot to take on for your dad. I remember an excellent post on here from someone who let their diabetes management slip and told us all about the price they paid. I think it is on a sticky in the heros of the forum section. Might help convince him?

 

[Concerned_Daughter]

Thank you for all your replies, I appreciate you all taking the time out to read my post, let alone reply!

grovesy - Thank you for your comment. My Dad is adamant that it is all down to his prostate removal but I still think it's down to his excess sugar, so thank you for agreeing with me on that score.

Northerner - Thank you for your reply and your welcome to the forum. You're absolutely right about my Dad's stubborness! It's one of his very defining features and one which I also have, so it's a battle of wills between us both at times, at least over his diabetes and probably why I am the only one he will (occasionally!) take notice of! 😉 The 12 weeks he eats 'sensibly' for are so that the HbA1c appointment will be straightforward and he can leave as quickly as possible, without being questioned or asking questions. That's why he hides appointments as he hates me going because I tell them the truth and keep them asking him questions and giving him advice. It does show that he can do it if he wants to, but he says he 'gets bored' and then reverts back to his old habits.

My Mum shops and cooks for him but she is actually part of the problem - she is very set in her ways, highly strung and doesn't like change. It sounds ridiculous (because it is!) but she does not like anybody accompanying her when she does the food shopping because it stresses her out. She will then buy the same things, week in, week out (whether it's needed or not). So instead of only buying what is needed to save money and food waste, she just refuses to buy anything new savoury meal wise for my Dad to try because it's 'too expensive'! I think he would be less inclined to eat sweet things if he had more variation in his meals. She knows what he should and shouldn't be eating, she has been to dietician appointments with him but she doesn't help him by buying things like chocolate, because she 'feels sorry for him' 😡 Trouble is, he is very fussy with his food and won't always try new things - his ideal meal would consist of just meat, followed by sweet stuff! You have summed it up when you said 'you have always done your best to respect your diabetes' - that's what my Dad needs to do! I will certainly contact the Diabetes UK Careline for advice, thank you.

Amigo - Thank you for your kind comment - reading it brought tears to my eyes 🙂 You're right, he is very crafty! He is also very contradictory at times, depending on the situation so I do suspect that in considered moments he is able to admit the truth about his condition to himself. You're also right when you say he would not attend counselling, especially as he can't even admit he has a problem on the face of it.

I am very close to him - our family situation is very complicated unfortunately and it's always just been him and me on our 'side' and I will be absolutely devastated the day I have to lose him, so holding that off for as long as possible is very important to me. It's funny that you suggested writing a letter to him as I had that very thought earlier in the week - thank you, I will do that. I'm sorry to hear that you have cancer but I wish you all the best in beating it 🙂 xx

 

[Concerned_Daughter]

stephknits - Thank you, I will have a look! 🙂

 

[banjo]

I,m sorry to read all the problems you are having with your father and understand exactly how you feel about loosing him as my mum has just been diagnosed - at 69 also - with terminal cancer. The only extra advice i can give you to what has already been mention is to- as we are with my mum - to be as open as possible with him and try and let him know exactly how you feel - i suspect you may have tried this route already tho and might be old news or like pushing water uphill. Have to agree writing a letter is a sterling idea and would give you the opertunity to let him a lot of things he may have heard but was unwilling to understand in a form that is unfortunately rarely used in modern times and much underrated. Good luck i hope you can turn things around at least he has the chance to live a longer and productive life if he wishes.

 

[trophywench]

Go round and prepare a meal for the two of them. Or invite them to yours.

Something entirely recognisable - eg a chop with several veg, but just NO spuds. Followed by eg sugar free jelly with or without fresh fruit in it, with or without cream.

A small ish (but not tiny) chocolate éclair is only 10g of carb (the size they sell in supermarkets 4 to a box for just over £1) so infinitely manageable.

All protein is carb-free so are most veg. Parsnips and spuds are on the naughty list but most others are perfectly OK.

And none of these things is expensive or 'bad' for a diabetic.

 

[zuludog]

CONCERNED DAUGHTER - I'm not sure what to do, you have a real Horse To Water situation there. Men are stubborn about their health in the first place, and besides the physical symptoms, a less well known problem is that diabetes causes problems with mental health, including dealing with reality and acceptance.

What a shame since treatment is available, and has in fact been offered and refused

I think that you know enough about diabetes, and so does your father as he's obviously cunning enough to avoid treatment and falsify results. So the problem is not actually treating the diabetes as such, we all know how to do that, including you & your father. And he obviously realises he has diabetes, hence the avoidance, denial, and falsification
The problem is getting him to accept it, and do something about it, and I'm afraid I don't have too many suggestions about that, but here goes

Ask Diabetes UK; they have almost certainly seen & heard of this sort of problem before

Try to see his doctor & other medical staff, and explain the situation, his denial, and slyness & deceit

This bit won't be very polite but I'm going to say it anyway. (I live in the north of England, we're not noted for tact & diplomacy!) - how old are you? fast approaching middle age? If your father is 67 you are probably around that
That means you will find it harder to worry and chase your father, and it will start to affect your own health. Do you have your own family? You've done a lot, but if he won't deal with it there really isn't much more you can do. Don't neglect your own life, and that of your family.

Tell your own doctor about the situation, and that it's now affecting you. Lay it on a bit thick if that's what's needed - worry, not sleeping, not eating properly, neglecting your own health and appearance. He will surely have seen this before, and have some idea of how to deal with it.

Besides 'straight' clinical or medical staff most areas have a Community Psychiatric Nurse, who, again, should be familiar with the problem and have a better idea of how to deal with it; but it needs a referral by a doctor, or similar, you can't just arrange it yourself.

Sometimes a damn good man to man talking to is more effective than the there, there, what a shame approach

Diabetes can be hereditary, so get yourself checked. Either at your doctors, or most pharmacies will give you a screening and a blood test without waiting.

Hope that's of some use, let us know how you go on, and please do ask again if you need any more advice or information

 

[Amigo]

Some great advice Zuludog but I somehow suspect Concerned Daughter wouldn't be telling his GP anything he doesn't already know and feels at a loss to control. Sounds like her father has had the riot act read from a number of medics but then goes on his merry way to continue as he sees fit. Maybe it's going to take a health wake up to change his behaviour.
His GP may actually refuse to discuss it on the grounds of confidentiality unless they share the same doctor and he knows them all well (like mine).

It's also unlikely that a CMHT (community mental health team) would accept a GP referral for a CPN to visit purely on the grounds of medical non compliance. Her father would need to give consent and it sounds like he'd be furious. I worked in this field for a very long time and know how difficult it is to get people into these services (even when they are mentally ill).

It's a very frustrating situation complicated by mum being complicit in the poor diet and fairly rigid routines. This really is an attempt to 'move an immovable object' but I hope he can be made to see sense or at least moderate his excesses.

And many thanks for your good wishes Concerned Daughter.

 

[Concerned_Daughter]

Wow, I really wasn't expecting all these replies! Thank you 🙂

banjo - I'm so sorry that your Mum has just been diagnosed with termimal cancer - 69 really is no age at all for such a diagnosis ((hugs)) And thank you for your comment - I have indeed been very open with my Dad about everything and thankfully that is just how we are with each other anyway.

trophywench - Thank you for your suggestions, this is something that is difficult for me however as I am a Vegetarian for ethical reasons so cooking him a meal would be difficult for me as I do not buy/handle/cook meat (and that's one of his favourite food groups!). However, I will be actively taking a more involved and stricter interest in his meals from now on, which will involve educating my Mum a bit but it seems like it has to be done.

zuludog - Thank you for your honest response - I am a Southerner but my best friend is a Northerner so I can completely appreciate your forthright manner! I will certainly be on the phone tomorrow morning to Diabetes UK for their advice and am very interested to hear their opinion.

As for me, without going into too much detail, I am a child of his second marriage, so he had me later in life and I am nowhere near middle age (yet!), but I do have a very supportive husband (thankfully) who gets on very well with my Dad. I also worked in MH for 5 years and that would not be a route I would wish to go down to be honest. I have also been tested routinely for diabetes but thankfully am OK for now. On the matter of him having a good talking to, believe me, I have spoken calmly, nagged and even screamed at him when I have lost my temper (not my proudest moment!) and it has little effect sadly. I am generally quite fiesty and fiery (get that from my Mum!) so I don't tend to hold back with him generally!

Amigo - Once again, thank you for your comments.

In conclusion I will definitely be speaking to Diabetes UK tomorrow to get their take on it. I found out this evening that my Dad tested his blood this morning before breakfast and it was 18, which is very worrying indeed. What ever happens, I am determind he will overcome his denial, one way or another. Thank you all again, your advice is very much appreciated! 🙂

 

[zuludog]

Well......you can see what Diabetes UK can suggest, but it looks like you've done as much as you can, certainly on your own. You might just have to accept that there's nothing more you can do
No doubt when he does start to lose his sight and have a foot amputated he will expect you to care for him

This is similar to smoking, where although some people would love to quit but can't, others refuse to believe there is a problem, despite the overwhelming evidence

Remember to look after yourself, as well