Encouraging my Mum

[Redkite]

Further to my query about recommended Hba1c for type 2's:

Yesterday I had my Mum over for the day, and she declined a biscuit with her coffee, saying she was "trying to be good". I asked if this meant she was having her Hba1c done soon, and she said she'd just had it done and been told it was too high (it was 7.1, and previously she'd been told to aim for under 7, whereas now, in her words, the goalposts have shifted and it needs to be under 6). She says they are "threatening her" with starting on medication, and this has obviously made her anxious, although she also says she "knows it's a progressive condition".

It makes me very cross that she has been left all these years with no actual patient education, and the impression that a decline into worse health is inevitable! On the other hand, it has also annoyed me over the years that she has stubbornly refused to test her BG or do anything I might have suggested (because the nurse had said she didn't need to 😡). She was diagnosed at age 60, initially tried hard and lost a fair amount of weight, and since then has ticked along a bit overweight but being reasonably "careful" with her diet, but with no carb awareness. She is now 73, and takes all sorts of tablets - thyroid, ACE inhibitors, statins, etc.

I tried to have a serious conversation with her earlier in the year when my uncle died suddenly of a heart attack aged 72. He was my Dad's brother, not my Mum's, but he'd also had type 2 for about the same length of time (was on insulin latterly). His parents had lived into their 90's, so his death at 72 was totally unexpected and may well have been attributable to his diabetes. But Mum was still resistant to changing her approach.

Anyway, I saw an opportunity yesterday (finally!) to encourage her to start testing, and (not allowing her time to go off the idea) I gave her a spare BG meter, lancets and a pot of strips to get her started. I've suggested she does pre and post meal tests for a week and writes it all down (I've made her a handy spreadsheet to record all the info on, AND a page of instructions). She was looking even more worried by then 🙄

Tests done so far (at my house) - pre lunch 8.5, two hours post 7.5 (had ham, salad, and yoghurt - 15g carb). She forgot to test at dinner time, so I rang this morning to remind her - oh yes, I'm just about to do it. Ten minutes later, I get a phone call - she couldn't get the finger pricker to work. Didn't have her glasses on, so that didn't help! I think she wasn't lining it up against her finger properly, but Dad thought she hadn't put a lancet in, so she pulled the cap off to check and promptly stabbed her thumb! Anyway, waking level was 8mmol.

She seems to be finding it all a bit stressful, but I'm hoping to encourage her to keep it up! There isn't much scope for increasing her activity levels, she does walk to the shops etc, but is mostly sedentary and has problems with arthritis in knees etc, so won't be taking up any new exercise. The question is, if she's careful with her diet but is still mostly in the 8's (BG), should she be asking the doc for meds?

(Sorry, this is quite a long post!)

 

[Redkite]

Can anyone help with the question at the end of my post above? Thx 🙂

 

[DeusXM]

I'd be inclined to look at it like this.

Your mother's blood sugar readings aren't that bad, although they are a little high. She's also already taking a lot of tablets as it is.

With that in mind, I don't see the harm in her doc adding another one (I'm guessing probably metformin) and she just carries on as normal. Metformin is a low risk drug and could potentially help with some of the BP and cholesterol issues. And given her readings are generally ok, she can probably do without the regular testing.

This isn't the advice I'd give to someone younger but I'd take the view that your mother is quite old, already has a lot on her plate and doesn't need to really do that much more to get her blood sugar into a better position. So rather than add to the list of things she has to worry about by making her test her sugar all the time and stress over spreadsheets and lancets and the like, I'd be inclined to just let her be and let the doc handle this.

 

[stephknits]

It's hard to say, redkite, I think if it were me, I'd try this new regime of being more careful with carbs and testing to find out what particularly raises her BS. What I would want is to be able to test to see if this was making a difference and therefore I would recommend her asking the surgery to give her another review in 3 to 6 months time, as she is acting on their advice. That way she will hopefully have the motivation to see if this works, before looking at other options.

 

[happydog]

Would it be possible to encourage her to try for say three months? My HbA1c was 18.5 at diagnosis in September 2012 and is now 5.3. My GP and DN were dead keen on the medication, I was not. Testing is essential and keeping a food diary helped a lot. I put together lots of small steps. Smaller portions, a low carb bread, reducing carbs such as potatoes etc. I know that you know all of this as you have done so well with your son. As she is taking other medication my inclination would be to stay off additional tablets etc for as long as possible. There is a sheet of exercises for chair bound people that you could get from the doctors. Would they consider sending her on a course now? Could you go to see the doctor with her and ask him/her the question that you asked and then weigh up his/her answer? You have a lot of knowledge. Each person is different so it is not easy to say what is the best course of action. If she is getting stressed about it that won't help either, so you have to judge if you think that she can settle and if you feel that she is sufficiently motivated.
Sorry not a lot of help but she could and should have lots of good years of life ahead and I hate the defeatist attitude of some of the doctors and nurses. Sorry to have gone on a bit and I hope that I have not offended you. Good luck to both of you with this 🙂

 

[jalapino]

You no the saying " you can't teach an old dog new tricks "?

Well I say rubbish!! if she is happy to test with a meter then I would agree with Happydog! 🙂

 

[Redkite]

Thanks everyone. Type 2 is a different ball game to what I'm used to with my son - he doesn't have a restricted diet (takes insulin for everything, so eats what he likes within reason and is very active). Having either type of diabetes and not knowing what your BG levels are is unthinkable to me! 😉

I told her she should do a week of tests and write down her meals, and then we can see whether her food intake is a problem or whether she is not actually fluctuating too much, but just wakes a bit high and stays there. A week's worth of data (if she sticks to the schedule!) should give plenty of information to go on. After that, I suggested she should do a couple of waking BGs each week, and occasionally some mealtime before and afters to keep on top of things. I don't think she would be up for continual testing, and perhaps doesn't need to.

I am not offended by anyone's ideas - I can see the logic in not burdening an older person with an onerous self-management schedule, but on the other hand if it was me who was in my 70's, and in this case it's one of my parents, it definitely seems well worth the effort for as many more healthy years of life expectancy as possible! 🙂

 

[Northerner]

I think that sounds like an excellent plan Redkite 🙂 I also (now in my mid-50s) consider being in your 70s to be relatively young - I fully intend to collect my 50-year medal when I am 99! 🙂

 

[KookyCat]

Having lost my Dad to complications of type 2 when he was just 70 and seemingly fairly well controlled my opinion will be a very emotional one, but I'd say push it a little bit and providing it doesn't cause her distress try and get her a little bit more control. I'm not a big one for regrets but I regret not taking a more active role in at least trying to get my Dad to address the carbs in his diet, mostly because he might well still be here at least for a little longer if I had. I said it was an emotional opinion, and it is, I'm not suggesting that you should push her too hard if it upsets her, but doing some testing now to fuel a few diet adjustments seems like a good idea. If medication will help and she doesn't mind taking an extra pill I'd push a little for that too.

I mulled quite a while about whether to post on this topic because I know I can't be objective about it, but in the end it's what I wished I could have done for my Dad.

 

[Redkite]

I mulled quite a while about whether to post on this topic because I know I can't be objective about it, but in the end it's what I wished I could have done for my Dad.

Thankyou KookyCat, and I'm really sorry to hear about your Dad. I understand completely what you are saying (not that it's in any way your fault, but I would feel the same), part of my motivation is that I don't want what happened to my uncle to happen to my Mum, and me to have not said or done anything to prevent it. Parents don't necessarily want to take advice from their own grown-up kids though, do they? I've tried to broach the subject many times over the years, but this time she's a bit more receptive because I think she sees going on tablets as the beginning of the end.

What ought to happen is proper advice from the healthcare professionals,instead of sending people out with vague advice to "watch what you eat".

 

[Northerner]

...What ought to happen is proper advice from the healthcare professionals,instead of sending people out with vague advice to "watch what you eat".

Going back to your original post, I do not believe that HCPs should 'threaten' people with medication, it is a terrible way to approach things. I know a lot of people won't use insulin, even if it would vastly improve their quality of life. because they have always seen it as a threat of something awful that they only have themselves to blame for

 

[KookyCat]

Going back to your original post, I do not believe that HCPs should 'threaten' people with medication, it is a terrible way to approach things. I know a lot of people won't use insulin, even if it would vastly improve their quality of life. because they have always seen it as a threat of something awful that they only have themselves to blame for

I agree, my Dad was petrified of insulin, because it was used as a bit of a stick, improve your control or you'll end up on insulin. To my dad that meant he'd be a "real diabetic", he didn't understand it might well have improved his life. There should be good quality advice, and that is so variable.

 

[KookyCat]

Thankyou KookyCat, and I'm really sorry to hear about your Dad. I understand completely what you are saying (not that it's in any way your fault, but I would feel the same), part of my motivation is that I don't want what happened to my uncle to happen to my Mum, and me to have not said or done anything to prevent it.

There is a certain irony for me that I was diagnosed almost a year after my Dad died. Had I known then what I know now I couldn't have lived with myself if I hadn't given it a try. They can be stubborn, and taking advice from your kids must be difficult, but I think it's worth a try. I hope it goes well and if she decides she doesn't want to take a bit more control at least you'll know you did your best.