Would like input for my 83 year old mom

[Joey_M]

Hi all,

My mom is 83 years old and has elevated glucose levels for about 5 years now. They rarely went over 150 and she has been able to control her glucose quite well through diet and exercise. But 2 months ago, she went into the hospital for 2 days for an unrelated issue & they fed her lots of high glycemic foods. Her doctor in the hospital said he was concerned she may have low blood sugar so my brothers fed her junk food and cake. When she got home, her glucose reading was 240 and that freaked her out. She returned to a good diet and her number dropped below 180. She went to her doctor for a routine visit and was very worried about her numbers so the doctor gave her xanax and glucophage. I got her to wait on both RX's and her numbers got down into the 130's - 140's with occasional 160's. She is good on her diet but slips a bit. She also walks over a mile 4 - 5 days a week. I just got her last lab results and her A1c was 6.5 & glucose was 128. I have a few questions:

1. Her glucose levels are always lower at the doc / hospital than home - could her testing equipment be bad? I changed the batteries a few times but doesn't seem to matter.

2. We prefer to keep her off glucophage as long as possible due to the possible side effects and not wanting another drug in her system at 83. What are people's thoughts on the benefit/need for meds at her current a1c level?

3. Her doctor shares very little info and when I went with her, he was angry when I asked questions. I found a better doctor but she is resistant to change although she doesn't like him - any ideas on how to persuade her?

4. How do I help her stay stricter on her diet - her weakness is white bread & noodles. I stocked her house with kamut pasta but when she makes food for my brothers, she uses white crap and then eats it herself.

5. My brothers think she should be left alone and I am too involved with helping her with her diet and that occasional sweets & white crap is ok - how do I educate them when they want to be in denial? It is hard doing it alone especially when they spend time with her and/or cook for her. BTW, I live in CA and she lives in IL - I fly there once a month for 4 or 5 days and stock her up on healthy foods and she does great when I am there. Work prevents me from more time with her.

Thanks,
Joey

[Joey_M]

Hi Tammy - thanks for your well written response. My post was from a couple of months ago and since then I got my Mom to a new doctor who while a generalist does a lot of work with geriatric diabetes patients. Given her A1c combined with low cholestrol and good blood pressure, he also agreed that starting any meds would not be warranted and might even be bad since she could go hypo-glycemic. She really likes the new doctor and he communicates very well and takes a balanced approach.

Good idea on the diet education but she doesn't have a very long memory for that. SO I call her every day and go over what she ate and what she plans to eat. You are so right that it is up to the person with diabetes but given her memory, I need to be her active coach. I let go worrying about my brothers and she now refuses food she should not eat when they offer her stuff. We just take it daily now and it seems ok.

Thanks again,
Joey

[tlmeredith]

Your mom's A1c is great!! Every doctor I have been too want your A1c's under 7. Any illness can raise glucose levels, but I don't understand why they fed her high glycemic foods---this just doesn't make sense.

When to doctor takes your mom's glucose at the office or hospital, are they using the hand held meters or taking blood draws? First, if they are using hand held meters there usually is a variance in readings from meter to meter--if the readings are drastically different then there could be something wrong with the meter. If this is the case, ask her doctor for a new meter---meter companies are always giving meters to doctor to hand out for free. If he doesn't have one and your mother has insurance, check with the insurance company to see if she has durable medical equipment coverage--this coverage should pay for the meter, but depending on the policy there could be a small copay.

And as for meds, I can't imagine why a doctor would put her on meds with an A1c of 6.5. Is your mom seeing and endocrinologist--they specialize in treating diabetes. If she isn't --I would suggest find an endocrinologist. It would also be good if you or someone could go with her. There is diabetes education that these doctors usually provide.  Getting your mom to switch doctors may be difficult, but if she is just seeing a primary care doc--maybe she would be willing to go to the specialist because she would not have to give up her primary care doc.  Or, if that is not the case--maybe you could get her to agree to at least trying the new doc for 2 to 3 months and then make a decision to continue or not.

Basically, when it comes to helping someone stay on the proper diet---the responsibility falls on that individual. The education I spoke about above sounds like it would be of value for your mom. I would suggest that your brothers be involved in the education as well. It sounds to me like they just don't understand the fullness of the disease. And since you don't live close to her--they need to be educated. This is something to discuss with the endocrinologist as well--or a new doctor.

Diabetes is challenging and it is difficult for family members who don't understand the disease, and a disease that is not physically visible until complications sets in.

Hope this helps! My Best wishes for success in your endeavor to find a good doc and to get your brothers educated and on the same page with you!

Tammy