OT: Diabetes Question
 

My mom and dad split up a couple of months ago and my dads health is not so well. He has diabetes. Not sure what time (not insulin dependent (perhaps type 1?)) and I found out a few days ago that my dad has started having sores on his feet. My mom pushed him to go see a doc and he did. He emailed me today and said that he could hardly feel it when the docs poked his feet. I am not sure what this really means. I remember when I was younger that my uncle past away from diabetes and I recall him having open sores on his feet and legs but I was really young so perhaps I was wrong.

Anyway, I have been telling him to watch what he eats and exercise. I am not sure if thats correct information or not or what else can/should be done. I would like to support my dad and help him (we are 3,000 miles apart) but want to give him sound info.

Also, the sores are concerning to me.

chefisaac,

Sorry to hear about your dad's medical problem. It's potentially dangerous to offer/accept specific medical advice over the internet (or phone-in talk radio shows, etc.). Your dad needs to see a doctor. That being said, the symptoms you describe are consistent with two common foot problems in diabetes: peripheral vascular disease ("poor circulation") and neuropathy (nerve damage causing numbness and pain).

Thanks Neuro. Not looking for medical advice per say. Thats on him to continue seeing a Doc but what he has been told and what he tells me might be two different things so thats why I like to glean for what other people have seen, learned, and/or gone through.

Type 1 diabetics are, by definition, insulin-dependent. If your Dad isn't insulin-dependent then he has Type 2 diabetes (sometimes called "adult onset"). Neuropathy is generally a sign that the patient has had poor control of their diabetes for a long period of time. More importantly, it's a sign that other more serious complications may be coming. Even with modern medicine things like kidney failure and blindness are still a possibility if a person doesn't bother to control their diabetes...

I'm Type 2 and am controlling it with diet and exercise now. There are several causes for type 2. Mine is insensitivity to Insulin on a cellular level. In other words I make enough insulin but my cells don't allow it to pass through the cell walls to be utilized. So when I was diagnosed I was put on 3 different meds. Actos made my cells more sensitive. Glipside lowered my blood sugar. Metformin slowed the conversion of food to blood sugar. When I began treatment I was on the max dose of all three. As I lost weight and controlled carb consumption the doses came down. Glipside was the most problem some as it really is strong and I had a couple instances where I had to eat a candybar to raise blood sugar or pass out. I kept a record of my all blood test levels so the doctor could adjust the meds for just the correct amount. After it was lowered 5 times I went off it after 8 months. Actos was removed at the 1 year time span and finally Metformin was removed after 2 years which was 5 weeks ago. So now I'm controlling it with diet and exercise. Sereral cousins of mine have Type 2 as well and one has to use insulin as he doesn't make enough insulin to control it. He exercises some to help but needs to lose more weight. He was in the 400 pound range and has dropped 70 lbs but hasn't lost anymore that I can tell in the last 6 months. He is controlling it with meds well as his A1c is now 6.2. My last test (5 weeks ago) showed me at 4.7 and I've been at that level for a year so no more meds. I had to get in his face several times to get him to go in and be tested. Now he's glad I did and says he feels better now that it under control.

There's no cure yet. So if I go back to eating poorly and gain weight and quit exercising I'll have to go back on the meds. It tends to run in families so it's something you should test for probably every 6 months. It also means the exercising and losing weight is an order of magnitude (10X) more important for you than the other 75% of people.

I'm also Type 2. Diet and exercise are EXTREMELY important to controlling Glucose Levels. Let's face it, they're important to anybody, but even more so for diabetics. Excercise makes your body more capapable to utilize it's own natural insulin. But, as for anyone just beginning an exercise program, try to enociurage your dad to discuss it with his Doc first.

My dad frusterates me because you has an issue with drinking too. He has been to classes on that and diabetes and has not followed through with trying to get better. This upsets me because I have lost others to diabetes as well.

I know the saying "you can lead a horse to water but its up to them to drink it". I know that but perhaps, like he nad my mom did, I should harp on him more about it. I do not really know what else I can do since being 3000 miles away is tough (cant go for a walk with him) and since he and my mom split up, it makes it that much harder. Plus he is putting in a lot of overtime and I know that leads (usually) to bad choices in food and a lack of excersise.

My spouse has type 1 and has had it for 50 years. He does tight control (tests his blood numerous times a day and takes insulin numerous times a day) He has peripheral neuropathy from the long term toll of diabetes but no other issues. He has to carefully watch his feet for sores because he might not feel them. Sores that don't heal can lead to infection and even gangrene and amputation. Not so common anymore but it still happens. Prevention and early treatment of sores is key.

http://diabetes.webmd.com/features/d...s-caring-sores
http://clinical.diabetesjournals.org...t/24/2/91.full

Tell him you love him, are worried about him, don't want to lose him and ask what his plan is to address his health issues.

Chefisaac,

It is very important for diabetics to follow through with proper management of their condition. I can empathize with you as my own father had heart disease and it was difficult to keep him on program. You can be supportive and encourage him in his diet and exercise but ultimately you have to accept the decisions your father makes for himself. "Harping on him" is not likely to be productive but frank, honest discussion might be. It's hard. We as family members always feel we should or could do more. I hope your father does well, but no matter the outcome, don't blame yourself for his decisions.

Best wishes to you and your family

I'm a type-2 diabetic also, and it runs in my family. When I was diagnosed, I considered how my mom managed hers, and lived to 91, and how my aunts and uncle didn't manage theirs, and died in their 70s. I decided that I want to squeeze every day I can out of life. I'm down 80+ pounds, ride on average 150 miles a week, and my a1c was 5.6 the last time I had labs done. Fasting glucose in the mornings is almost always between 80 and 95.

I've outlived my parents and brother by many years (Dad & Mom each died at 52, brother at 55). I turn 60 in July. I was diagnosed Type 2 in '05. I've been up and down a bit but right now, with losing 40 something pounds (221 down to 180ish) and starting back with exercise (though the weight loss has been more important long term - you cannot exercise your way out of diabetes) has brought my A1C to 5.6 and daily checks/fasting morning to around 90.

Once the neuropathy sets in it is not curable - you can treat the sores and watch problems but the damage cannot be repaired.

After it's all said and done your Dad needs to be under a doctors care closely from now on. From what you describe he is headed towards having either his legs or feet amputated.

Sign up for the local American Diabetes Association Tour de Cure. Tell your dad that you're riding for that THIS year in support of finding a cure, and in the hopes that your example will prompt him to start improving his health. And tell him that, if he doesn't change his behavior and get his diabetes under control, that you'll ride it in future years in his honor after his uncontrolled diabetes kills him.

Diabetes pisses me off. Well, actually... diabetics that don't change their behavior. It can kill you. It WILL kill you, if you let it. Neropathy, heart disease, stroke, blindness, high blood pressure, kidney failure, skin disorders, ... the list goes on. But pretty much all of the horrible symptoms and side-effects can be controlled and/or completely avoided if you make some lifestyle changes that all of us should be doing anyway - exercising more, eating less crappy food, watching our weight, and seeing our doctor regularly.

And that's what pisses me off the most (and why the ADA is my #1 charity): it's all so preventable by information, and by lifestyle changes. If people KNOW, and change what they do... it'd be no big deal. But so many people just don't know they have a problem, or don't see their doctor regularly, or don't have regular screenings for it, or don't know what to change once diagnosed, or worse (and too damned common) - know what they should do but don't.

Type 1? Yeah, they have it harder, cause they need insulin shots, or a pump, or other extraordinary interventions to live a normal life. But a surprising number of them do just that. I know quite a few Type 1 riders in the NC TdC. Fit, active, and you wouldn't know they were diabetic unless they said something or you rode behind them and noticed the tube from their insulin pump snaking out of a jersey pocket.

But Type 2? [Strike]I know[/Strike] I've known so many Type 2 people who refused to change anything about their life - they gave up, slowly. Like smokers, they knew their lifestyle choices were risky, but they didn't change.... Until they got lung cancer (for smokers) or they started losing feet or got put into a wheelchair (diabetics). And some of them didn't change even then.

I still have vivid memories of my grandmother eating cake when she knew it was killing her, a defiant and victorious look on her face as she grabbed it from somebody else's plate and shoved it in her mouth as fast as she could - before my mom could take it from her. In fact, that's one of the last memories I have of her when she was still lucid - before her first stroke crippled her brilliant mind.

Richard,

Great to see other TdC riders on the forum. This will be my first year riding for them. It is a great cause. I join you in encouraging anyone on the forum to look into their local TdC ride. Most have a low entry fee and fundraising minimum so anybody can participate. Not to hijack the OP's thread, but I think this relates.

http://tour.diabetes.org/site/PageSe...me=TC_homepage

I'm a Type 1 diabetic and I honestly think that Type 2 diabetics have a more difficult time. Injectable insulin is the single best tool for controlling blood sugar... and the majority of Type 2 diabetics that I've met don't have a clue about it!

This is so spot on! Everything said in this paragraph should be noted.

chefisaac, sorry about your dad. If he heeds his doctor's guidance, he should have a long, productive life. My mom was a Type-2 ... and didn't take care of herself. It was sad, but what can we children do? If they won't listen, or follow their doctor's advice, there is little anyone else can do. I am also Type-2, and try to control it, but I have a weakness for ice cream. Several years ago, I was able to lose forty pounds over a two-month period. I went from 225 lbs. to 185 lbs. The resultant weight loss allowed me to discontinue oral medicine. It's taken about five years for my weight to slowly creep up to its current 205-210 lbs. Yup, back on the medicine, (Metformin). I'm slowly working on getting it back down to about 190, but it is always difficult during the winter because after-work exercise is difficult to fit in, (along with a full-time mortgage-paying day job and teaching two nights a week at the local community college). Like jethro56 says, diet and exercise is so very important in controlling Type-2 diabetes.

- - -

p.s. Worst thing about loosing that weight is that my tennis game went down the toilet. No longer did I have that mass behind my strokes. I was a whole lot quicker around the court. I could get to a ball much sooner ... but once there, I couldn't do anything with it. Still haven't recovered my old game. Maybe time for lessons again?

As others have noted, the loss of feeling is a very bad sign. It means that blood sugar has been quite high for quite a while. I don't know what the reversibility of such symptoms are, but in most Type-2's I've known, once that happens, it's irreversible, although it's possible to stop it from getting worse. The key's again, are blood sugar control and that means loosing weight, lots of exercise, exception diet control and taking meds religiously. Tough to do if you haven't done it and haven't had family support. But something to try that many diabetics never do, is the push the envelope of physical exertion. Many doctors advocate any form of prolonged and regular exercise. It has varying benefits for people. But I notice that for many Type-2 folks who actually reverse their conditions and decrease or even go off meds, they become athletic. They train to the point of blood sugar deficits that come about due to 1hr or longer of physical exertion at 80% of possible max aerobic capacity. This is like having the heart beat at 140 bpm for 1hr climbing, say, 3000 ft, over 10 miles say. Serious exertion.

If the diabetes sufferer can do this regularly, I' m willing to bet that much of the risk factors like high blood glucose, retinopathy, neuropathy, sores, kidney damage, etc. simply will no longer be high. There's something about tremendous physical exertion and the corresponding body's ability to recover after such exertion that is far superior than just sedentary, if not sedate forms of activity, including a slow walk, or mozying like a "fred" on a bike. Simply put, if you're gonna ride to get healthy, then ride HARD.

If I had Type 2 and was overweight I would consider going on the short term, but extremely low energy/low carb diet to see if the diabetes could be reversed (not cured, that would be overstating the case). There is a study which shows this may in fact work: http://www.diabetologia-journal.org/Lim.pdf The findings were consistent with what happens to gastric bypass patients after their bypass and when they are on severe eating restrictions during their recovery.

Of course, the issue is keeping the diabetes from coming back after the restrictive diet is over.

Anyway, worth exploring with one's doctors.

I have diabetes... type 2, however, I've been on insulin for several years. I don't eat a perfect diet for a diabetic, but I do watch my carb intake and I exercise quite a bit... not enough, but more than most people. I ride my bike, commute by bike a few days per week (more when the weather is better), run/walk, play golf, and play tennis. I haven't had any severe complications. My circulation to my feet and hands has been affected. When I get sick I don't get well as quickly as I used to. Same with scrapes, cuts, and injuries... they don' heal as quickly.

I'd say your Dad's alcohol problem is more immediate than his control of diabetes. I know alcoholics that when they have been diagnosed with diabetes, their addictive personalities led them to exercise addiction that eventually replaced their addiction to alcohol... and in turn benefited their situation with diabetes.

It's a tough spot to be in. I know many diabetics that lead productive lives and are well into their 70's and 80's. But alcohol, cigarettes, drug abuse, and diabetes are not a good combination.

Thank you all. I really appreciate the advice and insights.

Richard: You message brought a few tears in my eyes. For all my life, my dad has pushed me to do better which I appreciate it. I think, from what you wrote, this is a great idea.

Sincerely thank you!

Agree completely, but... it sounds like chef's dad isn't going to be terribly open to a complete lifestyle change. So, as a diabetic, I'll suggest that the two most important things are: 1) checking blood sugar regularly using a glucose meter, and 2) taking medication religiously. If dad is going to eat poorly, I'll strongly suggest that one of the medications he should know how to use is fast-acting insulin (ex: Humalog, NovoLog, Apidra) so he can quickly bring his blood sugar under control if it is found to be high. Doing these two very simple things goes a long, long way toward reducing the possibility of diabetes-related health problems.

If I could add a third thing to the list, it would be: visit a doctor regularly (4+ times/year) to have a hemoglobin A1c test done.

Alcohol actually lowers glucose levels. When I was first diagnosed, and prescribed metformin, I was advised to avoid alcohol for the first month until my system adjusted to the medication. There was a real danger of hypoglycemia. But, before anyone thinks that excessive drinking is a miracle drug for diabetics, it also constricts blood vessels and increases BP, and in the long run, together with the other effects of un-managed diabetes, causes the blood vessels to become inelastic and increases the risk of stroke. But nothing says you can't have an occasional drink. I'll even have a beer now and then.

IMO, the most effective means of managing T-2 diabetes is attending the education class(es) and re-learning how to eat. Short term diets have been proven to be ineffective for long term management. Deprivation doesn't work. Feeling deprived is counter-productive to keeping weight off in the long term, because you go into those crash diets feeling like you can't wait for them to end. Diabetics need a diet they can stick with all of their lives-- and I don't even like calling it a diet. I refer to it as an eating plan. The old school "diabetic diets", ie, 1500-1800 calories, low carb/low fat/high protein, have been re-thought. The modern diet stresses complex, whole grain carbs, not low carbs. 45 grams of carbs per meal, 25 for between meal snacks., and snacking is highly encouraged. Fiber negates carbs gram for gram. There's no reason why a diabetic can't have an occasional treat while staying on a life-changing general eating plan. The only thing I don't ever eat is candy, because it's totally empty calories. But, if I'm at a birthday party, I'll eat a small wedge of cake, and I have ice cream about once a week, usually after my long Saturday ride.

Not exactly... Wine and beer both contain carbohydrates, so they tend to raise blood sugar. Liquor doesn't contain carbs, though your mixers (orange juice, Coca-cola, tonic water) might. Alcohol may cause blood sugar to drop after some time, but there are a large number of factors involved and the results are very inconsistent in my experience. The message here is: be careful! The last thing you want to do is be making decisions about medication when your mental faculties aren't at their best...

I was at a family diabetes camp last year. All type 1 diabetics. The doctor asked a new patient of his to talk at the camp. I guess he should have investigated what he was going to say ahead of time. He was in his 70's a healthy as a horse. He attributed it to his Hippy lifestyle. He said beer and such with carbs was unpredictable with his sugar level. Hard liquer would drop him low. And if you really needed something fast to drop a high, hit the wacky weed. Keep in mind this camp is put on by the JDRF so most of the kids were under 18 sitting with us parents as he was making his case for sugar level controls. Although he was in his 70's and was diagnosed around 10ish.

I do hope your dad will wise up though. I will keep him in prayers.

Isaac, sorry to hear about your Dad's problem but chances are giving him a hard time about it won't get you very far. I'm fairly new around here but it seems to me that you have come along way in 6 months or so and maybe there is something in your journey that you can share with him that might help him change his mind about the way he takes care of himself.