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Diabetes reality check

by Isabel Fawcett, SPHR

Diabetes self-care might not be entertaining if it were reality television. Yet diabetes has its recurring drama for some diabetics and their caregivers. The drama of extreme blood glucose fluctuations can be a cliff-hanging experience worthy of soap opera plots and counterplots.

Simply Diabetes

At its simplest, diabetes is a chronic disease distinguished by high levels of blood sugar. When the human body functions as it should, the pancreas produces insulin. Insulin helps the body regulate its blood sugar levels. Some diabetics' bodies fail to produce insulin. Other diabetics' bodies fail to produce sufficient insulin.

Diabetes Self-Care

Diabetics are expected to engage in rigorous self-care including regular blood glucose testing. Successful diabetics are mindful of food and nutrition management, foot and vision care and more. Diabetes management requires a concerted effort to be on top of one's game, as my mother had been for decades before I became her caregiver. Mom was so disciplined in achieving balance that her long-ago endocrinologist was able to discontinue her then-regimen of a daily insulin injection. Less than a year later, the doctor had to resume prescribed insulin injections for my mother.

Reality

I've known a diabetic whose prescribed dose of insulin injections totaled 6 per day. That was more than 20 years ago. Back then, I couldn't imagine more than a couple of injections daily for any diabetic.

I visited my friends' diabetic Mom after she became home-bound. I also called her on the phone to say hello. In her in-home care by her son, my friend's mother remained stoic. She would casually mention the thickening of the skin on her fingertips. Her fingertips had increasingly become resistant to the finger-pricks blood glucose testing she did multiple times daily. Sometimes she couldn't get a single droplet of blood no matter how many fingers she'd pricked.

One Insulin Injection and Counting

Mom's originally prescribed insulin injection regimen was a single insulin shot daily. After some time, the single daily injection was medically increased to two injections per day. Eventually, Mom had to be prescribed one injection in the morning, one during the day, and a third injection at bedtime. Many years later, a fourth bedtime insulin injection was medically prescribed for Mom. Four and holding is where she is today in her diabetes journey.

Mom always took her increasing prescribed injections regimen in stride. I, on the other hand, felt for her just as I did for my friend's mother when she self-administered 6 insulin injections daily for years. Diabetes can be quite the roller coaster ride with no amusement park in sight. I can see how some diabetics start skipping an injection here or there as they grow older. Insulin Therapy and Rogue Diabetics is an EldercareLink.com article that speaks to the issue of diabetics who fail to keep up with their prescribed insulin injection regimen.

Rotating Insulin Injection Sites is Nice - in Theory

Healthline.com's Where to Place Your Injections, offers an illustration of commonly recommended sites on the body for insulin injections. Although 1-inch between injection sites in each area of the body is recommended, I have yet to see a diabetic who self administers insulin be able to see the back of his or her arm with such precision, let alone who adheres to the 1-inch apart clinical guidance.

Insulin injection site rotation remains a nice medical theory and a goal for some insulin-dependent diabetics. Reality is a different ballgame. Some diabetics and their caregivers are simply doing the best they can by treading water.

Similarly, using all sites in a single area of a diabetic's body before moving on to use another recommended site presumes that diabetics and their caregivers remember to do that daily. Realistically, even individuals who are in optimum health with no chronic illnesses occasionally forget details. Diabetics and their caregivers are no different.

God Bless Appetite Fluctuations

Diabetes or no chronic illness, appetites vary, sometimes daily, and other illnesses can complicate that factor. When Mom has an early morning doctor's appointment, she may not be inclined to eat until she has completed the medical visit. It is understandable that she is not hungry that early, and is more than a little nervous about going to the doctor. Regardless, delaying any meal invariably affects her blood glucose - sooner rather than later.

The best I can do to mitigate a sudden blood sugar drop while Mom is waiting to see her doctor is to offer her a cup of yogurt with rolled oats and a hot cup of tea before we leave for her appointment. I can see some diabetics just skipping breakfast entirely and cruising until lunch time before eating the first meal in their day.

Occasionally, I remind Mom that this "stuff" eventually catches up with a diabetic's body. That's the simple reality of diabetes. I don't need a crystal ball to figure this one out.