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Elder diabetics: insulin therapy and rogue diabetics

by Isabel Fawcett

Depending on the type of diabetes with which individuals may have been diagnosed, the medical treatment regimen may include insulin injections or oral medications to help control blood glucose. If followed, medically prescribed insulin treatment can be successful in helping most diabetics achieve stable blood glucose levels within the targeted range. One critical factor, however, is whether the prescribed medical regimen is followed by the diabetic. Therein lies the rub.

Over the years, I have known many diabetics, rogues included. In fact, I have said to two of my diabetic relatives who are older than I am that, if I ever am diagnosed with diabetes God forbid, I might be inclined to join the ranks of rogue diabetics myself.

Let's be perfectly honest. Diabetes is not a walk in the park. I don't need to be a diabetic to make such a statement.

I am a caregiver to my mother. Mom has been a diabetic for more than three decades. I can comfortably speak to the issue of how diabetes can easily become an all-consuming mega routine in a diabetic's life.

If a diabetic lives long enough and requires assistive care, the unending routine of a lifetime is simply transferred to the elder's caregivers. Diabetic self-care routines never go away, at least not while a cure for the chronic disease remains elusive to medical science.

I do not applaud rogue diabetics. I simply understand the renegade spirit that yearns to be free of needing to take insulin injections daily, sometimes multiple times daily. No sane person wishes to be a human pin cushion.

It is reasonable to not want to pack insulin, injection syringes, blood glucose testing devices and alcohol swabs when packing for a picnic or a day at the beach. It is reasonable to me that, in face of perceived social embarrassment, some diabetics rebel. That is only human.

To be clear, I do not advise or recommend diabetic insulin rebellion. All I am saying is that I understand why some individuals may find it difficult to stick with diabetes self-management routines day-in and day-out, for a lifetime.

In fact, my first-hand understanding of the nuances of diabetes makes me work behind the scenes to make my mother's diabetes self-care regimen as seamless as possible for her sake. I don't want the routines to be all-consuming in my caregiving role, either. Seamless balance is the key to diabetes self-care routines.

Prior to becoming Mom's full-time caregiver, I affirm that she was not a rogue diabetic - quite the opposite, in fact. Thus, it was a red flag to me when I noticed her informal, almost imperceptible, departure from self-disciplined insulin injection administration to only adhering to her morning and bedtime insulin injections.

It didn't take me long in 2008-2009 to figure out that Mom had gone rogue on her afternoon insulin injections regimen. Just call me Sherlock. I intervened as her then-part-time caregiver to assist her as soon as I figured out what was happening. I first tried calling her from work to remind her when it was time to administer her afternoon insulin injection. So began my transition to becoming Mom's full-time caregiver police, flashing lights and all.

Insulin is a Whole Other World

Insulin options for diabetics are as varied as care days are long. Some insulin is longer-acting, while others peak within shorter periods, Longer-acting insulin, such as Lantus, may also supplement shorter-acting insulin like Humalog, for example. There is also intermediate-acting insulin. Some fast-acting insulin starts working to control blood glucose levels in as little as five to fifteen minutes.

Doctors are skilled at determining whether, when, what type, and how much insulin individual diabetics may need. Ask your elder's doctor if you ever have any questions about insulin effects or routines.

Skipping Prescribed Insulin Doses

MAD Magazine once had a classic feature portraying 'this is what he said versus this is what he meant.' The feature reminds me of rogue diabetics who swear up and down, including to their treating physicians, that they are following their prescribed insulin injections treatment regimen. Inference being, without fail:

This is what (s)he says: "Yes, I am taking my insulin injections"…as prescribed.
This is what (s)he means: "Yes, I am taking my insulin injections, except…."

My fellow caregivers may fill-in the ending in the latter scenario.

Over the years, I have encountered the following diabetic rogue profiles, among others.

• Diabetic elder praises Wendy's for their fruit salad offerings that may be healthier. First, the diabetic elder partakes of Wendy's home-style chicken fillet sandwich, fries, and regular sugar soft drink. Diabetic mentioned she would take her prescribed insulin dose - an hour, or more later? Something she may have said led me to believe she would be skipping her afternoon insulin dose that day. I gather it was not an isolated incident.

• Another diabetic follows his insulin treatment regimen, ignoring healthy eating habits. He baked a regular sugar cake and ate the entire cake in one sitting, after which his family members fondly nicknamed him "Greedy." I don't know what eventually ended his life. I do know that he died fairly young, seated in his living room chair.

• Diabetic more than 10 years younger than my mother, proudly states that his newly diagnosed diabetes will not stop him from enjoying the rich foods he always enjoyed, including buttered lobster tails, fine wine with every meal, and more. I don't know this individual's cause of death, either. His publicly shared philosophy was that something would take him out of this life anyway. He perceived diabetes self-care as cramping his style.

I recall so many diabetic rogue stories from over the years. Suffice it to say that I remain Mom's caregiver police. At 84, soon-to-be 85, Mom has earned her right to be a little bit rogue. For more than 30 years, she managed her diabetes routines like a pro.

I don't skip administering Mom's prescribed insulin injections, though I occasionally indulge her love of ice cream depending on her blood glucose trends. Mom's quality of life decisions and elder control will remain visible to me as as a caregiver. It's the golden rule of eldercare.

Russian Roulette and Insulin Doses

Russian roulette is universally known to be a lethal game. Eventually, the single loaded bullet catches up with the risk-taker holding the gun to his or her head. Medically prescribed insulin may be a pain in the arm, literally, but diabetes should never be a game of hit-or-miss.

Our elders' lives depend on consistent diabetes management and self-care regimens. Caregivers and elders, please take note by avoiding Russian roulette diabetes management practices.