Sugar Matters
May 13, 2014

Thoughts on a gentleman in clinic – dealing with life

Over the next few months, we will run repeat articles of Sugar Matters, as Dr Ramsetty is on maternity leave.

This week, I would like to remember a gentleman we saw during a visit to St Vincent.He was about in his 70’s or thereabouts. Tall, smiling when he spoke, very animated. He had diabetes for a number of years and had in fact received some treatment in the United States. He had been treated with insulin for some time, including with insulin pens (which are a specific type of delivery device, instead of using syringes).{{more}}
 
His hemoglobin A1C was not where it should have been, and instead was a touch on the higher side (around eight per cent). He explained he had some difficulties with insulin because no one was familiar with insulin pens in the clinic. I asked if he was able to give himself insulin and he held up two slightly shaking hands and said, “This tremor keeps me from being able to give a shot properly.” So, a nurse living nearby would come to his house every day to give him his shot in the morning, but he often did not receive an evening shot (which he did need). We talked about his diet and how he had already been trying to control his portions etc, but he admitted that he lived alone and sometimes ate “whatever was easy” in the house, or “whatever my friends have” when he visits other people. He told me that he did drink alcohol sometimes, occasionally too much, but not every day.

Why does this man stay in my mind?

Besides his smiling face and general approachability (I could have sat and talked with him all day!), this man’s 15-minute conversation with me brought up everything in life that jumps in the way of being in control of diabetes, or any other chronic disease for that matter. But this gentleman was working with the situations and trying to make things better.

First, he had limited help around him: no one knew how to use the insulin pens, he lived alone and there was no family nearby. BUT, he adapted: he asked for help from the nurse living nearby and returned to using syringes, because that was what was being used. Second, his diet was affected by what he could afford and what was simply available, which is often especially the case with older people not making a lot of money and living alone. BUT he was trying to keep portion sizes appropriate and watching his starches. Third, he admitted his faults in saying that he was drinking too much at times, BUT was trying to make that happen less and I appreciated that he was honest about that with me. And fourth, he had other illnesses, his tremor, that made taking care of himself more of a challenge. BUT he did not just give up and say, “well, I can’t give myself any insulin, so that is that.” He sought help in the clinic and with his neighbour nurse.

This is why I think of him, even now. He was a REAL example of how challenges pop up, and why, sometimes, taking control of diabetes is difficult, but that it CAN be done. For someone with this many challenges, an A1C of eight per cent (meaning average blood sugar over three months is between 180-220) is not that bad truly. It could be better, yes, but it shows he is trying.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com

Medical Director Endocrine Care Group

www.endocrinehelp.com

Tel: 843-798-4227