At a Distance

I rarely write personal accounts on my blog, but I will today.

Christmas 2005 was uneventful, and yet (aside from my gregarious and absolutely yummy 5 year old daughter’s wide-eyed grins and antics!) -- difficult. I spent Christmas with a Type 2 relative who stayed here in London as a guest in our home for the holiday.

It was difficult because I could see how diabetes is killing him. I read the prescription on his insulin vials which he kept in my egg container compartment of the fridge Lente insulin twice a day – 30 units in the morning and 10 units at night. In fairness to him, it is not an easy regiment to follow and is rife with hypos if mealtimes are not kept on routine. Obviously, this is even trickier if travelling abroad. I asked him about other treatment options. We had a short discussion on how his health insurance in the States was on a formulary system which would only give him other treatment options if he failed on the lente.

All at a distance, I watched his eating and drinking habits. Not good. I saw mood alterations. I watched him having a very difficult time at mobility, as we took short walks around London Parks -- which for a 65 year old man in the Noughties should be a pleasure not a task. I tried to discuss things in an intellectual manner, and also pleaded with his son (my husband) not to leave the Christmas cookies in plain site. My husband responded rather surly by telling me it went against all my own personal philosophies of self-management – ie, to deny and forfeit goodies, thereby treating the diabetic like a child. I agreed, but stashed them away anyway.

I was kept up at night by his wanderings around the house and his use of the bathroom at all hours of the night. I asked his wife, my daughter’s grandmother, what his “number” is. She responded by telling me his numbers were good.

"No,” I said, “not numbers. How is his A1c, his glycosated haemoglobin?”
“Never heard of that one.” she said.
“It should be around 7. Listen, find out what it is, because it is the best indicator of his health status.”

She said OK. But I never heard anything more about it. They went home. My daughter, their grand-daughter – was sad. She won’t see them for awhile. I know she will never forget taking her grand-mother and grand-father to the London Eye; they all watched the world as they loomed around from a rather unique distance. But I wonder how many more visits we will actually have with her grand-father. Triple by-pass surgery, peripheral neuropathy, autonomic neuropathy, and enzyme problems with digestion all make it a very heavy case.

I absolutely failed at helping him. However, it has led me to more closely look at the reasons why people with diabetes fail at self-management and seek isolation. My father-in-law watched me take my blood sugar at every meal. We could have done it together. I didn’t want to ask him where his glucometer was – but maybe I should have.

This personal issue of compliance and why it is such a huge problem for so many people with diabetes is going to be at the core of many of my articles in the future.
On another note, and to follow-up on my post("Who is the Leader of the Sugar Police in NYC") regarding the NYC Department of Health, I received this email:

Dear Elizabeth,
Thank you for for e-mail to the NYC DOHMH. Although the A1C registry has great potential to improve the quality of care and quality of life for people with diabetes in NYC, I recognize your legitimate concerns and will take your comments into consideration as we move forward with the initiative.

Diana K. Berger, MD, MSc
Medical Director
Diabetes Prevention and Control Program
New York City Department of Health and Mental Hygiene dberger@health.nyc.gov
(Tel) 212-676-2157
(Fax) 212-676-2161

2 Lafayette St.,
20th Floor: CN # 46
New York, NY 10007

With the knowledge of NYC’s desire to achieve better healthcare outcomes with difficult diabetes cases and post-visit with my in-laws, now I am not so sure it is such a bad idea after all.