I am not a nurse, but I am thinking of starting nursing school next year.
I need some advice about my husband. I am not seeking actual medical advice, because I know you can't offer that over the internet. I am looking for some insights though, based upon your experiences.
My husband is 35. 2 1/2 years ago (we were dating but not married), he was diagnosed with Type II diabetes. He was diagnosed after going to the ER with a blood glucose of well over 700. The hospital discharged him a few days later, and they told him to follow up with his PCP. At that time, he had never been to his PCP, who he had just sort of picked at random when enrolling in insurance.
So the PCP put him on two oral meds...glucophage and glucotrol. It seemed to help for a while. My husband was good about taking the meds, but not really being that aggressive about forming a structured meal plan. He did lose a LOT of weight (about 40-50 pounds), and is currently 6'4" and 179 pounds, so he's not overweight.
To make a long story short, I am more involved in his care now that we are married. I go to the dr with him and stuff like that. Over the past several months, the dr has informed him that his cholesterol and diabetes were "out of control" in spite of the medications. He made some changes, added some more meds, etc. He is still no better. In fact, he is worse.
So we are going to dr again tomorrow, and the dr said he thinks my husband will go on insulin.
I like our PCP, but my husband has had uncontrolled diabetes for 2 1/2 years now! Since being diagnosed, his Hemoglobin A1C has NEVER been within acceptable range. In March his Hemoglobin A1C was 8.5. In May it was 8. (It hasn't always been that high, but it has never been within normal range either.)
I want him to see a specialist. He won't go. My husband feels he's exhausted all of options, and he just has to go on insulin. From what I have read, it is not typical for someone of his age to have their diabetes deteriorate so quickly. Why is this happening so fast?
Also, his father had the same problems, and died of a heart attack in his early 50's. My husband's cholesterol is much better thanks to Lipitor, but the diabetes is still bad. Should patients with diabetes see a specialist, or is a GP enough? Shouldn't he see a cardiologist, or are we just supposed to wait until he has a heart attack?
He has no symptoms of complications yet (except the high cholesterol), but I want him monitored more closely. If there is a problem, I don't want to wait until it's life-threatening to diagnose.
In all of your experience, is it totally off the wall for me to expect him to see specialists in endicrinology and cardiology, or am I just being a paranoid control freak? Every time we fight about this, my husband asks me what I hope to get out of him seeing all these doctors. He wants to know what these other doctors can do for him that his GP can't do. Any insight?
I am just frustrated. His sugar is still totally erratic, he's losing weight, he's become weak and fatigued, and I am not sure the answer is insulin.
Jun 6, '02
Actually the answer may be insulin - to help him get under better control quickly. The high cholesterol is directly tied to the high Hgb A1C. Once he gets the blood sugars down and consistent for at least 3 months time, he'll see a big difference.
I'd strongly suggest seeing an endocrinologist who will give you more insight, more options, and is much more up-to-date with the latest in treatment of DM II than most general practitioners. I'm sure they will also provide him with a glucose monitor to see what the problem is, and instruct him in the foods than can help keep his blood sugar down. Yes, compliance to the diet AND medications is the key to prevent all the horrible complications that can develop. If you new husband is still hesistant about making the changes or seeing a specialist, well.....
This is coming from a nurse and Type II Diabetic..
Jun 6, '02
My hubby was diagnosed with Type II diabetis a little over a year ago. He was sent to a diabetic educator (nurse) and given a glucose monitor and instructed in its' use. At the time, he only tested his blood sugars once or twice a day, but I have now convinced him to check it 4-6 times a day and to keep his glucoses under 140 at all times.
Our insurance covered the cost of the monitor and the classes, and his strips are charged a co-pay at the same rate of his meds.
When he balked about testing his glucoses so often, I explained that I wanted to grow old with him; and not have him lose extremities, vision, etc. along the way.
Jun 6, '02
My husband is also a type II diabetic. I would say that your concerns about your husband's future health are well within reason. When he asks you what you hope to gain, tell him that you want to have him around a lot longer to love! I went through the same thing. In addition to making appts. with endocrinologist and cardiologist, has the family dr. done a 24 hr. urine to check kidney function? I would also add a visit to an opthamologist to be sure that his vision was not affected. You know what his glucose levels have been for 2.5 years, but none of us know how high they got before he sought medical help. Good luck with loving your stubborn man!
Jun 6, '02
I come from a family that has type II and type I both on maternal and paternal side of the family
I strongly recommend specialist input. My brother was also recently diagnosed in Nov. straight on to insulin and no time off work. His blood glucose is better controlled than mine[ I'm not diabetic yet!!]
Best of luck
Jun 6, '02
Absolutely. I think his primary should have referred him much sooner, but that is water under the bridge.
I agree 100 % with endocrinologist, opthamolagist, and podiatrist to teach him how to take good care of his feet. Please tell your husband to see the endocrinologist. Unc DM is so dangerous in the long-term. Ask him if he wants to enjoy his retirement someday, or spend it in pain from diabetic neuropathy? Or having a foot amputated? Or on a dialysis machine? Sorry to be harsh, but the time to act is NOW. I agree with Las Vegas, get the sugars under control w insulin if need be asap. I do home care and a lot of diabetic teaching. I have also seen a lot of people be able to get off insulin if they manage their diabetes well, under certain circumstances. Also agree with the glucometer. IT is also a good way to see how high his sugar goes after eating a certain food. Since he is young, he may even be able to manage a sliding scale, meaning he can adjust his insulin up or down according to blood suger, hence the need for glucometer.
Good luck. He is lucky to have you to care for and about him!
Jun 6, '02
My hubby is DM II too. I say he's the worst diabetic person on the planet. In Nov 2000, his Dad passed away from diabetes. I begged him at that time to start taking care of himself. He always promises that he will. He takes glucophage and insulin. He always takes that pill, it's the insulin he will complain about doing. Whenever he stops listening to me, which is often, I just tell his Mother...:chuckle: that seems to do the trick.
I've gone with him to see his PCP and diabetic nurse...I tell on him too. My PCP says I'm borderline diabetic and prescribed me avandia. I tell her she's wrong, she just checks my blood at THAT time of the month. :chuckle:
Jun 7, '02
I'm currently taking Actos - which is relatively new and I need to do some serious reading up on it. But, it's supposed to kick the pancreas into doing more in a very healthy way. Glucophage made me sick - too much stomach upset no matter what time of day I took it. I will admit, I have Humalog insulin for when I have those chocolate cravings, but the plan is to come off the insulin completely.