No May Meeting, Not Intentional

Tim called me this morning and said we were not having a May meeting. He had called several others and would be sending out an email to that effect. He said with what Sue, Brenda, Allen, Ben, and Barry were working on, he felt that some were busy enough without a meeting taking up their time.

The woman had been discharged from the hospital and Brenda and Sue were busy counseling her as well as getting her to classes the doctor had ordered her to take. Her husband was taking vacation to be able to attend the classes with her. In addition, he had told his wife that the children knew and she could accept that. From what Sue has told us, she is very unhappy that the children know, but the doctor has told her that is the reason for the classes and he was the one that informed the children.

Barry had said that the three of them were working with the fellow and his wife to teach them about diabetes and how to plan meals and carb counting. Allen had been with him and his wife at his last appointment. With the information from the doctor for determining the insulin to carb ratio needed and how to adjust his insulin they were making progress and he was now injecting before eating.

Barry added that working with his wife, she now had foods available to treating lows and she was working with her husband on adjusting his insulin use. He is starting to lose the weight the doctor said he should and would need to be careful in his insulin use.

Tim also informed us about another individual that A.J and Jerry were helping and he was having a difficult time with depression. He was not on insulin, but using metformin and was having stomach problems. They had talked to his doctor and were able to change to the extended release pill and he was doing much better.

The individual needed to lose about 40 pounds and Jerry had brought in Allison to help set out a meal plan he could follow. He is protesting the reduced carbohydrates, but Jerry told him that this would help him lose the weight. Because he could not exercise other than sitting in a chair, he needed to reduce the carbohydrates he consumed. Allison had explained this to him and he still does not want to eat any fat. Allison told him that it was not the fat that added his weight, but the carbohydrates that had contributed to his weight gain.

A.J had told him that he should be on insulin, but his doctor will not prescribe it and started to ask him is he was failing to manage his diabetes. A.J happened to be waiting for him and when he said this, A.J said he needed to change doctors and he knew one that would work with him to help make managing his diabetes easier. The individual said you do this when a doctor will not prescribe insulin. A.J said especially one that tries to make patients feel like they have failed.

A.J continued that he had started on insulin and then moved to an oral medication and finally was able to get off of all medications. This surprised the individual and he asked if this was possible. A.J said the fact that he was confined to a wheel chair, the odds were not in his favor, but it may still be possible if he followed Allison's advice and continued to work on his weights.

The last paragraph of the email asked if everyone would like an early June meeting, possibly on June 4.

An Acquaintance Admits He Has Diabetes

On July 24, A.J called me and sounded very urgent when he asked me to come to his house. When I arrive, he and Jerry were talking to the person from this blog. When Jerry let me in, A.J stated to me that I was right and he was glad he had listened to me. A.J told the fellow to tell me what his A1c had been. We nicknamed him Jon and he said that his A1c was 10. The doctor said I was right when I told him that if I were not a person with diabetes, my blood glucose would have been back down at or below 100 mg/dl.

He said he had taken his paperwork to show the doctor and his new doctor agreed that he had diabetes and he needed to start on medication immediately to prevent complications. I asked which one he started on, he said insulin, and when he gave the names of Lantus and Novolog, I knew what he would be asking. Jerry spoke up and said between A.J and you he will be asking many questions. Jon said yes and from what A.J has said, he asked if he could get the address for my blog.

A.J said let's go to my computer and give me your email address. Jon gave him his email address and A.J showed him my blog, copied the URL, and said he would include several other URLs to give him some reading. Jon was told about communication and A.J said he would try to answer his questions at first because my computer was still not back in full operation and I had more to do to get the sound working and download a few of the tools necessary to use some programs. I suggested the he get Jon's phone number and give him our phone numbers.

The Jerry asked him if he had time for the support group. Jon said he knew some of the members like Max and Allen, he listed several other members. Jerry said we will not have another meeting until September, but some of us do get together at a restaurant every Saturday afternoon if we were in town or have the time. Sometimes it can be only two members and other Saturdays can be as many as 20 members. We have no schedule we follow, sometimes we discuss diabetes, and others time a favorite non-diabetes topic. We avoid religion and most politics.

Jon said that to start, he would be doing a lot of reading and asking us for reading resources. Jon thanked us for our interest in diabetes and for making him get the second opinion by scaring the dickens out of him. With that he said he needed to be doing something and would be in contact later.

After Jon left, A.J spoke and said that I had read Jon right the first time and he was happy I had discouraged him from pushing the subject of diabetes then. I answered that I was glad I was right, but if several more weeks had passed, I might have encouraged A.J to resume his pushing. Jerry said that creating doubt was a good thing and that had helped him when he needed it.

With that, I took my leave and said we have work to do to keep Jon learning.

The Groups at Our September Meeting

We knew that several support groups would be present for the final with the specialist on interventions. We had 95 people present and had room for just a few more. With that many people we were happy that the air conditioning was working.

I was not prepared for the start. Dr. Tom took over and said we have had a successful intervention in the last two weeks. He explained that he had been brought up to date by several of the group and felt there was a good reason for the intervention. At that point he introduced Jerry to the group. He asked Jerry what his last A1c had been. Jerry answered 13.2%. There were several gasps and Dr. Tom asked people to be quiet as there would be more that would shake them up as they continued.

Dr. Tom explained that until last Saturday, he lived with his wife who is a dietitian. After several of our group had tried to work with him and had his wife stop them, some rather harsh information came to light. First his wife was very happy with his A1c and would not reduce the carbohydrates, had high fructose in many of the food items he ate, and would not let him reduce the carbohydrates he was eating.

He continued that when they were able to separate him from his wife, Jerry and he had about an hour's talk and a diagnosis that had been arrived at by the group. Dr. Tom said he had never had one of these, but had talked to another doctor that had experience with Munchausen Syndrome by Proxy. He saw a few hands go up and explained, Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. In the case of diabetes, this can take the form of feeding the person with diabetes with too many carbohydrates.

Next he asked Jerry if he remembered what his A1c was at diagnosis, Jerry answered 8.0%, his second was 7.5%, the last was the 13.2%, and the plasma blood glucose reading from the week before was 331 mg/dl. Dr. Tom asked what medication(s) he was taking and he said he was on metformin, 500 mg 2X, and now he is taking insulin. He said that A.J was a great help in working with him.

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At that point, Dr. Tom asked the intervention specialist to talk. The specialist stated that he had been able to talk with Jerry's wife and did agree with Dr. Tom's assessment. He could not say any more, but felt that the group had come to Jerry's aid for the right reasons and this was the first case he has seen. He said that normally you see this with one parent doing this to children, but one adult can do this to another adult.

Jerry then said that the situation had gotten out of hand and he knew that his A1c was heading the wrong direction. He said that with the support group members that had worked with him, he should be able to bring his A1c back in line or at least under 7.0%. Dr. Tom said that under 7.5% would be great, but that it was possible. Jerry said this was not what he had wanted in his life, but that there was support for action when he needed it.

The specialist then spoke for another half an hour about interventions and how valuable they could be. As he concluded, he asked if James had anything to say. James stood and said no, other than to thank everyone that had helped in his intervention and the support group for forcing a few issues when he had thought to go back to denial. He even said his wife had worked to keep him away from denial. He finished by saying he felt better now that his diabetes was being managed and that his last A1c was 6.6% and hopefully would be less at the next one.

Tim then said that they doubted we could have two meetings this valuable again, but that our group was happy for the meetings and hopefully presented something of value that everyone would remember and use to manage their diabetes more effectively. The meeting ended then. Some left, but many wanted to talk to James and his wife, and to Jerry. Dr. Tom did call him away and the doctors did want to talk to him. Allen, Ben, and Barry saw to it that they were not interrupted and A.J needed to join them. It took about an hour for people to disperse.

Helping Others

This last weekend, on April 26, I was shopping for a few groceries and I met a person I knew had type 2 diabetes. I knew this person was older than I am and was not prepared to his first question. He asked what my A1c on the latest VA report happened to be. I told him and since I knew he had been to the VA and had an appointment ahead of me, I was aware that his had not been good as I could hear him sputtering to his doctor as he was leaving his appointment.

He admitted his had been over 10.0%, but would not give me the actual result. He then stated that his doctor had wanted to put him on insulin, but he said he had refused. I asked if he had neuropathy and he said it was just starting. I asked if he was having vision problems and he finally admitted that he had not been to an eye doctor in several years.

He said that the doctor had prescribed two additional medications to take and that he would be starting a sulfonylurea and Januvia when his prescriptions arrived in the mail. These would be in addition to the metformin which would be reduced from the maximum to 1000 mg – 500 mg two times per day. He did not know the dosage of the other two medications and would know when he received the medications.

Then I started asking him questions about the number of carbs he was eating per meal and he said about what the registered dietitian had ordered him to eat. He said his wife was knowledgeable there and he relied on her for this. At that point, I became difficult and asked him if he even had an eye doctor. He admitted he did not. I asked him if later in the week a couple of us in our support group could stop by in the evening and talk to him and his wife.

When he was hesitant, I asked if Thursday would work. He continued not answering and I asked if he would give me his phone number so that I could talk with his wife and set up a time that would work for them. He finally gave me his phone number and said he would not be home until after 6:00 PM. I said I would call about 7:00 then and we parted company.

As soon as I arrive home, I called Allen and relayed the information to him. Allen asked if we were becoming advisors to too many people. Allen said he was also working with Barry to help another person. When I gave Allen the name, he said this was the person Barry had asked for help with, and I said I would back off then, as he did not need so many working with him. Allen did say his wife was the registered dietitian and was creating the carbohydrate problem.

I then told Allen to keep me out of the discussion and I would tell him that he was already working with two of our members. Allen said okay, and that Barry was a good friend of the person and had good relations with the family. Allen continued that Barry was the person who was working with his wife to bring down the amount of carbs and was better at this than even he was. Allen did say that Barry knew what his A1c had been and that it was not good. His last two had been very high so he was not surprised that the VA had added more medications.

I asked Allen to check on the number of test strips they were allowing now that he was on a sulfonylurea. Allen said he would and he hoped it would be more as they were not allowing sufficient on metformin. I said with both being retired they probably could not afford extra test strips. Allen said he would discuss this with Barry and see what needed to be done. I said I would send him and Barry a URL for a blog that might become helpful. With that, we ended our conversation.