August 17, 2000
Social Issues: Community Resources
Question from Wood River, Nebraska, USA:
My aunt was diagnosed at the age of eight with type 1 diabetes. She is now in her thirties. She is blind from it and is on kidney dialysis. Recently, blood sugar levels have ranged from 100 to 1480 mg/dl (5.6 to 82.2 mmol/L). The latest episode happened earlier this week, when her level rose to 1480 mg/dl (82.2 mmol/L). She is also recovering from gall bladder surgery.
I don’t know that much about diabetes, but I know well enough that those levels are not supposed to be that high nor that low. The biggest problem is finding a doctor that will try to help her. She has no insurance and is on Medicaid and disability. She lives in a nursing home. It seems as though when they find out she doesn’t have insurance their whole attitude changes, and they just push her by the wayside. I live in Nebraska and the closest doctor is in Omaha. He was one that did the same thing. Medicaid will not pay for her to go to Mayo Clinic or any other clinic to see someone and no one in our family has the finances to get her there or pay the doctors. Why would the doctors be experimenting with her insulin and letting it get so high? Is that normal? At times she hallucinates and other times she is really confused and has a hard time put sentences together. The nursing home doesn’t give her snacks when they are supposed to. They set them on an end table for her but don’t bother to tell her that they are there. We’ve talked to the person running the nursing home with no luck. Who else can we turn to for this matter? The doctor also knows about it, but nothing ever gets done. I feel helpless and I don’t have anywhere else to turn. Maybe you could give me some answers.
Answer:
Sounds like your aunt is having a tough time. She’s lucky to have someone in her family like you who is looking for help. I would suggest that you meet — perhaps with other members of your family — with the director of the nursing home and see if they can come up with better methods of helping your aunt. Meeting with the doctor at the nursing home and also her own primary doctor would also be helpful. Try not to challenge them but rather to ask their help in getting things to work in a better fashion. You didn’t indicate what kind of insulin program your aunt was using but often a system using multiple small doses each day coupled with frequent fingerstick blood glucose readings would help avoid these large swings in blood glucose levels.
Only her doctors would be able to give specific advice, I’m afraid, so go and ask them to try to help out and get some improvements made.
SB
Additional comments from Dr. Donough O’Brien:
It is possible that the wide fluctuations in your aunt’s blood sugars are related to the dialysis and you should suggest to her family that they talk to the dialysis doctor about this. What may be happening is that she is accumulating fluid as a result of the kidney failure and that in order to remove this the doctors have had to increase the glucose concentration in the dialysis fluid some of which would move back into the bloodstream to cause the high values.
DOB