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February 10, 2002

Daily Care

Question from Cedar Falls, Iowa, USA:

My 34 year old husband has had type�1 diabetes for 12 years, he eats meticulously (never skipping meals or snacks and we weigh all his food), he checks his blood sugars around 10 times a day and takes NPH with Humalog, but no matter what we do we haven't been able to control his blood sugars. He has awful lows (sometimes under 20 mg/dl [1.1 mmol/L]) during which he doesn't even know his name and awful highs (over 500 mg/dl [27.8 mmol/L]) during which you don't want to talk to him at all. He also has a microalbumin of 24. (What does this mean?) He had his liver enzymes tested last week, and the doctor called today and wants us in there pronto. I guess there were two different things that came back elevated. These have been coming back elevated for over three years now, and they have just kept checking it. He has problems starting his urine and erectile dysfunction which he has medication for. He has diabetic neuropathy and is on painkillers for this and goes to a pain specialist. We have tried to get him on the pump, but the doctor wants my husband's hemoglobin A1c to be 8-10% before he will let him go on the pump. (What sense does this make?) He has repeatedly been in the hospital for DKA [diabetic ketoacidosis] and was there once for 21 days trying to get his blood sugars under control. It never happened, and they told us that he has brittle diabetes. (We never got a good explanation of what that meant.) My problem is that I have a family who constantly asks him when he is going back to work (he has been on Social Security for a year and a half now), and that say he is just lazy, but he worked when I married him. The one saying all this stuff is my father who went to work with pneumonia and sees the Wilfred Brimley commercial on TV and cant figure out why my husband has a problem cause the guy on TV says just check your blood sugars. I am just looking for another perspective or point of view or explanation for anything that we can do. What are his chances of seeing our three year old grow up? I have watched him be sick every day for the past eight years I have been married to him, and maybe if I ask one more person, there will be something I can do to help him more.

Answer:

I can certainly empathize with you regarding your husband’s health issues. However, it is important to get him the best care for his diabetes. Brittle diabetes means he has extreme swings in his sugars. Some of the issues that cause him to be brittle may be self-care issues which can be addressed with diabetes education. You need to get him to a diabetes education group near your home and get some help on those issues that cause his sugars to swing.

By bringing his blood sugars down and keeping them from changing too drastically, he may have more success at preventing the neuropathic pain. The microalbuminuria level is usually normal to levels less that 30. This refers to the specific amount of a protein in the urine that when it is elevated, is a marker of diabetes involvement of the kidney.

JTL
Additional comments from Stephanie Schwartz, diabetes nurse specialist:

The insulin pump will not solve your husband’s problems. As Dr Lane said, he needs a referral to a diabetes team as soon as possible. You can contact your local American Diabetes Association affiliate or contact the American Association of Diabetes Educators at 1-800-TEAM UP 4 for a listing of those in his area.

SS