Ask the Diabetes Educator Archive

3/31/03

Q:

My boyfriend will not test his sugars until the week before he needs to see his doctor. The few times he does test his sugar, it is often 250+. Rather than being alarmed or concerned, he makes excuses such as "pigging out the night before" and he then assumes that it is nothing to worry about b/c had he eaten normally, he would have normal readings. He always has an excuse for not testing, for having high blood sugar, and for not listening to suggestions that he may need insulin. When first diagnosed his sugar was 600 and has on occasion been that high even on medication. He is currently on Glucophage 1000 mg in the morning and 1000 mg in the evening along with glucotrol. He has mentioned in the past that high sugar readings discourage him and make him not like to test his sugar. What made him go to a doctor in the first place was his extreme thirst and rapid weight loss (16 lbs in a few days). He really has not put any healthy weight back on and he looks immaciated (he claims that he always was too thin before he knew me...he is 55 now). Since diagnosed three years ago, being between doctors, between prescriptions, running out of meds here and there, and generally undisciplined care of himself, he has been sitting with 200-300+ blood sugar for most of the time.

Here are my questions:

1. If readings for a diabetic (at times referred to as having diabetes 1.5) are 300+ on more than one or two occasions while on medication, does that mean they need insulin for sure.

2. When is a diabetic only considered treatable with insulin.

3. How can I help my boyfriend become educated about what readings are Dangerously High and requiring medical attention, what all the specific symptoms of diabetes complications that should not be overlooked or taken lightly, and what are the irreversible prices paid when giving in to denial and not taking diabetes seriously.

A:
Denial is such a convenient tool for any of us in unpleasant situations; in your boyfriend's case, it could lead to severe complications if left unchecked. Someone diagnosed as "1.5" still produces some insulin, but it is quite unavailable to do a proper job. The majority of these individuals are often on insulin. And when do we know to do this? Daily blood sugar testing. Oral medications may or may not provide adequate control in his case. Without some effort on his part to manage his lifestyle and be willing to monitor, we cannot know. The symptoms you describe show he is not in good control most of the time; he could run the risk of DKA, which can end in a coma. This would be the case if his pancreas stops producing insulin; he could be on that path. That is the point where he will require insulin in order to live. I suggest at this time his practitioner is the one to "read the riot act" and not mince words. It may take some serious event requiring hospitalization before he wakes up and accepts his conditions. Already he may be losing sensation in his hands and feet, and background retinopathy may be forming. This would mean poorer eyesight requiring laser treatments. Today, diabetes can be well-managed if one is willing. It does not require one to "stop living." He is the one who must make decisions on the quality of the rest of his life. Your challenge will be HOW MUCH you're willing to tolerate as a potential caregiver.



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