"...and I test it often." --Wilford Brimley for Liberty Medical
    When my mother's life veered into the realm of Adult Onset Diabetes we began by testing her blood sugar thrice daily. Progress was slow, fingers were sore, and meal time was always preceded by a nasty exchange:
    Mom: "I don't see why we have to go through this."
    Me: "It's important. You'll feel better when your blood sugar is under control."
    Mom: "I feel just fine."
    And, she did. Her "improvement" was not as dramatic as it is with younger people, in part because she saw no initial reason to control her appetite for quality since she never has and in part because an old body adjusts slowly. She didn't notice her raised level of alertness and interest, wasn't always aware that her energy was simmering, rather than sluggish. She has, however, remained not only aware of but annoyed with daily blood glucose testing (although she's exhibited a curious interest in the numbers, lately).
    If our experience had proved the party line, I would still be stabbing my mother's fingers three times a day. In fact, the less stressed she and I are over her blood glucose, the more manageable her blood glucose becomes. I am not recommending our approach. I am beginning to understand, though, that when Adult Onset Diabetes onsets at or over 80 as a result of aging, the prognosis is far different than when someone drives their body to diabetes at the age of 45. My mother's medical records show that although the condition didn't develop overnight, it adjusted itself periodically until her 80's, at which time her previous doctor decided her insulin production needed to be stimulated with Glucophage (metformin). Thus, the conditions that can be expected to occur if someone's diabetes is left untreated at, say 45 (poor circulation, renal failure, congestive heart failure, the list goes on since it is a systemic dis-ease) will most likely not develop in my mother because she will not live long enough for their development. I have mentioned this to both her doctors at this clinic she now visits and although neither explicitly confirms my suspicions, neither denies them, as well. Her first doctor at this clinic, though, was forthright with her in allowing her the choice of whether or not to treat her diabetes, seeing as how "something else is going to get you before this does, Mrs. Hudson." He did stress that she could expect a more alert, energetic old age with treatment, but also acknowledged that it was up to her. She chose treatment, although she and I have an understanding that, at any time, any treatment is up for reevaluation.
    The difference between our testing schedule now versus at the beginning is extraordinary. I usually do a 3-5 day run previous to any doctor's visit, twice a day (if I remember), just so I'll know what to expect and have something to report. I test when she is looking particularly pale, or dazed, or her energy is lagging, or, for that matter, if she is frenetic, which happens, occasionally. If I'm monitoring her nutritional intake through a period of low activity, though, and she appears to be in a repair and/or adjustment phase of her cycle, I leave her fingers alone.
    Occasionally she is put on a short term medication (usually an antibiotic, although Prednizone does the same thing) that plays havoc with her blood sugar. I learned, from experience, not to obsessively stick her from hour to hour to see what it's doing when her blood glucose level turns her mildly bipolar. These are also the periods when I learned how to tune into the non-invasively observable cues as to what her blood sugar is doing and whether it should be allowed to continue unabated.
    Her current doctor adjusts his expectations of her glucose range as time goes by. Initially, he was happy if she remained under 200. Then, he liked an average of 150. Now, he squints if she has a morning reading of 130, but yesterday admitted that I need to keep her "above 100, now" (I didn't ask why) and not to worry when she decides she wants something sweet and her evening reading approaches 170 (if I take an evening reading). Nine months ago he was verbally taken to task by my mother's consulting hematologist (whom he chose) for allowing my mother's blood sugar to "float" around 150. He is young enough so that when his judgment is questioned by a specialist's specialist he talks fast and barks orders down the line. When I pointed out that the hematologist was getting excited about a 157 reading on a clean CBC with Metabolic Panel and A Whole Bunch of Other Tests, he calmed down, and now, with each appointment, we debate the merits of my management techniques versus the standard, well, party line. He is, for the time being, holding with me.
    A large part of the reason for my considerations of technique in managing my mother's diabetes stems from my sense of her perception of the aging of her body and the amount to which it needs to be observed by physicians. My mother's health history is one of regular check-ups, two minor surgeries, as little medicine and Medicine as possible, attention to whether she "feels bad" and how she defines this, and a relaxed acceptance of certain aspects of the process of aging that other less settled souls find intolerable. Thus, if you want to look at her body without poking around inside, be her guest, but when it involves instruments, anesthesia and something called "prep", well, my belief is that she radios her interior and warns, "Invasion imminent, prepare for evasive action," and, sure enough, her body rallies.
    So, we are relaxed about blood glucose testing around here. If the need should arise for more testing, I trust that I'll notice this. In the meantime, I invade my mother's privacy enough as it is. Just a few nights ago, while checking her underwear to see if she needed to change it and realizing how indelicate some of my ministrations are, I started laughing and said to my mother, her underwear around her ankles, "You know, Mom, I can't wait until I'm old enough so that someone can walk in on me and check my underwear every time I sit on the toilet!"
    She blossomed into a wry grin. "I want to be around to see that," she confirmed.
    It's true that health care is becoming more the responsibility of the cared for than has been the case. It is true that home testing of a variety of chronic, manageable conditions is a good idea and increases the likelihood that taking personal responsibility for one's health care will include taking advantage of the most reliable and up-to-date medical information and treatment. It is true that my mother's perception of how she feels cannot always be trusted because her "expectations" (all those internal warning signals that begin to slack off, as one ages, when it becomes apparent that a certain condition must be lived with) are lowered. It is true, too, that nothing beats the value of the habitual, detailed attention caretakers pay to their charges, in large part because of intimate bonds that were established years before.
    I am always anxious to delineate a cogent definition for the ineffable processes often labeled "just knowing." At the same time, when I can't lingualize those processes, I continue to trust them. It pays to have a doctor who agrees that the art of medicine lies within the ineffable processes.
- posted by gail rae @ 10:22   email...this post