I have just found out that my adopted grandfather (lolo) has a HBa1c of 10 at his last test a few days ago. His Dr. suggested insulin, which he outright refused. For such a smart man he is acting SO dumb about this.

His wife (lola) who I love like my own mother has an HbA1c of 6.8. She at least has agreed to start on metformin.

I am so upset! I really love this man!

His wife is also upset, as she watched her brother die and bankrupted her as she tried to pay for his dialysis (as a complication of diabetes).

I am going to try to talk to him tonight. Scold him, remind him of my girls who really need him as their grandfather, and somehow convince him that insulin is not a problem, but rather is the solution.

I hope I can get through to him.

Oh Sally, I have no advice or help for you, but I do hope you can help him see the sense in agreeing to insulin.

Yikes! That's a scary situation! I would take shots > dialysis just about any day of the week, even "gamble" on shots. You are a very excellent example and I hope you can get them to follow it!


It is understandable to be upset with this news. Temper your desire to scold him with your love and recognize that he is going to have to make significant changes in his life. At this stage of his life, those changes might be extremely hard to make.

Surely his doctor laid out multiple changes including insulin, so encourage taking the small steps he could take that will lead to the bigger ones.

It sounds like he has a strong supporter in you, all the best!

Sally- I imagine that he might be in denial right now. Would he be willing / able to change his lifestyle with diet and exercise to give him time to adjust to the diagnosis? When I was diagnosed I was close to an A1c of 11 and I had symptoms. I would say that I was a belligerent patient, but I tried to diet and exercise my way to a better BG. The type 2 meds worked for a while, then I got the correct diagnosis-LADA.
I can understand that denial phase though. Without real symptoms, he might not realize how bad it can get if he does not take care of himself.
Maybe try to get him to talk and listen to find out what he is thinking. Go from there. I am afraid that scolding will make him dig his heals in even more. If he thinks he has control of the situation - diet and exercise- he might get more motivated to take care of himself. Maybe give him positive reinforcement for each small lifestyle change he makes.
Good luck.

I'm sorry about this news about your loved one, Sally. I know it's got to be hard for you to confront someone you care about who doesn't understand or accept the things you do about D. But remember he is a different person who maybe handles things a little differently (or a lot) than you do. But remember that one way or another you also went through a process to get to where you are today, it wasn't instant, so you can't expect him to be there with you, not yet. You have to start with him where he is at at this moment. You know him well so I would advise using what you know about him to know how to approach him and expect him to take baby steps along the path he needs to walk. If he is of a generation that respects doctors, use that and grit your teeth while you say things like "the doctor says.." etc. My gut responds as others have, "don't scold", but again, you know the man best and some people of a certain generation and mindset DO respond to strong confrontation.

Personally I wouldn't suggest diet and exercise as an approach. His A1C is dangerously high and he really needs insulin. Also for many, especially if it flies in the face of a lifetime of behaviors, diet and exercise changes happen with more difficulty and take longer than just "taking the plunge" and starting insulin which most people adjust to fairly quickly after they get over their initial fear/resistance.

Good luck to you and know that between your shining example, his down to earth sounding wife and his doctor, IT WILL BE ALL RIGHT!

Zoe makes many excellent comments.

In my mess I got to 13.3, a horrible number and going down hill fast.

It took me actually 5 years to arrest the mess fully and I can share data and results:

a) diet and exercise alone when you are pre-diabetic are at much lower elevated numbers can be workable. Yes you absolutely need to do that in conjunction with Doctors help and meds.

b) at these numbers; my experience after 30 years says skip the glyburides, glimperides, ameryal, starlix et all and use rapid acting insulin - lasts 4 hours far better choice. This is for some key reasons:

- one needs to get the glucose generation from the food input (diet) reefed back. My choice/Doctor was 1200 calories. Doing so immediately puts one at risks for lows if using the oral pills ( metformin excluded.) insulin can be injected in amounts as needed while one is dieting.

- liver and dawn effect need to be checked to see if they are trying to make one into a marachino cherry. If so, metformin in sufficient doses will be needed to reef that back. Be aware that the liver can overwhelm serious diet and exercise efforts. I gained weight to 330 pounds till liver monkeyshines stopped.

- you need expert help of Doctor, Endo, dietition and get on lower carb diet-mediterranean diet but remember portion control is absolutely key.

- for me low fat diets are useless when fighting this mess and of little help. It turns out appropriate extra fat in diet slows digestion and slows digestion system racing thru the carbs.

- metering is absolutely key and right about now unless one has done this for a while and understands the gronks can be real formidable. Today I meter on wakeup, after meals and late at night when I go to bed. One may have to do more on initial startup.

The one a day, once a week are no better than licking ones fingers and sticking in the air to sense wind direction/presence.

- small timely meals are much better than irratic eating and volumes.

- for me, when I started into bailing the ship, I found it essential to go very low glycemic on breakfast and as little carbs as possible till lunch time.

This is not everything and takes time to implement. As Zoe indicated meds will be crucial getting this difficult situation ramped back and under control. This will not be an overnight sojourn.

- it can take up to 3 months or more to scavange out the excess glucose that ones body has collected and left around body.

- as my pancreas came back off the snooze after 26 yeras and decided to crank out some insulin, I inject 2 hours after meal to provide bolis boost. Usual timing for low/no insulin production is before or right at meal.

- exercise will help start getting excess glucose stored over the years/time burnt off and out.

-usually at these high numbers, the excess glucose over time has overwhelmed the pancreas and the islets have cut back on insulin production.

- Sometimes a Basil insulin like Lantus may also be helpful as well.

One can fix this and get numbers back. Best wishes and goodluck.

Hi Sally,

Such a difficult situation.. I would just keep at it and try to get him on insulin asap. He is an engineer so he should get this really.. insulin injections vs. everything else.. it's a no brainer really. But you know I recently bought my brother an a1c test and he still hasn't taken it.. I'm worried he may be developing type 2 or metabolic syndrome- he's a scientist too. Don't give up and include him more in your treatments too so he can see what it's all about. I would also mention a healthier diet/exercise also, maybe he can gradually change to that.For me as much as I couldn't believe everything that happened, and wondered if maybe they made a mistake, there was no problem understanding that I need insulin to survive, and I was so scared by it all that I did everything possible to get back to as normal as possible. Good luck!

Great work, Sally. Poco a poco as we say in Spanish - little by little.

good luck and best wishes. Snce he has been advised diet and exercise; For me, my opinion would be reef diet tight, be sure extra exercise and ease on insulin.

The exercise is crucial to keep insulin resistance down so it can do its job.

Oral meds are no answer here in my mind. Hey I am an electronics engineer and 30 years as type 2. Been there - done that - useless - I ended up a mess.

Insulin and tight diet work together,oral pills are outright pain.

Due to his high numbers, the pancreas and its islets tend to go into a off rip van winkle mode and drop insulin production. With reduce insulin production, liver becomes a pain adding too much glucose. Thats why insulin and metformin may be crucial getting things back in ball park.

Very Best wishes and good luck. Has he had a diabetes trainer beside Doctor?

Your concern and worry are most understandable. The old Doctor/patient of past does not necessarily get one fixed on right path as we know know that it takes the patient himelf working and driving this actively as well.

I lost 30 years as I too failed to understand the drive and focus to do right thing nad 15 minute to 1/2 hour vists really do not get one where you need to go. Unless the patient takes the readings and assists his Doctor, Doctor will never know what real numbers and status are until patient sick in hospital.

I think that enlisting the wife is a good idea! She may be willing to sacrifice herself for him but if you can get her on board, maybe get her to achieve some successes with BG, etc. like you have, she can see how it's done and then read him the riot act!

At least your tongue is low carb since it sounds like you'll be biting it a lot!

An engineer? I wonder if one of the many books recommended here might be an intellectual approach alternative. Engineers like rational, analytical thought. It might convince him that the situation is not his "fault" and may help him develop a systems approach to his therapy.

Sally- I think you have a good approach to take it one step at a time. One approach might be to invite him to go to the doctor / diabetes educator with you or his wife. If he has an opportunity to discuss your care and the focus is not on him, he might be more cooperative. I tried this already by inviting my husband (a physicist) to go with me to an appointment so he could hear from a medical professional about my health care. It made a big difference to my husband to hear the same info from an "authoritative" source.
I also agree that it would be helpful for his son / wife to contact the doctor or health professional in advance of an appointment.
Do the best you can to support him (diet, exercise, positive support), but try to remember that ultimately he makes his own decisions.
One more thing, how often does he test his BG? Does he test post-prandial to see what happens after a meal? These data might get his attention. Maybe request a prescription for more frequent testing too.

Not an advertisement in violation of website rules, but this 30 year plus type 2 wrote a book available out there as an engineer called at the Precipice by Jim Snell that documents my experience and approach fixing my own mess from 13.3 a1c back to good health.

If it will help, I will send him a copy. Please advise where.