Why so many infections?

This might be a type 2 question…

Why does it feel like all the old men die really horrible diabetic deaths in this town? They have horrible lower leg infections and are on the verge of amputation. Those infections persist for many months. I know that they are uncomfortable and unhappy. I only occasionally see this play out in men my age…and sometimes in workers who come through town as traveling workers.

I know that they are running super high a1cs, like 10s.

The wives insist that nothing can be done. Some wives are retired nurses. Some say things like, “He’s 72 years old,” and laugh at my ridiculousness when I suggest that they could bring that a1c down. Some are truly in despair at their inability to fix the problems that confront their aging husbands and seem willing to do anything, but are convinced nothing can be done.

I know that caregiving is difficult. I know that they don’t want to put the elderly at risk of low BG. Is this how its supposed to work? Is this really the best that anybody can do? Is it protocol to run the elderly at 10 or are the elderly choosing to run at 10?

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Running high numbers is your answer. All that extra sugar is feeding the infection,decreasing circulation. My opinion is to provide more education when people are diagnosed. It is so important to understand as much as we can about a very complex disease. For me diet and exercise are the key. Plus my meds. Nancy50

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Perhaps you are looking at the wrong person to bring about the necessary change. The wives are not to blame here and are somewhat helpless to create change. I’m sure that if she loves her husband she has tried.

The necessary change must come from the husband, if he is unwilling what can you do? Nothing is much harder to move than a set in his ways old man.

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You are asking these older people to change the way that they eat, and for many reasons they don’t want to or feel that they can’t.

You are also telling them that the way that they have been eating for decades has been wrong. The cook in the family, most likely the wife, who has been in charge of making the meals for all of these years, is now being told that she has been feeding her family unhealthy food. Who wants to believe that?

If it was easy to change the way one eats, we wouldn’t see so many overweight nurses and doctors. Surely they know that they are making less than healthy food choices.

Food is a comfort, certain kinds of foods represent tradition in many families. Food is love.

The energy it takes to make big lifestyle changes could be lacking in older folks.

I have friends in their late 70’s who have been healthy all of their lives until now. They have been told to cut the fat and sugar out of their diets, because of their heart problems and high cholesterol levels. I doubt that they do it even though they know that they should. They would rather have somewhat shorter lives and continue to eat what they love and are accustomed to eating.

These aren’t choices I would make, but I know many people who would even when faced with dire consequences.

At 72 most of your life is behind you, and change can be very difficult.

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I knew some type 2 diabetics with 0 toes, in a wheelchair, Snickers wrappers everywhere, as well as takeout containers everywhere…the only thing you might be able to do is to find a good nurse practitioner/ diabetes educator/endocrinologist who is OK with a cgm and carb counting 1st, and worrying about better nutritional choices later. Low carb as a treatment started around the 1700s, many 72 year olds are similar to Alan Arkins characters “what about me? i’m old. when you’re old you’re crazy not to do it”. if the 72 year olds are going to eat cake and donuts at.the birthday parties or funerals, it seems like giving them 12u afrezza cartridges, lyumjev, fiasp, and a libre2 or Dexcom is better than a 10 or 14 a1c. I’ve seen this approach work wonders, however, at 72, a lot of damage may be irreversible.

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OK. You guys are saying its behavioral stuff. I see.

I thought maybe the Docs weren’t teaching them how to be diabetics because they are old, like maybe not teaching them how to do sliding scale insulin. It seems miserable.

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I don’t see it so much as a function of age. Inflexibility is a life choice of some younger people, too. And I’ve watched many older people adapt to some pretty difficult health situations.

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Personality certainly has a lot to do with the choices one makes. My dad when in his mid 70’s needed to make dietary changes because of a life long leaky valve in his heart which was enlarging his heart. Overnight he stopped eating fat. He ate dry toast for breakfast and stopped eating desserts. My mom, on the other hand, wasn’t willing to or couldn’t give up foods that she loved.
I am thankful that I took after my dad concerning that aspect of my life.

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Someone has to want to change, maybe something will scare them, maybe something will make them change. But they have to want to. I had a friend that for a neighbor made them all sorts of healthy things to eat while going through cancer treatment and all the doctors and nurses were amazed at how well they went through it. But as soon as they weren’t there to do it the person reverted back to some very bad eating choices. They liked the way they used to eat and probably didn’t want to bother figuring out any other way.

I do believe it gets more difficult to make major changes the older you get. So to learn how to cook differently, eat differently, shop differently is quite a lot to learn and actually change. It’s just easier to keep the known factors.

When my mom was alive, she always made the meals even though she had a very bad back,and hip. My dad was in better shape although he had a heart issue. When my mom was sick he went out and got some food from the grocery store, but mostly he brought home meals from restaurants for them to eat. When she died same thing, he had a restaurant he went to every morning and every evening. But when he was younger he would figure out how to fix whatever needed fixing, rebuilt a car engine for my brother, ran the computer programing center at the college…but when he was old he wasn’t going to start learning to make meals or even make sandwiches.

You can talk to someone until they’re blue in the face, but until they want to, it won’t matter. It doesn’t mean you can’t keep trying, maybe…lol although they might start avoiding you.

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I think it is often a combination of a lack of effective training/teaching as well as attitude. Most diabetics I meet casually will not tell me their a1c, have no idea what their carb to insulin ratio is, insulin sensitivity is a mystery to them, etc. These formulas are essential to effective management, and diet and exercise are second…i fear many professionals skip over the basics. try nicely and discreetly quizzing them on their carb to insulin ratios and insulin sensitivity… ask them let’s say you test and you are 400mg/DL, how much insulin are you going to take to correct it? or how much insulin for the breakfast donuts, waffles, and coffee with cream and sugar, etc…might be a little more difficult with type 2’s but if they are running 10 a1cs they should have fast acting insulin on them and still know their ratios…

They have either given up, feel over whelmed or oblivious to the situation. Not everyone is as lucky or proactive as we are.

Just as an example, during one of my last visits my doctor mentioned that I was doing well in managing my T2. He said he wished his other T1 and T2’s did as well. I am not a poster boy of diet and blood sugar control, but I get by with the A1C of 6.5.

I asked my doctor how many of his other diabetic patients controlled their A1C as well as I did? He said oh maybe a handful. I asked how many is a handful? He said oh maybe a dozen and a half or two dozen people. Then I asked him how many diabetic patients did he have? He said oh at least 300 if not more.

That is why you see so many people with cut off feet going blind and other diabetic ailments.

I was out walking My dog one day and I saw this lady in a wheelchair in a park by a nursing home. She’s going down the sidewalk in a wheelchair by herself and she was headed towards an area that was really off camber and I said to myself I hope she didn’t go there because she’s going to tip over. Sure enough she did. Well she flipped forward and I noticed that she didn’t have any legs halfway from her thighs down, she was strapped into the chair. She looked like she was in her mid 40’s. She didn’t come out of the chair but she was screaming for help. I helped her up and her kids ran over to take over. After I helped her up there was candy all over the ground and pop was spilled all over the ground. I had recently been diagnosed as T2. That is been burned in my mind ever since, and I told myself I will never let myself become that way.

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I agree. I am angered by the lack of support, education and health plan coverage from HCP’s and insurance. People with T2 are lucky of they get any test strip coverage at all. The stigma of having T2D - that it is self-induced, caused by bad behavior and poor decisions is rampant among HCP’s. Having lack of access to supplies and support is a major key to their poor outcomes.

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I’m sorry for this experience, no matter where you live. I heard a podcast recently about doctors in areas where medical providers were far too few for the population, and they were nearly in despair at how many diabetics waited too long to seek help for their limbs until amputation was the only option.

Some had intentionally accepted their “fate” and decided that, since the disease was going to kill them anyway, they might as well enjoy a few things until the end.

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There is also a Type 2 drug that seems to contribute to amputations. Not sure if still on market.

But now warning removed ??

https://www.fda.gov/drugs/drug-safety-and-availability/fda-removes-boxed-warning-about-risk-leg-and-foot-amputations-diabetes-medicine-canagliflozin

Wow