Husband with Type 1 Diabetes that won't take care of himself

blondy2061h

I think one of the most important things about type 1 diabetes is NOT depending on the doctor to know what to do. You see the doctor once every 3 months, but YOU are the one that has to live with the condition all the time.

I also HATE the term "insulin schedule." Insulin use needs to be flexible to it fits into your life. If you are forced onto a schedule, that's near impossible to deal with and follow.

I'd be interested to know what type of insulins your husband uses?

I have found the best insulin plans to be pumping (a pager like device is worn all the time and delivers small amounts of insulin every 3 minutes to cover basal needs and "blobs" of insulin all at once to cover meals) or MDI using Lantus or Levemir as the long acting insulin and injecting Novolog, Apidra, or Humalog every time you eat. These types of insulin plans allow for flexibility regarding food eaten and when it's eaten.

Carb counting and having a known ISF (Insulin Sensitivity Factor) are key. Carb counting allows you to cover the carbs you eat with insulin so you don't have to follow a set diet and the ISF allows you to accurately correct high blood sugar.

I recommend you read the book Using Insulin by John Walsh, and Pumping Insulin if you think pumping may interest him.

Also, how often is he testing his bs?

J_Tunis

Thanks for your reply.
I'm not sure about pumps because as far as I know they don't have insulin pumps here (we live in Tunisia). Are they expensive if we buy one in the States?
He tests his blood sugar before he eats a meal and he usually takes insulin shortly thereafter but he either takes too little or he takes too much..he's on Humalog (rapid acting) and Lantis (he takes this at night). Sometimes he takes insulin without eating at all! And that's another thing, he doesn't eat that much, is that a problem or is that okay?

The doctor here is really helpful but my husband isn't really following any advice, he just does it "his way" which would be fine if it worked but it's not. I'm just frustrated and I don't know what to do know.

I should just sit back and let him do it his way then?

blondy2061h

Lantus and Humalog are good insulins. The Lantus he should take regardless of whether he eats or not. This covers his "basal" needs for insulin. The Humalog he should NOT take if he doesn't eat, unless his bs is high. The Humalog dose should not be a set dose- it should be dosed based on his bs and what he plans to eat.

Unfortunately, pumps are quite expensive...around $6k.

I would not just sit back, but I would not be judgemental either. It has to be a middle ground. Tell your husband your concerns. Tell him that you want to help him out. Ask him what you can do to help him.

SamQKitty

Sounds like your husband may not know how to count carbs. As Blondy pointed out, the humalog should be given based on an insulin to carb ratio (which the doctor can help determine) and one then counts the carbs at each meal and boluses the humalog based on the insulin to carb ratio.

For example, my insulin to carb ratio is 1 unit of insulin for every 10 grams of carbs (1:10). If I'm eating a meal that consists of meat (no carbs), a salad (15-25g carbs depending on size and type of salad dressing) and a slice of bread (15-20g), I would bolus for somewhere between 30-45 grams of carbs (depending on how I assessed the salad and bread). Since my ratio is 1:10, I would bolus 3 to 4.5 units of humalog.

Once the basal insulin (the lantus) is set properly and the insulin:carb ratio for the humalog is set properly, and he learns how to count carbs, he should be able to eat just about anything without going either too low or too high. Oh, sure, every once in a while I underestimate the amount of insulin needed, but then I correct by testing two hours after a meal (I also have a correction ratio...one unit will lower my blood glucose 30 points). This way, I'm hardly ever too low, and even if my bg goes high, it's only for a couple of hours.

I don't know what facilities are available in Tunisia, but perhaps through his doctor you can find someone to teach him how to count carbs.

The other thing he can do, at least for now, is to test, test, and test some more! That way, if he's going low, he can catch it before it gets bad and drink some juice or take some glucose tabs to bring him up to where he needs to be.

Diabetes is one of the few illnesses where the patient really has the most amount of control. That's a Catch-22, in that it can make us feel very empowered, but it also puts a large burden on us. I can understand his being depressed at having a serious, chronic illness, but I also suspect that some of his moodiness is being cause by his out-of-control blood sugars. He will feel tremendously better, both physically AND emotionally, if he can get them under better control.

Ruth

blondy2061h

I totally agree with Ruth that frequent testing is also very important.

firebirdstevev

ellenor

Hi
My son was not testing as regularly as he should, when he came across a message on another web site from a mother who had lost her child. We were both in tear's reading the message, but it really brought it home to him that although he hate's his illness he's certainly not ready to die from it!
best of luck to you both

[url]www.childrenwithdiabetes.com[/url]
In general dissussion "My Son's death must not be in vain"