Thursday , December 14 2017
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Sometimes You’ve Got to Get in Their Face

Woman, 86 years of age, very active, history of type 2 diabetes, but does not check glucose or even admit she has diabetes. She has refused to take any medications at all for the last 20+ years I’ve known her. Had gastroenteritis for 3 days. Even when well, she does not drink anything but coffee, and sometimes sugar-sweetened beverages, but only a few ounces of that at a time. During our visit, I encouraged her to drink more fluids, even if it was her few ounces of soda or to add water to that. At the time of her visit, her fasting glucose was 148. I was not as concerned about bringing that down due to her age, not knowing how she would respond to a glucose-lowering agent. Again, I encouraged her to drink more fluids.

In two days, I received a call that she was admitted to the hospital due to weakness and shortness of breath. Sure enough, she had developed a urinary tract infection and pneumonia. Her glucose was 196, and she was dehydrated. I was visiting her in the ED when the staff came in to tell her about her infections and that she needed antibiotics. Although she knew she did not feel well, at first she refused. I leaned over her gurney, put my face up to hers and looked her in the eye. I told her that pneumonia and/or a urinary infection is considered an older person’s best friend. That is, if they don’t want to live any more. I told her I thought she had lots of years left in her if she would take these antibiotics. I also told her no matter how much she wants to deny it, she does have diabetes, which makes it even more difficult for her body to fight infection. She quickly agreed to the antibiotics and fluids. Her electrolytes stabilized in a few hours after the fluids, as did her glucose. Her A1C was 7.9%, even acceptable by ADA Standards of Care for someone her age. She did not go into HHS, but I know if not treated soon enough, she could have. IV Antibiotics were continued for a week.

She is now back home, up and about and once again active in her community. When we last talked, she did not argue with me about the treatment she received, but neither did she thank me.

Lessons Learned:

  • For the elderly, accept glucose levels that are a bit elevated. For those who live alone, the acute complication of hypoglycemia can be more dangerous than long-term complications. Know the difference between numbers to accept and numbers to be concerned about.
  • Remember, aging can decrease one’s thirst sensation. The elderly can quickly become dehydrated due to not being able to detect the need to drink. Dehydration can lead to HHS. Always discuss the importance of drinking fluids, whether thirsty or not, with elderly patients.
  • For people who are in diabetes denial, let’s not let us, health care professionals, deny it. Keep a special eye out for glucose levels and always discuss it with patients whether they want to hear it or not.
  • Don’t look to be given credit for helping to save someone’s life. Seeing someone get better and knowing you had a hand in that should be enough.
  • It’s okay to give yourself a pat on the back.

 

Anonymous

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