Diabetes Self-Management Blog

Dad and my little brother were watching John Wayne movies one day last week when Dad gave a big sigh and, as quietly as that, passed over to a world where he could once again walk through his beloved woods, read the books he liked, and hold cogent conversations.

His Type 2 diabetes hadn’t been playing nice with him lately. Did that have anything to do with his death? Was it his age? He was 89, but my family tends to be long-lived: His mother was 96. The fact that he had normal pressure hydrocephalus (NPH), which can affect gait, continence, and memory? How about the carotid arteries in his neck, which were narrowed to the extent that doctors feared attempting to open them?

Maybe a combination of all of those?

Whatever. A couple of weeks ago, I got an e-mail from my little brother, with whom Dad lived, saying he may have had a small TIA, or transient ischemic attack (also called a ministroke). And, oh, by the way, Dad had a teeny little bit of thrush (oral candidiasis, which is a yeast infection in the mouth), and his blood glucose was 388 mg/dl and wouldn’t come down.

Not to worry, “they” told Bro to give Dad another 5 milligrams of glipizide (brand name Glucotrol) to bring his glucose down.

Didja ever just wanna bang your head on the desk and whimper?

Just to make sure I had an inkling of what I was talking about, I called a CDE friend before contacting my brother to tell him that high blood glucose can cause a stroke and, furthermore, high BGs can cause thrush and thrush can lead to high BGs. Plus, 5 milligrams of glipizide ain’t gonna do much of anything to bring down a 388 mg/dl BG.

Just as an aside, my “little” brother is because of age: He’s 16 years younger than I. However, at 6′5″, he tops me by a full foot.

And now back to our regularly scheduled blog:

The best reference I could find for diabetes and NPH was kind of old. It appeared in the April 1977 issue of the Journal of Neurology, Neurosurgery & Psychiatry and says that 51.5% of people with NPH were discovered to have diabetes. It didn’t say what kind of diabetes. That was compared with a 12.1% of people in an age-matched control population without NPH. Overall, by the way, about 0.5% of people over the age of 65 have NPH.

Symptoms of NPH are difficulty walking, urinary (and sometimes fecal) incontinence, and mental decline. If you start having trouble walking — kind of as if your feet are sticking to the ground — wetting (or worse) yourself, and experiencing slowed mental function, ask to be checked for NPH. Many times, families and docs just figure it’s Alzheimer disease or dementia and slap people into a nursing home. Lessening of the pressure on the brain can bring you back to normal if it hasn’t been too long.

Based on that 1977 paper, it seems as though diabetes could be a risk factor for NPH.

I’m going to lump carotid artery disease, TIAs, and stroke under the same umbrella because narrowed arteries can lead to strokes. The risk factors for narrowed arteries are:

• Age
• Smoking
• High blood pressure
• High cholesterol
• A diet high in saturated fats
• Insulin resistance
• Diabetes
• Obesity
• Sedentary lifestyle
• Family history

At the time Dad was diagnosed with carotid artery disease, he was in his late 70’s and had insulin resistance and Type 2 diabetes.

A TIA has the same symptoms as a stroke, but only lasts a short time. If you’ve had a TIA, however, you’re 10 times more likely to have a stroke.

How can you tell if somebody is having a stroke? Remember the acronym FAST, which stands for:

Face: Ask the person to smile. If the smile is one-sided, it could be a stroke.

Arms: Ask the person to raise his arms. If only one arm can be raised or cannot be raised as high as the other, it could be a stroke — particularly if combined with facial paralysis.

Speech: Ask the person to talk to you. Is the speech slurred? Choppy? Non-existent? Are all, some, or most of the signs present? Then…

Time: Fast! Call an ambulance if that’s the fastest away to get to the hospital. Go another way if that’s faster. Time is of utmost importance when dealing with a stroke.

And always remember: If there’s nothing wrong, you’ll be relieved to know that. If there IS something wrong, you’ll get help.

Information from the American Diabetes Association’s (ADA) 2011 National Diabetes Fact Sheet says that stroke was noted on 16% of diabetes-related death certificates of people aged 65 years or older in 2004, and people with diabetes have a two to four times higher risk of stroke than the general population.

So what role did Dad’s Type 2 diabetes play in his death? Who knows? Diabetes isn’t always listed as a factor or a contributing factor on death certificates. Maybe if it were, diabetes would rise higher as a cause of death.

The ADA says in 2007, diabetes was listed as either an underlying cause or a contributing factor on 231,404 deaths.

The Centers for Disease Control and Prevention (CDC) says there were nearly 2.5 million deaths in 2010, including 129,476 for stroke (and 69,071 for diabetes). The ADA doesn’t break down the figures for stroke.

It’s confusing. Yes, I know the years are different. At those numbers, it probably doesn’t make a lot of difference, statistically.

At the age of 89, did it make any difference if diabetes was a contribution?

When Dad came here for my granddaughter’s bat mitzvah, I took him fishing. He had been complaining he just couldn’t do the things he enjoyed: Couldn’t walk through the woods. Couldn’t fish.

There’s a place near here that’s a privately owned lake with some cabins on it. It’s wooded with clear trails and benches along the way. I took him there, along with groceries and books to sustain us, set a chair on the dock, and gave him a can of worms. I cooked and read. He walked and fished and read. We talked. We both hated to leave.

I would like to take Dad fishing again. But if I can’t, then I hope he’s somewhere nice, drowning worms.

Jan's Father Fishing

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