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doctored with foot ulcer since feb 14, but still not healed. Yesterday the foot doctor said he was puzzled as to why it is not healing. Some spots heal then they come back again so he sending Dad to a dermatologist to get a biopsy. From what I have read about foot sores, a biopsy probably should've been done in the beginning... Please help. Dr. says no signs of gangrene or close to the bone, but it sure looks raw to me.

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Sooo, the moisturizer (Cetaphil) applied  is not good???  He knows about dad's diabetes. Derm explained how it acts as a barrier against the sweat since theres no or less oils in elderly skin. Let moisturizer set 5 min then apply antibiotic ointment

This is why I always 2nd guess doctors 🤔😞

I asked about the drainage (which has slowed gown)...derm said it's ok it will still drain.  ?
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Yep, agree with CM. Enjoy every day with him.
I must have read Sunnygirls post too quickly regarding the moisturizer- she was correct about that.
You are on the right track. In a few weeks ask about the Doppler studies for circulation again.
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Brilliant, Bella :) I'm smiling because I think you really are focusing on the right things: hugs, kisses and cherry pie.

The feet... Well, I'm glad that somebody's taking proper control; that gives your father the best possible chance to heal. "Best possible" may not be all that great, is the only thing. Not to depress you, just so you don't get knocked sideways if it doesn't go so well.
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...still feel blessed and thankful though...got that kiss from my dad I've been waiting on all these years! WOW!!
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Just read last two posts...
Foot doctor said no to moisturizers from the beginning all through to last appointment last week
Dermatologist said yes to moisturizers after the soak to make a barrier ? Something about sweating and how older people don't have oil's in their skin  to protect from the sweat etc....let set for five minutes then put topical antibiotic cream on, dry socks switched several times a day if have to. Will know after 48 hours what the culture says then proceed from there, so confusing
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Usually the dressing is applied wet and then allowed to dry Sunnygirl (called wet to dry dressing). Weakened  bleach solution is also common now, especially if they think it's fungal. Sounds like they are covering all their bases. It's probably not healing quickly due to bad circulation from age & diabetes. Make sure he elevates his legs when he is sitting.
Will the staff at AL do the dressing? Pretty sure a nurse has to do it, so let the staff there know - they will need a copy of the order and wound care supplies too.
Eewww- bad infection control at the foot doctor's office! I would tell the doctor about it. He should know- that can cause bad cross infections. Yuck!
You are doing a swell job, Bella. Gotta move forward - the past is the past!
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I'm so glad you had a rewarding day with your father. Maybe, things will get better. I certainly hope so.

Does the dermatologist understand diabetic foot care? I've always been told to NOT put moisturizing lotion between the toes for a diabetic. ?? That's odd. I'm no medical expert. I bet the AL staff has some questions about that instruction though.
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Thanks all!!

Home now from dermatologists appt. he's calling it bacterium, took sample...new antibiotic, foot soak in weak bleach water!?😳...,dry it, moisturizer everywhere on foot/between toes, topical antibiotic, elevate when sitting,go back in 2 wks

I had to ask him to check other foot (I never thought to ask "foot doc" to check at other appts...I'm brain dead at times)...other foot is starting to get it now😡😥

Dad went to sit in a chair today with no arms on it at my house and hit the ground...it happened in slow motion right before my eyes...no balance at all, week legs/arms...normal person could've caught themselves...I helped him up, was a struggle (204lbs), he's ok,  little cut on finger...hate to see my dad bleed.   2nd time in 2wks he's missed a chair!

Anywhoooo, I loved the puddin outta my dad today, no frustration, and laughed a lot 😊I treated this day as it could be my last one with him.  I sat with him at AL as he ate his "frozen-food like lunch...he said "yes" when offered cherry pie...guess my long talk about eating healthy with diabetes on the hour drive home went in one ear and out the other....I silently judged him for his bad "choice",  then hugged him gbye and said, "I love you dad"...he grabbed my hand, kissed it, and said "I love you too"..............😢😍

Today, I feel blessed

And,if, this was the last day with my dad, it will be one of my best days ever!!❤️️


I'm thanking all of you sweet, special, supportive, caring peeps here!!!  And taking all advice!!!

Heavy heart/Smiling/Trusting/Gaining more confidence

Love, Bella😍
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Good luck with the Endo. I hope they can get your dad's condition under control.

On the face of it, an A1C of 7 sounds pretty good, but, if he's having super high highs and super low lows, that could explain the reasonable number of 7, though, it could be misleading. Can he take his blood meter with him to the Endo? The Endo's office will download the stored information to see charts that show trends.

I'm not sure if they still put the patient in the hospital for a few days to get their blood sugar under control and figure the correct treatment regimen, but, when I did mine years ago, my Endo, (God bless him, he saved my life. He's a the director of Endocrinology at UNC) gave me his email address and every couple of days, I would email him my  blood sugar numbers, how many units of insulin I took, etc. He then calculated what he thought I needed, made corrections and forwarded it back to me. He responded to me when he was on VACATION, after hours. Just a jewel of a man. He saved my life and got my formula right.

This is a challenging task though and if your dad is not on board.......I"m not sure how that would work. Maybe, the NH staff can step in and do the monitoring and communicating with the Endo.  Good luck though. His foot sounds like a very concerning and pressing problem. I hope they can treat it successfully.
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Bella, don't play the could've, should've, would've game. It is easy to think what you should have done in hindsight, but you clearly did the best you could at the time. You are acting in love. It is a huge challenge to manage the medical care of two elders who aren't always cooperative. You should be proud of your efforts. Please don't go off on a guilt trip -- you are needed where you are!

April is coming up soon. Another few weeks isn't as important as the fact that he will be seen by a specialist. Gather all the information you can, and bring it with you in writing. If you dad has his own glucose meter, bring it in -- they will download the data. If the AL uses their meter and they write down the results, bring in that list. Find out when the readings are done (in relation to eating) and write that down. Talk to the medical director at the AL and find out if your dad has displayed symptoms when he has had such low readings. No one expects that you "should've" been on top of all these things, but now that you are seeing a specialist it would be good to clarify some of these details so you can share them.

I take my blood glucose reading before meals, because that is partly how I determine how much fast-acting insulin to take. Since your father isn't taking fast-acting insulin why would they take his before meals? Well, maybe that is just their routine for people with diabetes. But I think it would be worth confirming the timing of those readings so you can tell the endo doctor.

Getting educated via the internet is valuable. BUT it is not the same as having many years of training and experience and having a license to practice medicine.

The problem with internet self-training is that without knowing the relative importance of various symptoms you can focus on the wrong things. An even bigger risk is that the people writing the articles can have excellent credentials or be total quacks or snake-oil salesmen. I check lots of things out on the internet, but I stick to reliable sources like Mayo Clinic, various University sites, and National Institutes of Health sites. I hope you do the same.

I'm concerned about your father's low readings! I suggest you look up Hypoglycemia on the May Clinic website, just as background for your visit with the endo.

Hang in there! You are doing your best, and that is all any of us can do.
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I think, in many, if not most, places in the US, Doctors are way overworked and are missing things and messing up more often because of it. Too many patients and not enough Drs. Add to that problem the Greedy doctors...Drs that are trying to rush as many patients through during the day because they get more money that way, and you've got a health care catastrophe waiting to happen that has nothing to do with politics and universal health care.
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Oh yeah he's a fun living senior all right ......at my family's expense and our time... always has been AND agree we have been enabling it
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Dad is 81. His old primary doctor ( I recently got him a new one) mentioned the above medicine you suggested, he said those are too expensive and his insurance, Medicare and Medicaid probably won't pay for it.

Going to dermatologist today to get a swab of the foot sore, that he has had since February 14, it is not responding to antibiotics.

Foot doctor is calling it a fungal bacteria, that started from a pressure sore on the big toe. I have read on the Internet immensely about foot sores and they say a swab should've been taken first and a wound care person coming in taking care of it
Foot doctor said that wasn't necessary that they can clean it put cream on it etc. at assisted-living which they did but every week I would take him back he cut more dead skin off and say I don't know why this isn't healing

 I question nurse at assisted-living about one care and she said they tried but they wouldn't come there etc.   I should've asked more questions but my mind is so full with my dad's questions going to Dr and my mom at the same assisted-living trying to get her to doctors and everything she needs a lot of times I don't think to ask the right questions. Appointment book is jampacked for things I need to do for them and take care of it's crazy and driving me bat crazy!  Sometimes I sit there at the doctor and think whatever you say whatever and especially with my dad because he never listens or does what he supposed to when he does get back to assisted living  Ugh

I saw a red flag here at this doctors office the very first day and I should've went with my gut.
The doctor's assistant did not put gloves on when she removed his sock and spread his toes open to check him which was oozing  and then turned around and typed on her computer...GROSS!! Yeah I should've left their bigtime and never went back and went somewhere else or am I overreacting ? I went to school to become a medical assistant along time ago and that is one thing that freaks me out is germs and how they taught us to carry out proper procedures.  Even  the CNA who helped wrap his toes one time when I was there layed the block of gauze on his floor!  I have seen poop on my dad's bathroom floor and in his shower so you know it's being tracked around because I could see his slipper marks  in the POO.   Yes,  I tell head nurse about it and they go in and clean. Supposedly per Dr's request the girls at assisted-living have been doing their best at keeping it dry and clean and sometimes he refuses to let them do it...he says he already did it.   The nurse at assisted-living says that's his choice they can't make him let them do it .   I have read on the net where the sore needs to stay moist   is this true ? maybe I have been reading wrong, I do have him an Endo appointment but not till April because they're so "busy ".  

 I've had my son in various different ERs numerous times from dirtbike accidents.   Seems we always have trouble getting things done right by doctors things aren't follow through, this is where I start reading on the net and question everything doctors nurses are doing    I even had a nurse tell me that's my problem and I need to get off the Internet ...  maybe they are right ?!?!!!!!

My dad's last visit with his primary, he couldn't find Lipitor listed on his medication list and  sternly told me I needed to ask the  nurse at assisted-living why it's not on there ....she went over it and said there it is "Atoravastatin"... dr not recognize that name !   Seems to me the doctor's nurse would check on this and not me am I wrong ??
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"Aggressive treatment" is explained above - usually a long acting insulin (Lantus) and checking blood sugars before a meal 3x/day and providing fast acting insulin coverage(Novolog/humalog) which is complicated and many younger diabetics have a rough time doing this due to compliance & time issues. There are many diabetics that faithfully test but more that don't. 
People also get insulin resistance after long term use of insulin. Your body just rejects it and you need higher doses.  Could be what is happening here as well.
Take your dad to an endocrinologist, bring a log of blood sugars (bring his meter too- if set up correctly it will save the time and results of each test for several weeks).
Every patient is different. His Hgb1AC is pretty good @ 7. There are many new diabetic meds out there today that augment insulin production (Januvia)& weekly doses (Trulicity) insulin that acts over a week, that can be given as an addition to his current diabetic medication regimen.
Have his circulation checked via Doppler.
Have the podiatrist culture his wound to see if any bacteria are there and if you aren't satisfied, have him evaluated by a wound care center.
Don't give up the ship!
I didn't see his age (could have missed it) but that plays a factor as well.
I will bet your dad is a fun loving senior living his life the way he wants to. Can you change his bad habits? You can try, but you can lead a horse to water but....you know the rest!
Keep us posted & good luck!
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What do you mean very aggressive treatment?

Yes there's one reading of a 40... 50s, 60s, 70s 80s 90s 100s all over the place
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Your father has blood sugar levels in the 40s?!! Forties?! I'd be unconscious. I have symptoms in the 70s. Wow. That sounds hideous to me.

Another disadvantage of very aggression treatment is that it risks more instances of low blood sugar. Not good at all.

I hope the endo comes up with a good plan they can administer at the AL, and that you keep your dad there.
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Oh no, I typed that wrong!!!

Type2 at age 55 then type2 around 70
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They test his blood sugars before meals at his assisted living and bedtime... I will doublecheck on this they may be doing it after meals not sure 

Will be interesting to see what the Endo says and how he changes things up but I'm afraid it's too late for my dad so much damage has been done
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And still growing that steel backbone to tell him know you're staying in assisted-living 🙄
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so yeah now he is planning on coming home from assisted-living into his new little cabin we built for him and I will be his main caretaker which I know I cannot do I don't mind taking him meals but I need to get more educated about diabetes so thank you for the suggestions
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Throughout the past years I have tried to help him I even went to classes with him about nutrition etc. and it was like going in one ear and out the other so I would give up and just keep that superficial relationship with him and let him be his own boss about his health
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Yes, I know Very confusing!!

Type1 diagnosis around age 55...I only know he took 1 pill a day for it
Type 2 diagnosis maybe she 70? Then lantus added to 1 pill, several yrs later 2 pills (metformin) plus Lantus
Last May, age 80, metformin went up to 3 a day with 33units insulin...now at 30units per dad's request because he thinks since he has low sugars in the morning he needs less insulin. The lowest has been 40, sometimes 50s 60s 70s, the doctor told him that's not to worry about just to eat a snack before bed which is usually a cookie..., sometimes he won't have the snack or have a really light supper and then of course his sugar is low

all goes back to him not taking care of himself grrr
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Anyone interested in diet and diabetes may find this paper by researchers from the Weizmann Institute published in Cell magazine in late 2015 extremely interesting:

Personalised Nutrition by Prediction of Glycemic Responses. (Google it is quickest)

It has had a certain amount of publicity in mainstream media since, but I'm surprised there hasn't been more. Surely no one has an interest in cultivating the need for pharmaceutical control of blood sugars, have they? [innocent expression]

Type 1 diabetes is not going to be significantly alleviated or cured, ever, by diet alone, sadly; but all the same the importance of understanding an individual's response to particular foods, and the reasons for that response, could be very beneficial.
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Bella, when was he diagnosed with Type 1? That is usually (but not always) diagnosed in childhood -- in fact, it used to be called Juvenile Diabetes. When was he diagnosed with Type 2? That piece is very confusing.

An aggressive treatment plan uses many tools to bring the glucose into a healthier range. For example, it may include a background insulin that works all day (Lantus) and a fast-acting insulin with each meal (Novalog or Humalog) and other drugs that can be injected or taken orally. It may include a more rigorously controlled eating plan, and exercise.

If this produces healthier numbers, why isn't it always used? Like decisions about any treatment plan, the advantages and drawbacks have to be considered for each individual. Some drawbacks of very aggressive treatment include:
The more parts to the plan, the more likely some non compliance.
Any drug can have side effects. The more drugs, the higher the chances.
Aggressively treating diabetes can be VERY expensive.

I am so glad Dad will be seen by an endocrinologist. This specialist is likely to keep up with the latest research and is in the best position to weigh the benefits and risks of various treatment approaches.
....
About his blood sugar being higher later in the day ... when is it being taken in relation to his eating? Immediately after eating the glucose level will start to rise. (For me it peaks at 55 minutes.) And then, as the sugar gets into the cells and out of the blood stream it comes down again. It should come down within the target range within 2 hours. So generally it is advised to take the reading at least 2 hours after eating.

I take a reading before eating, so I know how much insulin to take (on the sliding scale). It is usually within target range. Recently it was 267. OMG!! How did that happen? And then I remembered that I just drank a glass of juice. A blood sugar reading within an hour after eating is not terribly meaningful.

Ask the endo for literature. No doubt your father was given some at some point, but you will find it very educational to read the booklets yourself.
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Thank you MAC.

Someone asked earlier in posts...yes, he started out Type1 diabetes
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The sore started on bottom of big toe and spread between others toes and the pad. Oozing, smelly, tiny bloody...when I discovered it at assisted-living he was sitting outside "sunning" it, dripping on patio! I asked him how long this has been going on and he said oh couple of days (but obviously longer).   He didn't tell anyone at assisted-living about it either....antibiotics/topical cream, epsom soaks 2xs day, dry socks/shoes,  debriding since Feb 14 not helping. Foot doc is puzzled, says not responding to antibiotics , sending him to dermatologist Monday to get a sample of skin to see what kind of infection we're dealing with...Took dad to primary couple days ago and he more or less brushed it off and said "looks like fungal to me".
Maybe I'm overreacting, I am just scared of amputation, still learning here,so any advice is greatly appreciated
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Did get him an Endo appointment 👍
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MAC, what do you mean by "being aggressive with sugars..."?
And
"sliding scale "? You mean adjusting Lantus?

Still educating myself on diabetes
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Taking him out of AL is NOT something I want done and  I KNOW he needs to stay there!!!

He has always not taken care of himself and always pushed me away kindly when I tried to help.  He's a  very stubborn, independent, dysfunctional father...someone I could never have a serious conversation with.  Over  a year ago his home got infested with bedbugs....my husband and I paid for 7 mos. treatment of his dumpy trailer...tried to convince him to get out but would not...wouldnt follow instructions on how to help with bedbug treatment....mild stroke put him in the hospital then we destroyed his trailer, my husband promised to build him something new, even though we were thinking he may not recover well and end up staying in assisted-living hoping he liked it there ... now he's better and wants to come home to the new place.

We're we enablers by building something new?  Probably so.

Should we have yanked him out of the trailer? Yep!

"Self abuse"?  You bet, he's been doing it for years and wants to continue doing it at home.  Shows tiny signs of dementia, can't tell really...good showtimer!!

Now I need to tell him he needs to stay there and I am a wimpy chicken **** kind of person.  If I would tell him that I would have to run away and never see him again.... I do recognize and smart enough that I need to change...I am working on that and the support here has been wonderful.

I do love my dad and want what is best for him even though it may be what he does not desire.

Trying to grow up and grow a spine of steel, at the age of 54!

Bella
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Likely the chart says uncontrolled diabetes to warn the doctors that he has a history of uncontrolled diabetes and to be on the lookout for later disease caused by uncontrolled diabetes.

This is what you said above: "it used to be an 8 before assisted-living and it has definitely improved." Why would you consider taking him out of AL when it has been so good to him?

Is it not obvious that he is manipulating your emotions so he can get what he wants, which is freedom to abuse himself? He does not like the AL because they limit his access to the tools of his self abuse.

Yes,  you can certainly appear sympathetic to his cause, and say "this is where you need to be until you get much better. There's nothing I can do to make you well enough to come home. You just have to keep working on getting better."
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