Hi, everyone
Some of you remember me, I'm sure. However, I am now searching for answers in my capacity as caregiver for my T2 mil who is 84 and has had diabetes for at least half of her adult life. She is now in pretty frail health and I do her all her cooking. I wanted to kick her out of the kitchen for years, but I can tell anyone else who wants to take the dietetic reins from a loved one, it's a mixed blessing.
I dreamed of jettisoning meds and clearing her pains and cognitive decline (age-not AD) with meat, eggs, and no carb content beyond green veggies, yogurt, and butter. Instead, after almost a year she still has pretty marked dawn syndrome, starting to lose whatever benefit from her meds at about 6am and climbing steadily until her morning dose. That number goes from 130-160+, on up to 210 or so before her meds kick in.

Her doctor isn't bad. He told her to go LC back in 2018, when she started with him. But, she had no idea how to do that, and when I tried to explain it to her, she was just mystified. I offered to help her with food lists or menu planning but she didn't want my input and here we are.

So, let me move on to my question. We've tried several meds, with mixed results but she is stuck with Farxiga giving her an average of 160 or so (she has a Dexcom G7) despite a near perfect diet as opposed to Glipizide, which normalized her glucose but gave her hypos. The doctor now says she surely has lost some beta cell function due to age and long term damage. I asked him about some form of insulin since her pancreas is compromised but he says her numbers don’t warrant it. I don’t understand that since she often exceeds 300 if she tries to go off meds.
This is so frustrating to me. No one is willing to make it a priority to get her sugars down. I’m trying to get her in to see an endocrinologist who I’ve heard is better educated on diabetes but it was his NP who had her on Targendta and told me that an average of 150 to 160 is the best we can hope for. I understand that it also carries dangers of hypo but so many people take it, who shouldn’t be, that I don’t understand this.
Have any of you dealt with this?

Hi Ann, if your MIL is in frail health and has had diabetes for 42 years, what is your goal for her, what can she do herself and what are you willing to manage? In elderly patients, any co-morbidities and cognitive challenges are also considered in a treatment plan. The A1c level is allowed to be higher, up to 8% in elderly with diabetes. If you change the insulin but if she can’t manage hypos on her own, you need to be monitoring them. As the NP told you, an average of 150-160 may be the best in her circumstances.

Hi, Jey
Thanks for responding. My hope for her is that I can find a doctor with whom I can relax and trust to guide her with the most current and common sense diabetes knowledge.
For instance, I have heard, of course, that the expectations regarding A!C are different, regarding the elderly. But I've never known how to determine whether or not that was valid. I want a doctor I can trust to know best how to help her. I think we can
improve her cognition, because she does better when her sugars are lower. I also think we can mitigate her hypertension. Her ankles used to be swollen and now they aren't. She has excellent circulation all the way to her feet and that's not nothing.
I know that there isn't any chance she would improve to the degree that would be possible from a better starting point, but if I don't do my best for her, we may as well put her in a nursing home and let the chips fall where they may.


Edited to add:
She gets around with a walker, is about half independent with dressing and pretty close to fully able with her toilet. Her daughter and I do her showers. I am able to monitor any lows, as I use the Dexcom Follow app with her cgm. We almost never leave her alone, as my husband and I have moved in with her. He is still working full time but I am home with her.