Need help navigating life with diabetes? You can always Ask D'Mine! Welcome again to our weekly Q&A column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil offers some thoughts about lowering glucose levels to a PWD overseas, and he also sends some more serious advice to a father needing help with alcohol-related issues in his son.Ask-DMine_button

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Jamilu, type 2 from Nigeria writes: Hi, I'm 33 years old diabetic, it was found on me in 2004. Since then I'm taking medicine and recently with insulin injection. But still is high in my blood, 12 FBS or more than that. [U.S. readers, this would translate to a fasting blood sugar of 216 mg/dL] Here is my prescription: Morning glimepiride 4mg, Evening glucophage 2gr [2,000 mg in U.S. talk—Ed.], Insulin 28 units. Please, what can I do reduce it?

Wil@Ask D'Mine answers: Confession: I'm not up to speed on diabetes care in Nigeria, but your country seems to be frequently towards the bottom of those lists of places with good healthcare. The latest World Health Organization ranking put you at 187 out of the 190 countries it tracks, and it looks like you've got about 1 docs per 10,000 citizens. (For those of you dying to know, Burma was at the bottom of the WHO list and we in the USA were quite a ways down the list at #38. The best healthcare in the world? Vive la France!)

So you're facing some challenges over there. On the bright side, the prescription recipe you're taking is not all that different from what any doc in any country on the top quarter of the WHO list might give you. Plenty of folks here in the US take those three meds together. Personally, I'm not too big a fan of mixing insulin and glimepiride as it, in theory, increases the risk of hypos, but it's still done quite a lot. This is what I call "wedding cake diabetes therapy." Every time your blood sugar goes up, a new layer of medicine is added. You, my friend, have a three-layer cake. In many medical settings, no one ever bothers to think about removing one of the old layers when adding a new one, especially when you are running above target.

Innovation 2015

Now don't do this without talking to your 1/10,000th of a doctor first, but your best strategy is probably to increase your insulin. Generally speaking, 28 units isn't very much for a type 2. Most T2's need quite a bit more than that to keep blood sugars in check. And that's the beautiful thing about insulin: There's no maximum dose. You take what you need to take to get your blood sugar where you need it.

At least that's the theory.

D in NigeriaIn reality, there might be a few hiccups in Nigeria. First: Can you afford as much as you need? I see that in your country, paying for insulin, on average, eats up fully 29% of your annual income. Second: Can you even get what you need, if you can afford it? A Health Action International report stated that insulin is "shamefully unavailable" in Nigeria in general, and is completely unavailable in some states. And third: If you can afford enough, and if you can get enough—does it arrive in good shape? I'm concerned about that because you told me that you live in the state of Kano, in north-central Nigeria. I see from the news that that's an area of some political ....ummm... unrest, many power shortages, and overall decaying infrastructure. Any or all of these things could affect the quality of the insulin you're getting. Insulin that sits in a 100-degree warehouse somewhere for weeks or months might end up as worthless as distilled water.

So my first choice would be for you to be able to afford and get enough well-cared for insulin to keep your blood sugar in target. If that's unrealistic you'll need to turn to your diet to see what you can do to keep the carbs on the lean side. It's not a perfect solution, but depending on what you eat now, focusing on lower glycemic index foods, can make a hell of a difference for a type 2 like you when it comes to blood sugar control.

Hang in there, and let us know how you're doing. The American branch of the family is rooting for you. And speaking of American families...

 

A self-styled "Desperate D-Dad" writes: Dear Wil, my son, who's now six weeks from his 18th birthday, was diagnosed with type 1 diabetes approximately four years ago. He also has a significant alcohol problem that he refuses to admit or modify. He has been enrolled in an intensive adolescent outpatient treatment program for one week, but he has vowed to undermine it (and has been working hard at that). He states that if we sent him to a residential treatment program, he would sign himself out at age 18 and never talk to us again. He says that he only wants to have a few drinks with his friends but the number of empty beer cans we find in his room every day suggest that he has been drinking 6-10 beers or more per night alone in his room, in addition to whatever he drinks with his friends. Alcohol also has had a significant impact on his social/educational functioning: despite high intelligence, he failed four courses in 11th grade, frequently skipped class or just didn't go to school. He also (not coincidentally) has frequent hypoglycemia. He saw an alcohol counselor weekly over the last year, who he liked and trusted. The counselor recently told us that continued attendance was useless because my son was glibly lying to him non-stop. He also has not responded to loss of privileges (e.g., driving, cell phone) or rewards (purchasing a used car for him if he stopped drinking and went to school).

If he didn't have T1D, we would have him move out of our house when he turned 18.  But we're terrified that if he moved out and continued to drink the same amount of alcohol or even more, he could have a hypoglycemia-induced seizure or coma and he could die. We have no idea what to do. It is pretty clear that he has no intention of complying with the outpatient program and modifying his drinking, which is dangerous to him in both the short and long term. I know that you published a column on safe drinking habits for type 1 diabetics, which I found reasonable.  However, he is drinking to excess on a daily, not intermittent basis, and taking few of the reasonable precautions you recommended. Do you have any suggestions?

Wil@Ask D'Mine answers: Yikes, I'm so sorry, Desperate D-Dad! You are in an awful spot here. I'm not sure that I have any good advice to give. I did write several pieces on teen drinking a while back, but those dealt more with social drinking, peer pressure, and teen binge drinking. Full-blown alcoholism—and that's what this is, not a significant alcohol problem—is a horse of a whole different color. Alcoholism is a disease every bit as serious and destructive as diabetes, and it's also a piss-poor "mixer" with diabetes. Each make the other more dangerous than they are by themselves.

To make things worse, what you're dealing with is alcoholism combined with teen rebellion. Well, alcoholism combined with rebellion and covered in denial (his, not yours). Yuck. It's a bad combo even without the diabetes.

I think you are right to worry. I don't like his odds out in the world in this condition, but I really don'HEALTH Alcohol 074058t know what to tell you.

I wish I did.

The options at this point are all bad.  For what it's worth, I think you've actually done all the right things, but he's just not ready for help yet. But with all of that said, as you well know, your window to force help on him is closing rapidly. It could very well be the wrong decision, but if he were mine, I'd stick him in the residential program you mentioned. It's a tough call. The toughest. But for me, I'd rather never talk with my son again because he was mad at me forever, than never talk to him again because he was dead. Either would break my heart, but at least I could live with the first one. The second...

And maybe, just maybe, the residential program might get through to him.

Still, I had enough doubts about my advice to run them by our addictions specialist at my clinic in New Mexico to see what she thought. She actually agreed with me that you need to make one last desperate attempt while you still have the legal authority to do so. That said, she was pessimistic about the probable outcome. Actually, she's pessimistic about the odds of success on any "adolescent" treatment program—the numbers just aren't that great. "The problem," she told me, "is that kids this age think they're bullet-proof."

But she agreed with me that, even knowing these low-success statistics, she'd do the same. "You have to try everything you can try, right down to the wire."

She, like me, has her fingers and toes crossed for you.

And one last it-probably-goes-without-saying but I should say it anyway comment: Make damn sure your wife, his mother, is onboard with you on this. You must have a unified front, and you can't have both your son and your wife not talking to you forever.

Boy, do I ever wish I had some better advice to give.

But I don't.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.