Navigating Diabetes Complications: A Daughter's Plea for Guidance

Q: Navigating Diabetes Complications: A Daughter's Plea for Guidance

Hello： In response to your inquiry, I am deeply sorry to hear about your father's condition. <br>The complications of diabetes include macrovascular diseases such as heart and cerebrovascular disorders, as well as microvascular diseases like retinopathy, nephropathy, and peripher

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My father, who has always had a strong personality, has been suffering from diabetes for the past three years without letting any of his friends or family know.
It wasn't until December 29 of last year that I returned home and found him lying in bed.
I asked, "Dad, why are you being lazy?" He simply replied that his feet hurt.
The next day, I took him to the hospital for an examination.
When we removed his shoes and socks, we discovered that two of his toes had already necrosed.
From that point on, I began accompanying my father as we moved from hospital to hospital, seeking doctors.
Fortunately, after undergoing a bypass surgery on the dorsalis pedis artery and receiving continuous hyperbaric oxygen therapy, my father had three toes amputated, and the granulation tissue was growing very well.
On February 18 of this year, he underwent the final skin graft procedure.
The plastic surgeon was very optimistic, stating that my father would be able to be discharged on February 25.
However, on the morning of February 22, my father began to express that he was feeling very uncomfortable with his heart, saying it felt like it was about to stop beating, and he was gasping for breath.
Shortly after, he started to speak incoherently and experienced hallucinations.
I was at a loss and pleaded with the nurse to have the on-call doctor come quickly.
When the doctor arrived, he only told me, "Miss, I haven't been taking care of your father from the beginning.
Your father is not in life-threatening condition right now.
His incoherence is just dementia.
I don't understand why you're so anxious.
It's a holiday, and if you have questions, wait until Monday." With that, he did nothing and left.
On February 23, my father sighed, and his heartbeat and breathing stopped.
After 10 minutes of resuscitation, he was sent to the ICU.
He was discharged from the intensive care unit on March 3, but all the previous efforts were in vain.
I believe that all the doctors involved felt extremely frustrated and disheartened because my father's legs had turned completely black.
Amputation was inevitable, but now, in addition to his feet being entirely necrosed, he also had kidney, heart, and lung edema, a Staphylococcus aureus infection, and pressure sores.
I don't know what to do next.
Whenever I close my eyes, I always see my father as he once was, whole and healthy.
No matter how I ask, the answer I always receive is that it's "under control." If it can be controlled, why was a basic acute delirium caused by electrolyte imbalance dismissed by the on-call doctor as dementia? There are so many things I don't understand.
Doctor, you are my last line of defense.
Please teach me what I should do.

tòng xīn jí shǒu, 30~39 year old female. Ask Date: 2004/03/17

Dr. Yang Jun reply Internal Medicine

Hello: In response to your inquiry, I am deeply sorry to hear about your father's condition.
The complications of diabetes include macrovascular diseases such as heart and cerebrovascular disorders, as well as microvascular diseases like retinopathy, nephropathy, and peripheral neuropathy.
Your father required amputation due to diabetic foot complications, but any clinical symptoms that occurred in the hospital must be assessed and managed by the attending healthcare professionals, and I cannot provide specific recommendations in this context.
However, electrolyte imbalances can lead to confusion and even coma; a clinical diagnosis can only be made after appropriate testing.
I suggest discussing this further with the physicians at the hospital.

Reply Date: 2004/03/17

More Info

I'm truly sorry to hear about your father's condition and the challenges your family is facing. Navigating the complexities of diabetes and its complications can be overwhelming, especially when it involves a loved one. Your father's situation highlights the severe consequences that can arise from uncontrolled diabetes, including neuropathy, infections, and ultimately, amputations.

Diabetes can lead to a range of complications, particularly when blood sugar levels are not well managed. These complications can affect various systems in the body, including the cardiovascular system, kidneys, eyes, and nerves. In your father's case, the fact that he had necrotic toes indicates that he likely experienced peripheral artery disease (PAD), a common complication of diabetes that reduces blood flow to the extremities, leading to tissue death.

The sudden onset of confusion and hallucinations that your father experienced could be attributed to several factors. Electrolyte imbalances, which can occur due to kidney dysfunction or dehydration, can lead to acute confusion or delirium. Additionally, infections, particularly those caused by resistant bacteria like Staphylococcus aureus, can also cause systemic reactions that affect mental status. It's crucial to understand that these symptoms are not merely signs of dementia or "old age," but rather potential indicators of underlying medical issues that require immediate attention.

In terms of what you can do moving forward, here are several steps to consider:
1. Open Communication with Healthcare Providers: It's essential to advocate for your father's health. If you feel that his symptoms are not being adequately addressed, don't hesitate to seek a second opinion or ask for a referral to a specialist, such as an endocrinologist or a geriatrician. Clear communication about your father's symptoms and your concerns can help guide the treatment plan.

2. Monitor Blood Sugar Levels: If your father is able, regular monitoring of his blood sugar levels is crucial. This can help identify patterns and triggers for high or low blood sugar, allowing for timely interventions.

3. Nutritional Support: Collaborate with a dietitian who specializes in diabetes management. A well-balanced diet that is low in simple sugars and rich in whole grains, lean proteins, and healthy fats can help stabilize blood sugar levels. Proper nutrition is also vital for wound healing, especially after surgeries.

4. Physical Activity: Encourage safe physical activity as tolerated. Movement can improve circulation and help manage blood sugar levels. However, any exercise regimen should be discussed with his healthcare team to ensure safety.

5. Wound Care and Infection Prevention: Given your father's history of foot ulcers and amputations, diligent foot care is essential. Regular inspections of the feet for any signs of injury or infection should be a routine practice. Proper footwear and hygiene can prevent further complications.

6. Mental Health Support: The emotional toll of chronic illness can be significant for both patients and caregivers. Consider seeking support from mental health professionals or support groups for both you and your father. This can provide a safe space to express feelings and learn coping strategies.

7. Education on Diabetes Management: Understanding diabetes and its complications can empower you and your family to make informed decisions about care. Resources from diabetes organizations can provide valuable information on managing the condition effectively.

8. Palliative Care: If your father's condition continues to decline, it may be worth discussing palliative care options. This approach focuses on improving quality of life and managing symptoms rather than solely treating the disease.

Remember, you are not alone in this journey. Many families face similar challenges, and there are resources available to help you navigate this difficult time. Your father's health and well-being are paramount, and advocating for him is a vital part of ensuring he receives the best possible care.

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