Today I saw two different patients that both exemplify the severe and undesirable complications of diabetes. I would not wish them upon any person or patient. The first patient was a lady whom I will call Judy Lath*. She has been hospitalized for the past week and I discharged her today. She has been a long term brittle diabetic on an insulin pump.
Because of the brittle diabetes she has contracted complications with her eyes, her stomach, and her nervous system. She was hospitalized because of vomiting and dehydration. During the hospitalization, I discovered that she had what is called autonomic dysfunction where the nervous system doesn’t function to raise BP when a person stands up as it normally does without us even thinking about it.
With intravenous fluids and a medication called Clonidine to control her gastric symptoms as well as her essential hypertension, and a medicine called Florinef we were able to control her BP when she was lying down and keep the BP from decreasing dramatically when she stood up. I discharged Judy home today and she was feeling a lot better, although not perfect. She will obviously have a lifetime of complications.
The next patient I saw in my office is an example of a person who could have controlled his diabetes but desired not to and by the time he had that desire his feet were completely numb, he had undergone bypass surgery, and he is on disability because of congestive heart failure and recurrent infections of his feet. All this before age 50.
He is not an insulin diabetic and when he wants to he can control his glucose with diet and oral medication. The one large ulcer on his left foot has been debrided by the orthopedist and seems to be finally healing in even though it extends along the whole side of his left foot. The surgeon is able to cut on his foot without the need for local anesthesia because his foot is so numb. Unfortunately today the other foot ulcer was becoming more infected and I added a strong medicine called Levaquin to the Bactrim and Flagyl that he was already on. I will see him back next week for a follow-up.
I often use the example of this last patient to my other diabetics when they seem not to have the desire to control their diabetes.