BLOG: My father’s sugar log
About 15 years ago, I was visiting Jordan as my late father's diabetes had recently deteriorated, and he was hospitalized.
He was treated with insulin. My colleagues at the hospital prescribed 70/30 insulin on discharge. As they knew I was an endocrinologist, they deferred full management of diabetes — including dosing — to me.
Prior to that, my aging father's health deteriorated with multiple diabetes complications, including vision loss and kidney impairment. He couldn't see well to test his glucose and use insulin. It was not easy for us, or me, to draw insulin and inject it. Although I know the theoretical process of insulin administration as an endocrinologist, I found it difficult to do it when it came to a family member. With some reading and practice, I managed to get things going. I started the insulin treatment for few days, and then I had to return to the U.S.
I had to teach a family member to manage my father's diabetes. I taught my nephew, Mohammed, how to check glucose and give insulin. He did a great job, for the next 3 years, until my father passed away in 2008.
My father's passing was quite dramatic for me. At the time, I was in private practice at St. Francis Hospital in Cape Girardeau, Missouri, and my family remained in Lansing, Michigan. Prior to that I was a faculty member at Michigan State University. In late 2007, St. Francis Hospital asked me if I could leave MSU to restart their endocrine practice, which I had worked at in the late 1990s. Their had endocrinologist had relocated and left the area and the practice was shut down for 6 months.
The splendid surrounding area of Cape Girardeau, the Delta of the Mississippi and Ohio Rivers, is a large, sparsely populated rural area, with patients from five neighboring states: southeast Missouri, southwest Illinois, northwest Kentucky, northwest Tennessee and northeast Arkansas, with a population over 500,000. These rural communities were in dire need of several endocrinologists, due to high prevalence of diabetes and obesity. To my recollection, with St. Francis' endocrine practice that had been shut down, there was only one endocrinologist in a stretch from St. Louis to Memphis on I-55 at the time.
I took that responsibility and went there, restarted the practice, recruited an endocrinologist and two nurse practitioners, and then returned to MSU, after securing recruitment of another endocrinologist to replace me. During those 2 years, I would commute monthly, flying back and forth between St. Louis and Detroit.
On Oct. 30, 2008, my brother in Jordan called me.
"Our father is in the ER and is very sick," he said.
"That can't be," I said. I had just spoken with him over the phone the preceding weekend. He was doing quite well and in very high spirits and was so excited about the birth of his first great grandchild, to be born 3 months later.
"He is in the ER and there are over 10 doctors and nurses in the room!" my brother said.
I knew what that meant.
I asked to talk to one of the doctors. The doctor told me that our father was in acute renal failure with a creatinine over 10 and potassium over 10. They did CPR, but my father could not make it.
I booked the first flight to Amman, leaving the next day. I flew from St. Louis to Detroit. My wife met me in Detroit airport, and we flew to Amman so we could attend the latter part of my father's burial proceedings; but, sadly, we missed the funeral by just a few hours. Coincidentally, my mother-in-law was also in another hospital at the time, so the urgent trip to Amman was timely to see my mother-in-law. As my brothers and I looked through our late father’s belongings, we each took things to keep. I made sure to take by father’s sugar log, which I keep in the box with all the albums and other memorabilia. The picture posted above is a snapshot of my father's sugar log, as beautifully managed by my nephew, Mohammed. The writing is in Arabic on a calendar from a couple of years prior. Mohammed was very meticulous, and he kept a nice log: He would check the glucose in AM and PM and give the insulin according to my instructions per intermittent phone communications. I taught him to adjust the doses up or down per blood glucose readings.
Mohammed kept the sugars in a reasonable and safe range, with HbA1c around 8%, just appropriate for age and comorbidities.