How do you get someone at 92 to accept the fact they need insulin shots instead of pills due to A1C being 9 & now has mild retinopothy?

A social worker once told me “Let them live until they die”, which means to me, allow them to live their life as they choose.

However, this causes an additional burden on you. You will have to deal with the decline, more doctor’s appointments, more caregiving. Plus, the frustration.

One time I got my mom to do something because I lied. If you don’t get up, insurance won’t pay for any of this. She just had her knee replaced and refused PT. She got up right away.

Refusing to roll with the flow and medical suggestions could be an indication of hanging on to those last morsels or independence.

After YEARS of caregiving for my now deceased father and mother in a nursing home, I learned what I term as “Senior Anger Management”. In other words, dealing with you senior parents. Lashing out pushes them away. Being insistent does the same.

Know the psychology of your loved one and find a way to let them make their own decision. Consider a Plan B if this doesn’t work. My mom doesn’t listen to me but she does anything my husband says. Does your mom have a favorite family member?

I am not a medical person and this is all my opinion based on my own experiences.

It sounds like you're doing a lot of work for her. Is she mentally competent? How do you know that she's taking her pills? Some people don't make taking their medication a priority. Who would give her shots if she is prescribed them? It may be that she's just not able to live alone anymore. This is especially true if she starts with insulin.

I am a Type I diabetic and I know the complete diligence that is involved when taking insulin. When you take insulin, you really do need to do regular daily finger sticks to monitor blood sugar. Also, it may be that she is just needing more help with her insulin due to time. I've heard doctors say that people with Type 2 diabetes, often need more help, like shots, over the years. They don't know why, but, you can be doing everything right and still need to go to shots years into the diabetes.

If she's mentally competent, I'd just provide her with the information and options. It's really her choice. And, if she's not competent, I'd discuss it with her doctor and seek legal advice on the options. Could they increase her pills and/or add another pill hire a medication aid? I'd ask about the ONCE weekly injections.

Wolf - regarding “retinopathy just showed up... being caught early”, that is not accurate.

Diabetes as affects your eyes is asymptomatic; there’s no pain.
If retinopathy obvious, it has taken 20-25 years to be at this point.
It did NOT just start. Your mom at 92 has had diabetes couple of decades; her retinopathy is a side effect of diabetes.

How it gets detected as to type & extent is by a fundus examination of a dialated eye by an ENT or ophthalmologist. Often even with dialation the degree of retinopathy damage isn’t obvious; & that’s why her doc is wanting her to see a specialist. It will likely be a ophthalmologist who is retinal specialist. The usual is eye dialation fundus exam, fundus photography and flourescein angiogram. This lets doc determine if NPDR or PDR type of retinopathy.

My understanding is there is NO CURE for retinopathy. It’s not like glaucoma which has very good eye drops drugs which regulate the pressure causing the glaucoma, so keeps glaucoma totally manageable if caught early & drops done exactly as prescribed.
For retinopathy, treatment is laser surgery (to weld burst vessels), corticosteroid or A-VEGF shots to the eye, or vitrectomy (they remove some of the liquid that has the blood or “cotton” floaters).
Treatment does not stop it, just manage it better. If I had to guess, the issue will be that at age 92 with no diabetes lifestyle & A1C stability already in place (so she noncompliant for care), your mom won’t be a good candidate for having any of these done.

My dad was type 2 diabetic & saw a retinal specialist annually last 20 years of his life. He even brought home photos pulled from the angiogram that showed burst pattern on leak he had. He had a vitrectomy to get the blood balls out. Home for like 3 weeks, with no bending, no looking for stuff under the bed, on stool softeners. Then went back to work but my mom had to drive him to the lab for weeks. Dad was strict on his diet & meds, so his was mild. Diabetes over time leads to retinopathy for like 80% of diabetics. I think it’s the main cause of blindness for those under 65 in the US.
My hubs had retinal tear 5 years ago and had 2 laser surgeries abt 4 mos apart to basically spot weld the tear. He had sudden flashes of light & curtain in his vision, just lucky only a tear & not detachment. Saw retinal guy within couple of days of flash & surgery like day later. Post surgery hubs home a week, upright 24/7 & no screen time, then nothing strenuous for a month but back at his office. Hubs has had no issues since but sees regular ophthalmologist annually & retinal guy every 2 years & will till forever. Retinal work is not like out patient cataract day surgery, where your pretty ok in a day or so as it’s done now.
My point in all this is anything retina is going to require lots of compliance on your moms part and someone there for 24/7 oversight on her perhaps for weeks. Weeks....
If your kinda at burn out stage, really have a clear talk with the MD as to what aftercare needed for her & then have a reality check talk with your hubs on all this. Are you totally on your own, up for all this? It sounds like your really on 24/7 call for your mom; can you do this another 1, 2 or more years? She’s just beyond fortunate your like 1 house away. If you didn’t take over meals, take her to appointments, just “do” for her, she could not truly function independently on her own beyond a couple of days.... is that accurate? If so, she’s imo 1 incident away from going back into the NH; not AL as she’s 92, diabetic, actually lots of medication management needed as well as dietary restrictions, plus diabetic retinopathy which means she’s going blind. I know it sounds harsh, but you have to make a decision as to what’s best for her safety, security and health and ditto on yours as well.

Really, if you got hit by a bus manana, what then?

My father didn't want to do the shots, he said No for years, finally he conceded, I was against this from the get go. His body started breaking down and in died six months after starting the shots. He was old, there was no reason for this,

I agree with your mother, she is old, leave her be, if she says no, accept her decision, it is her life.

At that age, I would not worry about insulin.

high glucose in the blood will not kill quickly, Over the years it causes damage to all the organs, but then, so does insulin resistance. Honestly, it is a toss up which is worse at this point....more insulin to compound the resistance or more blood glucose. I would be willing bet that at 92 with A1C above 9 there is serious levels of calcium built up in the heart and arteries... this can only get worse no matter what you do short of removing all the sugar (carbohydrates) from the diet.

so, I am saying. Don’t worry about it. 92 is a ripe old age.

Wolf, what is the plan for moms future???

so right now her hubs is in a NH but she’s 92 & living in her home / apt on her own & kinda semi-independently as you do oodles of stuff for her? And her diabetes meds are just pills? That’s it, right?

if so I’d be somewhat cautious about having her move to shots & for a couple of reasons:
- just who is going to do this? and monitor her diabetes on clockwork like schedule for first couple of months after injections start?
BUT more importantly what it means for her future...
Why? Is cause eventually she will get beyond being able to live at home & needing to go into a facility; and facilities could view a resident requiring daily injections to be speciality care and will NOT take them in. Injections may not be standard medication management.

I’d suggest that you clearly ask at dads current NH, if they take new residents coming in & already on daily insulin injections. Not already being there and then get worse & have to transition to injections. But coming in on daily shots. If this NH won’t take in new residents on daily insulin injections, it’s probably going to be very difficult to find one that will. What then..... like dad in NH 1 & mom in a whole different one perhaps much farther away?

if she’s constantly having A1C yo-yo’s, there's gonna be a medical crisis. 92 with uncontrolled diabetes and diabetic retinopathy, things are not gonna get better. What’s her field of vision like? How close is she to being able to be considered legally blind? What are her extremities like? Numbness or foot issues? Has she had bad missteps or falls?

has any serious thought been given to having her move into the same NH that her hubs already is in? & doing this now while she’s still kinda ok visually & just on pills for her medication management. It kinda sounds like you are approaching burnout.
What’s the reasons why she’s not already where dad is?

My mil was legally blind & finding care was a challenge, my dad was adult onset diabetic that too was a challenge, he big timed changed his diet to avoid being injections dependent as it for him would have limited what he could do for work & his health... like even for something routine like getting dental work done.

Who's going to do the shots?

The reason I ask is that if it's a visiting nurse, that person will probably be the best person to talk your mother round and explain the routine for her. Specialist diabetes nurses know the subject inside-out and upside-down and have seen it all, from schoolkids who are already expert self-care managers to older men who are facing amputation and yet still chow down six donuts for breakfast. Does your mother have a needle phobia or anything like that? - same again, an experienced nurse will be able to help overcome it.

The Lord will indeed take every one of us in His own good time, but that's no reason to hurry Him along.

If she is competent, it may be that she just gets to make her own decision on diabetes care. I suppose it depends on just how aggressive you want to be with blood sugar control. It's all about the risk vs. benefits.

Those may vary depending on the patient, age, health status and lifestyle. I'd meet with an endocrinologist and certified diabetes educator before making a decision on insulin. It makes a huge impact on potential lows. With insulin on board, you really do need someone around to monitor drops. Even though I am very experienced with using insulin, now by pump, it's still a risky thing and you need all kinds of training and backup plans. I know a lot of experienced insulin users family members who have to call 911 because they went too low and passed out. Once, again, it's a risk benefit analysis.

Wolf - thank for your update post.
Regarding your brother “being in for a surprise”, please realize he does not have to do squat. If your somehow thinking he will himself do what you’ve been doing on-site daily in moms nearby house & errand runs for years for your mom, well, I bet there’s a better chance I’ll fit back into my size 4 slacks. He likely does not share your perspective on what is best for mom’s situation. Family is not required to do for their parents. If they want to take on the responsibility, that’s their choice, they don’t have to. Even if their named as DPOA, they can ignore it, or formally resign it.

So your brother lives nearby and has committed some of his free time to a volunteer organization, right? he’s sounds socially aware & part of y’all’s community. He’s decided to go with you two to the eye specialist next week, and this is great, he is concerned for his mom. After the visit will be an ideal time to make a informed decision as to what is best for her health safety & security and put a plan in place. If it means mom moves into the same NH dad is already in, move ahead with doing this. Perhaps Bro will take on getting your folks house cleared, made market ready & deal with Realtors. Your 1 house away, you’ll know what’s going on but let him take on that responsibility.

Perhaps I missed this, but how is dads NH stay being paid? private pay? Medicaid? LTC insurance? VA $?. This will make a difference as to house situation, but that’s imo a whole other question.

As an aside, if retinal guy wants a flouresein angiogram done, it is an invasive procedure & can be scary as you get major dilation, you’re fixed into a tight head set, then a set of images done on back of eye, then an IV run with a dye in it and as the dye filters thru there is 2nd set of images which capture where leaks and damages are in the back of your eye & optic nerve from the retinopathy. My dad, who was quite the wag, called it the annual Clockwork Orange. Images are quite astounding & in a way beautiful. I mention this as you might want to consider to use this as a “cudgel” that if you insist on staying in your home that you are going to have procedures like this regularly (and maybe work in daily insulin shots too) but if you move over where dad is things will stay status quo.

I've got to say, you seem warmly open to what folks have suggested you on this site. I’ve been on AC quite a while, and that’s not often the case.... like folks posting are often flat hostile to suggestions. Kudos to you! & good luck with brother & mom. Let us know how eye visit goes.

I don't know if this is a good idea or not, but could you tell her that if she does not get the shots then she will need to go into assisted living? I am also assuming that she will have to have someone give her the shots. Stress to her that she can decide between the 2 scenarios. Let her know that if she is not getting the shots, her decline is not something that you can manage, so she would have to go into AL. I don't know if it is an option financially for you.