Today's Stats:

Breakfast

Blood Glucose:     Time:  1015     Reading:  132

Blood Pressure:     Time:  1108     BP:  120/60     Pulse:  79

Breakfast:  1120  & Meds What she ate:  1 hard over egg, heavily peppered 2 slices thick cut sugar cured lean bacon 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with Niferex-150	helps the body metabolize iron
glipizide ER/10 mg	1 pill with meal	standard breakfast and dinner med to increase cells' sensitivity to insulin
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
aspirin/81 mg	1 tab with breakfast	standard breakfast med - given for anti-coagulant properties
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

    It's easy to tell, from her blood glucose, that she had the tomato pie last night. But, her blood glucose is well within range, nicely below the range at which the neurologist suggested I "worry", as well as being well within the range the SNF would like me to begin to administer insulin. Nothing unusual or noteworthy about breakfast this morning, except it came a little later than we've been establishing, lately.

Lunch

Blood Glucose:     Time:  1546     Reading:  98

Blood Pressure:     Time:  1603     BP:  113/57     Pulse:  68

Lunch:  1615  & Meds What she ate:  sandwich w/4 oz extraordinary, homemade tuna salad (the recipe for which I made up and intend to publish, very soon, when I launch the companion food journal to this web collection,), 2 slices potato bread Approx .5 oz Doritos Nachos chips 11.5 oz V-8 juice with 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
100% Aloe Vera gel/2 oz	just before meal	helps increase the cells' sensitivity to insulin
18 mg Iron Protein Succinylate	1 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron

    Nothing extraordinary about lunch, either, except that, after spending most of the "morning" (from about 1230 on) at Ben Franklin Crafts and Walmart, and having her argue with me about drinking water, I had to hydrate her for about 15 minutes previous to lunch. She loved the tuna salad, which is good. We can stop buying the tuna salad sold at our local grocery which, while it doesn't taste bad even to me, has more mayonnaise in it than tuna, not an awful lot of flavor and very little onion and celery, so that I always have to add both before she'll eat it.

Dinner

Blood Glucose:     Time:  2039     Reading:  197

Blood Pressure:     Time:  2046     BP:  126/60     Pulse:  60

Dinner:  2050  & Meds What she ate:  Taco Bell food: 1 Burrito Supreme, 1 Taco Supreme
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron
glipizide ER/10 mg	1 pill with meal	standard breakfast and dinner med to increase cells' sensitivity to insulin
vitamin E/400 IU	with meal	given for anti-coagulant properties
garlic/1250 mg	with meal	given for anti-coagulant properties
calcium-vitamin D/500-200 mg	with meal	believed to be an osteoporosis preventative

ABSENT MEDS:

Conspicuously Absent Meds & Supplements
Med/Dose	Administration	Explanation
1/4 cup pure cranberry juice w/12 oz water	after breakfast	I forgot it

    I suppose I could have administered her lisinopril, a quarter tab which figures to 1.25 mg, but her BP was so perfect I decided not to, since her BP often goes down at night, on its own, anyway, when she's doing well. So, today, no kidney protection, not even the cranberry juice.
    Her BG freaked me out. I figure it must have been from the potato bread and the Nachos, so, little by little, I'm learning what I can and can't feed her now that she's not taking metformin. God, "it feels like the very first time." And, that doesn't feel good. I guess I'll see what the glipizide ER does. Unfortunately, Taco Bell isn't the best of meals with which to control blood glucose, but, that's what she wanted, and she wanted it bad, so, I decided, ahhh, what the hell. Why not?

Miscellaneous Stat: Why not, indeed?!?
I know better than to do this, but my curiosity got the better of me. I decided, a couple hours after dinner, to take the following reading:

Blood Glucose:     Time:  2319     Reading:  206

Blood Pressure:     Not taken

    I kind of figured the Taco Bell food would have a bombastic effect, and it did, sure enough. And it scares the shit out of me. So, shortly, I'm going to start searching the web for supplements I can safely add to her diet that will keep me from using insulin. No, I did not administer insulin, tonight. I decided to let it go and see what happens in the morning.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0903     Reading:  136

Blood Pressure:     Time:  1004     BP:  146/70     Pulse:  56

Breakfast:  1017  & Meds What she ate:  2 oz pork sage sausage scrambled with one egg, heavily peppered 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with Niferex-150	helps the body metabolize iron
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
glipizide ER/10 mg	1 pill with meal	standard pre-breakfast and pre-dinner med
aspirin/81 mg	1 tab with breakfast	standard breakfast med - given for anti-coagulant properties
lisinopril/2.5 mg	1/2 tab with meal	Her blood pressure could take it, this morning
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

    Her type of glipizide changed this morning. She's been switched to the extended release version, which is taken with meals, as per the generic, printed pharmacy instructions; I did ask the pharmacist for specific instructions and he simply read from the bottle before handing it to me. The doctor's prescription had no specific directions included. I'll probably look it up later to see what really works, but, in the meantime, I'll follow the generic printed pharmacy intructions.
    Otherwise, there's nothing unusual about breakfast except her blood pressure seems to be back to normal for readjusting to Prescott, so I've continued lisinopril, although, of course its administration will depend on her blood pressure readings morning and evening.
    The 136 BG is, I imagine, a reflection of the tomato biscuit pie last night, which, although healthy and flavorful, was also loaded with sweet, fruity tomatoes and, as well, the biscuit crust was simple-carb heaven, even with half of the flour consisting of whole wheat flour.
    I think we're working back into routine. Feels good.

Lunch

Blood Glucose:     Time:  1426     Reading:  127

Blood Pressure:     Time:  1448     BP:  98/52     Pulse:  72

Lunch:  1455  & Meds What she ate:  1/2 a stuffed bell pepper I had frozen from the batch I made over a month ago with barley, celery, onion, green olives, sausage, artichoke hearts, parmesan cheese, greek feta dressing and I can't remember what other wonderful stuff was in it 11.5 oz V-8 juice with 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
18 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron
Aloe Vera gel 100%/2 oz	with meal	to help increase sensitivity of her cells to insulin

    Yeah, I know, that blood pressure surprised me, too. I even took her blood pressure twice. The first reading, taken at 1432, was 92/51, Pulse 69. I don't think it's dehydration, this time, and I don't think it's anemia. I think it's the lisinopril. I think, now that she is exercising a fair amount on a regular, daily basis, at least a good 2 hours a day (which includes therapy exercises and walkering), maybe her normal blood pressure is "improving" by regulating itself and giving her 2.5 mg of lisinopril, even when her systolic is 140+, is a bit too much. I'll keep this under close observation, though, in case the problem is something else. I'll find out if it's anemia after next week's blood draws. The next time her blood pressure can handle lisinopril, too, I think I'll give her a quarter of a tablet, which will work out to 1.25 mg. Maybe, now, that will be her optimal dose. Of course, I'll discuss these developments with her doctor.
    The truth is, it's hard for me to know, now, with these "new" guidelines regarding hydration, if it is dehydration or not. I thought I'd be able to tell from her blood pressure, and, as long as her blood pressure remains unaltered by lisinopril, I think this is a safe bet. But, when lisinopril enters the picture, it's hard. According the the old guidelines, when she laid down for her nap she "looked" dehydrated, but, according to the new guidelines, she didn't. Fuck. This is a difficult issue to negotiate.

Dinner

Blood Glucose:     Time:  1906     Reading:  109

Blood Pressure:     Time:  1940     BP:  112/54     Pulse:  66

Dinner:  1945  & Meds What she ate:  1/6th of the Spirit of Tomato pie 4 green olives 1/4 cup pure cranberry juice in 12 oz water Later at about 2130: 2 sugar-free York Peppermint Patties, 2 sugar-free Cerrita's wrapped chocolates, 1 sugar-free Brachs Starlight Mint, 1 sugar-free Brachs Hard Creamy Caramel
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs 1/2 hour before dinner	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron
glipizide ER/10 mg	1 pill with meal	standard breakfast and dinner med for type 2 diabetes
vitamin E/400 IU	with meal	given for anti-coagulant properties
garlic/1250 mg	with meal	given for anti-coagulant properties
calcium-vitamin D/500-200 mg	with meal	believed to be an osteoporosis preventative

Conspicuously Absent Meds & Supplements
Med/Dose	Administration	Explanation
lisinopril/2.5 mg	1/2 tab with meal	blood pressure wouldn't have been able to handle it

    I am seriously considering that Mom may, for the most part, be able to handle only one dose of lisinopril a day, now, with adjustments depending on readings throughout the day and to what I attribute ups and downs in her blood pressure. So, I think, from now on, as standard practice (with which I have sort of been fooling, anyway), when I do not give her lisinopril, I won't consider it a "Conspicuously Absent Med".
    She continues to eat very well and savor everything she eats. I am very pleased with how her blood sugar is performing, so far, on the glipizide E(xtended) R(elease). It will take a week or so to notice a pattern, and a few days, anyway, before I experiment with extending her diet to include, here and there, some of her favorites that I've previously shunned on her behalf. I am, though, for instance, curious to see how one of those Costco Oatmeal Raisin cookies is handled, between the glipizide ER, the cinnamon and the Aloe Vera 100% gel.
    She reports, by the way, that the Aloe Vera gel has no flavor, thus is not unpleasant.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0907     Reading:  134

Blood Pressure:     Time:  1001     BP:  112/56     Pulse:  68

Breakfast:  1030  & Meds What she ate:  1 hard over egg, heavily peppered 2 slices thick cut sugar cured lean bacon 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with Niferex-150	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and pre-dinner med
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
aspirin/81 mg	1 tab with breakfast	standard breakfast med - given for anti-coagulant properties
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

Conspicuously Absent Meds & Supplements
Med/Dose	Administration	Explanation
lisinopril/2.5 mg	1/2 tab with meal	her blood pressure is right on the money, so I decided to wait on this

    Well, damn, that cookie is still shaking itself out, it looks like. I'm sorry about this. I'd like to be able to give my mother a sweet, here and there, more often. But, at least, for the time being, this doesn't look like a possibility. I guess I'd better try experimenting with Splenda, again. I still have some. Both she and I, though, can detect a curious, rough flavor from it, aside from the fact that it is way too sweet. Now, too, that her taste is returning, this may be even more of a problem.
    My only problem with her blood pressure, now, is trying to find some way to get in at least 2.5 mg of lisinopril. Maybe 1.25 mg will do the trick...I'll have to check with the doctor. If so, I'm going to have him prescribe the 2.5 mg tab, for twice a day...this way, if she ever needs more, we won't use the Rx too fast, and, if she needs less, we're covered.
    Today we pick up the Glucotrol XL. She's been on standard glipizde. I'm hoping the extended release with help control her blood sugar a little better, along with all the other stuff I'm doing. Maybe it will even allow her to have cookies a bit more often.

Lunch

Blood Glucose:     Time:  1423     Reading:  123

Blood Pressure:     Time:  1447     BP:  96/51     Pulse:  70

Lunch:  1455  & Meds What she ate:  approx 8 oz Marie Callendar's Chicken Pot Pie soup with added frozen peas and peppered turkey breast 1/3 of a bag of microwave "lite" popcorn 11.5 oz V-8 juice with 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
2 oz/100% Aloe Vera gel	1/2 hour before meal	helps increase cell sensitivity to insulin
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron

    I am assuming her low blood pressure is because she's somewhat dehydrated, although she looks more plumped out than she ever looked at the hospital or the skilled nursing facility, and that's not saying much. Damn, this dehydration issue is getting to me. Just in case her BP is dropping because of a redoubled assault of her anemia (although she's looking nicely ruddy) I stopped cutting back on her lunch time iron and gave her two 18 mg capsules instead of one. I also made (yes, made, it was a battle) her drink a good 8 oz of water before lunch, then, of course, factored in the 11.5 oz. of V-8 juice and the water in the soup.
    Her blood glucose looked good, and I am pleased because I was able to find 100% Aloe Vera gel today. You'll notice I administered it to her 1/2 hour before her meal. I've read in some places that pre-meal seems to work and in others that with the meal seems to work. I figure, I'll try both. At this point, I'm scheduling it for lunch. That won't change, unless I find reason for it to change, since she takes her other diabetic medications at breakfast and dinner. Now, all I have to do is find nopal pads and start making nopal water for her to drink all day long. I tried the natural food grocery where I got the aloe vera gel and, surprisingly, although they carry lots of local produce and there is a large Latino community here who would definitely be interested in nopal pads, they don't carry them. The woman who told me about this told me I should be able to find them at one of two non-alternative groceries, one of which is out of the way and I haven't visited. The other is our regular grocery and, so far, they've only had canned, pickled nopal products. We've got a prickly pear out back, but I need to look up information on how to harvest and prepare the pads. I should probably do that soon. I think, though, first, I'll give the Aloe Vera gel some time to work and see what that does. As well, on Saturday, she'll be switching to the extended release version of glipizide. I don't know that this will make a difference, but I hope so. I thought it wasn't available in generic, but apparently it is, now, newly available. So far no insulin, using the expanded scale of above 200. I'm thrilled. I hope we'll never have to use it.

Dinner

Blood Glucose:     Time:  1932     Reading:  112

Blood Pressure:     Time:  1939     BP:  144/65     Pulse:  57

Dinner:  2005  & Meds What she ate:  1/6th of the ambrosiac Spirit of Tomato Pie
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and dinner pre-med
lisinopril/2.5 mg	1/2 tab with meal	finally, her blood pressure was able to take this
vitamin E/400 IU	with meal	given for anti-coagulant properties
garlic/1250 mg	with meal	given for anti-coagulant properties
calcium-vitamin D/500-200 mg	with meal	believed to be an osteoporosis preventative

    Well, I've got her out of her dehydration. No, she's not over hydrated, either. When she's getting used to Prescott, again, her normal systolic blood pressure is a little elevated. Since we'll be going up and down for at least a month, I expect this to continue, for awhile, unless her elevated level of exercise has an salutory effect on her. However, I will take note that I'd like her systolic to come in a little lower, despite the fact that some elevation allows her to take the lisinopril without a problem. We'll see what happens.
    Other than that, her appetite is good and she helped me make dinner. She cut the green onions. She hasn't been interested in or able to help me make anything in the food line for a long time. Good day. Sunshine.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0856     Reading:  124

Blood Pressure:     Time:  0924     BP:  111/60     Pulse:  72

Breakfast:  0957  & Meds What she ate:  1.5 oz pork sage sausage scrambled with one egg, heavily peppered 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/3 1000 mg tab with Niferex-150	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and pre-dinner med
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
aspirin/81 mg	1 tab with breakfast	standard breakfast med - given for anti-coagulant properties
Daily Senior Multivitamin	with breakfast	standard breakfast supplement; I also consider it her 1st calcium/vitamin D supplement of the day
folic acid/400 mcg	with breakfast	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

Conspicuously Absent Meds & Supplements
Med/Dose	Administration	Explanation
lisinopril/2.5 mg	1/2 tab with meal	her blood pressure was right on target and I didn't want to lower it any, so I didn't give her this, this morning; we'll see how it is at lunch

    I intended to get Mom up earlier, but I slept in. Today is my "aahm taard" day, although I'm not sure why. Just letting down, I guess. I almost had a problem getting Mom up, but she rallied when I mentioned sausage with her eggs. One again, only an hour from opening her eyes to starting breakfast. It's wonderful.

Lunch

Blood Glucose:     Time:  106     Reading:  1403

Blood Pressure:     Time:  95/58     BP:  1447     Pulse:  74

Lunch:  1410  & Meds What she ate:  sandwich w/2 oz lean pastrami, 1 oz swiss cheese, 2 slices oat bran bread, 2 Tbl stone ground mustard 11.5 oz V-8 juice with 1/4 tsp. cinnamon 1 Costco oatmeal raisin cookie
Med/Dose	Administration	Explanation
18 mg Iron Protein Succinylate	1 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state

    I forgot the vitamin C. And, yes, her blood pressure is correct. I also took it just before I served her lunch, got an error, then, again, during lunch, at 1421 and got 83/47, Pulse 75. This is dehydration, folks. I'll write about it later this evening. Suffice it to say that her short term memory has not forgotten that one of her doctors, in her presence, said, "have her drink only when she's thirsty". Now, getting her to drink anything is a pitched battle, and, finally, this confrontation ended up dehydrating her. Luckily I caught it very early, precisely because I take her blood pressure 3 times a day. I should have noticed something was a little strange about her blood pressure being so good this morning, but my only reaction was to celebrate that it was back in range, and so quickly, and at 6,000 feet of altitude. I figured, great! I don't have to worry about that anymore, I just have to worry about trying to figure out when to give her lisinopril. Needless to say, I started hydrating her, again, despite her protests.
    I'm very pleased with her blood glucose, though, and this is not related to her dehydration. It's why I allowed the cookie. She really wanted some chocolate doughnuts at Costco, and, unfortunately, a stray shopper, one of those, "Ah, go ahead and let her have it, she's old, after all" people, who had taken care of his mother for 8 years and admitted that he did not follow the same philosophy with her and did not regret it, tried to get me to allow her to head toward the cash register with the doughnuts. I didn't budge. The cookies were an acceptable trade-off for her. When I gave her the one, she, of course, wanted to sit down in front of the box and polish off at least half the 2 dozen. I told her, "Savor the one cookie, Mom, don't wolf it. You're only getting one, that's enough for your blood sugar. One cookie tastes the same as 12 and, believe me, your body will thank you."
    Some minutes later, of course, just before she headed in for a nap, she mentioned, "You know, I don't hear my body thanking me for that one cookie."
    "Well," I told her, "just because your body is ungrateful or never learned manners doesn't mean it isn't healthier for having only one."
    She responded with a comic glare.

Dinner

Blood Glucose:     Time:  1912     Reading:  177

Blood Pressure:     Time:  1817     BP:  126/61     Pulse:  78

Dinner:  1950  & Meds What she ate:  Nachos, made with Doritos tortilla chip cups, generic canned chili, chipotle salsa (no sugar), lots of chopped green onions, grated sharp cheddar and a very generous sprinkling of MPBIL's Southwestern Fire spice mix 2 Tbl sour cream to calm the fire
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	1/2 1000 mg tab with iron supplement	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and dinner pre-med
vitamin E/400 IU	with meal	given for anti-coagulant properties
calcium-vitamin D/500-200 mg	with meal	believed to be an osteoporosis preventative

Conspicuously Absent Meds & Supplements
Med/Dose	Administration	Explanation
lisinopril/2.5 mg	1/2 tab with meal	Didn't want to discourage the nice rise in her blood pressure from hydrating her, again, with lisinopril
garlic/1250 mg	with meal	given for anti-coagulant properties; I forgot it

    Her blood glucose? That was the cookie at noon crumbling. But, that's fine. I did not administer insulin. I did not worry. She enjoyed the cookie. I enjoyed her delight in it.
    She ate well, looked very good, did well with her therapy exercises before dinner, mentioned that they caused her to "work up an appetite", mentioned several times how good the Nachos were, barely touched her sour cream, "it spoils the spice", she said (that's a new one).
    Yes, by the way, I did take her blood pressure more than an hour before she ate, as soon as she'd recovered from her nap, in fact. I wanted to make sure that the liquid I'd made sure she drank before her nap was having an effect on her hydration level. It was. I saw no reason to take her BP again, an hour or so later, before dinner.
    And, yes, again, I forgot one of her supplements. This is becoming a habit, but I'm not worried about that, either. I don't forget the ones I consider important, the ones she can get in no other way but through pills. However, I do wish I'd catch up with myself, soon.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0830     Reading:  119

Blood Pressure:     Time:  0846     BP:  147/63     Pulse:  71

Breakfast:  0930  & Meds What she ate:  1 hard over egg, heavily peppered 2 slices thick cut sugar cured lean bacon 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with Niferex-150	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and pre-dinner med
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
lisinopril/3.75 mg	1/2 tab with meal	blood pressure appeared to be able to handle it
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

    Notice that within an hour of awakening my mother (I take her blood glucose immediately after awakening her, while she's still in bed), she was bathed, dressed and eating? No hassles, either.
    I'm experimenting with her lisinopril, in order to try to find the correct dosage for her. I'm pretty sure it's 3.5 mg, but that was hard to do with the tiny pink pills and a less than precise pill cutter. We'll see how her blood pressure washes out at lunch.

Lunch

Blood Glucose:     Time:  1337     Reading:  145

Blood Pressure:     Time:  1346     BP:  107/56     Pulse:  66

Lunch:  1415  & Meds What she ate:  small salad with mixed greens and herbs, 1 small sliced radish, a little shredded cabbage, 1 sliced green onion, a little shredded carrot and 2 Tbl home made Ranch dressing 1 deviled egg flavored with mustard, mayonnaise, minced Bermuda onion, dill pickle relish, celery salt, McCormick Salad Seasoning and onion powder 1 slice cracked whole wheat sourdough garlic/Parmesan cheese toast 1 cut licorice detox tea w/ 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
Iron Protein Succinylate/18 mg	1 18 mg tab with meal	dropped the dose by half; explanation below
vitamin C/500 mg	1/2 a 1000 mg tab with meal	helps metabolize iron

    Her blood pressure looks pretty good on 3.75 mg lisinopril. I'd prefer 3.5, but I think we can live with 3.75, for awhile. This may be the best dose, anyway, as it has to last until dinner.
    I dropped back the iron because her lips are taking on a slight maroon rim.
    I have to mention; I set up a few pages of data on my mother for the Home Health Care PT. He asked for about half the data I gave him. The last page, though, was a list of things I felt he should know about my mother before working with her. One of the items, close to the top, I believe, was that "her diet is superb". Every time I make her a meal, now, and I spend intense thought and a fair amount of time planning and preparing what she eats, I think of this. She does enjoy a "superb diet", always tailored to her changing likes and dislikes and her nutritional requirements. It's been a long struggle. She used to refuse vegetables, except canned spinach with lots of vinegar. She used to eat lots of sandwiches, usually made with loads of sandwich spread, baloney, peanut butter, pickles, sliced ham, maybe some margarine, thick slices of cheese, ketchup...except for eggs, breakfast meat, white toast and orange juice for breakfast, this was just about all she ate. It was common for her to refuse what I'd prepare for dinner and head for the bread and sandwich makings. Sometimes all she'd eat during a particular day was popcorn, supplemented with Hershey's Almond Kisses and a variety of packaged chips. It was almost impossible to control her blood glucose on this kind of diet and, needless to say, there were, eventually, other physical implications. Despite all this, though, she felt good, performed well, had a good energy level. Until mid-2002. That's when everything changed and age and her diet caught up with her. In some ways, declining health was the best thing that happened to her. It forced changes in her diet and life-style, most of which have taken the entire four years to accomplish.
    I expect her nutritional profile to continue to require fairly dynamic manipulation throughout her life, depending on how her body responds to advanced age. Her diet, however, is one of two aspects of her life that I work on of which I am most proud. The other is managing her medications and, so far, cutting back instead of adding medicine. Supplements tend to get added and subtracted as necessary, but, generally, so far, medications started high and have dropped, steadily, as I've discovered what works for her, what doesn't, and for what I can substitute nutritional management. I think most people caring for an Ancient One would be surprised at how few of the medications their Ancient One is on that they need, and how many of the goals the medications are supposed to address can be accomplished either with strikingly lower dosages or through nutrition and movement management. The problem, I think, is that doing this takes full time attention. Most people caring for an Ancient One aren't lucky enough to be able to devote themselves to full-time caretaking. Almost everyone doing what I do also has to hold down a job, usually full-time and often also has a family to manage. Sometimes some of the jobs I do can be done by various members of an entire family but, often, this isn't possible, either for cultural or family-specific reasons. Even nursing homes are able to care for Ancient Ones with the intensity and thoroughness of which I am capable.
    Bottom line? We need to seriously and quickly rethink how we incorporate Ancient Ones into all levels of society, starting with the family.

Dinner

Blood Glucose:     Time:  1816     Reading:  106

Blood Pressure:     Time:  1904     BP:  160/72     Pulse:  65

Dinner:  1905  & Meds What she ate:  Almost 16 oz (included second helping) of Kraft Macaroni and Cheese with added sauteed Bermuda onion, green pepper, celery, added grated Vermont White Cheddar, added Old Bay Seasoning, added sage pork sausage, mixed with half the recommended margarine and a couple splashes of 1% buttermilk instead of 1/4 cup milk. 1/4 cup pure cranberry juice mixed with 10 oz water.
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs 1 hour before meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with iron supplement	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and dinner pre-med
garlic/1250 mg	1 1250 mg tab with meal	given as an anti-coagulant instead of an extra 81 mg aspirin
vitamin E/400 IU	1 400 IU tab with meal	given as an anti-coagulant instead of an extra 81 mg aspirin
lisinopril/3.75 mg	3/4 of a 5 mg tab with meal	blood pressure could use it
calcium-vitamin D combo/600-200 mg	1 600-200 mg tab with meal	to help stem osteoporosis

    Her BP was high, for her, this evening, both systolically and diastolically. Although I was surprised initially, we'd had a spirited confrontation over her eating mustard straight out of the jar with a fork just before dinner, she was angry when I took her BP, and she is the type who, when she does get angry, which is rare, she holds much of it in, although it is obvious in her tight expressions and clipped responses. So, I figured 3.75 mg of lisinopril wouldn't hurt her.
    I finished my research on calcium/vitamin D supplements and am satisfied that giving her extra supplementation at dinner, besides what she gets at breakfast in her multi-vitamin and the calcium/vitamin D she gets in dairy products, etc., isn't going to hurt her. If her calcium shows a significant rise on her next blood tests I'll cut it out, but that's only a week away, so I think we're safe.
    I did remember the vitamin E, tonight. I gave her cranberry juice with dinner and, although she didn't get V-8 juice today, which tends to help keep her regular and she seems to be a bit constipated, again, she had plenty of fiber, today, contained in lots of vegetables and 2 slices of whole grain bread. Of course, today, she's also had a fair amount of cheese, which is a binder, and her liquid intake seemed low to me, although I didn't question her thirst, and won't unless she begins to look ragged, tomorrow.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0807     Reading:  120

Blood Pressure:     Time:  0855     BP:  143/65     Pulse:  65

BREAKFAST:

Breakfast:  0915  & Meds What she ate:  1 hard over egg, heavily peppered 1 4 oz slice sugar cured ham steak 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 6 oz orange juice diluted w/6 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with Niferex-150	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and pre-dinner med
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
lisinopril/2.5 mg	1/2 tab with meal	blood pressure showed she could handle it
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
aspirin/81 mg	with meal	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement
1/4 cup pure cranberry juice w/12 oz water	after breakfast	standard after breakfast supplement

    I'm pleased with her early rising this morning. I, of course, leaned on the excuse that the Home Health Care PT was coming and we needed to "get around" so that she wasn't still in pajamas when he arrived, between 1045 and 1100. This worked out well.
    Although my intention was to move the cranberry juice to dinner, I forgot it last night and she complained (once again, sort of hazily) of having trouble peeing. I'm never sure if she really is; sometimes she means she's having trouble defecating, but takes offense when I correct her, as though I am accusing her of not knowing her own body. Anyway, I decided to give her the cranberry juice this morning; but didn't bug her about drinking it. It took her a couple of hours to get it down.
    I am, by the way, not having any trouble laying off the water torture. It is a relief to feel that I don't have to do that, anymore. I still keep an eye on her from a hydration point of view, but my standards are much amended.
    I will be giving her vitamin E and garlic at dinner, but I decided to include the first of 2 doses of garlic with her morning meal. The SNF prescribed 162 mg aspirin, which I think is a bit high for her, from the aspirin point of view. If she was mini-stroking, and if it was connected to thickening blood, it could very well have been because I took her off aspirin, at doctor's orders, soon after the blood transfusion, under the doctor's supposition, which I have no reason to deny, that, if she is bleeding in the gastro-intestinal tract, the aspirin wasn't helping. Since she's on Protonix now and her anemia appears to be under fair control (I'll find out in a week if it is under good control), I'd prefer her to receive her anti-coagulants through natural sources, and both garlic and vitamin E are natural anti-coagulants. As well, the research does not indicate that they are irritating to the gastro-intestinal tract.

Lunch

Blood Glucose:     Time:  1310     Reading:  153

Blood Pressure:     Time:  1335     BP:  141/66     Pulse:  55

Lunch:  1400  & Meds What she ate:  Fried Chicken Soup: 8 oz Marie Callendar's Chicken Pot Pie Soup with 1.5 chopped green onions and about half a fried chicken breast I picked up at the grocery last week on may way home from driving up the mountain and was too tired to eat 11.5 oz V-8 juice with 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs 1 hour before meal	to pull her out of what I hope is her temporarily severely anemic state

    Very decent blood glucose reading, especially considering that she is no longer on metformin and didn't pig out on Cheetos before lunch.
    I simply forgot the vitamin C, which normally accompanies a dose of iron supplementation.
    I was a little surprised at her systolic blood pressure. I'm thinking that she could probably use maybe 3.5 mg lisinopril morning and night. 5, obviously, is a bit too much. It drops her right into the oh-no-zone, as per my experience, yesterday. But, I'll bet 3.5 would do it. I would need to have a compounding pharmacist do this. I just talked to one here in Prescott and Medicare/TriCare for Life does not cover compounds, so he told me it would be about $1.00 a pill. But, if this worked, it would be worth it. Now, what I need to do is research what are standard lisinopril doses. Perhaps there is such a thing as a 6 or 7 mg pill for which I can have an Rx written, and split one of those. If not, well, we'll just pay out of pocket for 3.5 mg doses.

Dinner

Blood Glucose:     Time:  1906     Reading:  103

Blood Pressure:1949     Time:       BP:  148/66     Pulse:  64

Dinner:  1950  & Meds What she ate:  mini-meatloaf hamburgers containing: 6 oz ground chuck; 1/2 egg; chopped onion, green pepper and celery; seasoned with Worcestershire sauce, garlic powder, onion powder and dried sweet basil Approx 5 oz. sliced canned beets pickled in tarragon and rice vinegar, garlic powder, dried thyme and pickling spice
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with iron supplement	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and dinner pre-med
garlic/1250 mg	1 tab with meal	standard dinner med
lisinopril/2.5 mg	1/2 a 5 mg tab with meal	blood pressure reading indicated she could stand it

    So, I was just congratulating myself mentally for remembering all her medications on her new schedule and realized I'd forgotten the vitamin E. Hopefully, mentioning it here will cause me to remember it tomorrow.
    She ate well, tonight, every bit that I served her. Drank well, too. Probably because she got a lot of exercise today, which I'll review at The Mom & Me Journals dot Net in a bit.
    One thing I want to mention. The SNF had her on a calcium/vitamin D pill, a 600 mg/200 mg dose, twice a day. She gets about this in her morning senior multi-vitamin pill. Although I purchased the supplement at Costco, yesterday, I haven't decided whether to give her the second dose. Firstly, she tends to run high on calcium, anyway. Secondly, I am very leery of supplement fads and, right now, there is a Calcium/vitamin D fad running rampant. I'm working on researching it but am finding little but the fad party line, even on medical sites.

Today's Stats:

Breakfast

Blood Glucose:     Time:  0933     Reading:  116

Blood Pressure:     Time:  1016     BP:  151/74     Pulse:  60

BREAKFAST:

Breakfast:  1030  & Meds What she ate:  1 hard over egg, heavily peppered 1 6 oz slice sugar cured ham steak 1 slice toasted oat bran bread with 1 tbl Fleischmann's margarine 1/4 tsp cinnamon on bread 8 oz orange juice diluted w/8 oz water
Med/Dose	Administration	Explanation
Niferex-150 [150 mg elemental iron]	1 hour before breakfast	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with Niferex-150	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and pre-dinner med
Protonix/40 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast med
lisinopril/5 mg	1 tab with meal	gave her a full tab because of high systolic and slightly higher than normal diastolic readings
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
folic acid/400 mcg	with breakfast	standard breakfast supplement
vitamin E/400 IU	with meal	standard breakfast supplement
garlic/1250 mg	with meal	standard breakfast supplement

    Obviously, Mom's medication schedule has changed, and will change once more, but, before I address this, in a separate paragraph, I want to note something about her breakfast medication. Because her systolic was so high, I decided to give her a full tab of lisinopril, especially since I'd forgotten to take her blood pressure last night, so I purposely did not give her any lisinopril with dinner. As you may have noticed in the above lunch stats, this was probably a mistake, as her blood pressure came in pretty low. So, I'll not give her any lisinopril this evening, unless her blood pressure is high, again. If it is, I'll only give her half a tab, then continue with 1/2 tab morning and night, as usual, unless her blood pressure drops significantly.
    You'll notice that the breathing treatments and metformin are no longer on her schedule. She has been taken off both these: the second because four of her consulting doctors "don't like metformin for elderly patients", especially if the patient's diabetes is a result of old age rather than life style and hasn't been going on for very long, which is the case with Mom's; the first because, since she is no longer smoking and her lung functions have improved dramatically, she no longer needs this treatment. As a side note, her oxygen consumption has also been dramatically reduced. The cranberry juice is going to be transferred to dinner, in order to spread fluids out and make sure I don't over hydrate her, again. I also decided, after breakfast, to move the natural anti-coagulants, garlic and vitamin E, to dinner, as, she should be receiving 162 mg aspirin but I only gave her half that, this morning, because of the other anti-coagulants. With the Protonix, I think she can handle a double dose of buffered, 81 mg aspirin. As well, one of her consulting neurologists suggested that I administer the glipizide about half way through her meal. I'm going to wait to see how her blood sugar settles, though. He suggested this because he thought that her blood sugar might drop dangerously low in the half hour previous to a meal. However, as her blood sugar readings are showing, today, this probably won't happen. I'll keep this technique in mind, though, as the days peel off the calendar and her blood sugar readings continue to provide me with information. I will also be actively pursuing information on nopal water and 80% aloe vera gel juice (without added sugar, this time) this week and trying those.

Lunch

Blood Glucose:     Time:  1358     Reading:  173

Blood Pressure:     Time:  1359     BP:  99/52     Pulse:  72

Lunch:  1420  & Meds What she ate:  approx 8 oz Marie Callendar's Beef Pot Roast soup with 1.5 chopped green onions and some added beef, in the form of beef jerky 11.5 oz V-8 juice with 1/4 tsp. cinnamon
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs with meal	to pull her out of what I hope is her temporarily severely anemic state
500 mg acetaminophen	1 tab with meal	her lower back was bothering her significantly because of all the walkering she did today

    I know, her blood sugar was pretty high. We went to Costco, today. She was wandering around with her walker while I checked out calcium/vitamin D products and when I caught up with her, she had settled herself beside the "White Cheddar Cheetos" sample table, was throwing away one sample cup of 3 Cheetos and starting on another. I asked her how many she'd had and she couldn't remember. Neither could the sample distributor. The distributor said, "That's all right, I don't mind." But, obviously, her blood sugar did.
    Her blood pressure was pretty low, as well, probably from the full 5 mg dose of lisinopril I gave her this morning. So, I won't be doing that, again.
    I also forgot to give her vitamin C with her iron, but I purposely gave it to her with her meal, rather than before. I'm going to see how this works out. The results will tell in her CBC. This particular form of iron carries specific instructions on the bottle that it works better with food, so, we'll try that, for awhile.

A Not So Miscellaneous Stat

Blood Glucose:     Time:  1736     Reading:  96

Blood Pressure:     To Be Taken Later

    This stat leads a discussion about how and why I will (and will not) be administering insulin to my mother.
    Yesterday, as the nurse at the SNF explained to me the schedule and technique for administering insulin (by injection) to my mother, she volunteered a piece of information that has intrigued me, since: "It'll take a couple of hours for her blood glucose to drop back to normal after you inject insulin." Although I didn't say anything, my mind responded thus, "My mother's blood sugar drops back to normal on its own in a couple of hours, as long as she doesn't load her system with glucose. What's the point of giving her insulin?"
    I had already decided to follow the recommendation of the neurologists that I "not worry" (translated, "not administer anything to artificially induce blood glucose reduction") until she tested in over 200, rather than the SNF's recommendation of starting to inject insulin in regulated doses at 151. However, at the time I decided this, I had no idea how or how quickly insulin injections work. Today, incidentally, gave me a chance to test my observations and thoughts out, when she came in at 173 just before lunch. I did not administer insulin. I did not change any of the planned foods for lunch. I just sat back and observed.
    When Mom awoke from her nap it occurred to me to take her blood sugar, just to see if it was still flying above the clouds. Sure enough, she was back to a perfectly normal reading, recorded above. Without insulin. Without anything administered at lunch, except cinnamon, to encourage her blood glucose to drop. And, I might add, after having consumed a soup with added teriyaki flavored beef jerky. If any of you are cooks, you know that one of the key ingredients that makes teriyaki teriyaki is sugar.
    So, I won't be administering insulin below 200, that's for sure. I may not even administer it in a certain range above 200, depending on what else I discover about her recovery level. As well, with a variety of other techniques, I may be able to keep her blood glucose from ever shooting above 200, except, perhaps on the isolated sugary holiday in which I simply can't monitor her sugar intake at someone else's house.

Dinner

Blood Glucose:     Time:  1915     Reading:  139

Blood Pressure:     Time:  1951     BP:  155/65     Pulse:  60

Dinner:  1951  & Meds What she ate:  Cobb Salad as described in previous posts with, this time, the addition of bits of honey cured ham steak, chopped green olives, bits of lean pastrami on a bed of a mixture of herb greens and dark greens Approx 3 Tbl homemade Ranch dressing
Med/Dose	Administration	Explanation
36 mg Iron Protein Succinylate	2 18 mg tabs given with dinner	to pull her out of what I hope is her temporarily severely anemic state
vitamin C/500 mg	with iron supplement	helps the body metabolize iron
glipizide/10 mg	1 pill at least 1/2 hour pre-meal	standard pre-breakfast and dinner pre-med
lisinopril/2.5 mg	1/2 a 5 mg tab with meal	standard dinner med

    Her blood pressure recovered from my judicious but unnecessary overdose of lisinopril this morning, so I gave her another 2.5 mg tonight. As usual, she ate all her dinner, although, as it always does with Cobb Salad, it took her a good hour to get through it. I think she likes to take a long time with Cobb Salad, in order to savor it. It is the only dinner, over the last few months, of which she consumed all without being cajoled. Since her appetite has returned, though, to its former state of a few months ago, I expect that getting her to eat everything before her (and sometimes asking for seconds), will no longer be a problem.
    You'll notice I took her blood glucose again just prior to dinner, even though I'd taken it a few hours previous. I did this because, after she awoke from her nap she decided she wanted some popcorn, which I prepared soon after taking her between-lunch-and-dinner blood glucose reading. I never refuse her popcorn, as it has many properties that allow her body to work to maximum effect. Thus, she and I split a 3.5 oz bag of generic microwave "lite" butter-flavored popcorn. I gave her no medication with it. As you can see, her blood sugar remained within acceptable levels throughout the evening.