Dad has uncontrolled diabetes and neuropathy in his feet.

I don't know what type of doctor would be appropriate. Have you discussed the matter with his Primary Care Provider? I think that I might. There are various treatment options for things like this. I'd try to get them ASAP. Maybe, someone around here who knows more about this type of condition will chime in. I know it must be very concerning for you both.

Thank you, just got him an appointment to his primary this afternoon

Does he live alone or with you? If he lives on his own, maybe he isn't eating like he should to get his diabetes under control. Is he seeing an endroconologist? They can help with the diabetes better than a regular doctor and he should be seeing one.

Is your dad still in AL? I know that states differ, but, in my state, the AL staff manage and administer the resident's medication. This is kept on a very strict schedule. They also take daily blood sugar levels, blood pressure, temp, etc. Is your dad Type I or Type II diabetic? Does he take pills, insulin or both? (I'm type I, so I know how challenging it is, even if you don't have dementia.)

With the correct medication, they should be able to get your dad's blood sugar within better control. My LO, went on meds and hers went from the high 300's to the low 100's in a matter of days! That will help him heal and to ward off further complications.

I like the idea of the Endocrinologist, if he can see one. I know sometimes, that's not feasible.

What kind of foot doctor is this?

Uncontrolled diabetes, established neuropathy - what is there to be puzzled about? Your father's bloodstream is full of sugar that shouldn't be there. It is very bad news for the blood's ability to supply oxygen to his body's tissues, and that is why the foot is not healing properly and why new areas of skin continually break down. He may well also have other problems by now, but step one: get him to a competent medical practitioner.

Other factors in the healing process include adequate blood circulation to the area. Often diabetics have diminished blood flow to the affected tissue due to PVD ( peripheral vascular disease). His PCP is a good start, maybe he will order a Doppler study to assess the blood flow of the arteries and veins in his legs, which can be treated by a stent or even a bypass of the veins (speculation on my part). High blood sugars and diabetes not in good control will effect healing, but often other issues that go along with Diabetes & high blood pressure effect healing as well. 
His PCP can get the ball rolling by assessing the wound and maybe send your dad to a wound care surgeon for better evaluation and possible debridement.
In the interim keep the wound area clean and inspect it daily for s/s of infection, gangrene. Check for redness, pus like drainage, swelling.  Elevate the affected leg and if it's a pressure sore, "float" the heels by placing a pillow at the bottom of the bed and prop up the feet to not allow them to hit the mattress. 
You are doing the right thing by taking him to his PCP first. Good luck!

Yes still in AL...moving back home soon near me (which will make me main caretaker)...he needs to stay in AL. "I" need to have "that talk" with him telling him he needs to stay in AL...his current primary has been his doc for a long time. After yesterday's visit it's no wonder dad's health has deteriorated over the years, but HE needed to be a responsible player in his health too!!  High  sugars (200's-300's at times ...almost everyday lunch,supper and some extreme lows in am...this doc tells him he's doing ok.  He knows he should a snack before bed.  Dad is on 3 Metformins daily and 30clicks of Lantus in am. He never followed a diet plan, took meds whenever, sometimes would forget to take them or just
didn't care.  He's had 5 bypasses but swears he never had heart attack (10yrs ago)...1st visit to eye doc (14yrs ago) on a scale of 1-4, with 4 being the worst rating for vision loss, he was a 4, severe proliferative retinopathy. Fast forward, so many years gone by with high sugars I believe his body is eaten up and destroyed by the sugar and was careless in caring for himself when he could have. I bet all his vessels are in a bad state.   I just don't know how far I need to go with us and searching and searching for different doctors to keep telling him the same thing and he does not comply.  maybe his current primary doctor has given up on him along time ago because he wasn't following directions, I don't know.  Now, in assisted-living, he gets good care,
help with meds, meals, which sometimes he skips meals knowing he should eat, he's checked on all day long to make sure he's getting along OK.   I love it there and everyone is wonderful and loving.  Most of the time you wouldn't know he's legally blind.  He walks super slow and very unsteady on his feet, walks with a stick he found in the woods from home. It won't be long til he falls.  Dad got placed in AL last August to recover from a mild stroke which kind it turned out to be a blessing because he was living in a bed bug infested trailer for six months before that . Wow when I go back and reread this it sounds so crazy ..... The stroke gave us a way to get him out of that trailer into the hospital because he refused to let anyone help him or convince him to get out.  Spraying for six months did not kill the bugs. So here we are, my husband tore down his trailer burned everything and has rebuilt him a little cabin like home, he promised my dad that he would rebuild him something (with us knowing that my dad needs to stay in assisted-living.) We've had hopes over the last eight months that dad would realize that this new living environment is good for him but he doesn't get it he wants to come home and that will be real soon.   I know we shouldn't have started to rebuild him something, all so confusing now, I honestly thought his health would get worse .  His doctor sees no incompetency or dementia... ( he's a good show timer)... I am with him a lot.  I see symptoms of dementia but then again I think he's always had it for as long as I can remember  🙃 cuz of bad choices.  I could get him to an Endo an hour and a half away from here but I still believe that he won't do what he's supposed to do, it's been a pattern his whole life. Like my dad used to say, you can lead a horse to water but you can't make him drink.

Thank you Shane! His primary doctor did mention everything you suggested, thank you so much because that makes me feel better about the doctors visit. Dr still wants him to see the dermatologist on Monday to see what kind of infection/bacteria this is. Dr. mentioned a vascular specialist for the Doppler etc.

The nurses at assisted-living help him clean it and check it every day so in the meantime hopefully it's OK to wait till Monday, his doctor saw no fear of gangrene setting in This is driving me nuts

Bella, this is going to sound harsh towards your dad, but to save your sanity you do have to remember that everything that is happening to him is the consequence of his own choices. Which he had every right to make, fine, yes; but this is where it's got him and it just has to be accepted. Sympathise with what he's going through by all means, but don't fall in to the trap of imagining that if you only try hard enough and do enough and care enough you'll be able to protect him indefinitely. No one can.

Perfect answer Countrymouse!!!
I have known this for years and have struggled with it back-and-forth like I'm on a teeter totter of emotions of wanting to help and backing off and letting him do the choosing. I'm 54, he frustrates the crap out of me,  and I love the crap out of him!  I see him sitting there like a little boy who can't see and my compassion/sadness  overflows .... but I am learning how to stay in my adult, clear mind to keep MY mental and physical being in a good state so I can sympathize and help him when needed. Tough Love is so hard... I really loved your reply country mouse and really appreciate the reinforcement in believing that conversation in my head that says , "no one can"

Thank you all for your responses here they have all been so helpful!!! Support here is amazing!!!

Bella,
It sounds like you have gotten your dad to a place where he is cared for and as protected as he can be. IT's a personal decision, but, I would really give a lot of thought before bringing him home to care for. It sounds like he needs much more care than one person can provide in the home. I'd read a lot about what is likely in store in making that decision.

My LO also had issues similar to your dad's. I would beg her to get treatment, but she would ignore it. Eventually, it happened. She got Vascular Dementia. Her Primary told her one day bad things could happen and there are some things worse than death. I didn't know what he meant at the time, but, now I do. I thought he meant amputation, blindness, etc., but no. It was the dementia. She now is in the Last stage of dementia in an MC.

You can only do so much. Does your dad have an Advanced Healthcare Directive (Living Will)? I'd make sure he has that and any other POA documents so that you can help him when he is not able to give input.

My questions on the Diabetes issue:
Did the Primary get your Dad's A1C? That would be very valuable. It'll tell you what his average blood sugar level has been for the last 3 months. I don't understand why with the Metformin and Lantus that he is taking, his blood sugar is running high? If he'll go, I'd see the Endo, even though, it's a distance away. The reason is that a person can get Type I diabetes at any time in life, even as a senior. That could mean that he's not producing any insulin. So, he may need fast acting with meals. The only way to determine this is with a complete exam and blood test with Endo. Also, pills don't have any impact on a Type I. Did his Primary mention this? I don't want to scare you, but, high blood sugars long term can also cause things like Diabetic Ketoacidosis. It's horrible.

You have a lot on your plate. I hope there's someone to help you. Take care of yourself too.

I suspect that you are right that your dad is not likely to be compliant with an endo's care plan than he has been up to now. But I still think it would be worth the trip. The AL can keep him considerably more compliant than he has ever been on his own, and if they have an appropriate care plan to follow the results can be optimized.

I really, really hope your father can stay in the ALF. You can visit and provide the love, but as professionals they can more easily enforce good practices than your dad would ever let you do!

I am POA and yes has a living will.... was able to get that when he had his stroke and he was willing to do that so that helps. Yes I need to grow a backbone of steel to have that talk with him regarding staying in assisted-living, I'm scared to death of having that talk. he started out with type one 1 for several yrs then got type 2, thus enters long acting Lantus... dad has been wanting to lower his dosage of Lantus which is 30 units...dad thinks since he's low in the morning that he needs to lower it and the doctor says no. Is A-1 C was seven last November and doesn't get checked again till May doctor says . I appreciate all the input you did not scare me about anything you said I need to hear this because I'm trying to educate myself so I don't get diabetes it runs on both sides of my family. Yes I am very stressed out I got on and mild nerve medicine, speaking with a life coach weekly, and coming here to the site daily 😊

Yes I agree, kind of reluctantly so but I do need to get rid of this doctor and get him to an Endo. If I was working at the assisted living as a nurse or whoever helps care for him I would love it if someone's child took some action to figure this out regarding his medicine and what is best for a diabetic, not just my dad's case but for everyone. I have learned more here from you all then any doctors !!
I thought it was strange that he wants him to wait a few more months to check his A1 C, totally weird guy

I'm confused about the type 1/ type 2 stuff. A type 1 produces no insulin of their own. Type 2 produces some -- may even produce above average amounts -- but the cells resist recognizing it.

A Type 2 may indeed become a type 1 -- the body can simply stop producing its own insulin. But I have never heard of a type 1 becoming a type 2. That is, once the body cannot produce insulin it doesn't somehow start producing it again. Did someone decide that the original diagnosis was wrong?

Who did these diagnoses? I really think a specialist -- an endocrinologist -- should be consulted at this time.

And an A1C of 7 is not "out of control." Who told you Dad has uncontrolled diabetes? (And, just as a point of interest, the American Diabetes Association prefers the term "managed" to "controlled." The disease is in control; our best hope is to manage it.)

I am an only child, I'm 54, my husband is my best supporter he's kind of stepped in and is acting like a brother to me how he helps my dad. I have a son and daughter who are a great support also for me at home I don't ask them to go there and help ...only that they visit and make treasured memories...

I'd take dad to an endo 1.5 hours away as a part of a bigger plan: to have him in ALF for as long as possible. It sounds like dad does not own his own place, so he may not have many assets and may be eligible for Medicaid-funded NH in the future. Having a good diagnosis with the medical direction that he needs to live in ALF or NH for care is an excellent starting point.

At your endo appointment, help the doc by giving the check in person a letter for doc asking for a firm recommendation that the pt be in assisted living or NH because of the lack of ability to take care of themselves as evidenced by the AIC and foot sores. Then you are able to shrug your shoulders and say, "there's nothing we can do dad, your diabetes is causing you problems, and we have to solve them before you can come home." You and I know the sores on his feet are a symptom of a bigger problem, one that he is not addressing. That means he chooses to stay in a facility. You blame other people for you not being able to give him what he wants because you follow doc's orders!

Boundaries by Townsend and Cloud is a great book.

Great tips above.

I agree about the Type I vs. Type II. There is a lot of information to process, but, it's true about Type I diabetics cannot become Type II diabetics. (Unless it's a miracle, Act of God, new technology that is on the cusp, etc. ) I pray for the day that we get a cure.

So, I would consult with the ENDO. Try to take a log of your dad's blood sugar readings with you or the Endo to see. He'll likely also want to see records from his diabetic history.

If your dad's A1C is really in the 7 range.....that's pretty shocking. I can't imagine someone in that range suffering complications like sores that won't heal. I'm speechless. I would be thinking more along the lines of 9 or 10. I'd still see the Endo. Maybe, things have changed.

You mention that your dad is wanting to decrease insulin dosage. If your dad does have dementia, which you believe, his judgment may not be sound or appropriate to make these decisions. That's why sometimes it's safer to allow professionals to be in charge of it, rather than having to wrestle with it every day by yourself.

Bella, you say, "I thought it was strange that he wants him to wait a few more months to check his A1 C"

The markers that this test detects stay in the bloodstream for approximately 90 days. There really is no value in having the test more than every three months. In fact, insurance will not pay for it more often, for that reason. For patients whose diabetes is well-managed the test is often recommended every 6 months or even less often.

I don't doubt you that your father has been non compliant and has not managed his disease well. On the other hand, if his a1C is 7 something has been done well! Perhaps this is the result of the care he is getting in the ALF. Had he been there 3 months before that test was taken?

If a diabetic can keep the a1C under 7 that greatly decreases the risk of complications. If it is at 7.5 the risk is increased. If it is at 8 the risk is even higher. But here is the thing: fewer diabetics will get complications if they maintain 6.8, but some still will get them. All we can do is reduce the risk, which is absolutely well worth doing. But there are never any guarantees. Even very compliant people can still face complications. Not fair! I know.

I'd say the best chance of reducing dad's risks and helping him heal now is to see an endocrinologist and keep him in the ALF. Being there has apparently been quite good for his compliance!

Well his diagnosis says uncontrolled diabetes on his chart and then the doctor says well your numbers look OK although they look high to me like during the day in the 200s. His A1 C was lastNovember 2016 and it was a 7 and Dr said that was kind a high,  he wanted to see it lower, that's why I questioned February would make it three months to recheck. But yes you are right it used to be an 8 before assisted-living and it has definitely improved so from what you were saying it's probably OK to wait till May to retest. i'm calling for an Endo appt today and working on getting my courage up to have that talk regarding to staying in assisted-living...... although I do wonder if there's been so much damage done already would changing his meds help any? I know it can't reverse damage and could possible keep things stable for a while but I do juggle around in my mind to just keep letting him make his own choices so confusing

Likely the chart says uncontrolled diabetes to warn the doctors that he has a history of uncontrolled diabetes and to be on the lookout for later disease caused by uncontrolled diabetes.

This is what you said above: "it used to be an 8 before assisted-living and it has definitely improved." Why would you consider taking him out of AL when it has been so good to him?

Is it not obvious that he is manipulating your emotions so he can get what he wants, which is freedom to abuse himself? He does not like the AL because they limit his access to the tools of his self abuse.

Yes,  you can certainly appear sympathetic to his cause, and say "this is where you need to be until you get much better. There's nothing I can do to make you well enough to come home. You just have to keep working on getting better."

Taking him out of AL is NOT something I want done and  I KNOW he needs to stay there!!!

He has always not taken care of himself and always pushed me away kindly when I tried to help.  He's a  very stubborn, independent, dysfunctional father...someone I could never have a serious conversation with.  Over  a year ago his home got infested with bedbugs....my husband and I paid for 7 mos. treatment of his dumpy trailer...tried to convince him to get out but would not...wouldnt follow instructions on how to help with bedbug treatment....mild stroke put him in the hospital then we destroyed his trailer, my husband promised to build him something new, even though we were thinking he may not recover well and end up staying in assisted-living hoping he liked it there ... now he's better and wants to come home to the new place.

We're we enablers by building something new?  Probably so.

Should we have yanked him out of the trailer? Yep!

"Self abuse"?  You bet, he's been doing it for years and wants to continue doing it at home.  Shows tiny signs of dementia, can't tell really...good showtimer!!

Now I need to tell him he needs to stay there and I am a wimpy chicken **** kind of person.  If I would tell him that I would have to run away and never see him again.... I do recognize and smart enough that I need to change...I am working on that and the support here has been wonderful.

I do love my dad and want what is best for him even though it may be what he does not desire.

Trying to grow up and grow a spine of steel, at the age of 54!

Bella

MAC, what do you mean by "being aggressive with sugars..."?
And
"sliding scale "? You mean adjusting Lantus?

Still educating myself on diabetes

Did get him an Endo appointment 👍

The sore started on bottom of big toe and spread between others toes and the pad. Oozing, smelly, tiny bloody...when I discovered it at assisted-living he was sitting outside "sunning" it, dripping on patio! I asked him how long this has been going on and he said oh couple of days (but obviously longer).   He didn't tell anyone at assisted-living about it either....antibiotics/topical cream, epsom soaks 2xs day, dry socks/shoes,  debriding since Feb 14 not helping. Foot doc is puzzled, says not responding to antibiotics , sending him to dermatologist Monday to get a sample of skin to see what kind of infection we're dealing with...Took dad to primary couple days ago and he more or less brushed it off and said "looks like fungal to me".
Maybe I'm overreacting, I am just scared of amputation, still learning here,so any advice is greatly appreciated

Thank you MAC.

Someone asked earlier in posts...yes, he started out Type1 diabetes

Bella, when was he diagnosed with Type 1? That is usually (but not always) diagnosed in childhood -- in fact, it used to be called Juvenile Diabetes. When was he diagnosed with Type 2? That piece is very confusing.

An aggressive treatment plan uses many tools to bring the glucose into a healthier range. For example, it may include a background insulin that works all day (Lantus) and a fast-acting insulin with each meal (Novalog or Humalog) and other drugs that can be injected or taken orally. It may include a more rigorously controlled eating plan, and exercise.

If this produces healthier numbers, why isn't it always used? Like decisions about any treatment plan, the advantages and drawbacks have to be considered for each individual. Some drawbacks of very aggressive treatment include:
The more parts to the plan, the more likely some non compliance.
Any drug can have side effects. The more drugs, the higher the chances.
Aggressively treating diabetes can be VERY expensive.

I am so glad Dad will be seen by an endocrinologist. This specialist is likely to keep up with the latest research and is in the best position to weigh the benefits and risks of various treatment approaches.
....
About his blood sugar being higher later in the day ... when is it being taken in relation to his eating? Immediately after eating the glucose level will start to rise. (For me it peaks at 55 minutes.) And then, as the sugar gets into the cells and out of the blood stream it comes down again. It should come down within the target range within 2 hours. So generally it is advised to take the reading at least 2 hours after eating.

I take a reading before eating, so I know how much insulin to take (on the sliding scale). It is usually within target range. Recently it was 267. OMG!! How did that happen? And then I remembered that I just drank a glass of juice. A blood sugar reading within an hour after eating is not terribly meaningful.

Ask the endo for literature. No doubt your father was given some at some point, but you will find it very educational to read the booklets yourself.

Anyone interested in diet and diabetes may find this paper by researchers from the Weizmann Institute published in Cell magazine in late 2015 extremely interesting:

Personalised Nutrition by Prediction of Glycemic Responses. (Google it is quickest)

It has had a certain amount of publicity in mainstream media since, but I'm surprised there hasn't been more. Surely no one has an interest in cultivating the need for pharmaceutical control of blood sugars, have they? [innocent expression]

Type 1 diabetes is not going to be significantly alleviated or cured, ever, by diet alone, sadly; but all the same the importance of understanding an individual's response to particular foods, and the reasons for that response, could be very beneficial.