Updated December 29, 2014.
This is the fourth chapter of our monthly series, Jim's Journey. Jim was diagnosed with type 2 diabetes in August of 2007. When we talked to Jim last month, he was working with a personal trainer and really trying to increase his exercise. This month is a different story as life throws him a curve ball.

Jim's September 2008 Stats

• Height: 5 feet 8 inches
• Weight: 220 lbs.
• BMI: 33.5 (obese)
• Smoking Status: 3 packs a day

• Medication: Metformin 1,000 mg. twice a day and Lisinopril 5 mg. once a day
• Current A1c: 6.5
• Current Fasting Blood Glucose: 110 to 120
• Current Average Blood Pressure: 120/80

Having type 2 diabetes might seem like enough to deal with, but life seldom gives us only one task to accomplish. Chronic diseases like diabetes strike, and then we have to pick up the pieces and go on, to meet the rest of what life hands us. Jim had new challenges to handle in September. While working on his fish pond, he slipped on some rocks and fractured his ankle.

Because he is a nurse, and nurses are known to be tough, he drove himself to the emergency room and came home with a walking cast. Jim needs recuperation time, and can't work for the next several weeks. He also needed to cancel his personal training sessions until his ankle heals.

When an accident like a fractured ankle happens to someone with diabetes, it can present a lot of additional things to worry about. Complications affecting the foot are a concern for people with diabetes.

Complications can include decreased circulation, and loss of feeling in the feet. A fractured ankle can really add to the complications. If a cast is applied, circulation can become compromised. Also a cast can cause friction on skin and create sores. The ankle itself might heal more slowly due to diabetes. Jim has to be very careful of all these things as his ankle mends.

Jim does not have an immoveable cast on his ankle. His doctor felt that it was OK to use a soft flexible immobilizer cast that can be fastened by Jim and loosened, tightened, or even removed, as needed. This can help him keep watch on the health of his foot and ankle, and enables him to make sure that there are no sores or "wear spots" developing.

But, this kind of cast also requires Jim to rest and keep off the foot as much as possible. This is a problem for Jim, who is very active and gets bored just sitting around. He seldom watches TV and prefers working on his fish pond, and otherwise keeping busy.

Jim's challenges:

• Resting the ankle
• Circulation in his foot
• Watching for sores or compromised skin integrity on his foot and ankle
• Watching blood glucose levels carefully
• Watching his diet more vigilantly because he is more inactive at this time
• Smoking - He may have a tendency to smoke more, out of boredom

Is there an up side?

Jim always tries to look for the silver lining when life throws him a curve ball. He says, "At least if I'm not working, I can have a regular schedule and eat more normally. I'll also be able to take my metformin at the right times, too." Jim, a nurse, works the evening shift at a busy inpatient unit, and seldom is able to eat at regular times. The chaotic nature of his job also contributes to him forgetting to take his evening dose of metformin sometimes. Having a little time off might help him develop some lasting good habits for meals and medications.

Jim's Monthly Stats

Jim's Monthly Statistics
Stats	May	June	July/August	September
Weight	230	224.5	220	220
BMI	35	34	33.5	33.5
Smoking Status	2 1/2 packs a day	2-3 packs a day	3 packs a day	3 packs a day
Medication	Metformin 1000 mg twice a day	Metformin 1000 mg. twice a day	Metformin 1000 mg. twice a day and Lisinopril 5 mg. once a day	Metformin 1000 mg. twice a day and Lisinopril 5 mg. once a day
Current A1c	7	6.7	6.5	6.5
FPGT	140 mg/dl	126 mg/dl	110-120 mg/dl	110-120 mg/dl
Current Blood Pressure	150/90	130/80	120/80 - 130/86	120/80
Cholesterol	-	-	175	175
Tryglycerides	-	-	253	253