Doctor's Orders: A Prescription for More Education and Empowerment

Doctor's Orders: A Prescription for More Education and Empowerment

My first-ever patient (like, for whom I am their primary care physician) was a person with type 2 diabetes coming to see me for their quarterly A1C and diabetes follow up. ⁣

As is often the case with most diabetes follow ups, this person hadn’t brought their blood sugar logs in -- not judging, I’ve been there! But it is tough from a doctor’s perspective.

I asked how often they checked, what numbers they typically saw on their meter, and all the other general questions you can think of when it comes blood sugar data.

The Real Life Need for Education and Empowerment 

But humans are notoriously bad at accurately remembering stuff like this. So I held off on making any changes, refilled their insulin, congratulated them on their downtrending A1C, and asked that they call back with their logs ASAP so I could adjust their insulin if need be. ⁣

When the logs made their way to my inbox a couple of days later (yay!), I looked at the numbers and was totally frozen. I had no idea what to suggest.

This person’s numbers were what we call “unpredictable” in the medical community. This means that the blood sugar numbers were so varied it was nearly impossible for me to attribute anything to the insulin doses themselves.

It's also impossible to pinpoint which factors caused which blood sugar, since -- to my experienced (both personal and professional) eye -- the numbers seemed to be related to things like food choices, activity levels, or even other medications rather than any insulin dosing.

But people with type 2 diabetes aren’t set up with the education, support, or resources to gather data and pay attention to their blood sugars in the way someone with type 1 diabetes is. Instead, the standard of care is to just throw insulin and medications at the problem.

And this is so much easier to do (and why people -- medical professionals -- continue to do it) because their risk of low blood sugar is so low (at least, relative to type 1).

The Real Life Prescription

I decided to do nothing and have this person call back in with weekly logs until I felt I had enough information. But the truth is, without living a patient’s life for them, I am never going to have enough information.

And that -- that last statement precisely -- is why patient education and empowerment (coupled with the support of their doctor to make sure that their decisions are evidence-based and not doing harm) is so important. ⁣Not just important, but vital if people are not just going to manage diabetes, but thrive with it.

It’s how I -- a person living and thriving with type 1 diabetes -- got to where I am today! I had the education, the empowerment, and the support of many other doctors before me. More education (not medication) is the answer.

Research backs it all up: when people are given access to the right information, at the right time, and in the right way, the person living with diabetes -- or any chronic condition, for that matter -- has an increased desire and ability to take a more active role in decision-making for their own health. 

Before this person left, I talked to them about making healthy food choices, giving more sliding scale for less healthy ones, and taught them how to self titrate their lantus.

It’s not much, but it’s a start. We will get there! ✨

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Jordan Hoese, MD, MPH
Feb 27, 2020

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