My first-ever patient (as in, 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 their blood sugar, what numbers they typically saw on their meter, and all the other general questions you can think of when it comes blood sugar data. 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 needed.
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, meaning that they were so varied it was nearly impossible for me to attribute anything to the insulin doses themselves, or 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.
We Must Do Better: Empowering People With Chronic Conditions
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.
If you have type 1 diabetes, like me, you probably experienced a lot of handholding in the beginning, as well as much further along in your diagnosis. We have it made—doctors, nurses, nutritionists, and the like come to our beck and call; they give us so much information (maybe not always the best, but mostly well-intentioned) that we are armed and feel mostly ready to take on our diabetes.
For others—people with type 2 diabetes, and any other chronic condition for that matter—very little guidance, information, or support is ever given. 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).
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.
More Education, Not Medication
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!
In the meantime, my doctor perspective and simultaneous patient perspective urges anyone trying to do better on their health journey to educate, inform, and investigate for themselves. This is a lifelong learning process for us all.