I noticed right away that he was hesitant to speak with me. After I shared with him that I, at a similar age, was newly diagnosed with type 1 too, he began to trust me more and more. I listened to him explain his routine, and it seemed as though he was doing everything right—though his medical record stated otherwise. He was testing his blood sugar, calculating his insulin correctly, and his injection technique was perfect. I asked him, “How long does your vial of Lantus last?” He innocently replied, “I’ve been using it since I was diagnosed in December.” Voilà! He was using expired basal insulin and didn’t even realize it. No one in his past two hospital stays asked him this question. In my five years as a Certified Diabetes Educator (CDE), I’ve observed many patients in similar situations who were not necessarily “noncompliant” but simply had not learned basic diabetes management skills.
Another patient, newly diagnosed with type 2 diabetes, was placed on a common diabetes medication. The patient was told he would have some gastrointestinal side effects and that the side effects should go away within a few weeks. Unfortunately, these side effects kept worsening, and he struggled to take the medication and live with his new diagnosis. The patient self-discharged his medication, and decided to join a diabetes education class that is facilitated by Certified Diabetes Educators. After learning of the common side effects of the drug he was prescribed, the patient confessed that he had stopped taking his medication and was getting used to eating what he considered to be “diabetic foods,” which are foods heavy in alternative sweeteners and often labeled as “Sugar-Free” on consumer packaging. He was eating many, many sugar-free products, causing his gastrointestinal distress to become worse and worse. Fortunately, we were able to help the patient to restart his medication and give him the information that he was missing about the importance of sugar alcohols and moderation.
People with diabetes (PWDs) deserve a trustworthy healthcare team. PWDs and CDEs openly discussing issues as part of this team is essential in helping the patient achieve diabetes goals. However, it is not always an instant connection; like all relationships, it requires constant maintenance. The patient can help the healthcare team understand challenges and successes by keeping all lines of communication open and honest.
Diabetes is a never-ending game. However we define success, we all want to “win,” but there are many challenges along the way that are part of the reality of living with a chronic condition like diabetes. As a CDE and a PWD myself, I live with the same challenges that my patients encounter, and I have seen the best results both personally and professionally when we are able to troubleshoot and conquer these challenges together. I try to remind patients that they have the right and the privilege to advocate for themselves, and should be encouraged to ask all of the questions that they have when meeting with the various members of their healthcare team. Oftentimes, the CDE may be very easy to get in touch with, and wants you to reach out to them and ask questions and get support. PWDs should use that resource and not wait until the next visit.
If members of your healthcare team are difficult to communicate with, it may be time to find new champions and teammates for your health. There are many healthcare providers in a wide variety of capacities. Finding someone that you can trust to help and share information about your diabetes may be a lot closer than you think. Talk to your CDE about what you need. If you don’t have a CDE, ask your primary healthcare team for a referral. It’s your life, your diabetes, and your health; don’t settle!
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