Diabetes Forecast

When Worlds Collide

By Paris Roach, MD, Editor in Chief ,

The phrase "living well with diabetes" means, first and foremost, finding a balance between the tasks of self-management and the variety of everyday life. Each day brings opportunities and challenges, new experiences, and, too often, stress and anxiety. Moods and motivation levels vary from day to day, as does the nature of interactions with family, friends, and coworkers. In other words, life is wonderful and complex!

Interactions with health care providers are also part of living well with diabetes. But this, too, brings challenges: the dizzying pace of activity in most medical offices, the need to see multiple practitioners in multiple locations and the cost of care, medications, and health insurance coverage, to name a few. What emerges is a picture of two worlds colliding. People want independent, fulfilling lives with minimal intrusion by diabetes. Providers have the health of their patients as their primary aim, but tend to focus first on using their knowledge and expertise to select safe and effective treatment plans and second on the impact on their patients' daily lives. We know that both aspects of care are important, but in our busy practices, the former often takes priority over the latter. As a result, people with diabetes may feel that their personal needs are pushed into the background. This leads to frustration with the seemingly impossible task of integrating self-management into daily life.

But clinicians and patients can indeed unite their worlds under common goals. From the provider's perspective, we need to confirm that our recommendations are understandable and reasonable. By doing so, we increase the probability of adherence to our advice while minimizing its impact on quality of life. We also need to understand that guidelines and treatment targets are useful, but that they're not the only measures of what constitutes the best therapy for any one patient. Finally, the contribution of diabetes educators, dietitians, and other non-physician personnel can be invaluable in providing patients with needed information in a somewhat less formal and time-pressured setting.

As the recipient of care, you have a job, too: Speak up, and let us know about difficulties you're having with meal plans, treatment schedules, the cost of medications, or whatever is standing between you and your ability to manage your diabetes. To take examples from my own practice: In discussing with one of my patients why her blood glucose control was so variable and her A1Cs were high, she explained that she was unable to afford her medication and was skipping doses to make it last longer. We agreed to try a less expensive alternative, and at her next visit, her blood glucose was much less variable and her A1C had fallen into her target range. Another patient took only 50 percent of his bedtime insulin doses due to falling asleep early, but was able to take 100 percent of his doses when they were taken at dinnertime.

And thus, two more collisions were avoided between my good intentions and the wonder and complexity of life.



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