"It Won't Happen to Me"
I've been spending more time lately seeing patients with diabetes who are in the hospital. This isn't because we're doing a poorer job taking care of patients in the clinic. Rather, it's because when our patients with diabetes get hospitalized, it offers us a chance to figure out what's not going well with their routine diabetes care.
Case in point: a 51-year-old woman with diabetes who was recently admitted with shortness of breath and kidney function that was quite a bit worse than just a few months earlier. Her first day in the hospital, she received fluids intravenously. That often helps, but her kidney function didn't improve. Her A1C was 9.5 percent, even higher than the 9.1 percent of five months before. Yet she had not followed up with the clinic since then or done much to achieve better glucose control. Why? She told the care team that she didn't feel bad when her A1C was elevated, so she hadn't really seen the need to put in the effort. When we told her that it appeared she'd had significant new damage to her kidneys in the past few months and had probably moved one step closer to dialysis, she cried. As we consoled and encouraged her, she said, "I didn't think anything bad would happen."
To regular readers of Diabetes Forecast, this will sound quite naive. What could she have been thinking? But as I talk with more hospitalized patients who are just beginning to see the damage that can come from poorly controlled diabetes, I can't help but realize that this perspective is an expression of a form of human nature from which we all suffer: the "it won't happen to me" syndrome.
It's why young, healthy people often don't buy health insurance and why many of us sometimes don't bother to put on seat belts. We figure bad things tend to happen to other people, not to us. But for patients with a variety of chronic diseases, it's a particularly dangerous mind-set. People with diabetes may skip their medicines for cholesterol or high blood pressure because heart attacks and strokes happen to other people, not to them. They may fail to check a blood glucose level after a meal that they really didn't mean to eat or may even skip their insulin altogether.
In the clinic, we too often do not have enough time with patients to find out what they truly believe to be the potential complications of their diabetes. What can come across as complacency by health care providers may contribute to complacency by patients who fail to control their risk factors.
Our 51-year-old patient from this story asked that we be sure to let other people with diabetes know that losing part of their kidney function is a real risk of not controlling blood glucose over time. We all assured her that we'd pass that along.