Diabetes Forecast

The Greenhouse Effect in Diabetes Care

By Craig Williams, PharmD, Associate Editor ,

"Orchid children" is a term used in psychology to describe youngsters who harbor great potential but also great risk. As the theory goes, when cared for properly these children can blossom spectacularly. But if not well tended, they have a tendency to wither. By contrast, "dandelion children" don't hold the same potential but will bloom whether raised with greenhouse care or in the equivalent of a backyard garden. Some folks just need a little extra care, and I think the same holds true for people with diabetes.

I recently saw a young woman in the hospital with her third episode of diabetic ketoacidosis in two months. She had been diagnosed with type 1 diabetes about four years prior, and after several years of good control, her A1C had now climbed to around 9 percent. She expressed frustration with her disease, and her clinic notes revealed a number of recently missed visits.

Several weeks after that encounter, I ran into another patient whom I'd seen in the hospital with ketoacidosis. He was diagnosed with type 1 diabetes during that admission. He told me that he was still the starting forward on his high school varsity basketball team and that his most recent A1C was 6.6 percent. He was working on starting a support group in his school district for high school students with diabetes.

As clinicians, we all like to think that we provide greenhouse care to all of our patients. And we strive to do so. But in truth, such care is rarely up to us. In the case of my first patient, she lived in a chaotic home environment with little support. Her energy to manage her diabetes by herself was beginning to wane. The second patient was exactly the opposite, with friends and family who accompanied him to clinic visits and asked at least as many questions about his care as he did.

For many patients, this difference helps but is not critical. These are our dandelions. We are able to give them what they need in periodic clinic visits, and they do pretty well. But for the orchids, this difference in the level of support is crucial. In our brief clinic encounters, we note how these patients can wither when they lack the proper support. We watch as they get admitted to the hospital when the complications of their diabetes acutely worsen.

But when family and friends tend their greenhouses, we get to watch our patients blossom. We take a little credit only because the most rewarding thing in medicine is to feel that our efforts have directly helped someone get better. But we know who the real gardeners are. And to all of those family and friends who help us care for people with diabetes, we thank you for letting us watch your orchids bloom.



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