Vive la Différence
Our clinical team recently saw a patient with type 2 diabetes who uses 190 units of NPH insulin in the morning, 120 units of NPH in the evening, and 30 units of regular insulin with meals. While she was in the hospital, she needed even more insulin, and her blood glucose still wasn't well controlled. Her A1C was above 9 percent. The same day we saw a patient who uses only metformin, has pretty good blood glucose control, and didn't need any insulin while in the hospital. Her A1C was 6.1 percent. This would make sense if the patient with poor blood glucose control had lived with diabetes for years, was very overweight, and rarely exercised while the one with good control was newly diagnosed, not too heavy, and exercised often. But the patients were similar in all these regards.
While the marked differences between these patients were not lost on me, they were much more striking to a new student who was working with me. She is just beginning her career and has not seen many patients. The questions she asked as she helped us take care of these women reminded me of just how different people with diabetes can be.
This year I am on the committee that helps to plan the American Diabetes Association's annual scientific meeting. One of my jobs has been to read a few hundred summaries regarding new therapies and ideas for therapies that researchers are working on all around the world. As with so many things in medicine, it is both inspiring and humbling to see how much we know and, at the same time, how much we have to learn. Truth is, while we continue to better understand what causes diabetes and how to manage it, there is still much that we do not understand very well at all.
The French phrase vive la différence refers in part to not worrying about figuring out why differences exist and just learning to live with the fact that they do. Fortunately, in the world of science, no one is content to simply live with the differences; we all want to understand the "why." But as we work to do that, we remember every day that people with diabetes and others have to live with these differences.
As a pharmacist, I try to help patients find the right medications to control their diabetes while causing as few side effects as possible. If lifestyle changes can get the job done without medications, then that is even better. After 15 years of helping patients, I am still struck by the differences among them. And as a clinical scientist, I will keep asking why. But until we have all the answers, I'll also try to help patients approach their diabetes in the spirit of vive la différence.