Friday , October 20 2017
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The Danger of Assuming a Patient “Knows What to Do”

Female, 41 years of age, A1C 7%, Indian, family history of type 2 diabetes, at least one was insulin-requiring. For unknown reasons, perhaps the fact the patient was a personal trainer and “should have known what to do,” her hcp didn’t put much attention on her A1C, nor was she asked to return for follow up.

For various reasons, one of which was not having insurance, she did not return to a hcp for 3 years, not until she fell down the steps, and was found to have a hairline fracture of her coccyx. The injury made her inactive and depressed, and she gained significant weight over a 6-month period. Fortunately she had insurance now, and decided to get a physical. When she visited an endocrinologist, her A1C was 11.7%. She was told she had diabetes, was immediately treated with insulin, and within weeks her A1C had come down to 6.5%. Her numbers have for the most part been in good control for eight years now. She no longer takes insulin. She eats healthy, is active and takes metformin and Jardiance. She went on to become a registered dietitian (RD, LDN) and is now working to become a certified diabetes educator (CDE).
Lessons Learned:
  • If and when your patients have an elevated A1C/glucose levels, teach the importance of managing it, what normal levels are and teach ways to lower glucose levels, including referral to diabetes education.
  • Don’t take for granted that your patients, even if they work in the field, will know what to do nor expect them to do it.
  • By learning more, this patient says…”By finding a health care provider who took my numbers and family history seriously,  and recommended early and aggressive treatment, I am confident that I have delayed and may even have prevented the disaster of devastating and costly diabetic complications.”
This is my story,
Sandy Narayanan, MS,RDN
Board Vice Chair and Program Director
Marjorie’s Fund: The Type 1 Diabetes Global Initiative. 

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