Monday , November 20 2017
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Denial: Numbers Don’t Lie

Woman, 64 years of age. History of Class II Obesity and hyperlipidemia. While she had obesity, her glucose levels were elevated. A1C 8.2%. She followed a lower carb meal plan, was active, took metformin and a GLP-1, a statin and an ACE-I. She lost 22% total body weight. A1C then remained in the 6-6.5% range for 3 years on this treatment plan. Over the past 8 months, due to insurance and her statement of denial that she ever really had diabetes, she stopped taking her glucose-lowering medication, statin, and ACE-I, wasn’t as strict with meal plan or activity, and stopped checking her glucose, but did not gain back her weight.

Lab studies done. A1C elevated (9.8%), as were her fasting plasma glucose (288) and lipids, triglycerides 596. Visited with patient. Discussed lab results. Recommended and both agreed to her resuming a low carb meal plan, increase fluid (water) intake, activity, statin, ACE-I, metformin and GLP-1 (slowly to avoid untoward side effects), since did respond well to these in past, check glucose levels and let us know.

More lab testing was performed to confirm and to differentiate type of diabetes. We needed to know what type of diabetes was this, which would help us decide treatment.

Labs rechecked. A1C 9.9%, FPG 282, triglycerides 664. Antibodies were negative. Contacted patient. She once again denied she ever had diabetes, did not yet resume medication or the other recommendations she and I discussed.  Stated, “I’ve kept my weight off, I feel fine, I don’t have diabetes.”

Lessons Learned:

  • Not everyone who has diabetes is overweight or has obesity.
  • Losing weight does not help all people who have diabetes lower glucose levels.
  • Losing weight can be a sign/symptom of hyperglycemia.
  • Not everyone who has diabetes has symptoms.
  • Always recheck levels to make sure of diagnosis.
  • Give patient a copy of the lab results.
  • When you, as a health care provider, have offered (and discussed) diagnosis, treatment and care that patient rejects, recognize the trust is broken, which is an important aspect of the patient/provider relationship.
  • Consider whether to continue as the patient’s health care provider when your patient does not agree with your diagnosis and agreed upon treatment plan. If or when your diagnosis and treatment is not being accepted by patient, recommend patient get a second opinion or for the patient to seek another health care provider he or she can work with, but stress the importance of patient being under medical care for this condition.

Anonymous

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