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Include Caretakers in Diabetes Patients’ Plans to Lower A1c

May 11, 2015

A married male patient, 68 years of age, has been prescribed long-acting insulin twice a day because once-daily does not work 24 hours for him, and his dose is large. Therefore breaking it into two smaller injections helps bring down his glucose, but only when he remembers to take his insulin. The provider has been working with him for two years offering different strategies for him to remember to take his insulin including reminders on his phone. The wife is present on all visits. Knowing the marriage is strong and the wife is very organized, the provider asked the patient and wife if it would be okay for the wife to get more involved in making sure the patient took his medication on time. They both agreed but….

They both agreed, but she said, “He really needs to do this on his own.” The patient then promised that he would. The provider said to both of them, “I agree, but we’ve been talking about this for over a year. We need to come up with a different plan, your A1C is not coming down.” The patient and his wife both then agreed with this assessment. The wife noted that she brushes her teeth every night before going to bed. The new plan is to have a small calendar in the bathroom, and then, when the patient takes his insulin, he will put a check on the date in the calendar. If there is no check, the wife will wake her husband up and ask if him if he remembered to take his insulin. If he didn’t, she will give him the pen so he can do it immediately. If he says he has taken it then, well, that’s it, they’re done and he’ll go back to sleep. They seemed pleased with the plan. Time, numbers, and A1C will tell if this plan works.

Lessons Learned:

  • Regular timing of medications is hard for some people to remember.
  • When it comes to long-acting insulin taken at night, many patients forget.
  • Patients want to improve their care, will promise to do so, but for many,  “life” seems to get in the way.
  • Having a support system can help, but only if the patient and support system are in agreement.
  • Sometimes, as a healthcare provider “you got to do what you got to do” in the patient’s best interest.


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