How To Impact Your Patients Lifestyles
in 20 Minutes!
Special Feature by Stephen Freed, RPh, Diabetes
Educator, Publisher
Over
the next few weeks I will share with you my experiences in traveling
to 15 small towns in central Illinois and providing diabetes education
for over 450 patients. There are a number of stories I will share with
you and provide you information from what I learned and used to help
patients with diabetes take better control.
We set up appointments, in each city, in advance and
saw 30 patients a day. For the most part they brought their logs, medicines
and lab results. We provided information on current monitors, new insulin
analogs and reviewed their current diabetes management. We offered suggestions
on how they might improve their control. Each patient was provided with
an instant A1c test. We discussed the result in relation to their nutrition,
physical activity, blood glucose monitoring and their medications.
While traveling to these small towns, I discovered
it is not like educating patients in a large metropolitan area. These
were small towns where everyone knew one another. Some of the stores,
you could take 10 steps outside the pharmacy in any direction and be
in a corn field. One of the most striking things I learned was, in each
town there was only one or two doctors to whom everyone went to for
their diabetes management.
I was able to see how aggressively each doctor managed
diabetes from the results of the A1c test. One town had an average A1c
of 9.3, here most of the patients were using oral medications and were
using maximum amounts of 2 or 3 oral diabetes medications. In another
town, the average A1c was 7.5 and many of the patients were on insulin
and insulin plus oral medications. Once I had done my first 3 A1c’s,
I had a good idea what the results would be from the next 20 to 25 patients.
I also discovered in most areas, no one knew what
their A1c result was, or what it meant. Most were only monitoring their
fasting blood sugars maybe once a day if they were on oral meds. Those
on insulin were also monitoring, on average once a day.
Many of the patients were farmers and had a very active
lifestyle in the growing season, but very inactive in the winter months.
I was left with the impression that they thought diabetes was a seasonal
disease, when they told me how inactive they were during the winter
months and how high their blood glucose was.
This week, I would like to share with you an unusual
story that one of the patients shared with me.
During our discussion, Susan shared with me how she
was diagnosed with diabetes and what her doctor shared with her. After
being on oral meds for 2 years, Susan’s blood sugars were still
in the 9% range, so her doctor decided to put her on insulin. He demonstrated
how to inject by using an orange and filling the syringe with insulin
and injecting into the orange. He then had Susan fill the syringe carefully
and also inject the orange. It looked fairly simple for Susan and the
doctor was satisfied that she would know what to do. He told her to
use 20 units of insulin once a day and monitor her blood sugars in the
morning and at bedtime and report back to him in 3 days. After three
days Susan called the doctor and told him her blood sugars were still
the same. He then told her to increase the insulin to 25 units twice
a day and call back in another 3 days. After 3 more days, Susan’s
blood glucose was even worse then when she started. The doctor was very
concerned and asked if she was eating or doing anything different or
did she have the flu or a cold?
She told him that she had never eaten as many oranges
and maybe that was raising her blood sugars. The doctor asked her to
explain why she was eating so many oranges. She then proceeded to explain
that she was injecting the insulin into the oranges as he demonstrated,
and then ate the oranges.
Next week, I will provide with some information
that I know you will find useful with your patients.
This Program was supported by an unrestricted
grant from Novo Nordisk and Therasense
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