I recently traveled to 15 small towns in central Illinois and
provided diabetes education for over 350 patients.
Because I only had 20 minutes with each patient, I
had to be short, precise and to the point. One of the first things we
discussed was the A1c test and the results.
I asked them if they understood what the A1c number
meant? Over 98% could not answer the question. I then proceeded to ask
them, when was the last time they checked their blood glucose? When
they replied that they had checked their blood glucose yesterday morning.
I then asked them at what time? After they replied, for example at 7AM,
I then asked them what their blood glucose was at 8AM and they said
they didn’t check it at 8AM. I then asked them what about 10,
11, 12, 1, 3PM, 6PM, 3AM, etc. They replied that they didn’t know
because they only checked it once that day.
I asked them what that one reading meant as far as
their diabetes control. They usually told me that from that reading
they felt that they were in good, fair or bad control.
I explained the information they obtained from that
one reading had little relevance as to their diabetes control and that
if they checked their blood glucose one time that day, it was their
blood glucose for that one second in time. Since there are almost 100,000
seconds in a day and they only knew what their blood sugar was for that
one second, what did that tell you about your diabetes control?
They began to understand that one reading was a useless
number as far as letting them know how well they were doing. That number
had nothing to do with their diabetes control as far as the big picture.
Only an A1c could do that.
When told the reading they got first thing in the
morning had little to do with what they had eaten the night before,
most of the patients were surprised. I explained that prior to them
awakening, their bodies were providing the necessary glucose to give
them the energy to get up and get dressed and have breakfast which would
provide them the energy they needed for the morning. When you have diabetes,
you don’t have enough insulin working to prevent the liver from
releasing glucose and it over releases glucose into your blood.
To help bring this point home I used a the chart called:
Your
Quality of Life Number (available at the end of this feature)
The Quality of Life Number also known
as the A1c tells them how well they are controlling their diabetes.
The A1c tells them their risk for getting all the complications from
diabetes, and it also tells if we are more susceptible to every other
disease and chronic illness
When your A1c is above normal, it decreases our immune
system and leaves us more susceptible to just about every disease and
chronic illness imaginable. The A1c result will determine their quality
of life as they get older.
They learned it was their report card, it represented
their grade as to their control. And also their doctors grade as to
his ability to help them with their diabetes.
Explaining that Diabetes is a Lifestyle disease and
they are the only ones with complete control was eye opening to many
patients.
Since their A1c number is important for them to understand
should be as close to normal as possible, every time they see their
doctor, they need to request the result and discuss with their doctor,
how to work together to get it down to normal. They needed to track
that number over time to see how well they are controlling their diabetes.
Diabetes is a progressive disease, and if they did
nothing it would get worse over time and if they worked hard at maintaining
a good A1c, it would help prevent the complications.
Together we reviewed with them their A1c number and
what it meant as far as their blood glucose levels. Using the Quality
of Life Number chart we equated this to their average glucose and explained
this was an average so some readings had to be higher in order to have
this average. If the patient had never seen higher than their average
readings I explained they were probably testing at the wrong times.
Since most of the patients knew that the diabetes
causes the most damage to your body when it is high. We had to help
them understand when are their blood sugars the highest, and when asked
they mainly answered “after your eat”.
It is amazing to see the look on a patients face
when they realize that they are telling me diabetes causes the most
damage when their blood sugars are high and yet they never check it
then……………..
Continued
To get the “Do
You Know Your Quality of Life Number” form that I used,
click
here Your Quality of Life Number
In 2 weeks: Tips to getting your patients
to monitor more often.
Comments or questions: send to publisher@diabetesincontrol.com
Click here
for the whole series
This Program was supported by an unrestricted
grant from Novo Nordisk and Therasense
Print
This
Impact
Your Patients Health Archives
