A patient, 48 years of age, female, type 2 diabetes and obese, was referred to me for diabetes and weight management. Her first visit was 8 a.m., after fasting for 10 hours. Her A1c was 7.4%, BMI 37, BP 164/92, HR 92. The previous hcp had recorded she was recommended a low carb diet and the following medications:
- Metformin, 1,000mg twice daily
- Byetta 10mcg sq twice daily
It was also written that she was non-compliant.
During our visit, the patient told me she has not taken her medications because they made her feel sick to her stomach. She also said she didn’t really know what to eat. She said she was told, “Lose some weight by eating a low carb diet. You can learn more about it on the Web.”
She told me she tried to follow what she was told to do, but the medicine made her very nauseated. She did check out on the web about low carb diets, but they were so opposite to the way she had been eating and her family eats, she couldn’t stop all the carbs, and eat differently from everyone else. She also said the foods she thought were okay were too expensive.
We discussed her lifestyle, including her family, work schedule and a bit about her eating habits. I realized it was more than could be discussed in one visit or really more than I could or should manage without a multidisciplinary team. I recommended she take one metformin (500mg ER) tablet daily after dinner and see how she tolerates that. I informed her that she might feel queasy the first week or two, but this should go away. If it doesn’t or if it is intolerable to let me know; really to let me know either way because she may be able to tolerate an increase in dosage if she does well. I also referred her to a local diabetes education program. She needed to better understand diabetes, diabetes management and how to fit diabetes into her life, step by step.
She attended diabetes education classes, started the metformin, and in time, working together, she was able to increase it t0 1,000mg daily. She made livable food changes as well as became more active.
She visited 3 months later. She had lost 12 pounds, A1C now 6.8%, B/P 136/74 and HR 78. She said she felt much better and thanked me for listening to her, taking “her” into account when we came up with a plan.
I will never label a patient as being “non-compliant.”
- When one has been labeled as non-compliant, keep an open mind. Use motivational interviewing techniques to learn more about the patient and the patient’s lifestyle.
- Refer to diabetes education.
- Managing diabetes takes a multidisciplinary team and the patient should be the captain of that team with some professional education and guidance.
- Don’t label a patient compliant or non-compliant!
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