Man, 69 years of age, of Italian descent, “a numbers guy,” has type 2 diabetes, A1C 8.9%, taking a GLP-1 daily, and metformin 1,000mg twice daily. Blood pressure was managed, in target range of ~110-120/70-80, HR 76-82, weight-BMI 25.3. Had been on an SGLT-2, but developed DKA, so he can no longer take SGLT-2’s nor did he want to. Checked fasting glucose some mornings a week but not every day because he did not like to stick his finger. He really didn’t want to deal with his diabetes. Due to his recent illness, he was willing to try something new and different, especially since I told him it’s about numbers and he would not have to regularly stick his fingers. I really didn’t have to teach him much other than how to insert the sensor, how to swipe, and what the arrows meant. He figured out the rest.
Within a week, he seemed to be a different person. He was checking his numbers often, sent me downloads and even food logs! He was able to look at the numbers and see real-time that his elevated A1C was not all related to his fasting glucose but also his post prandials. He was eating a high carb diet and did not drink much water. He didn’t like water.
He was able to see what happened to his glucose when he did not drink much water and when he ate lower carb foods vs. higher carb foods. In time, not too long of a time, he agreed to taking basal insulin. He saw how that helped, but after a week or so, we could talk about increasing his water intake. He did so. He saw improvement, but not enough after meals, especially dinner. Once he could see the numbers himself, he was open to taking rapid-acting insulin before dinner. Big improvement! Then some days he had a high carb lunch. He learned when he has those, he needed to use his rapid-acting insulin. He’s done so and all works now. He even drinks water and doesn’t complain. His A1C was 7.1% in 2 months after starting with the CGM. I anticipate an even lower A1C, without lows at the 3-month mark after starting the insulin. He’s very pleased with his treatment, how he feels and the progress HE has made.
- Use shared decision making. Consider the whole person. not just one’s health issues. Take into account one’s ethnic background, likes and dislikes (this man likes Italian foods & numbers) when together the plan is established.
- Use tools/technology so patients can make informed decisions to work with you to best manage their diabetes.
Joy Pape, FNP-CDE
Medical Editor, DiabetesInControl
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