Female, 76 years of age, type 2 diabetes, well managed, A1C 6%, on metformin 500mg daily. Patient also has well-managed hypertension, hyperlipidemia, and osteoporosis. She lives alone. Wants tighter diabetes control. Was having hypoglycemia when on 500mg twice daily. Requests, almost begs me, to increase her medication. States she’s afraid she’s going to have kidney problems.
I provided her age-related guidelines from the ADA, as well as showed her her blood pressure (118/76), labs that are all normal. I educated her on the importance of preventing hypoglycemia, especially at her age so as to help her prevent a fall, which can be devastating if she falls and breaks a bone.
When I asked her why she is so afraid of the kidney problem despite her diabetes, blood pressure, and lipids being well-managed, she stated she knew someone who had diabetes and kidney disease. She equates diabetes with dialysis. She does not want to be on dialysis.
We have revisited this situation and her fears for three visits. It seems the last visit she “understood” and no longer begged me to increase her medication.
I think we averted more than one disaster. One being hypoglycemia and a possible disaster related to that, such as a fall, and also the disasters of misunderstanding and fear. Misunderstanding and fear can lead to the possibility of her increasing her medications on her own, as well as affecting her quality of life.
She left our visit stating she was happy and more relaxed. Confessed to me that she realized she overreacted and felt so much better feeling armed with the education and understanding she now has.
- Many people have fears and misunderstandings about diabetes and diabetes management.
- Ask patients what they are afraid of regarding their diabetes. Do they have anything in particular that concerns them about having diabetes?
- Teach/review target age-related glucose, blood pressure, and lipids. Many people don’t know what their target numbers should be.
- Teach again and again. Knowledge can be the the best treatment for, and prevention of, complications of diabetes.
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