Young man, 21 years of age. type 1 diabetes since 9 years of age. Has not been to see hcp for a year. States he doesn’t like people interrogating him, but came in because he needs his insulin. States he doesn’t check his glucose because he can tell what it is. Tired of having type 1 diabetes and tired of checking numbers. A1C in office–10.2%. Has been taking long-acting nightly when he remembers, guesses at how much rapid-acting to take when he eats and when he remembers to take it. Discussed some of the newer technologies–insulins and CGM.
Patient was open to trying longer-acting insulin, that if he missed it in the evening, he could still take in the morning when he did remember it, and wearing a CGM that is easy and would not alarm. He chose the Libre Flash. I happened to have the sample of one reader and one sensor. He put it on himself, found it to be simple and was actually somewhat motivated at the end of his visit. Motivated enough to schedule a follow-up visit with me.
- Many people who have type 1 diabetes and have had it since childhood think they have a handle on their diabetes without knowing numbers. They are also tired of people asking the many questions and answers it sometimes takes to best manage their diabetes, so they avoid seeing hcps unless they absolutely need to. Sometimes that would be to renew meds/supplies/etc.
- Keep the above in mind for those people who have obviously been avoiding their visits and don’t do a lot of “prying.”
- Teach new technologies and ways to make managing their diabetes less of a hassle, but yet gives them the ability to better manage their numbers. I have found this to be a way to motivate many who haven’t been motivated to manage their diabetes.
- Understand that monitoring glucose levels is not all that is needed to manage diabetes, but it’s a good start for the motivated patient to then be more motivated to do more.
Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl
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