Woman, 55 years of age, type 2 diabetes for 15 years. When first diagnosed, did all she could to learn everything about managing her diabetes. She even went to two complete diabetes education courses. The second she paid for on her own. In time, she started checking less, ate more and more unfriendly diabetes foods, and due to a chronic ankle problem, became more and more inactive. After losing her insurance, she then stopped taking her medications and checking her glucose, until she noticed bloody drainage on her clothes from rashes several places on her body. She went to her HCP and sure enough, her glucose was elevated, A1C 13.2%. She got back on track, took her medications and started checking again. Her numbers and rash improved, A1C lowered to 7.2%. She does visit her HCP now every 3 months. A1C is now in the 9% range. She reports, “I can’t deal with this chronic condition. When I’m in crisis, I take care of myself. When I was diagnosed, I took charge, then I just get tired of this diabetes, it’s 24/7. So, I give myself a break. Then again, when I had blood on my clothes, I realized it was a crisis again. I took care of myself again. Now, I’m just tired of it. No, I don’t do the pricking. It reminds me I have something wrong with me. It’s just too much. I do start pricking and get careful a week before I know I’m going back to my HCP. That’s when I check and take care of my diabetes.”
- Diabetes is 24/7. Teach patients they can take a break. Negotiate with patients “safe break time.” For some, taking off from diabetes once a week helps. For some, not checking daily, but three times a week works.
- It is not unusual for patient who have diabetes to say they are “all or nothing” type of people. Work with them to teach simple steps, such as one to two goals a week to work on.
- Know your patients. If they check only when they know they are coming in, schedule appointments more often. For those who are diligent, schedule appointments less often.
- Encourage diabetes education and shared patient decision making, allowing patients to decide what is realistic for them and empowering them to reach their goals.
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