Winter Highs

Dec 20, 2016

Female, 20 years of age, type 2 diabetes, is obese with anxiety disorder, untoward response to several classes of agents. Reports eating lower carbs since last seen. During the warm weather, random glucose levels and A1C were near normal. Today is a cold winter day. Random glucose 188mg/dl. States she doesn’t get it; she is eating lower carbs. Discussed diabetes management is not all about food. Questioned her activity status. She reports being a lot less active than she was in the warmer weather. The cold weather and her anxiety keeps her from leaving her house except once in a while, like today to come see me. Explored options of increasing her activity at home. Asked her bluntly, what will you do? She then took out her phone, asked me to help her with her app that counts steps. Once we found her daily average, I recommended increasing her steps by 500 steps and to make that her daily average. Told her that’s only 5 minutes more stepping/day. In one week, increase another 500 steps/day, continue to do so weekly until she’s pushing it but not overdoing it so it stops her. She was in agreement.

Lessons Learned:


  • Teach patients that there is a lot more to the cause of type 2 diabetes than just overeating.
  • Teach the importance of activity to help manage diabetes.
  • Set realistic goals. When discussing increasing activity with patients who are inactive, explore not only what they should do, but ask, “What will you do?” Make it simple and doable. I’ve seen many people start small, add more activity and better manage their diabetes. Setting unrealistic goals can stop a patient from being active at all.
  • Being active can not only help manage diabetes, but also anxiety.


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