Is it the patients that are ‘uncompliant’ and ‘uncontrolled’, or is it the system?   

 

Some days you do everything right. You take insulin for every meal, count the carbs in your food, and test your blood sugar way more than your doc actually recommends. You follow protocol to a T and it just doesn’t work out. Days like this it’s easy to feel defeated. In medicine they like to throw around the words ‘uncontrolled diabetic’ a whole lot. They reference kidney failure and foot amputations. They say that these things are due to ‘un-compliance’. What these textbook definitions don’t say is that the majority of patients who are ‘compliment’ with standard protocol are still ‘uncontrolled’. They make blood sugar management look like a perfect math equation with few variables but it is far from that.

Here is a graph (from a little over 2 years ago) that shows the average HbA1c of people with type 1 diabetes by age group. Next to it is a HbA1c table for interpretation.

A1c-by-Age-T1DXhttps://myglu.org/articles/recent-findings-from-the-t1d-exchange-clinic-registry

a1c-chart

http://healthy-ojas.com/diabetes/a1c-glucose-chart.html

 Situations like this make me wonder, is it the patients that are ‘un-compliment’ and ‘un-controlled’, or is it the system? I really don’t know.

This seems like semantics to most, but I’m under the impression that its more than that, it’s a game changer. From my experience, it effects the mentality of some health care providers. If the patient is ‘un-controlled’ then to provide better health care you focus on the patient. You ask them questions like, “What did you eat two weeks ago on Tuesday 2:30pm that made your blood sugar spike to 300mg/dl. Did you miscount carbs there or did you forget to take insulin?” Although, this question might seem appropriate, I personally don’t feel it to be effective (and neither do any of my type 1 friends). Do you remember what, why, and how you ate two weeks ago? The focus of ‘fixing’ goes towards the patient’s individual actions, not towards the system in place. Rarely, does it seem the rules of standard of care questioned. Ideally one would say, “If your blood sugar spikes above 200mg/dl after every meal you eat then maybe the recommendation of eating 40-60% of your calories from carbohydrates isn’t working for you.” The rules or 15g carb snacks and waiting 2-4 hours postprandial to correct a high blood sugar may not work for everyone. The availability of supplies by location, fiances, insurance, prescription timing, availability is also not as accessible as I feel it should be to allow for perfect control and compliance.

One of many examples from earlier this week on Instagram:

I haven’t been wearing my continuous glucose monitor this week because the company decided to stop shipping their products to patients with Cigna in the entire state of Mississippi (or that is what I was told). I was informed of this 2 weeks after I ordered my Rx. Alright, cool…. So I’ll just move on with my second week of medical school pricking my finger 10 times a day and paying for my insurance that I can’t use towards it. I’ll try my hardest… But if I can’t figure this out it could potentially decrease my gym frequency, cause me to wake up 2x a night to test, and raise my HbA1c. I’ll use my copious amounts of free time to call my insurance and third party distributing companies. #negativenancyinthehouse #dexcom #medschool

Update: After posting this Dexcom called and sent me a complimentary sensor until I can get it sorted out. Thanks Dexcom. My faith in industry is temporarily restored.

I realize there are a lot of good people out there, good doctors with their patient’s best interest in mind, good companies who believe in the product they promote, and even good insurance company policies. I believe in a good world and I guess that’s my main reason for posting this. For those trying to help, maybe it’s time to re-evaluate our approach to the problem.

13743641_1238167799561753_1525305195_n 12822542_1061643360559334_1112458110_n

I’d love to hear what other people’s prospective are on this topic. What do you feel would be a better solution to the current standard of care? How do you feel about the use of words uncontrolled and uncompliant ?

Thanks for reading as always, Hannah

 

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