Type 1

The Frustrated Type 1

We have a 60 year old type one come in to our office and say “I have had diabetes longer than you are old”. I am 44 years old and she was diagnosed with type 1 since she was 9 years old.  So, she was right.  She said, “I have been to many many doctors and YOU can’t fix me”

We are used to these patients that come in and say they have had diabetes longer than we have been in practice, because that’s just 13 years, so not to hard to do, but, this patient, (we will just call her Mrs J Houston), she just went out there and threw in my age, without even asking how old I was. 

We endocrinologists all have had this story told to us in one way or another.  We all have a usual speal to respond to them, things like “I’m sorry you feel that way, but I am a specialist and I have taken care of many many type 1 diabetes like you Mrs Houston, and I am sure I can help you!!”  Then, she becomes our patient and we make her life better, just like we promised her over the years.  We bring her A1c down from 12 to 8 range and after many years, both her and the practice are semi- happy because the final details of her being in tighter control is because of her compliance and we can’t help her and we suddenly become free of this responsibility and life goes on. 

We have a lot of Mrs Houstons in our practice. 

I told Mrs Houston about my App Practice and I started seeing her there instead of my clinical practice.  What happened after was just fantastic.  She learned how to take her insulin properly which she has never done before.  She learned the details of the physiology of her insulin.  Now mind you, she has heard this before, but there is some great power in watching over her sugars in real time and looking at the highs after the meal because of her timing of the insulin.  She was taking her insulin right before the meals and I advised her to take it 10-15 min before instead.  Then, boom! All of a sudden, sugars got amazingly better.

The other big thing is that her compliance just went through the roof.  Because I was watching her sugars all the time (well, not ALL the time), but I watched most of her sugars.

The power of real time is that over the years, she had brought sugars into the office of many doctors and there is a dis connect of these sugars to real life and both the doctors and patients forget this.  Once the sugars are being monitored in real time, every detail becomes meaningful, timing, what you eat, etc.   All the things that we are telling them for years, all of a sudden become important and real vent.

Compliance also improves but in a different way.  Patients have been compliant over the years and their sugars have been better, but they are not motivated and have no one to watch over them and have any accountability. 

So, with this added accountability and just a little bit of learning, patients get better.

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