Being defensive/on the offensive about your diabetes – not a good idea

Editor,

This week I had the challenge of needing to speak with two patients, both of whom were somewhat hostile on initial visit.

The first was a man, 57 years old, who came to the hospital with chest pain and was found to be having a heart attack. He eventually went on to have bypass surgery. I saw him in consultation for his diabetes after his heart surgery.{{more}} He used a lot of foul language, even while describing side effects from his diabetes medication. A colleague of mine visited him later to provide some diabetes education, and he sent her away, saying he “knew everything about diabetes.” Well, it would appear not, because his A1C was high. I gave him a few days to cool off, then returned again today. Thankfully, he was in a much better mood and he wanted to talk, saying he wanted to get well, including taking better care of himself. To my surprise after we talked about options, he ASKED to be sent home with insulin. Turns out that his blood sugars are doing so much better in the hospital that he is quite pleased with it, and wants to continue on the regimen we suggested. PLUS, he finally accepted that he did NOT “know everything” about diabetes and needed some re-education.

The second patient is a lady in her early 60’s, also admitted to the hospital with chest pain. When I went to see her she was in the midst of having a heart evaluation. She was very loud, both defensive and offensive towards me. She also said she “knew everything about her diabetes” and no one could teach her anything. After trying in vain to calm her down, I left, telling her I would return the next day and I was going to do some testing to see how well controlled she was in truth. Guess what? No surprise: her hemoglobin A1C was high, above 9% in fact, which is terrible. Second, I did return the next day and she was all ready to talk, apologizing for the day before and talking my ear off. She told me about stress she had in her house, including a sick husband, other medical problems she had, money problems etc. She talked and talked; she also admitted that she was hard-headed and had come up with her own goals for management of her diabetes, even though they were not what her doctor suggested. After more talking, she agreed to let me adjust her insulin regimen and she is doing much better. And is much happier.

What is the big lesson here, besides obviously that you should not be yelling at your medical team? L-I-S-T-E-N!!!!! These two people were convinced they knew “everything about diabetes’. Clearly their high blood sugars showed otherwise. The man was well educated, had diabetes for the past 3 years, and worked for a medical device company. The woman had diabetes for 20 years. Both had reasons why they should have a good grasp on this illness, but they did NOT, and when they finally were ready to listen is when the door opened for their control to improve. So, please don’t be defensive (and certainly not offensive!) when your medical team wants to discuss your diabetes care and make suggestions. NO one knows everything, and if your control is poor, something needs to change.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com

Medical Director Endocrine Care Group

www.endocrinehelp.com

Tel: 843-798-4227