Case Study 2: Denial?

This week I was asked to see a gentleman in consultation that had just come out of heart surgery. His blood sugars were high and he needed to be treated with intravenous insulin (this is very important in order for his heart surgery to heal well and quickly).{{more}}

Gradually, his blood sugars improved and as he recovered, I was able to speak with him some more. He informed me that he did not have diabetes –“it all checked out fine when they checked in the past” he said.

Meanwhile I had his laboratory studies available for me to review, and his hemoglobin A1C was 7.5%, which places him firmly in diabetic range. I looked through his medical history and there it was listed, “Diabetes.”

What is going on here?

There are a few options:

1) He could be in denial about his diagnosis. He was not taking any medication for treating his diabetes, and was not following any special dietary changes towards that issue.

2) He perhaps does not understand that he truly has this disease. I have come upon several patients who were never fully explained the details about their diagnosis, so they truly don’t know or understand at all that they have it. Sometimes, it is because their health provider did a poor job of explaining, and that should never happen.

3) He could have been confused. It was only a day after his surgery and he was still quite medicated for his pain. While he seemed to be alert enough during the conversation, it is possible he wasn’t quite alert enough for details.

4) Perhaps the hemoglobin A1c is incorrect, and he is right – he does NOT have diabetes.

Given the combination of the high hemoglobin A1C and his high sugars during his hospital stay, I am certain he does in fact HAVE diabetes. That part is correct. Why he is not aware of the diagnosis could be from a number of reasons, including misinformation, poor information or plain denial. So what did I do?

In addition to talking care of his insulin doses, I asked our diabetes educator to speak with him the next day when he would surely be more alert. She is our specially trained nurse with a background in diabetes (types 1 and 2). She sees patients for a variety of reasons, including clearing up misconceptions about their diagnosis, reviewing dietary guidelines, showing them how to use a meter, discussing treating low blood sugars etc. I spoke with him for a little bit, but the consultation he has with her will be much longer and with the specific purpose of improving his understanding of his diagnosis.

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