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What drives you to embrace the challenges, frustrations, and triumphs of helping your patients battle diabetes?
I saw a patient just this past week, a 56-year-old African-American gentleman with type 2 diabetes. He was 3 months overdue for his 3-month follow-up appointment, a time frame he had lobbied for. I can’t recall the last time he tested his SMBGs consistently, let alone brought his meter or log book. His A1c had been consistent – it was 13.7% at the last appointment, and when he last checked about 2 weeks ago, was 14.1%. Here’s the kicker – at each of the last several visits, he declined adding a GLP-1 RA or insulin.
Here he was again, quietly admitting, “I haven’t really checked my sugars since last time” he saw me, in September 2015. After further, non-judgmental, supportive questioning, he finally told me, “I tested maybe two times since then.” He didn’t bring his log book or glucometer. When we revisited the additional medication question, he again pleaded for more time. “I’ll get my act together and go back to checking, and if they’re still high, I’ll go onto that injection med you’ve been talking about.”
This, after showing him his A1cs, and even converting them to an estimated average glucose. “I have to say, we do have enough numbers telling us you’re above goal.”
So why my statement above?
1. I love seeing patients turning things around.
Yes, I love surmounting a seemingly dauntingly challenge. Helping patients in some small way do the same – that’s exciting and exhilarating to me. Sure, there are many patients I work with who haven’t yet found that spark of either inspiration, or desperation, or both that ignites change. But, over the years, I’ve had the privilege of caring for individuals with diabetes who have found it, and have sustained their progress. The human spirit truly is unconquerable.
2. Diabetes embraces all of medicine.
I think of all of the areas that this disease touches, from the retinas to the nerves, from the heart to the kidneys, and am continually fascinated by the underlying mechanisms and pathways. Plus, much like savoring a play or a symphony that we’ve read or heard for the 50th time, there’s always something new to learn. To marvel at the elegance of how the body works, or at times doesn’t work, renews my awe for nature.
3. The future of diabetes gives me hope.
I am, at heart, an optimist. What advances will we make in the coming years in our understanding of this disease? Will those insights lead us closer to a cure? Will the GRADE study point to an agent (or more than one) that is an optimal second-line agent after metformin in those with type 2 diabetes? Will EMPA-REG be confirmed by the other two studies, lending support for a class effect of SGLT2 inhibitors on decreasing cardiovascular and all-cause mortality? Will an artificial pancreas become a reality? If there are answers to these and many more questions, they may revolutionize the field.
Fast forward about 5 hours later that same day. My patient is a 62-year-old whose A1c has rocketed up from 7.8 to 16.5%, despite adhering to recommendations. I begin speaking with him about glucotoxicity, and he agrees to start insulin. Though he seems a bit uncertain about his transition, he smiles and expresses his appreciation.
I’m definitely not saying that all of this is easy, and each of us has faced the frustrating aspects of combatting diabetes. Yet, as with everything else, we should do our best to embrace both the challenges and the triumphs.