By Stephen Freed, RPh, Diabetes Educator, Publisher
We set up appointments, in each city, in advance and saw 30 patients a day. For the most part they brought their logs, medicines and lab results. We provided information on current monitors, new insulin analogs and reviewed their current diabetes management. We offered suggestions on how they might improve their control. Each patient was provided with an instant A1c test. We discussed the result in relation to their nutrition, physical activity, blood glucose monitoring and their medications.
While traveling to these small towns, I discovered it is not like educating patients in a large metropolitan area. These were small towns where everyone knew one another. Some of the stores, you could take 10 steps outside the pharmacy in any direction and be in a corn field. One of the most striking things I learned was, in each town there was only one or two doctors to whom everyone went to for their diabetes management.
I was able to see how aggressively each doctor managed diabetes from the results of the A1c test. One town had an average A1c of 9.3, here most of the patients were using oral medications and were using maximum amounts of 2 or 3 oral diabetes medications. In another town, the average A1c was 7.5 and many of the patients were on insulin and insulin plus oral medications. Once I had done my first 3 A1c’s, I had a good idea what the results would be from the next 20 to 25 patients.
I also discovered in most areas, no one knew what their A1c result was, or what it meant. Most were only monitoring their fasting blood sugars maybe once a day if they were on oral meds. Those on insulin were also monitoring, on average once a day.
Many of the patients were farmers and had a very active lifestyle in the growing season, but very inactive in the winter months. I was left with the impression that they thought diabetes was a seasonal disease, when they told me how inactive they were during the winter months and how high their blood glucose was.
This week, I would like to share with you an unusual story that one of the patients shared with me.
During our discussion, Susan shared with me how she was diagnosed with diabetes and what her doctor shared with her. After being on oral meds for 2 years, Susan’s blood sugars were still in the 9% range, so her doctor decided to put her on insulin. He demonstrated how to inject by using an orange and filling the syringe with insulin and injecting into the orange. He then had Susan fill the syringe carefully and also inject the orange. It looked fairly simple for Susan and the doctor was satisfied that she would know what to do. He told her to use 20 units of insulin once a day and monitor her blood sugars in the morning and at bedtime and report back to him in 3 days. After three days Susan called the doctor and told him her blood sugars were still the same. He then told her to increase the insulin to 25 units twice a day and call back in another 3 days. After 3 more days, Susan’s blood glucose was even worse then when she started. The doctor was very concerned and asked if she was eating or doing anything different or did she have the flu or a cold?
She told him that she had never eaten as many oranges and maybe that was raising her blood sugars. The doctor asked her to explain why she was eating so many oranges. She then proceeded to explain that she was injecting the insulin into the oranges as he demonstrated, and then ate the oranges.