I’ve learned a lot from my patients over the years. Sometimes, the lessons are learned as I walk beside them through struggles, both medical and non-medical. Sometimes, the lessons are explicitly stated, words of wisdom that stick with me through the years, and change the way I understand illness, or life in general.
The first such lesson I remember was from a middle-aged woman who had been diagnosed with type 1 diabetes only a few years prior. She came to me with blood sugars that ran critically low in the middle of the night, but sky high during the day. The situation only worsened when she tried to adjust her insulin. Back in those days, our tools for managing diabetes were far more limited, and our insulin regimens far more rigid.
After we adjusted her dosing so that the peaks and valleys of her insulin effect were a better fit for her life, we started fine tuning the control of her blood sugar. We needed to balance her insulin, with her activity, with her food. This is when she said to me, “Diabetes is the original do-it-yourself disease.”
The truth of this statement resonated with me then, and I still hear her words almost every time I see a person with diabetes 20 years later.
The stakes are high. Control of blood sugar is directly correlated with the odds of developing one of the terrible complications of diabetes, such as blindness, strokes, heart attacks, kidney failure, amputations, and nerve damage.
That control rests in part with our medicines, but the real challenge of diabetes lies in the fact that success depends on changing habits, and that is difficult indeed. People with diabetes are asked to change the way they eat, the way they move, the very way they live.
They are often asked to monitor their blood sugars, which to date has meant pricking their fingers to take blood, and to make decisions based on those results, sometimes multiple times a day. Then, do it again tomorrow, and the next day, and the next day. Additionally, diabetes medications and supplies are awfully expensive!
There is some hope: new technologies are making it easier to handle the mechanics of managing diabetes, and new medicines are allowing more flexibility in lifestyle. But the burden of success still rests very much on the shoulders of the patient, to balance medicines, with activity, with food, in all the decisions he or she makes every day.
Diabetes is no doubt, the do-it-yourself disease.
Debra Johnston, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streamed most Thursdays at 7 p.m. central.
