Ideas

As we discussed and I thought about how expensive the disease of Diabetes is for the patient and especially the uninsured and lower socioeconomic patient, I tried to think of ways that could cover more patients at a less expensive rate.

Utah County has several great resources for uninsured, low income, and homeless patients. I also know that the Mountainlands Clinic is overwhelmed with the ratio of health care worker (NP, MD, PA) to client. Then I thought about how we use telemedicine in the ER a lot. All of our pysch consults are through the tele and a patient being interviewed and assessed via a TV screen. Not only does this allow the counselor to have more time to see more patients (less travel time, etc), but it saves money (travel costs, etc). We use it for neurology consults as well as the neurologist can visually assess and using the nurse at bedside perform a stroke scale right through the screen. 

Why can’t we use something like this for low income, uninsured patients? There would be more time, less cost, more patients able to be seen and assessed. Anyway, just a thought.

A Hard Life

As I thought about the case study this week, I thought about hard life can be for some people. Some times we make things harder for ourselves than they have to be, but then some people are just dealt a difficult hand in life. People with diabetes are in this group. I complain about counting calories because I don’t want to gain a few pounds or I want to lose a few. But people with diabetes, and add to that all the health problems that can accompany diabetes, have to be accountable for everything they put in their bodies. If insulin dependant, they must monitor their blood glucose frequently every day and then inject insulin several times each day. 

I know the person in the case study is make believe but I also know that these are real problems that real people have. It made me feel so badly for this woman, who already has the difficulty of managing her diabetes, dealing with her nephropathy and retinopathy, but now must deal with being a single mom and staying healthy for herself and her child.

I had a patient yesterday who is a type 1 diabetic. He can not work and could not get his Medicaid approved to get insurance for his medications. He had horrible diabetic ulcers on his legs and hip which were exacerbated by his scratching of the sores. What a difficult life this young man has. 

This is a horrible disease. For those who are vigilant about controlling their sugars and keeping their A1c levels low, life may not be as hard and they might expect a good quality of life. For those who are lukewarm in their glucose monitoring, it will only be a matter of time before they start suffering from the ravages of high blood sugar. 

Point 2

In our group, I was responsible for writing point #2 in our weekly project discussion/case study. I wrote about nutritional building blocks. It was fairly simple teaching but a good reminder to myself of how important a balanced diet is, not only for someone with diabetes but for myself as well. I have started gaining the weight that I have kept off for the last two years and it is very disconcerting to me. I don’t feel as healthy, I don’t have the energy that I had, I don’t feel as good about myself and I just feel uncomfortable all of the time.

As I thought about my regression and how difficult it is for me to get back into a healthy and lean lifestyle, I thought how difficult it must be for someone with diabetes. It’s not just about how they feel about themselves, it is matter of life or death for them. The future will look very bleak to the poorly controlled diabetic and yet I can understand how they would rebel and just say, “I’m tired of restricting myself. I want to eat what I want to eat”. 

How do you teach someone or inspire someone to have that desire to live healthy? To be disciplined in what they eat, what they do and how they monitor their glucose. Well, I know that I must set an example myself and try to be more disciplined in my diet and exercise and care for my health. 

So Much Information

Wow. There is so much information out there on Diabetes. I always thought it was so straightforward. High sugar, low sugar, insulin, metformin, no sugar, carb counting. Man, was I wrong. There are so many options for people who suffer with DM and the big push is to individualize and customize treatment plans, nutritional therapy, medication therapy to each person. I think this is wonderful.

When my son-in-law eats the carrot cake everyone wants me to make for birthdays, I always felt guilty tempting him to eat SUGAR….oooooooooooo. He would tell me that it is ok for him to eat it and it turns out, it is. With moderation and proper insulin dosing. 

There are new discoveries every day and as I said in my readings comment, many of the answers to the questions we haven’t even asked yet are sometimes right in front of us, as is the case with the correlation between Vitamin D supplementation and better metabolic control and lower HbA1c levels. Weird.