This last week I have had several examples of how powerful the relationship with a patient is to bridge gaps and sustain positive changes in self-care.
One patient, Marie (not her real name), was adamant she would not start insulin. In fact, she told her doctor that she was just going to stop seeing any doctors because her diabetes was out of control and all they wanted to do was start insulin! She was referred to me in the provider's last desperate attempt to help the woman understand all the implications of her choice. That was three months ago. We have visited for an hour two or three times a month. Every visit we discussed some aspect of diabetes and she came to talk freely about her fears. She associates "the needle" with drug abuse and pain. Even testing her glucose hurt her fingers. (I later discovered she'd been using the same Lancet all the time which of course was by now dull, and very painful, not to mention potentially infectious!) She was sure giving her own injections would also be very painful. She has had a difficult and lonely life and has been abandoned repeatedly. She admits to terrible depression. She does not care about herself and feels utterly worthless. She resents having to "give up sugars" -- the last pleasurable thing left to her since she no longer uses drugs or alcohol.
As her Clinical Care Specialist, I accepted her where she was. I gently provided her the facts. We walked whenever weather would permit. We walked to the store and learned to read labels for carbohydrate content. We looked at what foods she did like, considered options to reduce total CHO content.
I listened a lot.
Finally last week while we were walking, I asked again why she was so afraid of going on insulin. She said it would hurt too much. I said we had great new needles and she'd barely feel a thing. She said, "Oh. Okay. Can I start it this week?" I was astounded at how matter-of-fact her tone was. She's taken to doing her insulin with meals and in the evening, requiring frequent glucose checks as well. She called me this week so terribly happy and excited that her sugar was 160, the lowest she'd ever seen! She's feeling great. She's feeling empowered to control what she had thought was uncontrollable! We still have a long way to go but she has done remarkably well in a relatively short time.
It took patience and more time than any provider can be reasonably expected to give. However, hopefully Marie will manage her diabetes well enough to avoid many of the complications she feared in the past. Her prognosis improves with every positive step toward self-care that she takes.
