Don’t let diabetes control you
Diabetes, if left untreated, can cause devastating complications. Type 2 patients come to me every day, exhausted from fighting a never-ending battle against excess weight and its negative effects on blood glucose. It takes a lot more than medical diagnostics and treatments to bring the disease to heel. Endocrinology specialists work with diabetes patients to figure out how to help them implement behavior changes that offer the chance of a better quality of life.
Take my patient Keith, for example. His battle with diabetes had already raged for fifteen years before he came to me at the Joslin Diabetes Center in Boston. He was anxious, upset and frustrated by the disease and his inability to get it under control. When he walked into the exam room, his blood sugar measured 10.4 percent in A1C tests designed to gauge blood glucose — a high score even for diabetics — and he weighed 250 pounds.
Retinopathy, a common side effect of diabetes that causes damage to the blood vessels in the retina and results in vision loss or blindness, was already affecting Keith’s vision. He was frightened by these complications but unsure how to get a handle on his blood glucose. He knew he wanted to see his grandchildren grow up but didn’t know what changes to make. Nothing had worked in the past, and he wasn’t sure if his diabetes could get any better.
A short time later, he discovered our DO IT Program, part of our Diabetes Outpatient Intensive Treatment Program that allows us to spend four intensive days together, trying different strategies to discover new ways to live. It’s exciting for my patients and me because, at the end of those four days, we can see the results.
We can’t fix every problem, but we have enough time to change a medication and see better numbers, have a patient try a new meal plan and find that their blood glucose isn’t spiking after meals, or try a different exercise regimen and marvel at the responses on the blood glucose meter.
In Keith’s case, we began by changing his insulin regimen because it wasn’t meeting his needs. Our dietitian then helped him make better dietary choices. Our exercise physiologist worked with him to find an exercise program he could do on a regular basis. Three months later, Keith has lost 20 pounds, exercises regularly and his A1C dropped to 6.4 percent — an impressive reversal to a prediabetes score. He’s enjoying his life and while diabetes remains a big concern, it no longer overwhelms him as it did when he first came to see us.
These kinds of challenging cases help me to see just what is possible when patients and health care providers work together to meet a patient’s goals.
Endocrinology has always appealed to me: It’s one of the few medical specialties where doctors can prescribe a drug that actually fixes a deficiency. But diabetes requires even more than medicine. My time spent leading the DO IT Program has shown me the importance of collaboration between many specialists to combat this multifactorial disease.
Dr. Lyle Mitzner is a staff endocrinologist at the highly rated Joslin Diabetes Center in Boston, one of the world’s premier centers for diabetes research and treatment. He also teaches at Harvard Medical School.