Dr. Andy

Reflections on medicine and biology among other things

Wednesday, February 22, 2006

Not your average patient

This post at Barbados Butterfly about managing diabetes:
Ask known diabetics how often they check their BSLs (blood sugar level same as glucose-Dr. A), in the at home. What numbers (level) do they usually get? Do they write them down?
reminded me of my own experience with a diabetic. My lovely wife was retrospectively diagnosed with gestational diabetes aftern delivering our son at a whopping 11 pounds 10 ounces. (via c-section, thankfully). His head was so big the little cap they give newborns wouldn't fit him.

Gestational diabetes is similar to type 2 diabetes but occurs in pregnant women. It usually resolves after delivery, but women with gestational diabetes are at increased risk to develop type 2 diabetes later in life.

With our daughter, we and her doctors were more on top of things and she was placed on diabetic diet and told to check her blood sugars 4x/day. She was to follow up in 2 weeks. 2 weeks later on our way to the OB appointment, she told me she was a bit worried about what to do as we'd gone out to dinner one night and she'd neglected to check her blood sugar. Only having 55 of 56 values, she was afraid the doctor would be mad and did I think she should make up a value for the one she missed.

I replied that she obviously had no idea how compliant the average patient was; that she was probably the first patient in 3 years to be so diligent. Sure enough, the doctor was amazed what a good job she had done.

Such fastidiousness does have its rewards. On her final check of glycosylated hemoglobin (a sort of integral of glucose levels over time; higher levels indicate poor control of diabetes) her value was not only not elevated, but BELOW the normal range.

Our daughter still weighed 9 pounds 8 oz.


At 4:21 PM, Anonymous Anonymous said...

No offense to you personally, Dr. Andy, I'm surprised in the latter 20th century your wife wasn't screened for gestational glucose intolerance. In my opinion, that's mildly sloppy ob care. especially in a field with the 2nd highest malpractice risk.

At 9:46 AM, Blogger Dr. Andy said...

Actually they did. As I recall (this was a while ago, I was just MS-IV Andy then) she failed the 1 hour test, then on the 3 or 4 hour test, her glucose was high at 1 hour, then bottomed out by the end. At the time that was considered normal, but my sense is that now that would be considered concerning as it represents a delayed but over-vigorous insulin response.

At 8:09 PM, Anonymous Anonymous said...

Thanks for the comment on patient compliance. I am dealing with high bs as a consequence of a long illness following a burst divertiulum. I feel guilty every time I forget to take a reading. Usually, this is just once or twice a week and my Ac1 is OK at 5.7. Guess I need only be moderately anal retentive.

At 6:07 PM, Blogger Barbados Butterfly said...

I'd be amazed if a patient actually checked his/her reading four times a day. Usually I tell patients that I'd like them to check 3-4 times a day but, unless it's a critical situation (eg pregnancy, IDDM), I also say that I appreciate that this is a major imposition. Often I tell patients that there is a 'bare minimum' option - checking a reading once a day (at varied times) and writing it down. I'm still always surprised when patients actually do this.
I always ask patients "What numbers do you get?" because any patient who hesitates or appears to be making up a question is probably lying or doesn't check their sugars. Plus, patients who happily say "Oh, I usually get somewhere between 10 and 20" (when normal is 4-7mmol/L) immediately identify themselves as poorly controlled and in need of education. It's surprising how many people think having a BSL of 25mmol/L is okay.


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