Blood Sugar Management

As people with diabetes there are some problems and disease threats that pose higher risks for us than other individuals without diabetes. These are called complications.

For the sake of today’s education we will focus primarily on those complications directly related to blood sugar dysregulation itself, and living with a chronic and, thus far, incurable disease. 

 

Language matters! Stigma kills!

As we explore diabetes-related complications it is important to be aware of the impact of our language and attitudes as clinicians in the lives of our patients.

We must avoid judgmental language that can not only impact our patients’ emotional lives, but also inhibit their clinical progress.

 

Diabetic – Person With Diabetes (PWD) Diabetic complication -  Diabetes Related Complication Caused by diabetes/high blood sugars – Correlated to Intimidation/scare tactics – empowerment and empathy Never base therapy escalation on “Success” or “Failure”

To label a patient as “Diabetic” implies a disregard for the individual and their personhood beyond their disease. Instead reach for a phrase like Person with diabetes, or Person living with diabetes.

Likewise referring to any complication as a “Diabetic” complication implies that diabetes alone is responsible for this health issue. This may or may not be true. As we discussed earlier, a patient can do everything “Right” and still have complication onset. So we should refer to complications as being diabetes RELATED. And besides, people without diabetes get retinopathy, neuropathy and other common diseases states related to diabetes as well. So labeling these diseases as “diabetes complications” may be placing blame where it does not even belong! It may lead to clinical biases that can cause us to miss the true, or full range of causal factors involved in a medical issues.

 

 We should also use language that says that complication risk is correlated with blood sugar levels or the presence of diabetes. Not “caused by”, as this is blaming language, and may not be clinically accurate.

 

Finally, we should not base our therapy needs on success or failure of the patient. For example language like “We will try diet adjustment, but if you can’t get blood sugars down we need to start medication”  The reality is that some patients can have a perfect diet and workout regimen and will still need medications to meet the needs of their physiology. Focus therapy choices on metabolic needs and supporting wellness rather than repercussions of failed efforts. A better conversation would have been “We know that diet and exercise are two ways we can impact blood sugars, but those alone may not be sufficient to meet your body’s needs. So let’s take a trial period and see how much improvement we can get from diet and exercise alone and reassess how we can meet your body’s needs fully in another 3 months” (then set some specific, measurable, realistic and sustainable goals for the next 3 months).