When Diet and Exercise are not enough

Mrs. Jones presented to my office approximately six months ago having been told that she had type 2 diabetes two years ago. Her HbA1c was 8.2. This is a measurement of how well glucose has been controlled for the previous three months. Normal is under 5.7 and anything over 7 is typically considered too high. Her number correlated with an average blood glucose of 186 and we know it needs to be under 120 to avoid serious diabetic complications. Since her previous primary care doctor had not been able to adequately help her,  I sent her to an endocrinologist. She returned to my office six months later and was proud to point out her HbA1C which was down to 6.2. Blood_Glucose_Testing_-_Kolkata_2011-07-25_3982She said to me, “I read my records from my previous doctor.  She told me to diet and exercise. That’s all she ever said. She never told me why it applied to my diabetes. Now I understand how increased weight and lack of exercise affects insulin. Why didn’t she tell me those things?” I thought about it. Why didn’t I tell her? I assumed that the physiology and treatment of her condition had been well explained to her and that she was just ignoring her doctor’s advice. Diet and exercise alone as words are not powerful enough for people to understand their importance. Education is more than advice. It includes understanding the significance of the recommendations.

How many times am I guilty of the same poor communication technique? Doctor comes from the latin docere, to teach. It is part of my job and I hope my patients feel comfortable enough to say, “Hey, I don’t understand that” when I am unclear.  Only by working together can we hope to improve the “outcomes of chronic disease”. And more importantly, my patients will feel better and live longer.

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One thought on “When Diet and Exercise are not enough

  1. Re: when diet and exercise are not enough. AND Type 2 diabetes.
    I can understand why the other Dr said “to diet and exercise”. You had obviously tried to teach by explanation and consequences. Not everyone learns that way. Some people only truly understand when they try something for them selves. These are the ones who learn by experience, trial and error. As a past nurse, OHS and workers comp professional and eventually a trainer assessor I found that many people only learn by experiencing the the impact of a process . Learning by lecturing / verbal instruction or reading an instruction book just don’t work for a lot of adults. As the old adage says, you can lead a horse to water but you can make it drink.

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