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As I am working with patients, I have so many thoughts about how different each patient is. I also have thoughts about how in this day and age, with all we have available, some people who have had diabetes for oh so many years still have no clue how to manage their diabetes.
I just met a well-educated man, new to our practice, who has had type 1 diabetes for over 20 years. He, as with many people, thought carbohydrate counting is an exact science. He just thought he hadn’t found the right tool for counting carbs yet. We let him know it is not an exact science, and neither is the way people respond to food, medication, activity, etc. In this gentleman’s case, one of the issues is that he has been injecting insulin in the same area of his abdomen for years. One side of his abdomen is now larger than the other. He thought it was just the way he was gaining weight. The endocrinologist examined him and taught him the reason his abdomen is shaped as it is is actually due to not rotating sites where he injects insulin, which can affect how his body responds to the insulin he takes. The endocrinologist taught the patient how to rotate sites and to keep a record of where he injected his insulin as he evaluates his glucose levels.
Lessons Learned:
- Glucose variability has various causes. The various causes should be taught to patients.
- Glycemic variation, among other things, can be related to lipodystrophy. Check insulin injection sites of your patients and teach to rotate sites. Read more at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014793/
- Have realistic expectations. Carb counting (knowing how food will affect one’s glucose level) is not an exact science. This is not to say one should not learn how certain foods affect their glucose levels, but don’t expect to eat the same thing every day and expect glucose to be the same. There are so many factors in what affects one’s glucose levels, which will take learning over time. If possible, have your patient use a CGM with good records of the time of day, medication taken (how much, what time, and where medication is injected), food eaten (including amount), drink, any and all activity, and sleep. Although other factors can affect glucose, this is a good start.
Joy Pape, FNP-C, CDE
Medical Editor, Diabetes In Control
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