Debra Johnston, MD
I have learned a lot from my patients over the years. Sometimes the lessons are learned when I go through medical and non-medical battles alongside them. Sometimes the lessons are explicitly stated, words of wisdom that have stayed with me over the years and change the way I understand illness or life in general.
The first such lesson I remember was from a middle-aged woman who had only been diagnosed with type 1 diabetes a few years earlier. She came to me with blood sugar that was critically low in the middle of the night but sky high during the day. The situation only got worse when she tried to adjust her insulin. Back then, our tools for treating diabetes were far more limited and our insulin regimes far more stringent.
After adjusting her dosage so that the peaks and troughs of her insulin effect better suited her life, we began fine-tuning her blood sugar control. We had to balance her insulin, activity, and food. At that point she said to me, “Diabetes is the original home improvement disease.”
The truth of that statement resonated with me at the time, and I still hear her words almost every time I see someone with diabetes 20 years later.
There is a lot involved. Controlling blood sugar is directly related to the likelihood of developing one of the terrible complications of diabetes, such as blindness, stroke, heart attack, kidney failure, amputation, and nerve damage.
That control rests in part on our drugs, but the real challenge with diabetes lies in the fact that habit depends on changing habits for success, and it is difficult indeed. People with diabetes are asked to change their eating habits, the way they exercise, and the way they live. They are often asked to monitor their blood sugar, which used to mean pricking their fingers to draw blood, and making decisions based on those results, sometimes several times a day. Then do it tomorrow and the next day and again the next day. In addition, diabetes drugs and supplies are terribly expensive!
There is some hope: New technologies make the mechanisms used to treat diabetes easier to manage, and new drugs allow more lifestyle flexibility. However, the burden of success still rests very much on the patient’s shoulders, balancing medication, activity, and food in all of the decisions he or she makes each day.
Diabetes is without a doubt the do-it-yourself disease.
Debra Johnston, MD, is part of the Prairie Doc® medical team and currently practices family medicine in Brookings. Prairie Doc airs at 7pm most Thursdays on SDPB