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Just come clean: speak the truth


Following on the heels of the non-compliant pregnant woman I spoke about last week, let’s talk about another woman I saw this week in the hospital. I was asked to see her because she was being treated with a super-specialized type of insulin that is five times as strong as the usual kind. Not many doctors are trained to use this insulin, so I was asked as a specialist to guide her treatment.{{more}}

I knew this woman. I had seen her in the hospital before and recalled that when we tried continuing her on her home doses of medicine, her blood sugars always went low. This time I switched her over to a more common type of insulin and decreased the total dose as compared to her home medication doses. Sugar dropped. I decreased the dose the next day. Sugar dropped again. By this time I was suspicious, and when her hemoglobin A1C lab result came back as 13.9 per cent (meaning her average blood sugar was over 350) my suspicion was confirmed. The trick was getting her to admit my suspicion so we could address the real problem here.

Today, I went to see her and said, “You know, the doses of insulin you are now receiving are about one third of what you are taking at home.” She was quiet.

I continued, “there is no possible way that you are taking that dose of insulin when at home; it simply is not possible, when you are having low blood sugars here in the hospital while receiving so much less insulin.” She paused then said, “well, I don’t really take my insulin at home like I am supposed to.” And there it was. As it turns out, instead of taking her insulin three times a day, she was taking it mostly once, or maybe twice. She had not admitted this to her usual doctor, who was instead under the impression that she needed more insulin because her blood sugars were staying so high.

I should also mention that this woman has already had an episode of kidney failure, from which she thankfully recovered, but was now in the hospital with an infected bone in her foot. She has already had toes, then half the foot cut off. Now she needs everything below the knee cut off. She has met with me, with other doctors, with diabetes nurse educators, with nutritionists and vascular specialists in the past. She has two sisters who are nurses. But this woman just will not take her medication as prescribed, and then does not admit it to her main doctor, who turns around and INCREASES her medication to make things better.

Do you see how dangerous and ridiculous this situation can become? For one thing, this woman is doing herself absolutely no good by not taking her medication properly. Second, because her doctor doesn’t really know what is going on with her medication (not taking it), he keeps making changes that make no sense. Why increase a medication she doesn’t take? And lastly, her initial hospital team was about to treat her with those big doses of medication that her main doctor put her on, the ones she told them she was taking (but in truth, not really). Take a guess at what would have happened if she received those big doses of medication – they could have killed her from severe low blood sugars. All of these things happen when you decide not to take medication as prescribed and FAIL TO COME CLEAN AND ADMIT IT TO YOUR DOCTOR.

I beg you, be honest with your doctor and nurse. ADMIT it if you are having trouble keeping up with your medication regimen, or even if you outright don’t want to take it. Your team will explain IF there are other options, and what else can be done, or reinforce why this option you have is the only or best one. Hiding the truth only hurts you more.

Until next week, stay safe and healthy VIncies!

Anita Ramsetty, MD

Medical Director Endocrine Care Group

Tel: 843-798-4227