Contributor: Frank Lavernia, MD
As a diabetes practitioner for almost 40 years, I always wonder what a new PWD’s expectation will be of me. Our staff members are instructed to ask new PWD to gather and share as much information from various doctors (health care practitioners and consultants) as they can. Their records may have recent office visit information that is relevant to their diabetes, hypertension, hyperlipidemia (cholesterol and or high triglycerides), renal disease, etc. We hope that these records also contain a history of any recent hospitalizations, medications (currently used or others that were stopped due to adverse events), lab results, and any diabetes-related complications.
Our staff shares the importance of this information gathering with PWD: it gives the new diabetes provider an insight into what it has been tried and worked (or not worked) in the past. This will avoid starting over from scratch and losing valuable time in addressing some of the medical problems they are presently experiencing. We ask new PWD to write down recent visits with other diabetes team members such as ophthalmologists, retinologists, podiatrists, cardiologists, nephrologists (kidney), neurologists, certified diabetes educators, or diabetes education classes. All of these points of reference are conduits to further explore and address any complications patients may be experiencing.
A list of the current medications is critical at that first encounter, including medication dose, when they are taken, or whether or not they are taking them. Better yet, we ask them to bring a bag containing all the meds they currently take, and/or empty vials/packaging for injectables and supplements. I am always amazed at the amount of medications that PWD bring into the office when we ask them to bring everything. Unfortunately, sometimes we also find that there is little kjnowledge about the medications they have been prescribed and the reasons to take them. Many times we find that many medications are taken from the same group (where the mechanism of action is the same) that could cause harm or, at the least, be a waste of money. We may also find at that first encounter that many are not taking medicine at the time it is prescribed (for instance, some oral meds should be taken at bedtime, and some should be taken on an empty stomach).
Many using insulin have been instructed incorrectly about the ideal time to inject. The first injectable prescribed for type 2 diabetes treatment is, with few exceptions, a GLP-1 RA injectable (taken once a week). This is very different from insulin, which may be injected multiple times a day. This can get confusing. If they have a blood glucose meter and are using it regularly, they are instructed to bring their monitor and logbook. We reassure them that we have software that can download their readings, so we can look at them together.
Finally, we suggest that they are welcome to come to their appointments alone, but bringing a significant other(s) is often helpful due to the amount of information that is given in a visit. This may seem like a lot of work, but it reassures them that we are very serious about helping them understand the prescriptions and instructions we give them, monitor and manage their blood sugars, and avoid complications.
Dr. Lavernia has been a practicing diabetologist in South Florida for more than 35 years. He was the founder and director of the North Broward Diabetes Center in Florida. He is an adjunct faculty member of the National Diabetes Education Initiative (NDEI), Vascular Biology Working Group (VBWG), and for the Coalition for the Advancement of Cardiovascular Health (COACH). He is also a member of the American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes, and the National Hispanic Medical Association. He is a member of the DiabetesSisters Board of Directors.