As you know from my introduction last week, I’ve been a clinical pharmacist for 10 years, and specifically a type 2 diabetes pharmacist care manager for the last 4 years. I’ve spent every day managing patients’ chronic conditions, educating patients, discussing their blood sugars, and adjusting their diabetes medications in attempt to improve their disease…and I’ve learned some very important lessons over this time period.
First and foremost, however passionate and motivated I am to help someone, this ultimately means jack sh*t until THEY are ready to make a change for themselves. I counsel patients on diet, on medications, on lifestyle, and even on exercise, but similar to an alcoholic, if the patient is not interested in taking charge of their health, they won’t improve.
The Blood Sugar- Insulin Merry-Go-Round…
So here’s the thing with type 2 diabetes- its a viciously brutal cycle, and will ultimately kill you unless YOU make a change. While working as a diabetes care manager at a large HMO organization, hard to manage uncontrolled patients were referred to me by their primary physician for medication adjustments and titrations.
Under our program, I would follow up with each patient on average once a week to review their blood sugars and adjust medications appropriately. Motivated patients received counseling and a few medication adjustments, and were often discharged from the program (and deemed “controlled”) in 6-12 weeks, but patients that weren’t interested or ready to improve their condition were simply stuck in a vicious cycle of poor food/lifestyle choices → increased insulin doses.
You see, the only option for patients that do not agree to change their lifestyle, is of course continually increasing medications. Simply increasing insulin without dietary and lifestyle changes leads to hunger and weight gain…leading to poor food choices, higher sugars and increased insulin resistance…requiring higher insulin doses…then hunger, weight gain, worsening insulin resistance…requiring more insulin, and on and on (a cyclical merry-go-round where sugars are not controlled on very high insulin doses in attempt to correct a bad diet.)
I’m overly simplifying, but you get the point. Ultimately the patient becomes so insulin resistant that not matter how much they take, the insulin effect is minimal. The patient is literally killing themselves with food, and it killed me to watch the train wreck ensue.
This cycle is indeed never-ending UNTIL patients learn to take control of 4 most important pillars of their lifestyle: diet, exercise, stress reduction, and adequate sleep.
Constantly witnessing this vicious cycle is one of the reasons I recently decided to quit my job as a diabetes care manager. I have a passion for working with patients dealing with diabetes and metabolic syndrome, BUT I do not want to continue pumping unmotivated patients with more and more medications as a bandaid over the underlying issue- a sh*tty lifestyle.
My goal going into the field of healthcare has always been to help patients reduce their need for medications by improving their lifestyle as much as possible. As a pharmacist, I could certainly counsel patients on lifestyle factors, but as a coach this will always be my #1 priority.
Type 2 diabetic patients must, MUST make substantial changes in their overall lifestyle to control their condition, and I want to lead these patients on a path to do just that. Rather than simply increasing medication doses, I want to spend adequate time coaching patients- as a mentor, using my background as a both clinical pharmacist and a trainer to get them where they need to be. Do you know one of the best ways to improve insulin sensitivity (aka, to help your body use your own endogenous insulin)? Strength training. Plain and simple: MUSCLE. Of course, this must be combined with a proper low carbohydrate diet consisting of real, unprocessed foods. Barbells and broccoli… who would have guessed?!
To be able to make a long term lifestyle change, you must want it. You must want to educate yourself, and to find someone to help guide you on this path.
Now, I’m well aware that right now, I’m probably preaching to the choir. More than likely, as a reader of Heavey Duty, you’re in pretty decent shape. You value your health, your wellness, and your fitness. However, more than likely, there are people you care deeply about that are struggling with pre-diabetes, diabetes and metabolic syndrome. A friend, a coworker, a family member. Maybe they’ve recently been to their doctor and were started on diabetes medications. Perhaps metformin or glipizide. Maybe even insulin.
Don’t get me wrong, these medications are effective and 100% have their place in treatment, but they should not be used as a bandaid. If you know someone that is ready to make a change, I urge you to help them find the right path. To take control of their condition, and make changes before they develop severe life threatening complications (aka- kidney dysfunction, nerve pain, foot ulcers, vision problems and a wealth of other diabetes related complications- serious sh*t, bro.)
I am happy to help them on their journey to gain control. To teach them how to control their blood sugars, to reduce medications, to reverse the metabolic derangement, and set them on the right path via blood sugar management and comprehensive coaching specifically for type 2 diabetics and pre-diabetics.