Permission to speak freely.

• Assessment: Poorly Controlled Diabetes

• Plan: Initiate Insulin Therapy

___________________________

Grady Primary Care Center, Summer 2014

"I think I can manage this with diet and exercise."

"I believe that being careful about your diet and getting more exercise will help. But my recommendation is that we start you on insulin. I  know you don't like needles, but--"

"I'm definitely not taking insulin. That's out of the question."

"I see. Remember that blood test we checked? The A1C test?"

"The one that says how your sugars have been for a whole month?"

"Sort of. More like three months. But yes, that."

"I remember."

"Well. Yours was very high. In the double digits."

"Where should it be?"

"I'd be ecstatic if it was between 6 and 7%. It was 12.5%. That calls for insulin."

"I hate needles. You'll have to try something else."

"You've tried pills already. They aren't working. You need insulin."

"Is there an insulin that isn't given through needles?"

"Not that I have to offer."

"Oh well."

"I'm sorry. I wasn't sure what you meant by 'oh well.'"

"I meant, 'Oh well, guess we in a jam, ain't we?'"

"Aaaah. I see. I guess we are then."

"Insulin ain't gonna happen."

"I hear you. And I've already talked to you at length about the things that can happen if you ignore your high blood sugar, right?"

"You have. And I'm not 'ignoring' it."

"Well, I meant not doing whatever it takes to control it. Sorry about that."

"I'll do anything. Just no insulin."

*pause for a moment*

"Okay. Well listen--I'm pretty disappointed that I can't convince you to go with my recommendations. I have the pharmacists here and everything to teach you about using insulin. But I guess you've made up your mind."

"So what pills are you going to add?"

"None."

"None?"

"None."

"What the hell?"

"You need insulin. And that is my recommendation. You're already on three different pills for diabetes. They aren't enough. At this point, you need insulin."

"Well, I am letting you know that I need an alternative."

"I don't have one."

"So that's just it? Insulin or nothing? That's crazy."

"I'm sorry you feel that way."

"Why can't you just up my pills some more?"

"Because that isn't right. And it won't be enough."

"Hmmmph."

"Ma'am? Can I ask you a question?"

"You just did."

"Okay. Well a statement."

*eyeroll*

"Okay, so check it--if your blood pressure was sky high and I needed you to take pills for that. . . . but instead you said, 'No, Dr. Manning! I think I just want to take apple cider vinegar and mustard for my blood pressure!' You know what?  I wouldn't go along with that as a viable option, either."

"Vinegar and mustard?"

"Some people use that for high blood pressure as a home remedy."

"Does that even work?"

"Uhhhh, that would be a no."

"I feel like you're forcing insulin on me."

"I'm sorry you see it that way. I just care."

"You care about making money."

"Making money? Um. No. Definitely not the case. You just need insulin."

"I have a question. If I was your own sister what would you do? Your own sister with high blood sugar who really, really, really didn't want to take insulin."

"My sister? Oh, that's easy."

"Well?"

"I'd pin you to the ground with my knee in your chest and hold you there until you got your insulin. I'd sit right on top of your and draw it up and stick you in the back of the arm. Sure would. And I'd do it every single day until your A1C was under 7."

*silence*

"Are you serious? That's what you'd do to your sister?"

"Dead serious."

"You'd put your knee in her chest?"

"You'd better believe it. Or I'd just put her in a headlock."

*laughter*

"Damn. I'm just not ready for insulin."

"I hear you, sis. But listen--insulin is ready for you."

"I hear you, doctor."

"Do you? Like really hear me?"

"Yes. And I can feel your knee on my chest."

"You can?"

"I can."

"Good."

*both smiling*

***
Happy Tuesday. And yes, she took insulin.