Self-control of diabetes. “Smart insulin therapy”.
It is somehow not customary to raise the issue of the inadequacy of training for patients with diabetes at professional conferences of endocrinologists.
They talk about the latest insulins, technological advances in the means of their administration, inventions in the field of self-control of blood glucose levels (devices for daily glucose monitoring, sensors, transmitters, applications for mobile phones). These achievements are important and have made revolutionary changes in the lives of patients with diabetes. However, for most people, the issue of their compensation (achieving the target level of glycated hemoglobin (HbA1c), fasting blood glucose and 2 hours after a meal) lies in much simpler things. Namely, in the correct understanding of individualized selection of insulin doses. If we narrow it down even further, the main issue is the selection of short-acting insulin doses depending on the amount of carbohydrates consumed with food.
What’s wrong?
It is very rare to meet patients with diabetes who know how to do it correctly. It has become so that in Ukraine, as in the entire post-Soviet space, the beginning of insulin therapy in patients with diabetes takes place in the hospital. It would seem that there should be no problems with training. But…
During two weeks (14 days!) of hospital stay, you can teach anyone and anything. And not just how to count carbohydrates in consumed portions of food and calculate insulin doses. Unfortunately, everything happens exactly the opposite and not to the benefit of the patients.
Instead of being engaged in education, patients are busy with placebo drips and placebo injections. After two weeks of such “work”, the patient leaves with insulin doses matched to the hospital food and good blood glucose levels. So, it seems, and not bad. But they leave, unfortunately, without any understanding of how to change insulin doses depending on the consumed products. Once at home and starting to eat differently from the hospital, patients begin to suffer from inexplicably high, then low blood glucose levels.
Why did the doses selected in the hospital stop working?
Since no one can get answers to this question, patients “come to terms” with such a terrible situation and eventually head towards complications of the disease. For some, the mantra of the endocrinologist of the hospital comes in handy. It sounds like this: “at least once a year, or better twice a year, a patient with diabetes needs to be “dripped/injected” to “clean” the vessels in the hospital.
And so these young people with a depressed mood appear among the elderly and senile in endocrinology departments. For hospital doctors, such patients are a godsend! They silently accept the torture of drips and injections, without even demanding any more work. You think that during subsequent hospitalizations they will teach those who were not taught during their first stay in the hospital. They are not. Those who were not taught at the beginning have developed a clear long-term tactic of silence. Let these patients figure it out themselves, and if they cannot figure it out, sorry, then this is the patient’s problem. In addition, unfortunately, some endocrinologists are simply sure that most patients with diabetes have mental decline due to the presence of diabetic encephalopathy, which means that you can not waste your energy and not teach. Plus, you can always restrain the patient by “non-compliance with the diet”.
And what about diabetes schools?
You will say, what about diabetes schools, don’t they really make education more accessible to patients? It must be stated that diabetes schools do not perform this function or perform it poorly. Imagine a meeting at a diabetes school. There they simultaneously gather several patients of different ages, with different problems, with different types of diabetes, and in an hour of training, the doctor or nurse who runs this school must give out everything that is known about diabetes. It is clear that there can be no talk of any feedback or any structuredness of classes. So in most cases, diabetes schools, which are such the pride of the chief doctors, do not fulfill their role. The only thing they help with is that doctors have a direction to refer patients to, if they have “extra” questions, to the “diabetes school”.
It is certainly possible to change this situation. But this requires systemic solutions in the organization of care for patients with diabetes. It is necessary to bring training to the forefront of managing patients with diabetes. So far, the bloated inpatient fund continues to work on “droppers and injections”, and patients do not receive training, despite the lost money and time.
So what to do?
We suggest taking the author’s practical course “Smart Insulin Therapy”, developed by an endocrinologist.
The course includes three lessons, during which you will learn:
– how to correctly calculate the dose of insulin depending on your
