by IDS Director of Patient Care and Education, Alicia Downs
One size does not fit all in diabetes management – Why your needs may mean your local diabetes specialists are not your best fit.
We live in a very diverse nation here in the USA. From densely populated cities to sparsely populated rural areas, from congested academic hubs to far-flung islands. This means that we have some areas with a lot of choices for clinical care and some areas where patients are challenged to reach any clinical resources at all.
Likewise, diabetes management is incredibly diverse.
Common perception and media coverage would have us believe that diabetes management falls into the camps of Types 1 and 2, insulin or non-insulin management. But this is a gross oversimplification (And there is already nothing simple in diabetes management, even if that is all there was to know!)
In fact, there are dozens of different forms of diabetes! Each subtype brings different nuances to the care and management of diabetes. Differences in physiology, insulin production, other hormonal balances, signaling and release of those hormones, timing of digestion and even brain chemistry are all interwoven to create very different prognoses that result in differences in management that can range from nuanced to paradigm-shifting! This is before we then begin to compound on changes brought about by additional diagnoses, stages of life, differences in physical activity needs; the list could go on and on.
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The very type of diabetes we are dealing with could mean that our local diabetes resources simply are not equipped to guide and empower us to best manage our diabetes.
If you are struggling in your diabetes management, it may not be that YOU are the problem. It may be that your clinical team is under experienced in managing YOUR form of diabetes and simply has not told you.
I have heard prescribers say, “Why does it matter what the cause of the diabetes is, they’re on insulin. Insulin management is insulin management.”
This statement is so far from the truth of the matter. Differences in the underlying physiology of the disease process causing diabetes are key in determining how to best manage it.
- Will oral agents be beneficial?
- What systems of the patient’s own physiology will work for or against them in their management?
- Are they still signaling their own glucagon release?
- How about hepatic glucagon signaling at mealtimes?
- How are incretins and other exocrine hormones impacted?
- Does this condition alter reproductive or growth hormone cycles?
- Does it impact fat storage signaling in the body or autonomic function?
I have seen patients struggling on intensive insulin therapy when all they really needed was a daily pill to have well-controlled blood sugars because their diabetes team did not know to run a genetic screening.
I have seen others struggling with ongoing digestive issues when their team had no idea that their form of diabetes was most commonly also associated with pancreatic enzyme deficiencies that can be easily supplemented.
Understanding the nuances of the impacts of Cancer therapy, or post organ transplant induced diabetes is critical to a patient coming through those treatments with improved outcomes and empowered in their wellness journey, and a patient feeling victimized by their bodies and left wounded and suffering with a life long burden of care even though they won their fight for their life, “what is life when the quality of it has dropped so far?” was a heart breaking question posed to me by one such patient.
It is an incredible privilege here at Integrated Diabetes Services that we focus on intensive Insulin Management.
As a Registered Nurse who is Board Certified in Advanced Diabetes Management (RN, BC-ADM), I have been able to study and work with more patients with rare and specialized diabetes needs in my years of clinical practice than I would have seen in multiple lifetimes of practice in some of the largest diabetes centers in the nation. This all means we have special skill sets and advanced experience working with rare and challenging forms of Diabetes, and combinations of diagnoses.
If you are having trouble finding the right care for your needs, don’t let geography be a barrier. And don’t let insurance coverage be a barrier either.
When your local clinical supports are not able to meet your specialized needs, you have the right to seek specialized care, even when it is “out of network” and out of state. You can get special permissions and approvals for specialized care.
Reach out to our administrative staff at info@integrateddiabetes.com if your care has not been able to meet your needs. As our BC-ADM, I would be happy to review your diagnoses and needs and provide you with information on how our practice can help you meet your diabetes management support needs.
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