Why Sticking to Treatments Is Such a Challenge
Diabetes educator Constance Brown-Riggs has heard all of the excuses. Her patients aren't taking their medication, or they aren't sticking to their treatment plans.
"I forgot," they tell her.
"It makes me sick," they say.
"I felt terrible so I stopped taking it."
Here, in a nutshell, is the great problem with modern-day diabetes treatment. We have many effective therapies, ranging from simple diet and exercise to complex interventions such as insulin pumps and glucose sensors. And yet many patients-for one reason or another-can't stay on course.
The problem has no single cause. And there is no single solution. Brown-Riggs, author of "The African American Guide to Living Well With Diabetes," points to the sheer cost of treatment and drugs as one potential barrier. But whatever the case, diabetes educators and patients need to work together to figure out what's causing the problem.
"First and foremost I must drill down and discover what's preventing the patient from taking medications as prescribed," Brown-Riggs says. "I never refer to a patient as being noncompliant-which implies that the patient simply refuses to take their medication as prescribed. It's rarely that simple."
That being said, there are a handful of ways that people with diabetes, both type 1s and type 2s, can fine-tune their medical and treatment regimens. Here are five suggestions, along with comments from Brown-Riggs.
Know What You're Taking and Why
Here's a story from my own life. My doctor had pressured me for years to deal with one aspect of my diabetes treatment. She had a specific pill in mind that I could take.
I kept putting her off. It didn't sound that serious, after all, and why would I spend time worrying about something that wasn't crucial to my treatment? But then my doctor finally explained in detail what the pill would do. Not only would it treat one thing, but it could help prevent another. Facing the fact that a simple, relatively cheap drug could help me in multiple ways, I gave in. And what's more, I still take that pill every day.
Now, if I had given in earlier-if I had taken the recommendation without knowing the different ways the drug could help me-I might not be so devoted today.
"Many people simply don't understand the how and the why of their medications, how they work and why they're important to their diabetes management," Brown-Riggs says.
Beyond that, it's important to know precisely how to handle the drugs you're prescribed. There are right and wrong ways to take nearly everything, and you need to know what the drugs do, how they act on your body, and what happens if you miss a dose.
"People with diabetes often misunderstand how and when they should take their medication," Brown-Riggs says. "I'm reminded of one of my patients who came in complaining about frequent episodes of hypoglycemia. After a lengthy inquiry, I discovered the root cause. He misunderstood when he was supposed to take his insulin. Instead of taking his rapid-acting insulin prior to the meal, he was taking his insulin two hours after the meal. Clearly he didn't understand how his insulin worked. It was also obvious to me that he confused his self-monitoring blood glucose timing with his insulin."
Stay Informed About Your Disease
If you're reading this piece, you're already ahead of the game. Reading the coverage offered in Diabetes Health-both the magazine and website-as well as a multitude of other magazines and publications devoted to diabetes can only help you.
Doctors and diabetes educators are often pressed for time. They might not be able to spend the time needed to really educate you. So do it yourself. Find reputable books and magazines and websites. Read them, and make sure you understand what you read. Keep doing it until you feel you really have a grasp on your condition.
Knowing what's reputable isn't that difficult, either. Avoid any book or article or website that promises miracle cures. Look for material written by medical experts and endorsed by major health associations or hospitals. And if you have any questions, ask your doctor.
For Brown-Riggs, staying informed and up-to-date goes both ways.
"All too often, the patient's difficulty with taking meds as prescribed is a result of poor education," she says. "So, is it the patient who is noncompliant or the healthcare provider who is noncompliant with established protocols for patient teaching?"
Make It Easy to Do the Right Thing
When you go to the grocery store, don't buy boxes and boxes of doughnuts, and candy, and cakes, and pies and ... mmmm. Sorry, I got carried away there for a moment. The point is, if treating your illness depends on maintaining a certain diet, don't keep temptations around the house. Yes, this might mean some difficult talks with your spouse or kids. It might mean some difficult talks with yourself!
Yet it's so important to make doing the right thing as easy as possible. If you want a snack, and the only snacks you have on hand are healthy ones, you're probably going to eat a healthy snack. If you want to drink soda and only have sugar-free cola (or better yet, water) available, chances are that you're going to go with the healthier option.
Brown-Riggs has an alternate take on the same concept. If you need to take certain medication every day, look for ways to make it part of your schedule.
"In cases where the person simply forgets to take meds as scheduled, I look for ways to tie the medication timing with other routine task," she says. "Setting alarms on phones or computers works for many people. For those who work by appointments, I encourage them to note their med schedules on their calendars."
Give Yourself Regular Pats on the Back
People with diabetes face real and pressing problems every day. The condition can cause serious, chronic health issues. It elevates the risk for cardiovascular disease. And you'll likely have to deal with it for the rest of your life. That's pretty darn scary.
But you shouldn't let that fear guide you. Negativity, especially the kind of frantic self-hatred that many people with diabetes experience, can hurt your attempts to establish positive habits. The more you think that you're "bad" or somehow falling short, the more you'll think that staying healthy is impossible, or something that only other people do.
So, avoid the vicious cycle. Celebrate the things you get right. Reward yourself with a healthy snack (not a pint of ice cream, in other words) or a celebratory bauble. Get your spouse, or kids, or friends on your side, and make sure they know that you're succeeding. Words of praise from other people go a long way.
However you celebrate, though, remember this last piece of advice:
Keep Going, No Matter What
I have been a diabetic for a quarter-century. Believe me, the times are often that I want to forget it all. I want to chuck this disease in the river and watch it float downstream. And if you've had diabetes for any length of time, you know precisely what I'm talking about.
We don't have that choice. We don't have that luxury. Instead, we have a responsibility to our loved ones-and ourselves-to keep working. We have to manage this disease each and every day. We have to make healthy choices. And we can never, never give up.
As Brown-Riggs reminded me, we must overcome fear to receive the best care possible..
"Oftentimes, patients are afraid to talk to their doctors about challenges they are having with medications. I tell my patients they need to have open honest conversation with their healthcare provider. Perhaps their medication timing or even type can be adjusted based on the patient's challenges," she says.
There will always be something to try, and something to adjust. And this means we will always have an opportunity to build positive, lasting habits.
(For more information about Constance Brown-Riggs, see her website at eatingsoulfully.net.)
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