By Dr. Steven Kaufman, Staff Endocrinologist

A person with type 1 diabetes must think about his or her glucose level every seven minutes of every day, without a break. In addition to keeping up with these regular glucose checks, he or she must also consider how their food choices, activity, emotions and physical well-being will affect glucose levels, a critical part of diabetes control.  This can be challenging even for a person with time, knowledge, and financial resources. Overlay other medical and behavioral health conditions on top of a heap of social barriers and one begins to see the challenge confronting a person with type 1 diabetes from a resource-poor urban community.  This is Francisco’s story.

I have seen Francisco numerous times during his hospitalizations for uncontrolled diabetes, a disease that has resulted in kidney failure and toe amputations. Though Francisco heard about the importance of glucose control from various physicians and nurses, but little communication existed between Francisco’s hospital doctors and his outpatient physicians. The frequent hospitalizations and resulting fragmented care left him unable to establish a relationship with his primary care provider.

Until recently, Francisco’s food choices resulted in continually elevated glucose levels. But in the past year, Francisco has had approximately 30 percent fewer hospital visits. The change in his care started approximately nine months ago when Cynthia, a Camden resident and dedicated LPN, was assigned to help Francisco coordinate his many medical needs. Cynthia quickly recognized Francisco’s cycle of hospital admissions: an elevated glucose of > 500 mg/dl after a high carbohydrate meal forced the nursing staff to call 911 even if Francisco was asymptomatic.

Cynthia first contacted Francisco’s endocrinologist to help develop a nurse-driven, personalized insulin regimen for glucose levels greater than the meter can read. She also began attending all of his medical appointments to improve communication between his seven physicians, and notifies them each time he is admitted to the hospital. Perhaps most importantly, Cynthia treats Francisco with respect and supports his individuality. “I treat Francisco as a grown man, not a child”.  Cynthia also visits Francisco and home each day, helps prepare a healthy breakfast, and arranges for others to assist with lunch and dinner.

The initial results are promising. While Francisco has been to the hospital since the new insulin protocol began, the number of ER visits for uncontrolled diabetes is decreasing. Cynthia and Francisco recognize the positive effects from the changes. Francisco now has more time for church, shopping, and participating in activities at his medical day program. He is making better decisions about his diet. He used to feel he had no control of his blood sugar levels and now feels he has the ability to keep them controlled.

Importantly, Francisco acknowledges his role in his health, and takes pride in his ability to control his diabetes. And he is more open about participating in his own health care decisions. He acknowledges Cynthia can be firm, but always fair. They have forged a special relationship based on respect and caring.

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