By Francine Grabowski, Lead Diabetes Educator

You are fired. These words can instill fear, grief and chaos in the lives of the recipient.

These words were heard by Mrs. Jones 5 years ago – not from her boss, but from her primary care physician (PCP).

The doctor, who worked with her for 10 years, warned her during every visit that if she didn’t start controlling her diabetes with diet and medication, the disease would kill her. Mrs. Jones tells of seeing her diagnosis on the bill, “uncontrolled diabetes,” and feeling frustrated and condemned to a life of the disease. Then she received a letter stating that her doctor would no longer work with her because she was not taking care of herself. “I was fired,” she says. “I was humiliated and felt hopeless.”

After being asked to leave her PCP office, Mrs. Jones came to the Camden Coalition of Healthcare Provider’s Diabetes Self-Management Education (DSME) classes every Friday for 13 weeks. She learned techniques to understand how her daily activities affect her blood sugar levels. One step at a time, she began to learn to control her diabetes.

First, she learned how to inject her insulin properly, which was difficult because she is left-handed, as well as when to take the medication. Once she was using insulin optimally, she had to look more closely at eating patterns. Mrs. Jones sometimes skips meals, so she learned techniques to control her blood glucose in those instances. She began using the healthy food plate model to eat properly, filling half her plate with vegetables and a quarter with starches. She learned that eating a teacup of rice did not affect hear blood glucose.  Slowly, she experimented with different food patterns.  What happens if I eat Chinese food?  What happens if I skipped lunch? What happens if I eat pizza?  What happens if I sleep in? What happens if I forget to take one medicine? When Mrs. Jones first came to class, her blood glucose was in the 400s.  At the end of 12 weeks, it was typically in the 100s.

Mrs. Jones’ story is not a one of an unruly patient sabotaging her health despite the best efforts of her physician.  It is one of a patient overwhelmed by her disease and lacking the proper education and support structure necessary to manage a chronic illness.

Rather than fire a patient, a health care provider should be asking questions. What am I doing or not doing to contribute to my patient’s high blood glucose. What resources exist to help me help my patient?  What is the root cause of my patients “non-compliance”?

Mrs. Jones often talks to the class about being called uncontrolled and being “fired” from her doctor’s office. But now she ends her story differently. She no longer takes the blame, noting that if she had known what to do, she may have been able to control her diabetes.



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