A new approach to diabetes

Janet was excited today – she came in a taxi with Roy. Roy lives in the same block of flats but below her and has diabetes as well. They chatted in the taxi, shared information and discussed problems.

It would seem that in Janet’s opinion she is doing better than Roy. It was interesting the way that she described ‘better’ a view that is very important for the NHS and those involved in diabetes care to consider:

“Nobody has talked to me about insulin yet – so I must be doing better than Roy”.

How interesting – where I usually think of insulin as just part of the therapy, Janet thinks about it as a sign of failure. And as it happens – so does Roy – he, apparently, is very disturbed by it and she thinks he is worried.

“So what are you planning to do about it Janet”. I don’t really know why I asked the question, but the answer came without any hesitation whatsoever.

“Roy’s coming up for tea later; we are going to have a chat about his control. He lives on his own – I want to see what he eats and see if we can help each other”. Hmmm, I have wanted to know what he eats for years.

I know that this does fill me with some fear. Janet’s control is not too hot and I might be talking to her about some basal insulin soon. But I decided to leave that one out. Concentrate on some dietary advice and leave a final note about getting out a bit more and losing some weight.

Roy’s appointment was less productive. His HbA1c was worse and he had put on weight. It was an interesting discussion where he described everything as a ‘series of failures’. I seriously wanted to talk about disease progression and treatment progression, but I just sat back and listened. Eventually I asked:

“So you met Janet in the taxi today” and at last I seemed to get a positive reaction. Yes she seemed nice, no he didn’t know that she had diabetes and yes she had asked him around for a ‘natter’. He was really interested that her diabetes was better controlled than his (based on the fact that he had a discussion about introducing insulin) and that he was interested to understand how she did it.

It would seem that he would rather learn about diabetes from Janet than from me. I can live with that if both of their control improves. Loneliness and a feeling of continual failure, including the view that insulin is associated with failure rather than success is a learning point for us all. There is no wonder that people don’t always do what the healthcare professional suggests which contributes to significant waste of medicines in the NHS.

The first point is that a taxi sharing service is a great success – but we should make better use of it encouraging more people with the same condition, living in the same area to share the taxi.

The second point is one of reflection; we have many older people with diabetes living near each other in a community. I wonder if they know each other. When you speak to the local community pharmacist he will double the numbers including patients from other practices.

So I might start working on a new plan. We ask all patients to attend a meeting run by the local community pharmacist. We provide patient guided learning material so the pharmacist acts as a facilitator – the CPPE consultation skills for pharmacy practice is a useful and timely resource. And we invite associated healthcare professionals to attend and answer questions and other providers to talk about the services that they offer, lunch clubs, walking and exercise.

Community healing in practice?


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