Becoming the Patient: Not as Easy as It Looks

Svetlana Katsnelson, MD

Disclosures

May 12, 2014

I felt a little pinch as the representative inserted the small needle of the insulin pump into my abdomen. Even though I am not diabetic, I was being set up with an insulin pump (filled with normal saline) as part of my endocrine fellowship training. After the pump was in place, I tried to grasp all the information on what I needed to do and how to operate the pump. And quite frankly, I felt a little overwhelmed as I tried to learn all of the functions in a 15-minute visit. Along with various other functions, I was shown how to input the amount of carbohydrates I would be eating so my pump would bolus the appropriate amount of "insulin." The representative also showed me how to check a fingerstick glucose level with the glucometer. "Ouch," my brain screamed as I stuck my finger for the first time and felt the unpleasant prick. Although I remind my patients to check their fingerstick glucose levels, often up to 4 times a day, I had never done it myself and now humbly understand how truly painful it is. As I left to go home and start managing myself, I realized that this was not going to be easy.

I first became a noncompliant patient after I got home and grabbed an apple from the fridge. I remembered as I chewed my last bite that I forgot to enter the carbohydrates for the apple into the insulin pump. "Well, next time I will be better," I promised myself. Later that night, I was proud of myself as I remembered to enter the carbohydrates for my dinner. About an hour later, I sat down at my desk and set up to check my fingerstick glucose. My face twisted as I felt the painful prick of the lancet, and I realized that I needed to change my pricking spot because the side of my finger was starting to feel a bit sore. After showering that night, I almost forget to reconnect my pump. I went to bed with the insulin pump and felt myself shifting in bed because I was not used to having anything attached to my body. The next morning, after I woke up, I grouchily reminded myself that I needed to check my fingerstick glucose before I ate. I again cursed the lancet as it pricked me, and I realized that I did not want to keep doing this. I just wanted to enjoy my day without these unpleasant interruptions.

As I walked into the hospital, I grabbed a breakfast bar from my bag and quickly ate it. It was not until I had to check my fingerstick glucose before lunch that I remembered that I never gave the insulin bolus for the bar. I then rushed to our conference room, with the goal of getting there about 10 minutes before my colleagues so that I could check my glucose before our session started. I was glad to find the room empty because I certainly did not want a repeat of when I had checked my glucose in the cafeteria and received several stares from strangers. In fact, I now found myself having to budget extra time into my day, not only to not check my fingersticks but also to find a place where I had privacy.

The rest of my week was filled with constant failures on my part, from forgetting to check my fingerstick glucose to forgetting to give an insulin bolus before my meals. And, of course, there were the dreadful times during the day when my fingers were pricked. Furthermore, one night the pump alarm kept going off because, as I later learned, I had not correctly programmed the low blood sugar threshold. I was irritated by this alarm that was robbing me of my sleep, so I turned the pump off. This was a luxury I could enjoy but my patients with diabetes could not.

I found myself eagerly waiting for the week to be over so the pump could be removed. But I also felt guilty as I realized that it is never over for my patients. They do not get to take time off from diabetes; they live with it every day. The experience provided me with a better understanding of how to use the devices that many of our patients use every day, but it gave me much more than that. I truly began to understand how difficult it is to live with diabetes. From struggling to find moments of privacy during the day to check my fingerstick, to keeping track of every morsel I was eating to get my insulin coverage, this was an unwelcome change in my life. I realized that although we have the best intentions as healthcare providers for our patients with diabetes, we are often distanced from their experience. I have spent so much time counseling and teaching my patients that I forgot to learn from them.

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