Non-Compliant Diabetic Suffers from Drowsiness and Leg Pain
53 Year old male patient has a history of uncontrolled type II diabetes – A1c of 11.2; hypertension – blood pressure 162/90; hyperlipidemia – cholesterol 216, triglyceride 213; and diabetic retinopathy without macular edema. The patient wants his blood sugars to be better but has poor medication adherence and is not motivated to make changes or confident that he can do it. After the initial PCN (Primary Care Navigator) visit, patient chooses not to continue in the Care Navigation program unless his wife participates and tells him what he needs to know because of time constraints due to his job, which involves much traveling.
The patient’s wife joins the Care Navigation program for her own health issues, but the patient still decides not to participate. Six months later, the patient has changed his mind, meets with the PCN, and is referred to the clinical Pharmacist. The patient becomes more compliant with insulin injections. Patient is also more compliant with GLP1 after switching from Trulicity to Victoza, as he does not like the auto-inject pen. The patient is given a new meter to sync by phone so he, the Care Navigation team, and his primary care physican can more easily review his blood sugars. Patient complains of leg pain and is subsequently diagnosed with diabetic peripheral neuropathy and treated with medication. The patient mentions to PCN that he sometimes nods off while driving for work. The patient is educated about eating healthy snacks throughout the day and discovers that talking on the phone helps him to stay awake while driving. The schedule for taking certain medication is also adjusted so that he has less daytime drowsiness.
Seventeen months after the initial PCN visit, patient’s A1c is down to 8.0, his blood pressure is down to 128/78, and lipid level is improved – cholesterol 123, triglyceride 145. Patient’s retinopathy remains the same. He no longer has leg pain from diabetic neuropathy, no longer feels drowsy while driving, and his medication adherence is now good.
Housing Issues Impacting Patient’s Health
The Resource Coordinator (RC) first spoke to this patient in early July 2018, when she appeared on the emergency department discharge list. At that time, the RC connected her with the summer energy assistance program and assisted getting the patient connected to a behavioral health therapist. The patient, a 54 year old female, contacted the RC again in early August due to a water leak under her home and was unable to pay to have it repaired. She’d been staying at a friend’s house due to her water being turned off.
The patient has a history of type II diabetes and mental health issues, including bipolar disorder, anxiety, depression, and grief. The patient stated that she was depressed and felt defeated due to her financial situation and she had lost several close family members and was experiencing grief.
The patient seemed reluctant to attend behavioral health therapy, so the RC followed up with her and strongly encouraged her to call and schedule an appointment, which she did. After several calls, the RC was able to connect the patient with an organization called Renewable Hope through Habitat for Humanity. They were able to gather volunteers to fix the water leak under the home, in addition, they replaced some of her roof, mowed the lawn, and cleaned up around the exterior of the home. Renewable Hope also assisted the patient in completing an application to lower her water bill with the City as she had an outstanding bill of $2,000.
This assistance made it possible for the patient to move back into her home. She was feeling less hopeless and was very appreciative of the work that was done. The patient expressed relief due to the financial assistance and is meeting with the behavioral health therapist.
Depressed Diabetic Patient
This 63 year old female patient has a history of type II diabetes, hypertension 184/104 (ranged 150-160/100) and depression. The patient was non-compliant with medications and didn’t want counseling. She was tired of having to follow a diabetic diet because she felt it made no difference in her blood sugar readings.
The Primary Care Navigator had frequent contact with patient and made referrals to a pharmacist, new dietician, and behavioral health. After frequent visits and phone calls, patient’s insulin was adjusted, the new dietician had a different approach to diet management so patient had regular visits, and met with LCSW (Licensed Clinical Social Worker) for behavioral health. After 2-3 visits with LCSW, patient started to make lifestyle changes. She kept her appointments with the other disciplines and started seeing a decrease in her weight, blood sugar readings, and blood pressure. Within 5 months of the initial Behavioral Health referral, the patient was weaned off of her insulin. She lost 20 lbs and her hypertension was controlled.
Patient has made major lifestyle changes with diet, exercise, and daily routines. She follows a plant-based diet, is in a nutrition support group, and is talking about getting a certification to help others make lifestyle changes to assist with better diabetes control.
Within four months, the patient’s A1c dropped from 8.1 to 6.2.