Individuals with diabetes are expected to become experts in self-care. They need to learn about -- and put into practice -- healthy meal planning and counting carbohydrates, blood testing, exercising and medicine taking. They also have target goals for blood sugar levels, amounts of exercise, caloric intake and more. With so many things to balance, it’s easy for something to slip their minds.
Why Patients Lie
Between visits, many individuals with diabetes may have forgotten a few times to test their blood sugar levels. They may have slipped up and had a couple of high-calorie meals. Maybe they didn’t exercise as much as they had planned.Do they come clean? Or do they tell a few white lies to make it appear they’re doing a better job than they actually are with their diabetes management? After all, what’s the big deal? Their health care providers won’t care or even find out. Right?
Wrong. The results of their hemoglobin A1c tests will show what their average blood sugar levels actually have been over the past two to three months, so fudging their self-monitored blood sugar readings or being misleading about their adherence to their diet and exercise routines won’t work. Plus, any changes in regimen will be based on falsehoods and prove useless or even dangerous.
The Importance of Good Communication
Telling the complete truth can be a daunting task if diabetics have experienced negative reactions from either their diabetes care teams or their loved ones. Maybe they’ve had health care providers who have placed blame on them, instead of looking at ways to make things better. Perhaps partners or friends have wondered why they can’t work harder or do better.Dr. Barbara Anderson, senior psychologist at the Diabetes Care Center at Texas Children’s Hospital and professor of pediatrics, Baylor College of Medicine, has seen this happen over and over. “Encouraging and positive communications by clinicians is one way to achieve honesty in the patient/physician relationship,” she says. “If we want patients to be honest, it’s got to have noticeable positive benefits for them.”
Anderson says it’s vital for people to have health care teams they can work with. “Find a physician who is honest and will treat you as a whole person,” she says. “Make sure they are up-to-date in the field. Look for a team that says, ‘we are going to work with you as your coach.’ Ninety-nine percent of diabetes treatment is self-care and one of the biggest mistakes physicians and all of us make with patients is to over-simplify the burden of diabetes self-care.”
“Some physicians expect patients to be honest about blood sugar logs,” she says. “Then they draw huge circles in red pen around all the high numbers that the patient has recorded, and the judgmental comments and blaming start.”
Sandra Krafsig, a certified diabetes educator at Marlborough Hospital in Massachusetts, agrees. “The log book is not a report card,” she says. “It’s a tool to help pick out trends, trouble areas that we can work on together to balance glucose and meals.”
In order for the log book to be a successful tool, it needs to be accurate so the observed trends reflect reality.
The Positive Benefits of Honesty
Difficulties in self-managing diabetes are often due to issues with treatment plans. If patients are honest, their health care providers will be able to analyze their successes and failures in terms of their treatment plans. They can then figure out how to adjust the plans to allow for greater success in the future.Together, people with diabetes and their health care providers can figure out what might have led to any high readings, how they can be avoided and whether changes in their treatment plans are needed.
Those who haven’t followed their exercise programs need to let their health care professionals know that, too. They should try to explain why they haven’t been compliant. If their routines were too difficult or too boring, new exercise plans can be created that might be more successful.
If they are taking other medications or over-the-counter drugs and don’t let their health care providers know, they run the risk of having other drugs prescribed that could interact badly with the ones they haven’t mentioned.
Diabetes is a juggling act. When people with diabetes are honest with their health care teams about how they are managing their self-care, they provide the necessary information for creating more effective treatment plans.
Sources:
Anderson, Barbara J. Telephone interview. 29 Aug. 2007.
Johnson, Carla. "Lying to Doctor Can Mean Health Risks." Washington Post. 16 Feb 2007. 1 Sep 2007 <http://www.washingtonpost.com/wp-dyn/content/article/2007/02/16/AR2007021600984.html>.
Krafsig, Sandra. E-mail interview. 29 Aug. 2007.
Penckofer, Sue. Telephone interview. 29 Aug. 2007.
