By Dr. Abhilasha Gupta
Introduction – Ms. TC is a young, morbidly obese 46-year-old female who is an insulin dependent diabetic with hypertension (HTN) and hyperlipidemia (HLD).
Challenge – Ms. TC was not taking her insulin and had an A1C of 14.4 on June 30, 2017. Our Health Care Manager Bertha and I tried to figure out her challenges and found out she had not been taking a lot of her meds, including blood pressure (BP) medications, regularly. She had a lot of medication bottles, some of them almost a year old, while others were discontinued.
Action – We advised her to bring all her medication bottles to straighten out her med list. Bertha patiently straightened out all her meds and taught her how to fill her pill box, how to properly take the medicine, and how to set alarms on her phone for compliance. We gave Ms. TC samples of Toujeo and taught her the correct way to inject insulin. Comfort Care was scheduled to bring her every two weeks for a while so we could closely monitor and gradually adjust her insulin dose based on her blood sugar (BS) numbers. Home health was also set up for a few weeks to ensure she was taking her meds regularly. She also attended healthy eating and diabetic education classes. We advised Ms. TC to call us every day with her BS and BP numbers as the BP numbers were also high.
She reported her data every day by a phone call, along with information on why she thought her BS was high on that day. Eventually, she could correlate good numbers with her medication and diet compliance. She also changed her eating habits and started walking one to two hours every day as part of her exercise.
Results – We rechecked Ms. TC on September 21, 2017 and found out her A1C was now 9.2. This was a phenomenal improvement.
We used our existent old techniques which we learned from each other in Patient Care Coordination. Along with teamwork from Bertha, home healthcare nurse Carol and diabetic educator Roxanne, the patient’s diligence and cooperation was the key to make such a remarkable turn-around.
Update – As of October 17, 2017 Ms. TC’s A1C was down to 7.5 percent.
Abhilasha Gupta, MD, graduated from JLN Medical College, Ravishankar University in Raipur, India. After completing her U.S. Medical License Exams, she finished her Internal Medicine residency at Muhlenberg Regional Medical Center in New Jersey. She is board certified in Internal Medicine and practices primary care in the Austin market.