Examined Lives: On World Diabetes Day, one patient’s story about the power of taking control of her own wellness

By Amy Lynn Smith

I’m about to celebrate 25 years of living well with type 2 diabetes. I say “celebrate” because I choose to celebrate how far treatment has come, and all the places it still can go to make this disease even easier to live with.

Most important, I choose to celebrate that type 2 diabetes is a chronic condition that’s largely up to me to manage. There’s nothing more empowering than knowing I can be in charge of my own health.

Living with diabetes isn’t a path you can walk alone

My initial diagnosis knocked me over. But I quickly realized that I could either take care of myself or suffer the consequences.

I did my best. I followed healthy eating plans and exercised. I took my medications as prescribed — medications that have improved significantly in the last 25 years. I saw my primary care physician and endocrinologist regularly, and they made adjustments to my medications that would help improve my blood glucose control for a while.

But it wasn’t enough. There were times I felt discouraged and lonely in my quest for wellness. And I became increasingly frustrated with my doctors’ frequent unwillingness to look at the big picture — to see me as more than a person with diabetes.

Diabetes is only one facet of my health

I’ve been lucky. I haven’t developed any serious complications after nearly 25 years. But despite good overall diabetes control, I still found myself struggling to feel my best. I was battling frequent bouts of insomnia and sometimes overwhelming stress, which aggravated my fickle gastrointestinal system. Other than occasional lifestyle recommendations, my doctors were all quick to reach for medication as a solution.

I asked for nutritional guidance and didn’t get much of it. I asked about my struggle to deal with stress, and they largely ignored the role stress can play in the management of diabetes and overall health.

Most of the time, they’d do some blood tests, give me some orders to exercise more and watch what I eat (without any specific direction), write a prescription, and send me on my way. This approach was anything but empowering.

Chronic disease is the intersection of so many of the Great Challenges of health and medicine: stress, sleep deprivation, the evolving role of the patient, whole-patient care and medical communication, at least for me. My care providers weren’t recognizing that. I knew it was time for something new.

Finding an approach to care that works for me

During my search for better ways to manage my diabetes, a friend who works in healthcare told me about functional medicine. According to the Institute for Functional Medicine (IFM), it’s an innovative approach to medical care that uses the latest medical research to develop personalized care for each patient based on his or her unique environment, lifestyle, and genetic background.

My friend had been diagnosed with rheumatoid arthritis. But after working with a functional medicine practitioner she discovered her only problem was allergies to gluten and dairy. Her symptoms quickly disappeared and she’s never felt better. “It changed my life,” she says.

It didn’t take me long to see that functional medicine was exactly what I’d been looking for. It’s grounded in the idea that chronic disease can’t be treated like acute disease — which is how my doctors, although well intentioned, had been treating me.

Here’s how Mark Hyman, M.D., chairman of the IFM, describes the difference between functional medicine and traditional approaches:

“Functional medicine is a new way of thinking about solving the puzzle of chronic disease. Current medicine is really the medicine of ‘what’: what disease do you have, what drug do I give. Functional medicine is the medicine of ‘why’: it’s focused on etiology, on causes and mechanisms. So if we can get to the root causes of disease — which, predominantly, for chronic diseases are lifestyle — and if we can address the fundamental drivers of chronic disease, which also drive our costs — then we can have a fundamentally different way of delivering healthcare, providing healthcare, and getting much better outcomes at much lower costs.”

Sure, my care providers had told me lifestyle changes are paramount to managing my diabetes, but I hadn’t found someone willing to give me the support to make the principles work for me. Until now.

I started working with a functional medicine practitioner about three months ago, and the personalized, holistic approach to care is unlike anything I’ve ever experienced. I don’t feel like I’m being “treated.” Instead, I feel like I’m an empowered partner in my own care — with the support of a practitioner who is standing at my side every step of the way. Between sessions, we exchange emails every few days to see how the changes I’m making are working.

She’s completely overhauling my diet, which I like to call it my “new fooditude.” I’ve cut out processed foods and do most of my own cooking, giving up the bad habit I’d developed of eating out far too often. Every once in a while is enough now. She’s also eliminated foods that can trigger unhealthy responses, and is adding them back in one by one to see if there are any I need to avoid for good.

Just over a month into my new fooditude, I’ve seen dramatic changes. My energy and stamina have improved, I’m sleeping better than I have in years, and when I’m faced with a stressful situation I find myself responding with a calm, clear head.

Best of all, my body is starting to do a better job of producing insulin naturally as it adjusts to my new fooditude. My practitioner has told me I’ll probably never be able to stop taking insulin, but I’ll probably need less of it over time. And I’ve already thrown two medications overboard that were doing nothing for me but masking symptoms I’ve relieved by eating better.

This journey is just beginning, and it will probably last a lifetime. But I can say this: I like where it’s headed. I finally feel like I have a care provider who is seeing the whole me — everything that makes me who I am and contributes to my sickness or health. When you consider that diabetes is something you live with every day, like any chronic disease, a holistic view is essential.

I’m more than my diabetes. I’m a multifaceted person. I’m grateful to have found a practitioner who sees me that way, and an approach to medicine that provides ongoing guidance while putting me in charge of my own wellness.

-1Amy Lynn Smith is a writer and strategist who frequently writes about healthcare. You can find her at alswrite.com or on Twitter @alswriteShe will moderate a TEDMED Google+ Hangout tomorrow, “Finding new allies in chronic disease care.” Tune in at 2pm ET for a conversation with experts and to ask your own questions.

 

Posts by guest contributors do not reflect the views of TEDMED.

Live online event: New allies in chronic disease care

What are the best new advances in building a web of care to help contain and manage chronic disease?

For Seena Haines, Professor and Associate Dean for Faculty of Gregory School of Pharmacy at Palm Beach Atlantic University, it’s integrating pharmacists into primary care models, with a special focus on reaching under-served and indigent patients.

Screen Shot 2013-11-12 at 4.29.58 PMA former dietician turned pharmacist with a specialty in ambulatory care, Haines is in a unique position to understand the value of collaborative care, particularly when it comes to cardiac health and diabetes.  Pharmacists have healthcare provider status in 11 states, and there is a growing movement to integrate their work into primary care settings like clinics, physician offices and home-based health care services. Pharmacists can help find and respond to medication-related issues, including issues of cost, compliance and effectiveness; order lab tests; review patient progress and report results to physicians.

“There’s a workforce shortage in primary care in our family medicine space, and therefore nurse practitioners, doctors of pharmacy, case mangers and dietitians all have to come around and bring our own skills and expertise. Otherwise, the health outcomes we’re striving for are unreachable and too time-consuming. We have to be strategic in how we message patients, and maximize what we do,” Haines says.

Research shows that patients are typically significantly healthier as a result of working with a pharmacist, particularly when it comes to blood glucose levels and cardiac health. A Kaiser Permanente analysis of patients with coronary artery disease enrolled in its Collaborative Cardiac Care Service, comprising a nursing and clinical pharmacy team, showed that those enrolled within 90 days of an acute cardiac event were 89% less likely to die for any reason within 3.6 years compared to those not enrolled in the program. The earlier the program was started after a coronary event, the more effective it was in reducing mortality.

Another Kaiser study, this a 10-year-long retrospective, reported that including a clinical pharmacist on a care team for patients with type 2 diabetes lowered non-fatal cardiovascular disease risk by 5.5 percent over a decade and increase cost effectiveness, particularly over time.

Haines says expanding the primary care team helps bring medicine to special needs populations. She currently runs four foundation-supported safety-net clinics in Florida. Her students also do community outreach programs in schools on tobacco cessation and asthma management.

“Inspiring motivation is key, as well as being culturally targeted to groups you’re working with. It’s important to engage patients in their own care and treatment strategy,” she says.

Which other new models in collaborative care are making a difference in managing chronic diseases?  Join our TEDMED Great Challenges Google+ Hangout tomorrow at 2pm ET to discuss strategies that work, and find out what’s on the horizon. The discussion will be moderated by Amy Lynn Smith, a writer + strategist and person living with diabetes. Special guests include Seena Haines, as well as Robert Gabbay, Chief Medical Officer of the Joslin Diabetes Center, and Loretta DiPietro, Chair of the Department of Exercise Science at the George Washington University School of Public Health and Health Services.

Click here to register and get started. Tweet your questions to #GreatChallenges. We’ll answer as many as we can on air.