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Diabetic Destruction

This past week a middle-aged female from a neighboring community presented with a chief complaint of facial swelling. Upon evaluation, she clearly had anasarca with swelling from head to toe. She suffers from diabetes and had been seen once before in clinic... 6 years ago. At her lone prior visit, her blood glucose was nearly 400mg/dL. She was started on oral medications and encouraged to follow-up for re-evaluation and ongoing management. She did not return as promptly as we had hoped.

Now, after several years of poorly controlled/uncontrolled diabetes, the disease has wreaked havoc on her health. Her labs were most notable for evidence of kidney failure (BUN of 71, creatinine of 6.9). Her future is not bright. The quantity and quality of life she has remaining will most likely be markedly constricted due to complications arising from uncontrolled diabetes. I do not think she was able to fully appreciate the gravity of the news she received at her brief clinic visit.

This far too common scenario is sad and frustrating- particularly due to its largely preventable nature. With modest dietary modifications and very basic medications, the life trajectory of this particular patient, as well as what seems like countless others, could be and should be drastically different.

The sadness and frustration regarding this particular patient was compounded by her 13 year old son who accompanied her and was also being seen as a patient. Our patient's son had an acute viral upper respiratory infection (i.e. a cold), which should be self-limited. In a few days he will be over his cold. But, he also happens to have developmental delay and is deaf. What will become of him as his mother's health fails?

Mother and son will both suffer long-lasting effects from the destruction caused by diabetes.

Such cases, while maddening and heartbreaking, further strengthen our resolve to provide the best care we can to the most patients possible. We hope to stem the tide of destruction wrought by preventable chronic disease such as diabetes and alter the arc of the lives of our patients and their families.


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