I am a new NP and don't know how to "wake up" noncompliant DM2 patients. Unfortunately, a significant number of these patients are in denial and refuse to make any lifestyle changes and some even refuse to take their medications and/or insulin as prescribed. I experienced this during clinical rotations and now am seeing this as a practicing NP. Has anyone had success with this situation and can share some tips?
Examples:
1. Patient who is DM2 for 20 years comes in and says he/she eats whatever they want, whenever they want. A1C1 > 12 !!! Shrugs at everything I say. Their biggest concern is hypoglycemia, although they are only on a low dose of basal insulin and can't specify their last episode of hypoglycemia. Called clinic today to say they no longer want to use insulin and only want to be on one oral medication (I refused and said patient must make appointment to see me). This patient also has refused to get any annual lab work for past 3 years or other exams such as eye, foot, etc.
2. Another long-term DM2 patient with A1C1 > 10 and random BG > 180. This patient's biggest concern is hypoglycemia and is convinced that a BG of 150 is perfect and that an A1C1 of 10+ is just fine; became agitated when I explained this is not the case. Patient admitted close relative had just had a foot amputation due to DM2, but was indifferent. Patient had lost weight due to other health issue, is still slightly overweight, and was concerned about being too thin and frail. Patient stated they don't know what they eat and don't care. I had a hard time convincing this patient to obtain routine lab work, but they did it. I had a panic attack when I received CMP: eGFR 65, Creatinine > 3.0. I was amazed this patient was still alive! Patient was sent to ER, of course.
