Diabetes Viewpoints

A Lesson

By Melissa Conrad Stöppler, M.D.

I’ll never forget my first hypoglycemic episode. It taught me a lot. I had literally just been diagnosed with type II diabetes the previous day; a routine health screen at my workplace had showed a markedly elevated glucose level. Certain that this was an error (I had no symptoms of diabetes), I phoned our family physician to ask if I could come by to have a repeat blood glucose test.

As it turned out, my family doc was on vacation. But there’s someone covering for him, the receptionist explained. This on-call doc at another practice would be glad to help you out. Maybe I should just wait and get an appointment in endocrinology, I worried. On the other hand, I wanted the repeat testing just to prove that the lab had made an error.

To summarize what happened, the on-call doc convinced me, through a series of finger stick measurements, that, in fact, something was wrong and suggested an oral glucose tolerance test for the next morning. After that was done, he convinced me that I needed treatment right away and prescribed an oral hypoglycemic medication in a middle-range dosage.

Even being a physician, I didn’t know what the first-line treatment for a new diagnosis of diabetes should be. There were so many medications out there, and my own medical specialty (pathology) is more concerned with the diagnosis and process of disease rather than the specifics of drug treatment. And at that point, I was confused, afraid, and felt much more like a patient than a knowledgeable doctor anyway. So I listened, got the prescription filled, and took my first dose.

I didn’t feel anything different for a while, and in my newly-diagnosed state I was doing fingersticks probably every hour with my shiny new glucometer. My levels were OK. I felt fine. It wasn’t until I got in the car to run an errand that I realized I was over-medicated. The full-blown, frightening, and of course potentially very dangerous symptoms of hypoglycemia set in while I was driving. I was such a “new” patient that I hadn’t taken any precautions for hypoglycemic episodes. Luckily, I was saved by a package of small chocolate bars I had in the car that someone had given to one of my children.

Later, at home, I was able to reach a friend and colleague on the phone, who happens to be an endocrinologist specializing in diabetes care. I told her about my new type 2 diagnosis, what my glucose levels had been, and what the on-call doc had prescribed. Her response was swift. No, no. I shouldn’t take that. It was too strong, and I needed a thorough workup and careful consideration of a treatment plan before I took any drugs. Ashamedly, I told her I had already taken the medication and explained what had happened in the car.

Looking back- of course now with perfect clarity- I see that I was at fault. And the on-call doc who was covering for my usual family doctor was, too. I have to mention that at the time my glucose levels, although high, were only mildly elevated, just beyond the pre-diabetes level. They weren’t in a life-threatening range, and my urine ketones were negative. I didn’t need to start taking a substantial dose of an oral hypoglycemic medication without counseling, education, and further work-up. I needed a treatment plan that included dietary changes and to try low doses of medications to find the best way to control my condition.

That was the first of many lessons I would come to learn about having diabetes.

Read more of Melissa's columns here.