A Diabetes Educator Fights for a Patient’s Correct Diagnosis

By challenging the hospital’s traditional hierarchy, she may have saved this young man’s life.

Sometimes, the first person to spot your type 2 diabetes misdiagnosis is another healthcare provider. And sometimes, that healthcare provider has to fight to get you the right diagnosis despite the obvious evidence.

A young man diagnosed with type 2 diabetes

“I was working at an outpatient diabetes program in the suburbs of Chicago,” recalled Brenda Jagatic, CDCES from Healthier Stronger Happier Diabetes Care. “A young man came to see me for an appointment. I’d never met him before.”

“The patient was very tall, very thin, in his mid-20s, and taking metformin to manage type 2 diabetes. His blood sugar was in the 300s,” said Brenda. “Unfortunately, he also lacked health insurance.”

Metformin is an oral medication — one of the first medications created to treat type 2 diabetes.

While metformin is a powerful yet underappreciated medication, it cannot replace insulin.

Metformin works primarily by reducing how much glucose the liver produces all day long. In some people in the earlier years of type 1.5 diabetes (LADA, latent autoimmune diabetes in adults), LADA can delay the need for daily insulin therapy. But metformin can only do so much if your body’s natural insulin production is declining because your immune system is attacking and destroying the beta cells that produce insulin!

Brenda’s patient was well beyond any stage of type 1 diabetes when metformin might have been enough. (Metformin can be taken with insulin in type 1 diabetes to help manage insulin sensitivity and blood sugar levels.)

“I called the young man’s doctor to share my concern that he might have type 1 diabetes and that whether he has type 1 diabetes or type 2 diabetes the patient would likely benefit from starting on insulin to get his blood glucose to target,” said Brenda. “The doctor said he’s on metformin, and he’ll see him again in three months.”

This highlights an increasingly common dilemma: the doctor is immediately concluding type 2 diabetes simply because of the patient’s age. Meanwhile, the doctor is ignoring the many other factors that point to type 1: he’s very thin, and his blood sugar isn’t improving on type 2 medications.

The doctor’s dismissive attitude also highlighted another dilemma: the assumption that type 2’s blood sugar levels aren’t improving because of expectations, stereotypes, and stigmas that people with type 2 are lazy.

Brenda didn’t need much time with the young man before concluding that something definitely wasn’t right.

Stepping around the doctor to get the right diagnosis

“I called my boss and asked for help,” explained Brenda. “Then I asked the patient to come back to the clinic that same day after eating his lunch. When he returned after his meal, his blood sugar was even higher, and his urine was positive for ketones.”

Brenda was no stranger to type 1 diabetes (T1D). Her husband has lived with type 1 for most of his life. Fortunately, the manager of the clinic also knew type 1 diabetes intimately — her daughter and grandchild were type 1.

“When you have family with type 1, you get it,” said Brenda.

After a few phone calls, Brenda got the right support from her manager. She was instructed to send her patient to the ER. The patient returned to the diabetes center with prescriptions for long-acting and rapid-acting insulin and an order for diabetes education for starting a basal-bolus insulin regimen. He returned to the diabetes center for 3 additional Diabetes Self-Management Education and Support (DSMES) sessions.

“He wasn’t particularly friendly or grateful, but I didn’t care, that doesn’t matter,” remembered Brenda. “He deserves the best care possible, even if he’s got an attitude.”

The young man continued to see the original doctor. The doctor never said a word about the patient to Brenda or referred him to Brenda for further diabetes education and support.

Getting a Second Opinion

Asking for a second opinion is easier than it sounds. We’ve all been taught to trust doctors. And most of the time, we should trust the doctor. But every now and then, doctors do make mistakes.

Unfortunately, some doctors don’t appreciate being questioned, which means they might dig their heels in deeper on your type 2 diagnosis despite the alarming conflicting evidence.

It may be time to get a second opinion on your type 2 diabetes diagnosis if:

• You are losing weight without trying
• You’re struggling to improve your blood sugar
• You’re experiencing changes in your vision
• Friends or family say your breath smells a little funky
• Your breathing feels labored
• You are paying very close attention to your diet
• Your A1c is still over 8% despite changes to lifestyle habits and type 2 medications
• You’re experiencing recurring yeast infections (as a woman)
• You’re feeling exhausted despite resting

Getting a second opinion might mean talking to another clinician (nurse practitioner or diabetes educator) within the same clinic or contacting a separate clinic.

Don’t wait. Speak up. Ask for a second opinion. Reach around the doctor if they won’t support you. Take action!