Seniors & Chronic Illness: Diabetes Management through Doctor-Patient Dialogue

Case: Is Medication Needed for Elevated Fasting Blood Sugar and Fatty Liver?

Patient Example 3, also from the Chinese Academy of Sciences, is an 86-year-old academician. He has had diabetes for over 20 years and has been taking sitagliptin 100 mg once a day for recent years. His blood sugar has been well controlled for a long time. He has a variety of conditions including ischemic cerebrovascular disease, coronary heart disease, dyslipidemia, lower extremity arterial occlusion, hyperuricemia, mild fatty liver, and osteoarthritis. He does not have the common diabetic retinopathy and nephropathy. Not long ago, he was hospitalized due to falling five times in two days (without fractures), extreme malnutrition, frailty, and difficulty swallowing. After more than 20 days of nasogastric feeding, his nutritional status improved significantly and he was discharged.

The old gentleman currently has fasting blood sugars between 5.9 and 8.2 mmol/L, postprandial blood sugars mostly less than 10.0 mmol/L, HbA1c of 6.6%, normal serum creatinine, blood urea nitrogen, and liver function, uric acid of 498 umol/L, triglycerides of 2.88 mmol/L, and normal blood lipid indicators. He is currently thin and comes to the clinic in a wheelchair. The purpose of his visit is firstly to control his fasting blood sugar better and secondly to use some medication for fatty liver. I expressed my opinion to the old academician. If he wants to control his fasting blood sugar better, metformin could be added, but this is not appropriate because he is thin and recently had difficulty eating while hospitalized.

The current blood sugar level is already very ideal for him, and there is no need to add more medication. As for mild fatty liver, there is no need for medication, nor are there suitable drugs available. On the contrary, it is recommended that he increase nutrition, gain weight, improve physical strength, and enhance quality of life. Elderly patients with multiple diseases and significant weight loss should pay more attention to nutritional support. If blood sugar rises after strengthening nutritional support, we will discuss whether to adjust the treatment plan. Currently, he already has multiple diseases and takes multiple medications, so it is not appropriate to easily add more drugs. Any medication that can be avoided should be avoided or used sparingly, and there is no need to control diet; eating small frequent meals and diversifying food choices are more suitable.

The old academician agreed with my explanation and did not request further medication or tests.

The first two patients have been seeing me for a long time, and we understand and trust each other well. They listen to what I say. As a doctor, I fully understand the patients and communicate with them patiently. Sometimes patients come to the clinic just to relieve their worries or anxiety.

A few days later, I saw on WeChat that Patient Example 1 was taking photos in the autumn sunshine among the grass, fully enjoying happiness, and I was very happy to like her post.

Example 3 is an old scientist who came to see me for the first time, and the doctor-patient communication was also smooth.

These three patients came to the clinic to express their thoughts and needs to the doctor, and none of them took medication. Through in-depth conversation, their concerns were resolved.

Avoid Over-treatment

It is an objective fact that people get sick more often as they age. Some health problems are not necessarily diseases but physiological changes that come with old age, such as the decline in memory and poor sleep quality in Patient Example 2. At a certain age, especially after developing chronic diseases such as diabetes or hypertension, one must learn to coexist with the disease, understand and objectively and rationally treat the disease. On one hand, one should not indulge oneself, not get checked, not follow up, or not take medication, live an unordered life, and let the disease go uncontrolled, allowing complications to occur and develop; on the other hand, one should not be overly concerned or anxious. For example, hypertensive patients with stable blood pressure and diabetic patients with stable blood sugar do not need to monitor blood pressure and blood sugar multiple times a day, nor should they worry and be anxious about blood sugar, blood pressure, and weight changes within a certain range. These basic physiological indicators cannot remain unchanged, and fluctuations within a certain range are acceptable.

In today's society, with the rapid development of science and technology, the application of high-tech in hospitals is becoming increasingly widespread and deep, and more problems are being discovered. For the elderly, it is increasingly difficult or almost impossible to find individuals who are completely healthy and without abnormalities using modern medical equipment and techniques, while it is quite easy to discover many diseases and abnormalities. Therefore, one should not request more in-depth examinations, more aggressive treatments, or more frequent visits just because there are some abnormalities or diseases. This will inevitably lead to over-examination, over-treatment, and waste of medical resources, causing many unnecessary sufferings to patients, including psychological pain and family burden. For the elderly, over-treatment may even lead to premature death.

Follow Doctor's Orders, Treat Diseases Rationally

In terms of diseases, some diseases must be treated, even immediately treated, such as some urgent conditions that require emergency handling or timely referral, such as diabetic ketoacidosis, hyperglycemic hyperosmolar state, and severe diabetic foot with infection and ischemia, acute myocardial infarction, acute stroke, and some acute infectious diseases, etc. For patients, once they experience obvious and severe discomfort or pain that is different from usual, they should seek medical help in a timely manner.

Abnormalities found in physical examinations and confirmed chronic conditions should fully respect the doctor's opinions, follow the doctor's orders for treatment or examination, and not assume to handle it on their own or carry a heavy mental burden without wanting to seek medical advice.

Some patients, once they find abnormalities in certain indicators, search the internet or inquire everywhere, inevitably encountering some information that is difficult to distinguish between true and false. It is strongly recommended that the elderly, first, listen to and respect the opinions and suggestions of medical personnel, follow the doctor's orders for treatment and follow-up. Second, strengthen learning medical knowledge from regular channels, such as professional societies, health books, and hospital websites. Third, under the guidance and help of medical personnel, learn to observe their own condition, monitor key health indicators (such as blood pressure, blood sugar, and weight), and report to medical personnel as soon as possible once obvious or severe abnormalities appear. Fourth, maintain a good mindset, adhere to a healthy lifestyle, and treat diseases scientifically and rationally. Do not blindly believe the opinions of non-professionals, listen to information on the internet selectively, or follow the opinions of health product, health food, and equipment salespeople. If one's own cultural level is low and unable to self-learn and self-monitor, seek help from family and caregivers under the guidance of medical personnel. Fifth, patients with severe anxiety and depression need to listen to the opinions of medical personnel and, if necessary, seek treatment from a psychiatric specialty.

Learning to coexist with chronic diseases can enable patients to live better, longer, and more economically. Chronic diseases do not necessarily mean that the quality of life of patients will inevitably decline. If the relationship with chronic diseases is not handled correctly, it will bring irreparable serious consequences.