I’ve got a handful of patients with consistently high A1C. I’ve tried providing very detailed education on diet, referral to nutritionist and diabetes educators, and still there is no change.
Usually once someone is taking 40 units of insulin and their A1C is higher than 9-10 I’ll refer to an endocrinologist. I’ve seen patients taking 100 units of insulin but I don’t know if that’s just what it takes with some patients.
Most of the patients in this category do not regularly check their blood sugar and home and none will bring a log with them to the clinic. I feel like diet and medication compliance is a big problem with these patients and worry if one of them got a wild hair to actually take their medication and somehow have a few low carb days in a row they would end up with hypoglycemia.
I’m really frustrated with the situation, I know I’m not doing a great job with these patients and end up sending unnecessary referrals to the endocrinologist who’s already too busy.
Any advice or insight would be greatly appreciated.
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