An Introduction

I am so excited to have been invited to contribute to this blog and interact with the readers of Diabetes Self-Management! I am a clinical pharmacist and a certified diabetes educator, and I have specialized in helping people manage their diabetes in both the hospital and clinical setting for the past 25 years.


Working with people with diabetes is always very interesting, as well as incredibly rewarding. Each person brings his unique experiences, challenges, beliefs, and disbeliefs to his visits. I try to create an environment during each appointment in which my patients feel comfortable being honest with me about how they are managing their diabetes and the barriers they are encountering. When I am able to identify an area to work on and my patients experience positive changes in their blood glucose numbers as a result, it is so gratifying.

So many times I hear, “No one ever explained that to me” or “I didn’t know that.” One person told me that I “saved him from the fire of diabetes.” He shared with me that he had thought the diagnosis of diabetes was life-ending for him, or that at the very least that he would have to completely change his lifestyle. He thanked me for giving him the tools he needed to modify his life to fit diabetes into it. I am happy to say that that was four years ago, and he is still doing great! I hope to share some of those tools with you through this blog.

About 10 years ago, I began spending time in the hospital setting in addition to my clinic work. I was shocked to find that diabetes was basically ignored during hospital stays and that elevated blood sugar levels were considered acceptable. Luckily, much research over the past decade has been performed demonstrating a direct relationship between elevated blood glucose levels and poor outcomes during hospital stays. Many hospitals are now implementing protocols to control glucose levels during stays.

With the growing number of people being diagnosed with Type 2 diabetes, it is not surprising that some are receiving their diagnosis during a hospital stay. Sadly, many people end up in the hospital due to complications from poorly controlled diabetes. My goal for a newly diagnosed person is to get him started on the right treatment regimen and to provide the beginning foundation of his diabetes knowledge base.

For people with poorly controlled diabetes, it is necessary to identify any gaps in their knowledge base and to change their treatment regimen. Finding the right provider to take over a person’s care, or communicating with his current provider to ensure ongoing successful management after discharge, is also important. I will share more about how you can prepare for a successful hospital stay with diabetes in a future blog entry.

In addition to my work in clinic and hospital settings, I have also spent a great deal of time in academia training health-care professionals about diabetes, with a special focus on physician education. A common problem with physician prescribing in the area of diabetes involves something called “clinical inertia.” Simply put, it is the failure of doctors to start or intensify therapy when needed.

Doctors often tell me that not enough information was provided to them during their training regarding diabetes, and many lack a comfort level with prescribing insulin or else fear that their patients will be unhappy if they place them on insulin. People with diabetes can help avoid having this experience with their own provider by asking if their therapy should be changed if their diabetes is not well controlled. In future pieces, I will talk about how to improve your doctor visits.

While there is much more work to accomplish, managing diabetes today is much easier than when I first began my practice and we only had a few oral medicines and animal insulin available to us! There have been a lot of positive changes during my many years in the field, including the availability of newer medicines for diabetes and an increased recognition of the need to empower people with diabetes to actively participate in their care.

I look forward to sharing tidbits from my practice experience on managing your diabetes and working with your provider to achieve good results. And I’m eager to start connecting with readers — I know I will learn a great deal from you!

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  • Redneck Angel

    Hi! I am a person w/diabetes–of over 40 years now(Type2). You are so right about hospital stays. Even the Doctors ignore it. a couple of years ago when I was in the hospital as a result of a car wreck the Hospitalist asked how I managed it, when I explained she said she never heard of doing it all on a sliding scale, dependent on frequent BSs. Since I always carry a glucometer & insulin–I just “fixed” her standard-dose regimen when it needed it. But I cringe to think what would happened if my mind wasn’t clear (as many people sick enough to be in the hospitals’ are), & able to manage it myself…. You would think that it would occur to any kind of doctor that any person w/long-standing diabetes, who is still standing, might have an idea or 2 on how to best manage their diabetes wouldn’t you? Apparently, not so!
    I am looking forward to hearing your take on ‘how to do’ & ‘what to do’….Susan

  • jim snell

    First, welcome aboard and sharing your experiences.

    Your perspective and comments about diabetes – type 2 , hospitals and Doctors is definitely most curious.

    As a 30 year plus type 2 who had a stroke and spent the last 7 years bailing out the mess to save my life and learn all I could about this pestilence; it is extremely discouraging when one looks at the numbers world wide afflicted, the drug costs and the utter lack of knowledge and ignorance that is costing our society billions.

    The knowledge out there is inadequate, scarce, much mis-information and a total focus on the pancreas and insulin while ignoring the complete body system
    and organs – liver, kidneys, skeletal muscles and others and steps needed to manually control once body out of whack!

  • Mary G

    Six years ago, I was diagnosed as Type2 during a hospital stay after having a stroke (determined to be caused by extreme stress). There was a team of volunteers who taught me how to use a meter and a booklet on diabetes and not much else. This was all very nice, but I was given NO guidance at all as to what to eat. The dietician assigned to me was less than helpful as her only guideline was 1800 calories a day. There was a lot of carb choices and artificially sweetened items like ‘industrial orange’ jello. When I ordered a salad, I got 3 carrot sticks and 3 celery sticks period. My blood sugar was hardly controllable. I was determined to get a handle on my condition after being discharged and rehabbed. I read everything (especially blogs)that I could concerning diabetes and talked to other diabetics. I also tested frequently to see how foods affected me and kept a journal which I shared with my doctor. I have been able to reduce meds over time. I also contacted the hospital and requested that they provide a diabetic friendly menu for their patients (since they already had Kosher and Heart Healthy menus). I look forward to your educated input on this important subject.

  • Pauly

    Dear Dr. C, happy you have joined this great helping program!
    Iam type 2 and under control . A1c late May was 5.7
    Owe a lot to keeping me sharp and understanding of this awful disease .

  • Robin J

    Found your blog interesting and hope for what will come. I have been a Type 1 for 49 years. I have seen so much change. I have to agree that hospitals are not where a diabetic wants to be. There is no consistency of care. I think the staff needs a total education of diabetes care. Blood sugars are before a meal not after because someone forgot. I had a good education and foundation when doctors took care more seriously. When you find a good doctor you are lucky. (There are many good doctors out there.) I have heard more recently about how patients are sent home with a booklet and meter and calories. No education nor where to go to find the right education. Don’t give up continue to search and you will learn.

    Look forward to your next blog.

  • Cathy

    Two items – when I was first diagnosed, was prescribed Metformin and Byetta, but practically no educational info, didn’t learn for a few months about counting carbs, and that was from a helpful nutritionist. Secondly, was hospitalized for surgery, so took no D2 meds the morning of, doctor didn’t prescribe those meds for the second morning either. Blood sugar went pretty high, I was insulted when he sent in someone to talk about my high blood sugar. It stabilized as soon as I took my meds at home.