Me, looking at office glucometer: So your blood sugar is 395.
Patient: Oh. I think it’s probably high because I’ve been stressed a lot.
Me: Last time it was 400.
Patient: Yeah. I don’t know why! I barely eat anything at all. Why does this happen to me?
Me: Tell me what you had to eat today.
Patient: Nothing! Only water!
Me: Really? It’s 4 p.m. Aren’t you hungry?
Patient: Well, I had some coffee this morning. With some crackers.
Me: Ok. Well, the crackers could make your blood sugar go up a little bit.
Patient: Oh yeah, I also went to Taco Bell with my daughter. But don’t worry! I had something with chicken in it.
Me: Like a burrito? A taco?
Patient: I don’t know. But it had chicken. Chicken is healthy, right?
Me: Well, it depends what’s…
Patient, interrupting: Oh, I forgot! Then I went to Wendy’s with my nephew.
Me: You went to Taco Bell and then to Wendy’s?
Patient: Yes, but don’t worry. I only got a shake!
Me: A shake has a lot of sugar in it. A LOT.
Patient: It wasn’t the biggest size.
Me: How often do you eat at Taco Bell and Wendy’s?
Patient: Oh, not that much. I usually eat at better places, like the Olive Garden.
Me: Do you eat the breadsticks?
Patient: I get a salad.
Me: Do you get the pasta?
Patient: Sometimes. But also the salad!
Me, weeping a little inside: Have you ever seen our nutritionist? She could really help you figure out which things to order when you go out to eat.
Patient: I don’t think I need to see her.
Me: Everyone can use a little reminding about how to eat a healthy diet. I think it might be good for you to see her a few times.
Patient: Ok, I’ll go.
Me, conscious of the fact that we have vastly exceeded our visit time already on discussion of a different issue: Great! I’m doing the referral right now. Take this up to the front desk. I’ll see you in 2 weeks. Bring your glucometer, ok?
It is a huge bummer to know that this patient needs about 10 hours of intensive diet and diabetes education, and I can provide less than 20 minutes of that. And the 20 minutes also included a discussion of leg pain, psychosocial stressors and a skin infection. Sigh.