Improving Type 1 Diabetes Care: A Guide for Physicians
Introduction
Type 1 diabetes care is evolving, yet many patients still leave their doctor’s office feeling confused or under-informed. The reality – revealed by countless personal stories on the Juicebox Podcast’s Grand Rounds series – is that critical gaps in care persist “even among the most dedicated professionals.” This guide distills key lessons from candid conversations between a patient advocate (podcast host Scott Benner) and diabetes educator Jenny Smith. It aims to help clinicians provide more comprehensive, empathetic care and to inform patients what they should expect (and ask for). The goal is twofold: “to let doctors know what you need and deserve; and to let you know what to ask for.” This guide blends expert recommendations, patient experiences, and actionable steps – so that endocrinologists, diabetes educators, primary care providers, and patients can work together to improve outcomes.
Key Message: We’re going to try to explain to physicians what they don’t know about diabetes. Even well-trained physicians can miss nuances of day-to-day diabetes management. By embracing these insights, healthcare providers can bridge the gap between clinical knowledge and real-world practice.
Early Diagnosis: No Missed Red Flags
For many individuals, the journey with type 1 diabetes begins in an emergency room or urgent care setting. Symptoms like excessive thirst, frequent urination, unexplained weight loss, and fatigue may escalate dangerously before a diagnosis is made. Unfortunately, frontline providers sometimes overlook these signs, especially in settings where type 1 is considered “rare.” However, once you’ve encountered type 1 diabetes even a couple of times, there’s no excuse for missing it the next time.
Practical tips for timely diagnosis:
Don’t Dismiss the Possibility: Even if a patient doesn’t name a diagnosis, trust that they know something is wrong. Remain alert to classic diabetes symptoms, regardless of age or risk.
Perform Quick Screening Tests: A simple finger-stick glucose test or urinalysis for glucose and ketones can be lifesaving. One parent recalled wishing their pediatrician had known “it was okay to just do some blood work”rather than delaying tests.
Establish a Protocol: Consider creating a checklist for patients presenting with concerning symptoms. This might include, “unexplained weight loss or excessive thirst → perform a finger-stick or urine test.”
Learn from Each Case: Debrief with your team after each new diagnosis to refine your approach. “Have a meeting… The last couple of times we’ve diagnosed a person with type 1, it didn’t go well… What could we have done?”
By promptly identifying type 1 diabetes, you not only avert emergencies like diabetic ketoacidosis but also set the stage for better long-term management. Early diagnosis is the first opportunity to build trust with patients and their families.
Communicating the Diagnosis with Clarity and Compassion
A new diagnosis of type 1 diabetes is life-changing. How a physician communicates this news can profoundly affect the patient’s understanding and mindset. The challenge is to convey urgency without causing panic and to provide reassurance without minimizing the seriousness of the disease.
Avoid extremes in messaging:
Scare Tactics vs. Minimization: Some patients hear dramatic warnings that overwhelm them, such as descriptions of dire complications, while others receive overly casual reassurances. Both extremes can be counterproductive. Instead, aim for a balanced message that stresses the importance of managing the condition while offering hope and clear direction.
Explain the Basics Clearly: For example, state: “You have type 1 diabetes, which means your body can’t produce insulin. Insulin injections and blood sugar monitoring will keep you safe, and we have a plan to help you adjust over time.”
Invite Questions: Encourage the patient to ask questions and express concerns. Phrases like, “It’s okay if you don’t know what to ask right now; I’m here to help, now and later,” create a supportive environment.
Beyond “Don’t Die” Advice: Providing Comprehensive Early Education
Many newly diagnosed patients receive only the minimal instructions necessary to survive until their next appointment. However, this is not sufficient for long-term success. Patients need to learn the finer points of diabetes management, such as:
Insulin Timing (Pre-Bolusing): Teach that rapid-acting insulin isn’t instantaneous and that administering it before meals can align its action with the rise in blood sugar.
Meal Composition: Explain that while carbohydrates have an immediate impact on blood sugar, but don’t ignore that fat and protein can also influence levels.
Dose Adjustment: Clarify that initial insulin-to-carb ratios and basal rates are starting points. Encourage patients to expect adjustments as they learn more about their own responses.
Monitoring and Targets: Make sure patients understand their blood glucose targets and the need for regular monitoring, even if initial goals are set conservatively.
When to Seek Help: Inform patients about the signs that should prompt immediate medical attention.
A good practice is to provide a take-home resource or printed material that summarizes these points. This prevents patients from feeling forced to search for potentially unreliable information on the internet.
Ongoing Support and Follow-Up: Continuously Adjusting the Plan
Initiating insulin therapy is only the beginning of a lifelong learning process. Problems arise when providers treat the first prescription as a one-and-done event rather than a starting point for ongoing management.
Key recommendations for follow-up care:
Early and Regular Follow-Ups: Schedule a follow-up appointment within 1-2 weeks to review blood glucose logs and adjust insulin settings.
Titrate Targets Over Time: Explain that initial targets may be higher for safety but will be tightened gradually.
Empower Self-Adjustment: Teach patients how to make small adjustments on their own, such as slight increases in basal insulin if patterns suggest it.
Be Available and Responsive: Provide patients with clear instructions on how to reach you or another team member for interim concerns.
Celebrate Success and Encourage Questions: Avoid punitive reactions if a patient successfully improves their numbers independently. Instead, ask, “What have you done differently that helped?” and use that as a basis for further guidance.
By embracing a model of continuous learning and adaptation, you build a partnership with your patients. This approach ensures they never feel abandoned and that you remain their trusted guide in managing diabetes.
Embracing Technology and Data in Diabetes Management
Modern diabetes care is highly data-driven. Devices like continuous glucose monitors (CGMs), insulin pumps, and smart insulin pens are increasingly common. However, not all providers are comfortable with these technologies, leading to missed opportunities.
Practical steps include:
Stay Informed: Familiarize yourself with the basics of major devices and their functions.
Educate on Device Use: Teach patients about device limitations and proper techniques, such as the correct way to perform a finger-stick test or calibrate a CGM.
Utilize Data Collaboratively: Work with patients to analyze trends in their glucose data. Encourage them to look at patterns rather than isolated readings.
Personalize Device Options: Discuss different technology choices based on the patient’s lifestyle and preferences.
By integrating technology into your practice, you can help patients manage their diabetes more effectively and with greater confidence.
Personalized, Patient-Centered Care (No One-Size-Fits-All)
Perhaps the most resounding theme from the Grand Rounds discussions is the need to treat people with type 1 diabetes as individuals – not as identical cases following a rigid protocol. Every patient has a unique lifestyle, emotional state, and set of challenges.
Strategies for personalized care:
Listen Actively: Spend time understanding the patient’s daily routine, challenges, and goals.
Use Patient-Friendly Language: Adjust your explanations to suit the patient’s level of health literacy.
Foster Open Communication: Create a non-judgmental environment where patients feel safe sharing their struggles.
Empower Decision-Making: Involve patients in treatment decisions and encourage them to ask questions.
Acknowledge When You Don’t Know: Admit gaps in knowledge and commit to finding answers together.
Address Emotional Health: Recognize that managing diabetes is as much an emotional journey as it is a clinical one.
By focusing on these elements, you transform the doctor-patient relationship into a true partnership, enhancing both adherence and outcomes.
Special Considerations: Diabetes Through Life Stages
Different life stages and situations require tailored management strategies. For example, during pregnancy, tighter glucose control and additional support are needed. Similarly, the challenges faced by adolescents, working adults, or older patients differ.
For each life stage:
Discuss Anticipated Changes: For women of childbearing age, begin discussing how diabetes care may change with pregnancy in a supportive manner.
Customize Goals: Adjust insulin doses and monitoring frequency according to the patient’s stage in life (e.g., puberty, menopause, aging).
Provide Preconception Counseling: For patients planning to become pregnant, ensure they understand the need for tighter control and close coordination with a specialist.
Plan for Transitions: Whether it’s transitioning from pediatric to adult care or adjusting for new work/school schedules, prepare patients for the changes ahead.
Addressing these life stages proactively helps patients feel equipped and supported, rather than overwhelmed by sudden changes.
Conclusion:
For healthcare professionals, supporting a person with type 1 diabetes is an ongoing journey. By addressing the gaps in early diagnosis, enhancing communication, providing comprehensive education, embracing technology, and personalizing care, you can profoundly improve your patients’ lives. And for patients, knowing what to expect and what questions to ask can empower you to take control of your diabetes management. Together, doctors and patients can build a future where type 1 diabetes is managed with clarity, compassion, and confidence.
For Patients: What You Should Expect and Ask For
At Diagnosis and Initial Treatment:
Clear Information: You deserve to understand why you need insulin, how to monitor your blood sugar, and what your initial targets are. If the explanation feels rushed or incomplete, ask for a follow-up session.
Balanced Communication: Your doctor should inform you about the seriousness of diabetes without using scare tactics. You should leave with a realistic plan that makes you feel safe and understood.
Next Steps: Make sure you know when your next appointment is, who to contact with questions, and how the care team will support you until your follow-up.
Early Education and Follow-Up:
Comprehensive Education: Beyond basic instructions, you should learn about concepts like pre-bolusing (taking insulin before meals), how different foods affect your blood sugar, and when to adjust your insulin doses.
Ongoing Adjustments: Understand that your initial insulin settings are just a starting point. Ask your provider, “How will we adjust my plan as I learn more about my body’s responses?”
Resources: Request take-home materials or recommendations for reliable educational resources to help you better understand your diabetes management.
Active Participation and Empowerment:
Your Voice Matters: If you’re noticing patterns (for example, consistently high readings at certain times), ask, “What can I do to adjust my insulin at that time?”
Device Education: If you’re using or interested in technologies like CGMs or insulin pumps, ask for detailed guidance on how to use them effectively.
Mental and Emotional Health: Managing diabetes is challenging. It’s okay to talk about your feelings. If you feel overwhelmed or stressed by your care plan, bring it up so that your doctor can offer additional support or refer you to someone who can help.
Life Changes and Special Needs:
Planning for the Future: Whether you’re a young person thinking about school or a woman considering pregnancy, ask your provider how your management plan might change during different life stages.
Self-Adjustment Skills: Inquire if you can learn how to make small insulin adjustments on your own, so you don’t feel helpless between appointments.
Bottom Line for Patients:
You deserve a healthcare team that listens to you, explains things clearly, and works with you to create a personalized plan. If you ever feel your questions aren’t being answered or your concerns are dismissed, it’s okay to ask for a second opinion or additional help. Good diabetes care is a partnership, and you are the most important member of your care team.
Thank you for taking the time to understand the lives of people living with type 1 diabetes
Check out the full list of Grand Rounds takeaways which can be found here.
This list is a comprehensive collection of recommendations for healthcare providers managing type 1 diabetes. It was derived from detailed discussions on the Juicebox Podcast’s Grand Rounds series.
You can listen to the Grand Rounds series here, the series includes:
#1080 SERIES INTRODUCTION
#1097 HOSPITALS, URGENT CARE & INITIAL CONTACT
#1102 DIAGNOSING DIABETES
#1107 INSULIN AND SAFETY
#1112 FOOD AND NUTRITION
#1118 PREGNANCY
#1125 TECHNOLOGY PART I
#1126 TECHNOLOGY PART II
#1130 HUMAN STORY
#1139 COMMUNICATION
#1148 DIABETES MANAGEMENT
#1151 JON ODEN, M.D.
#1155 SCHOOL NURSE
#1162 HODGEPODGE
#1173 DR. MAGGIE MUELLER
#1192 DR. MARWA
#1228 DR. JESSICA HUTCHINS
#1231 ONCOLOGIST
#1249 DR. NADER KASIM
#1259 GAS PASSER
#1277 DR. TARLOW