Walking down the spiral staircase versus jumping off of it

"My blood sugar doesn't like to be less than (200-250) so don't give me that damned insulin!"

Have you ever met that patient? The one who fusses when you get their blood sugar "too low"??

Here is how I teach to that:

First, I have visual printouts of what the symptoms look like for Hyperglycemia (high blood sugar) and Hypoglycemia (low blood sugar). Patients benefit from pictures, not words. I set something like this on the table.

"Here is the deal. Your body likes this state we call "homeostasis." In a nutshell, it means your body wants to be at all times. Sameness. If one thing moves - other things have to move too" I draw this on the whiteboard:

What that looks like: (Pointing to the hyperglycemia chart) "Your blood sugar begins to rise and other systems compensate to keep adapt. Around sugars of 250, your body starts pulling water from here there and everywhere to push that sugar off by your kidneys. You get thirsty, you might be peeing all the time, you may be constantly hungry or you may be tired all the time and feel like you just can't get stuff done."

Patient agrees or disagrees with these statements. I adapt my approach to the ones they identify. 

"Also, you can have trouble seeing things and you might have a small wound that just won't heal - or worse yet gets infected like crazy! Why? Because bacteria like to eat sugar so your body is like Daytona Beach during Spring Break!"

Patient usually laughs - then becomes a bit uncomfortable.

"You didn't get this way over night. You aren't going to have "normal" blood sugars overnight either. We need to walk your blood sugar down, like walking down a spiral staircase to a less dangerous level of blood sugar."

Patient may argue about how their body doesn't like below ___ blood sugar. 

What are we worried about? (Pointing to the hypoglycemia chart) "Your body has gotten USED TO these blood sugars. If we immediately try to bring you down to "normal" your body doesn't have time to adjust. You will have the SYMPTOMS of low blood sugar, even though your blood sugar IS NOT LOW. So, when you hit 250 (down from 500) you feel like crap! You're shaking, your heart is beating, maybe you are sweating and you feel like you're going to fall out. You are starving and ready to chew off your own arm, you have a headache and you are ready to kill the first person who looks sideways at you. Sound familiar?"

Generally the patient is nodding emphatically.

"Well, this is not ACTUALLY hypoglycemia - but it feels that way. If your blood sugar was...say...under 100 - I'd be getting you a full meal together. If your blood sugar is, say 250 and you feel like this - I'd say you are not in immediate danger - but I also know you still feel like crap. For that, I'd get you a small snack, to help you feel better, but not to jack your blood sugar right back up through the roof."

A glimmer of understanding begins to fuel itself. 

So, think about bringing your blood sugar like walking down a spiral staircase. We want to take it one step at a time. You would feel a lot better walking down that staircase, than jumping off of it - wouldn't you?

Planning the new diabetic regimen begins. 

PS: If any of this works for you - please use it! The talk about homeostasis and "feeling" crummy when we overshoot our mark can be adapted to talking to a patient about their hypertension medications as well.