Diabetes: Making Medical Decisions as Your Health Changes
For a lot of people, diabetes leads to serious health problems. These life-changing conditions bring with them new medical decisions and plans.
Medical decisions are very personal. Different people handle them in different ways.
- "In the past year, I've learned I have kidney disease from my diabetes. Wow. My wife and I decided we need to change how we take care of ourselves. We walk every day. We eat better, and that has helped me lose some weight. I actually feel better than I did before I learned about my kidney disease."
- "I am very sick. The diabetes, the heart problems, the kidneys, and now I've lost feeling in my feet. My doctor and I have talked about making sure I'm comfortable in my final months and about what we're not treating anymore. For example, my doctor says I don't need to check my blood sugar all the time. But I am careful to have my snacks and meals so I don't get low blood sugar and fall down when I stand up. The last thing I need is a broken hip."
- "My vision is nearly gone. It's from years of having high blood sugars. When my sight got really bad, I didn't want to go on living. But there's so much support out there to help you adjust. Now I have the depression under control and my life is okay. And even though I can no longer read, which I loved, I now listen to books, podcasts, and lots of other interesting things. In some ways, I feel more connected to the world than I did before."
How did these people decide about their lives and their health care? With their doctors and caregivers, they balanced their medical needs with how they want to live their lives. They used shared decision making.
Shared decision making
As your health declines, medical decisions get to be more complex. Daily life can be more difficult.
If this is how your life is right now, you have more reasons than ever to share medical decisions with your doctor.
- You depend on your doctor to give you wise treatment advice.
- Just as much, your doctor depends on you to share what's most important to you.
- In reality, you are the person who decides how you lead your life and handle your health.
With your health and quality of life in mind, you can problem-solve and plan with your doctor. You can also do this with other health providers and with the caregiving person or people in your life.
What is best for you?
How do you want your health care to make your life better? For you, this could mean:
- Feeling better, or not feeling worse than you do now.
- Preventing a health problem from getting worse.
- Being in good enough health that you can plan on an important event a few months from now.
- Avoiding treatments or testing that make daily life more difficult.
- Avoiding treatments that may not help or that you don't want.
- Helping you get to the end of your life in comfort.
As a team, you and your doctor can decide what to treat and how to treat it. To start, you can think about questions like these:
- Have I reached the point where my doctor might relax my blood sugar control?
- What do I want my daily life to be like?
- What care is most likely to improve or protect the quality of my life now? What about in the months to come?
- What plans am I looking forward to in the next few months? How can my health care help me stay on track with these plans?
Your answers reflect what's most important to you right now. Remember them. And use them to guide your medical decision making with your doctor. Revisit your answers over time. They may change.
Other Works Consulted
- Kirkman M, et al. (2012). Diabetes in older adults. Diabetes Care, 35(12), 2650–2664. Available online: http://care.diabetesjournals.org/content/35/12/2650.full.
Current as of: December 20, 2019
Author: Healthwise Staff
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
David C.W. Lau MD, PhD, FRCPC - Endocrinology