Prioritizing Paul’s Fears

My neighbor Paul (not his real name) has type 2 diabetes and we often compare notes. He’s a bit of a hypochondriac, so when we discuss what going on with ourselves, certain of his fears emerge.

So far, I’ve just listened. If you listen long enough—and this applies to “listening” to your own numbers—a pattern merges. Paul’s pattern is one of generalized fear over almost every aspect of his disease. “Are my numbers too high?” “Too low?” “Why can’t I lose weight?” “What if I go to sleep with too low a number and die during the night?”

His fears are a jumble. Rather than try to talk him out of them, I’ve taken to telling him that one way he can relax a bit is not by denying his fears but by prioritizing them. Address the ones that scare him the most, let’s call it List A, and let the other ones drop down to a B and C list of fears.

At the same time, I insist that he understand how some of his fears are mitigated by some of the good news about his condition:

Good News: Paul is 69. He only recently began taking metformin and glimepiride after all his years with the disease. As a result, his body is especially receptive to both drugs. They are working on him the way they would with a much younger, drug-naïve type 2.

Bad News: The glimepiride was working so well that his post-breakfast numbers were dropping into the high 50s. His nighttime just-before-bed numbers were just above 100. The drug’s hyper-effectiveness put him into Big Worry mode.

Good News: Paul is a former computer software designer and consultant, which means he has a scientific frame of mind. I recommended that he experiment with taking half as much glimepiride as prescribed and noting the results. If his numbers were still worrisomely low, he could stop taking the drug entirely.

I told him, of course, to consult with his doctor beforehand before making unilateral adjustments to his doses. But I said his doctor would probably agree, based on the simple fact that Paul had gone years and years without glimepiride. So doing an experiment to learn the best dose was not going to threaten his health. (His doctor agreed.)

Bad News: Now Paul is fretting because he hasn’t lost any weight on his recently adopted routine of metformin, some glimepiride, watching his calories, and brisk morning walks.

Good News: I gently said this might be a concern he should demote to his B list. “Look, your numbers are wonderful—you’ve achieved what many doctors and endocrinologists would kill to have their diabetes patients reach, which is consistent numbers near or below 100. The drugs you’re taking are working well, and there’s a hidden blessing in that they are working so well.”

I’m not looking to cure Paul’s anxieties, just to plant the seeds of a different perspective about them. In the process, I’ve relearned a simple fact about type 2 diabetes: While the description of the disease is common to almost all of us who have it, each one of us has it differently.

Paul is late to the game in some respects, and it’s interesting to see how his treatment is unfolding. I wish I had his sensitivity to drugs that no longer work so well for me. But being able to see a friend doing well with diabetes goes on my A List of things I’m grateful for.