For diabetic patients, stress can present a long-term threat.
It would be difficult to imagine a scenario where stress is a good thing. However, it can have a particularly negative impact on people who have diabetes. November is American Diabetes Month ® – an opportunity for sales reps to initiate a discussion with their physician customers about the challenges their diabetic patients face and the solutions available to address those challenges.
A heavy toll
There is no shortage of stress in life: Health, physical injury, finances, work (or lack of it) and relationships can all play a role. When stress occurs, the body tends to respond with a fight-or-flight action, according to the American Diabetes Association (ADA) website. Levels of hormones increase, causing the body to store additional energy (in the way of glucose and fat) for the cells. The cells, in turn, do their part to protect the body from danger.
In people who have diabetes, however, the fight-or-flight response does not work well, notes the ADA. Their insulin is not always able to allow extra energy into the body’s cells, leading to an overload of glucose in their blood. Furthermore, if they are distracted, they may forget to check their glucose levels as often as they should. In people with type 2 diabetes, both mental and physical stress can raise blood glucose levels. Particularly, during long-lasting stressful situations, diabetics are at risk for long-term elevated blood glucose levels.
A healthy response
Since stress blocks the body from releasing insulin in people with type 2 diabetes, reducing stress in one’s life can be helpful. (People with type 1 diabetes don’t make insulin, so stress reduction won’t have the same effect on them.)
There are several ways to fight stress, such as exercise, dance, volunteering or taking up a new hobby. Sometimes a small change, such as taking a less hectic route to work, can help one reduce stress. Other times, it requires a major change, such as applying for a job transfer or moving to a different part of the country. In addition, the ADA recommends the following:
- Breathing exercises. Take deep breaths in and relax your muscles as you breathe out. Breathing exercises should be done at least once a day for 15 or 20 minutes.
- Progressive relaxation therapy. Tense the muscles, then relax them.
- Circling, stretching and shaking parts of the body – particularly to music – can be therapeutic.
- Positive thoughts. When negative thoughts arise, replace them with happy or proud thoughts. Sometimes a memorized poem, prayer or quote can be used to replace a negative thought.
Living with diabetes – taking medication, checking blood glucose levels regularly and sticking to an appropriate diet – can be stressful in itself. But, compounded by daily or unexpected events, stress levels for people with diabetes can be that much higher. Sales reps can provide a value-added service to their physician customers by reminding them to touch base regularly with their diabetic patients to determine how well they are coping with stress in their lives.
Hemoglobin A1c testing
A discussion about diabetes is not complete without ensuring physician customers are equipped with A1c tests. While blood glucose tests enable patients to monitor their daily blood glucose levels, they need an A1c test for a broader picture of how well their diabetes treatment plan is working. Also referred to as a glycated hemoglobin or HbA1, the A1c test provides an overview of the patient’s average blood glucose control for the past two or three months.
Diabetics should have their A1c levels measured when their diabetes is first diagnosed, and at least twice a year, according to the American Diabetes Association. But, in many cases, levels should be measured every three months, particularly when patients begin a new medication or fall short of blood glucose goals.
Hemoglobin, which is found inside red blood cells, carries oxygen from the lungs to all of the cells in the body. As with all proteins, hemoglobin links up with sugars, such as glucose. Patients with uncontrolled diabetes have too much sugar in their bloodstream. The extra glucose enters the red blood cells and links up – or glycates – with molecules of hemoglobin. As excess glucose builds up in the bloodstream, more hemoglobin is glycated. Diabetic patients on medication may find that one week their blood sugar levels are too high, and the next week they return to normal. But, the red blood cells carry a “memory” of the first week’s high blood glucose in the form of extra A1c, according to the American Diabetes Association.
As old blood cells in the body die and new ones with fresh hemoglobin replace them, the record of A1c levels changes. The amount of A1c in the blood reflects blood sugar control for the last 120 days, or the lifespan of the red blood cells. Compared with a non-diabetic patient who has approximately 5 percent of all hemoglobin glycated, a diabetic whose blood glucose levels have been out of control for a long time may have levels as high as 25 percent, according to the American Diabetes Association.
Selling hemoglobin A1c tests
Distributor reps should ask potential physician customers how they presently are getting A1c results for patients. Some follow-up questions should include the following:
- “Doctor, have you done any in-office A1c POC testing in the past, or are you considering doing so?”
- “What do you find effective about the way you currently do A1c testing?”
- “What, if anything, would you change about the way you do A1c testing?”
In spite of the quick results using the A1c POC test, some physicians still prefer to send their tests to a lab. Distributor reps should remind customers that rapid test results create an opportunity to provide patients with immediate treatment decisions in the office, as well as educate and counsel them to better manage their disease. There are no follow-up calls to a lab to track down results, no phone-tag trying to connect with patients and no need to schedule follow-up office appointments.
Know your customer
Physicians who may be interested in A1c testing include:
- Pediatricians
- Internists
- General and family practitioners
- Cardiologists
- Endocrinologists