Non-Compliance with Diabetes

Are you wrestling or dancing with your patients?

Written by Michelle Archer, RD, CDE

As a Certified Diabetes Educator who supports health care professionals to help people Live Well with Diabetes, I cringe when I hear or read the phrase “the patient is non-compliant”.  At times I hear medical office staff use the phrase ‘non-compliant’, less often do my colleague’s comment in this way.  I personally don’t cringe at the thought of working with any individual regardless of their struggles.  I don’t cringe because the patient has not met the outlined treatment goals nor because “non-compliant” patients are particularly difficult to work with. Nor do I struggle because of the belief that patients living with diabetes lack motivation or personal drive to succeed. To the contrary!  I cringe that so many others including the office staff, health care providers, or family supports are placing such a harsh judgement on the person living with diabetes often without ever actually experiencing or reflecting on the day-to-day burden, stress and daily challenges of living with diabetes.

You see, living with diabetes is HARD.  It’s like wearing a backpack of burden you wouldn’t wish on anyone you care about.  Diabetes may seem easy enough to manage: just eat right and exercise every day and you’ll be fine, but it’s so much more than that.  Diabetes is a strong source of feelings and frustration both for the person living with diabetes and also for those who love and care about them. 

People living with diabetes are constantly reflecting on their daily choices – some of which they have no control over.  If you live with type 1 diabetes, your daily life is not unlike walking across the Grand Canyon on a tightrope: each move you make can have serious consequences.  Too much insulin? Possible hypoglycemia and the need for an emergency room visit.  Miss your insulin dose too many times due to many factors that can go wrong with injections and you can end up in DKA and at the emergency room.  Want to socialize with your friends over food?  You’d better be accurate in estimating the carbohydrate amount of the meal but also be accurate in how fast or slow your body absorbs those carbs.  You need your mealtime insulin to peak at just the right time to keep your blood sugars in target or you’ll be dealing with the effects of your blood sugar being too high or too low for several hours after.  Managing Type 1 diabetes is like walking on a virtual tightrope every day. 

Living with Type 2 diabetes is more like having a 4-lane highway across the Grand Canyon, where you have more options and choices for managing your diabetes and your day-to-day life is not usually filled with life-or-death decisions.  While there are many decisions that you must make when you live with type 2 diabetes, often those decisions come under the watch of those who love and care about you.  Do you eat cake on your birthday or on anyone’s birthday or do you get the fruit plate?  Do you eat a balanced diet filled with healthy foods like fruit or limit fruits because they contain sugar?  Do you exercise before or after eating, morning or evening?  Do you eat before you exercise to avoid low blood sugar?  What should you do if you have low blood sugars overnight and high blood sugars during the day?  Often there are a lot of questions and for most people living with diabetes, there are no books with all the answers.  Google has answers but are they the right answer for this situation or this person living with diabetes?  Diabetes is a significant burden filled with challenges unique to each person living with the condition.  What works for your neighbour or your parent may not work for you.  Their medicines may be very different than yours.  Their lifestyle is likely different than yours.  Even their overall health may be different than yours which can lead to needing very different approaches to diabetes management.

What exactly can we do as health care professionals when we see or hear that a person living with diabetes is ‘non-compliant’?  What do we do when our role is to help and support people to live a healthy life? 

The answer couldn’t be more clear!!   When you hear others or yourself thinking or saying that a patient is non-compliant, turn that judgement around and reflect on your role in the relationship.  Whose goals are being set and not met: yours, the doctors, or the patients?  Who decided if the person with diabetes is compliant or noncompliant?  Consider that as the support person in the circle of care in diabetes, are you ‘dancing’ or ‘wrestling’ with the person living with diabetes?  Are you deciding what is best for them and ‘wrestling’ with them to meet that goal?  Or are you dancing with that person, a process of give and take, leading and following, and asking them what are the next steps for them in their life? 

Once you work through the process of letting go your need for control and your need for compliance and meeting targets, you can move on to a place where you support people in setting and working towards THEIR goals.  You will find yourself in a better place emotionally as their support person.  You will move away from the headspace of noncompliance and frustration and into a mindset where you are happy to see even the most challenged patients because they need you and you can help them!  You are now a health coach and cheerleader for your patients.  You are another one of their supportive teammates.  And that is what people living with diabetes need: more support and less pressure and judgement.  You’ve got this!


Do you have experience with noncompliance in diabetes?  Leave a comment below or join us in our Diabetes Training 101 Inc Community of Learning on Facebook.  It’s free and a safe place to discuss all things diabetes.

Want to learn more about how to support people living with diabetes and move away from wrestling with your patients and the ongoing frustration with noncompliance??  We have an online Diabetes Management training program for Canadian Health Care Professionals called the Diabetes Manager University (DMU) that can support you in working more effectively with your patients.  It is a self-study, self-paced program with ongoing support so you can learn as your busy schedule allows.  Click here for more information on DMU program.

Or sign up for our FREE Diabetes Manager University Mini-course. 

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