The Hidden Obstacles Behind Uncontrolled Diabetes

Dr. Andrew Lancaster, an endocrinologist at CHRISTUS Health in Alamogordo, once cared for a patient whose blood sugar remained uncontrolled, even though they were taking insulin as prescribed.

Diabetes is often discussed in simple instructions: eat better, move more, take your medication. When blood sugar stays high, the explanation can sound just as simple.

Fortunately, Dr. Lancaster knows diabetes is more than just following a treatment plan. In many cases, work schedules, housing, transportation and food access shape the outcome as much as the plan.

Instead of assuming the patient was not following the treatment plan, Dr. Lancaster asked a different question: Tell me about where you live.

The patient lived in a trailer without reliable utilities. There was no refrigerator. Without a safe way to store insulin, the medication simply couldn’t work as intended.

Dr. Lancaster worked with community health workers, and a simple solution was put in place: a small refrigeration device to safely store insulin.

The treatment began to work.

Dr. Lancaster said the experience reinforced a lesson. Good diabetes care starts with curiosity and context, asking the right questions to uncover barriers that can derail a treatment plan.

It helps to kind of be in a small place and to know and to have a sense of what the real obstacles to health care are. We can bring people together and get some of those resources to the patient. Dr. Lancaster said.

Why Diabetes is Difficult to Manage

In southern New Mexico, managing diabetes can be especially challenging. Many people work sedentary jobs.

Healthy food can be expensive or limited. Fast food is easy to access. Extreme heat affects when people can safely exercise. Poverty and long-term stress also play a role.

On top of that, diabetes often has invisible symptoms.

People may feel fine for years, only discovering the damage once complications appear.

That’s what makes it dangerous. Dr. Lancaster said.

Small Steps Matter

When someone is diagnosed, Dr. Lancaster doesn’t ask people to change everything at once.

He encourages small, steady steps. One walk. One better choice. One habit at a time.

He also reminds patients to give themselves grace. A bad day doesn’t erase progress.

For Dr. Lancaster, the goal of diabetes care is stability.

I tell my patients my goal is for them to become boring patients. Boring means things are under control. he said.