Dr. Margo S. Hudson is a board-certified endocrinologist. She is also board certified in Internal Medicine. Hudson graduated from Tufts University School of Medicine (Boston, MA) in 1979 and completed post-graduate training at Michael Reese Hospital (Chicago, IL), University Hospital (Newark, NJ) and the Joslin Diabetes Center (Boston, MA). She is currently on the Endocrinology teaching faculty of the Brigham and Women's Hospital (Boston). and is a member of several professional societies. Recently she presented research on the Accuracy of Real-Time Glucose Monitoring In Post-Operative Cardiac Surgery Patients with Diabetes. Among other endeavors, Dr. Hudson also participated in Louisiana's disaster recovery following Hurricane Gustav (2008).
Diabetes1: What types of questions do most of your patients ask and how do you answer them?
Dr. Hudson: New patients want to know what is going to happen to them, and whether they will have any serious complications or not. While we really can’t predict what will happen to them, we are doing a much better job to increase their chances of not developing any problems. Patients who have had diabetes for a while want to know if there is any new treatment that will make their lives easier. This is especially true of those on insulin or oral medication. If there is something new, I tell them about it, whether it’s a new type of insulin, meter, pump, glucose sensor, oral agent, or just a new approach.
Diabetes1: Do you encourage self-responsibility?
Dr. Hudson: Clearly the most important person in the whole management of this illness is the patient. They play the biggest role in management so it is kind of a fine line between empowering them to take care of themselves and blaming them if something happens. Some patients do better than others. Some people can manage this disease better than others, and I don’t want to blame patients if they don’t have good outcomes. It’s very hard to say this will happen or this won’t happen or you can control things or you can prevent things. I think that they can play a major role and I think we understand a lot more about what contributes to all the various problems.
Diabetes1: As for empowerment, other than handing them the standard glucose monitor or dietary information, do you recommend that patients try to find other tools such as books, websites, etc.?
Dr. Hudson: Absolutely. There is a huge range of patients who are able to go and seek out information on their own and bring it to me. There are also patients who are unable to read or who are overwhelmed by other issues such as drug or alcohol addiction or other medical problems; that they are just not really able to focus enough. There is a whole spectrum of patients with diabetes with social and education problems that would make them rely on me.
Diabetes1: Do you have an opinion on weighing food and carb counting?
Dr. Hudson: You want consistency. To do that you have to know what is in what you’re eating, unless you eat the same thing every day. You have to adjust what you eat to your medication or your medication to what you eat. Or adjust your activity. Unless you eat the exact same breakfast, lunch and dinner and you do the same activity every day and you have the same level of stress every day you’re always making adjustments. So the more knowledge people have, the more people can use the knowledge, and the better off they’ll be. Not everybody can successfully incorporate such knowledge into something useful in terms of food choice and adjustment of activity levels for the medication they are taking.
Diabetes1: Do you find patients saying things like: I ate the same thing as yesterday but today I was 400, yesterday I was 120. What happened?
Dr. Hudson: You have to try and have people understand all the factors that go into the final blood sugar. What is it that contributes to the blood sugar of x at this point? I think most people can understand the basic factors.
Diabetes1: Do you find that people experience information overload?
Dr. Hudson: They can either embrace it or they are overwhelmed. There are patients who feel the more knowledge the better and who are very scientific about it. They want to know fat and carb content. Then, there are some people who don’t welcome that into their life.
Diabetes1: Do you advocate to your patients to keep a log?
Dr. Hudson: It depends on what the patient is doing and what I’m going to do with the information. There are patients with A1cs in a good range without hypoglycemia and who are on a stable oral agent – metformin. If they record their blood sugar once a week to make sure they are not having significant highs, they do not need to write down any more information. It’s not necessary to write down everything they eat and what their blood sugars are because they aren’t going to get hypoglycemia. If everything else is fine and their A1c is normal, it doesn’t matter too much.
Diabetes1: If a patient is overweight, do you recommend that they keep a log to keep track of what they eat?
Dr. Hudson: I have people keep food diaries. But, if keeping a food diary for a long period of time were successful, everybody would be keeping a food diary. At some level it breaks down.
Diabetes1: What is the difference between those who bring you blood sugars to analyze, and those who don’t?
Dr. Hudson: People who bring me their blood sugars usually need me to try to recognize patterns that they don’t recognize. Not everybody can look at their blood sugars and recognize that they are always high in the afternoon or they’re higher in the morning and they’re low in the afternoon. Sometimes, I can recognize a pattern and have them make an adjustment. For some patients, however, there isn’t a recognizable pattern because there is probably some other factor that they aren’t sharing. Sometimes a three day Continuous Glucose Monitor System (CGMS) reading can really be revealing. About half the time it will reveal something we do not know.
Diabetes1: What other new approaches are you taking?
Dr. Hudson: Especially for type 2s, from a cardiovascular standpoint, if you’re going to put your efforts into something, you want to make sure their blood pressure and lipids are good and then you can work on the blood sugar.