Endocrine Abstracts

Introduction

The emergence of the concept of the expert patient has changed the paternalistic doctor–patient relationship. The ’knowing’ patient is an active actor, his level of knowledge acquired during therapeutic education programs (ETP), allows him a certain autonomy in the management of his pathology. We focus through a case report of ketoacidosis on the useless intervention of an ’expert’ patient to prevent it.

Case report

A 25-year-old patient, type 1 diabetic since the age of 6, having received in our departement as part of therapeutic education, a training in functional insulin therapy, which she stopped for lack of funds. She was admitted to the visceral surgery departement for surgical management of appendicitis. The postoperative course was marked on the second day by the installation of hyperglycemia at 3.3 g/l with ketosis. On biological assessment, natremia was 140 mg/l, kalaemia 4.3, alkaline reserves 12 meq/l, with good renal function and significantly improved creatinine reactive protein. We noted that the patient had been put by the healthcare team, only on rapid insulin boli since admission. In addition, she reports having unsuccessfully requested from caregivers to give her her basic insulin regimen for fear of falling into ketoacidosis. Our treatment consisted of introduction of the correction regimen and then, the return of her previous insulin regimen with good progress.

Discussion/conclusion

In the case of a chronic disease, in this case diabetes, the patient’s quality of life will be ’impacted’ by the therapeutic choice. In particular, compliance with this choice will be all the greater the more the patient has participated in the decision. By observing his body and his reactions to the disease, the patient-expert accumulates experiential knowledge (derived from knowledge of the disease in vivo) that can complement the physician’s clinical knowledge and guide its decisions. The behaviour of this patient-expert does not aim to question the legitimacy of the physician, since this legitimacy is institutionalized, but raises the question of the acceptability and credibility of this legitimacy.