Physician's need to become more educated when it comes to treatments. Not always injections work, specially if you are a student,working or traveling. I noticed that many phycisian's are not open minded about pumps,or any other available possibilities out there. Education is key to continuing your care for your patients. Learning and showing interest in expandin beyond the vial and syringe is important for patients. Learning about pump and calculating basal and adjustments should be learned by primary physicians. Not bump patient to an endo who knows nothing about patient and treatments done previously. communication is key to success of patients with type 1 or 2. Many physician's don't communicate with one another and contraindicate patients care and medications. Educate your phycisian.
I hate to be combative but the author's comments seem to apply to the whole type 2 diabetes treatments and mentality. Rather than a dynamic learning industry that is watching and learning all aspects of types 2, looking for oppotunites to encorporate new approaches and ideas to stop the rot; it seems trapped in the past hanging onto outdated dogma and past thinking while the number of cases explode world wide.
I don't want to seem combative, but when you deal with a faulty medical system that allows those who need it to fall through the cracks because of not having any knowledge of diabetes it upsets me. Care should be equally the same for both types, yes there is a difference between the two, but the care should be the same. In my family we are 3 diabetics and deal with this daiy and it's not easy, if we stick together and inform ourselves the care will be adequetly different. There are so many ways of treating this horrible desease, they are all stuck in their antique ways and treatments that they don't give a chance for patients to excell and get full control. Like I said education is key and doctors being educated is not such a bad thing. Maybe that way there can finally be a cure or other applicable treatments permisable for all of us. If we educate, we can make a change in the way the medical proffecion sees type 2 diabetics.
I think that T2 is more complex than T1 so I dunno if it's entirely appropriate to treat them the same way. Brian posted a guys name that reminded me of having seen his article before and it goes into a lot of detail that explains, from the "science" perspective, why T2 is so challenging to treat. Link to article
Part of the problem for T2 is that, compared to "traditional T1" (not considering variants like LADA/MODY/etc.), the onset can be very slow, without the massive weight loss, peeing, blurry vision, etc. that I and many of my "colleagues" had w/ T1. T2 seems, in many of the case histories people report through Tu, to manifest itself more slowly. This combines with a societal aversion to blood testing and the sort of conservative approach "follow up in 6 months..." after a sort of elevated fasting BG,see what it is again, then maybe a glucose tolerant test, all the while someone may be exposed to the potential for damage through elevated BG after subjecting a system straining under some of the 8 potential system problems noted in Dr. DeFronzo's article.
It seems to me traditionally a lot of type 2's are not aggressively managed until major problems start occurring, then the PCP wants to shove them off on some endo to figure out. My personal advice, any time you are dealing with a complex problem, skip the PCP and go to the specialist. Most of the PCP's here wont even touch diabetes management, its an automatic referral to an endo,
It all deppends on your level of diagnosis, I was diagnosed in 1996 and have been dealing with it ever since. All states are different on the handling of care, I came from Conn. And there they advocated for patients. Here in Florida it's known as the " FAT PEOPLE DESEASE " weight is an important part of treatment and healthy eating and exercise. But what happens when you are beyond all that, No one is understanding what i'm saying, if the medical proffecion cared more for their patients there would not be complications with diabetes. Everyone understands type 1 and type 2. Been dealing with it for over 2 decades. And everyday I learn something new, be open minded and ask questions.
I hear you. I have had a disturbing number of doctors just tell me that my diabetes is my fault. If I just didn't eat like a pig, I could lose weight and I wouldn't have diabetes. OMG. Do they have any clue? I have diabetes because I was dealt a terrible set of cards. Diet and exercise could only go so far. I tried all the medications. I did my job, but when it came to my medical team, I often felt let down. Today, I have moved to insulin. I have gotten much better control. But I am left with a real sense of disappointment at how I have been treated. I am sorry you have had to deal with this as well.
I have had my share of disagreements with primary care physicians but I feel a need defend them a little here. As a 20 year veteran of the Type 2 wars I realize how much that patients have affected the way they operate.
Many patients resist everything they try to do for them. They resist diet recommendations, they resist exercise recommendations and they resist with every fiber of their being when insulin is even mentioned. No wonder a PCP is ready to ship us off to an endo when they can no longer manage us. I think they are just traveling the path of least resistance.
Another point I would like to make is that it's not just doctors determining the course that this ship is taking. Insurance companies and good ole Uncle Sam have their hand on the wheel also. Currently it is very difficult for a T2 to get approval for a pump from Medicare and a lot of insurance companies take their queue from Medicare. I think a lot of this has to do with stigma of Type 2. Many feel that T2 is not as serious a disease as T1 and besides those overweight T2's could help themselves if they would only lose some weight. I believe this because I was one those resistant Type 2's
Our medical system was designed as a two tiered system where the PCP takes you so far and then refers you to a specialist. PCP's are suppose to be gate keepers, to treat the common and then pass the difficult on to those with special training. The PCP is suppose to have a good comprehension of a lot of things and the specialist should have extreme knowledge of a few things.
OK.. I'll get off my soapbox now.
Stay on your soapbox! Stemwinder makes a key point. Very few, if any, of the docs we see are doing "research". They are, to a large degree, "spam in a can" clockpunchers who are closely monitored. They have to feud with insurers who "follow government guidelines" no matter how inappropriate they are. The guidelines and standards overlaying the dialogue about how to take care of us are woefully inadequate and date back to the more primitive eras (what, 20-30 years ago?) at the dawn of the test strip era when, compared to zero blood sugar tests ever, 4/ day may have seemed luxurious. Now, many people get strips, if we fight for them, and many people don't because they believe the line their doc and insurance company feeds them. Fixing the standards to come up with a more modern and flexible approach to supply availability and goal setting offers a "great leap forward" ( 大躍進!) using management of current technologies and communication approaches, plus maybe Gila monster venom, to come up with a new strategy that will achieve better results across the board.
Its not just the Docs, but the "approved cures" and legal rigamarole as well as the in fighting in the research arena and some of the dogma that is strained from all of that.
Given the stone henge tools and lack of better 24/7 analysis packs that could capture a few 24/7 days of a body at work,sleep,play etc and then have the computers of the starship Enterprise analyze and summarize for doc - maybe we could really arrest this monster down. Its amazing what the docs are doing fighting such odds. We are starting to see tool kits of hormones but here again, science finds one and that becomes the next holy - grail - NOT. But does provide opportunity to fix low running hormones and tune the plant back to working properly.
From where I sit after 40 years designing, debugging and fixing complex micropeocessor based control systems, I would barely have been able to do my job if all I had was an old analog one or two channel oscilloscope ( read caveman - fingerprick machine)to analyze the internals. To me; present debugging tools for diabetes have all the capability, flair, efficiency and data capturing of wind soxes and wet fingers raised in the air. Far be it for me to criticize the ingenuity of our brighter members but exploding numbers in type 2 and lack of agreement how human body actually work suggest we are missing something.
It has always (for my entire 12 years of being a T2) been my approach, that this is my disease and I am the leader of a team of people who "work" for me. Thus when they join my medical team, or when I ask them to be a part of my team, they need to be sure of their knowledge in their area of diabetes. Docs only get the equivalent of a month of education on this disease....unless they are majoring in it. So if my doc wants to be on the team, he/she better bone up on what's the latest and most successful treatment for diabetics. Along with that, he/she better be ready to ask questions and do some research on things, not just the newest and latest drugs brought in by drug reps. My nutritionist, trainer, nurse, lab people, etc whomever I put on the team must be ready to do the same things. It is my health, my life, it is only their job. Since we are all different in our "D" treats us, our treatment isn't a one size fits all treatment. We have to be proactive on our own treatment....and not be afraid to find those people who will work with us, not just giving us 30 seconds of their time,