What kind of care should people expect after being diagnosed at a clinic, urgent care or emergency room?
During the diabetic screening, I heard several stories where people had gone to one a medical facility were told they could be Pre-diabetic or diabetic. They were "patched up" given a prescription and left without any long term care plans. Of course I think this is horrible and grossing under serving the community. I counseled the these people and told they need be under the care of an Endocrinologist to get a proper diagnosis.
This just made me think shouldn't the public expect more from our medical facilities? If they were given an HIV/AID dx'd would they have offered all kinds of counseling and resources? I can under stand their position but I also think they can deliver information about community resources for diabetics. I would have loved to have the information about the several diabetic clinics they have here in Los Angeles. I eventually dumped my internist for a Diabetic Clinic that gave me better care.
Am I wrong for thinking this way?
Do you think that one reason people aren't fully diagnosed--that their diabetes isn't named and written down on their charts--is that the diagnosis is a death-knell to getting health insurance and life insurance? I understand that in 2014 Americans will no longer be prevented from having health insurance because of pre-existing and/or chronic health problems, but that seems inadequate to this Canadian!
Good point. I can't get health or life easily because I was diagnosed T2 at 34. I can get life through employer group. Health I can get for a large amount of money through Oregon's high risk pool. Sad thing is, I'm probably healthier than many people who are getting insurance.
Unfortunately it's a familiar story, isn't it? I was started on Lantus by a primary and the endo stepped it up and added Novolog, but neither said anything about how to recognize or treat a hypo. Fortunately I'd read about it on the internet because my first full day on the Novo resulted in my first low. My first CDE said I could use 1:15 for my carb ratio (I needed 1:8) without looking at any logs.
I know I'm fortunate to have insurance and decent doctors, I really do, but it is hard to put it all together. There's so much to learn, the doctors don't seem to have time to provide enough information and the CDE seems more geared to basic nutrition and checklists while I want practical information on managing the insulin and BGs.
At this point I certainly wouldn't trust anybody else to manage this disease for me - there are way too many variables every day. But I'd think everybody needs a knowledgeable partner - whether CDE or doc - to be as successful as possible.
Christalyn, Jean and Randy, I agree with you all. It boggles my mind to think of the great numbers of people who are being diagnosed with diabetes right now and who are not getting the kind of support and information they need to make a positive difference in their lives. A personal "sponsor" or guide in the learning process would be worth their weight in gold!
I also think that the medical community should be forced to come to terms with the truths and realities of diabetes. I love my endocrinologist. He's fantastic. I'm very, very fortunate to have found him right at the beginning. But the CDE and the dietician I was referred to seem not to know about the value of a low-carb way of eating. Both of them have told me that my diet isn't balanced; that I won't be able to achieve good results; that the good results I'd achieved in the first six weeks may have been accidental; that my then 30-lb. weight loss wasn't healthy because I'd done it by eating 20-30 grams of carb per day (neither of them expressed any approval of my weight loss even though I did need to lose those pounds!); that no one can sustain a low-carb diet indefinitely because people get bored, feel deprived and find they simply have to binge on huge amounts of high-sugar, processed foods in order to feel happy; and that no matter what I had done or was doing, I had to accept that I probably had serious cardio-vascular disease because all diabetics do.
If I had paid attention to the CDE and dietician, I may very well have simply regained the weight I lost and my average BG might have returned to around 18.1 mmol/L where it was when I was diagnosed. My endocrinologist, however, told me that he was thrilled with my progress and to keep on doing what I was doing. And so I've lost about 45 pounds and my average BG these days is about 5.6 mmol/L (101). I feel great. I look good. I'm not suffering. I do let myself indulge in a treat occasionally. My health is terrific. I'm quite certain that if I had accepted the 150-200g carbohydrate/day diet the dietician recommended, I would have gained a lot of weight and my BG would be in the upper stratosphere.
Food is about culture, history, family and memories. It relates to our mental and emotional well-being as well as to the relationships with have with friends and family members. Not everyone even has complete control over what is presented to them at meals. Eating a healthy low-carb diet is more expensive than eating more carbs, too. But there are ways to address all of these considerations, and many more, and be healthy.
Low-carbing doesn't work for everyone. That's just fine. We should each do what works best for us. If that means counting calories and limiting saturated fat, go for it! If it means eating six small meals throughout the day, do it! Everyone should be encouraged to take care of themselves in the best possible ways and no success should be denigrated.
I also think that pre-judging people with diabetes, making blanket assumptions about us and gearing health care options accordingly, is simply unethical. I met a dietician at a social gathering recently who told me that, while she understood that a very low carbohydrate diet could be healthy and effective, she never advised anyone to try it because she knew that, at mid-life, few people are capable of making major, lasting changes. This kind of grand generalization, however, denies vital information that diabetics need to have, such as that keeping blood glucose levels within a normal range will prevent complications like blindness, kidney disease, circulatory disorders and amputations.
Soooo agree Alan!
Exactly, Alan!!! These people sound like the chain-smoking doctors of the 1940's denying the connection between smoking and lung cancer. Hello?
Carbs elevate the blood glucose of diabetics. Maybe we shouldn't be indulging in mountains of them, especially if we're so insulin resistant that we have to inject gallons of insulin to cover them?!?
Oh, absolutely! What will most people do when given a choice between keeping their feet and eating 60-90 grams of carb per meal?
I do wonder, too, whether a lot of this disinformation is attributable to discrimination against middle-aged and elderly people and against people who are overweight or obese. In other words, people who simply may not be considered to be as useful, valuable or attractive as our society prefers?
I'm cynical and bitter... time to take the dog for a walk and feel better!
Amen to that sir. I was diagnosed as a TypeI 13 months ago at 24 years old with no family history. I went from eating fast food 4-5 times per week, to only twice since I was diagnosed. My triglycerides went from 300+ to low 50s, 134 overall cholesterol with 75HDL as of 4 weeks ago. A1C of 5.8%.
Alan is right, our health is our hands. It's the blessing in disguise I have found with our disease. I wish every day of my life I could cure this, but I also take life by the horns and have made improvements that would have never been made had I not been diagnosed. A applaud all of you who do the same.
Thanks Ann. You experience sounds a lot like mine. I have a great GP (no endo) who is very helpful and supportive. I made exactly one visit to the CDE and was disgusted by the direction she gave me. Frankly, it scared me. If this was the advice I could expect from a trained professional, how on earth was I supposed to learn what to do?
The assumption that people of ANY age are incapable of major life changes is maddening as well. Although I do understand that it can be generally true for a lot of people, age really has little to do with it. Most people are resistant to change under any circumstance. I saw this in the first couple visits with my GP, but in fairness he did not know me. My first visit with him was the physical that diagnosed my D.
I think that a peer support system would go a long way towards improving overall D care and success. We all know how scary, emotional and overwhelming this diagnoses can be. Having some one to act as a compass and cheerleader that will be there regardless of insurance, would have meant the world to me.
I had an interesting & disheartening exchange with a CDE member here some time ago. Like the woman you spoke with, she admitted that lowering carbs was essential & her justification for not recommending it was the same. She claimed people wouldn't/couldn't, it would simply frustrate them & she wanted patients to feel good about their efforts. Huh? Are people with hypertension told to eat as much salt as they want?
Appalling that this level of gate-keeping is a constant. Truly enrages me to encounter anything this disrespectful, condescending & patriarchal. Give people options & allow them to decide. Don't only present one way as The Way. Medical professionals aren't parents & we're not children. Agree it's unethical.
This issue goes deep, of course. I mentioned this on another thread, but worth repeating here. CDE's & RN's (registered dietitians) are kept adhering to the party line by their professional organizations who don't tolerate deviation. A
CDE RN friend told me of a colleague who was persecuted for writing an article that butter is healthier than margarine. Her article was researched & sources cited. She was vilified & threatened with having her license revoked! No license would have ended her career, or severely limited her job options.
"few people are capable of making major, lasting changes" Probably true Margret Mead said “It is easier to change a man's religion than to change his diet.” But there are more than a few people around here that have done it. I cut carbs drastically at the age of 59, cold turkey. I'm 62 now and have no plans to change because my diabetes is not going to go away and I want to make full use of the years I have left.
To deny patients this information is unethical IMHO.What they do with it is their business. We are bombarded with information about a heart healthy diet, why not a diabetes friendly diet sans the "health whole grains" and other carbs that are slowly killing so many people whose metabolisms can no longer process them properly.
Hey Christalyn. Have you heard of the Strong on Insulin Group (SOIG)? They have monthly meetings for Type I diabetics exclusively, They are held in Westwood at UCLA. I learned about it from my Endo Dr. Drexler and my DE who is also a type I. I'm going to my first one next Thursday, Let me know if you would like more information. I think you could get a lot of your questions answered. The "special topic" is artificial pancreas.