Sunday, May 6, 2007

New diagnosis

I don’t understand the treatment for Type 2. I don’t really know a lot about medications that are available. I read Diabetes Forecast and have stopped skipping through the Type 2 articles and actually reading them. I’ve tried to understand this “other diabetes” because many friends and acquaintances have that disease.

A woman that I work with at school was diagnosed with Type 2 about a month ago. Her doctor (at a major medical center in the twin cities) sent her home with a prescription for Metformin, directions for its use, and a scheduled appointment for diabetes education four weeks from that time. She filled the Metformin and started taking it. I asked if she was testing, and she said that the doctor said that she could wait until the education class.

The education class was last Thursday. This woman left work early to attend it.

She came back to work on Friday. I asked how the class was. She said that she couldn’t be in the class because she had to meet individually with her doctor. Apparently her blood sugar was high. They did a “1AC” (A1c) and it was 19.8. My jaw dropped.

19.8. OH… MY…GOSH! I didn’t know the test range went that high. Isn’t that a serious medical condition?!?!

I ask if they gave her any insulin. She said no, that the doctor had just told her to keep taking the Metformin, test her blood sugar twice a day, and come back for a follow up appointment in another month. What?!

I wish this were the only time that I had heard about that kind of plan for someone newly diagnosed with Type 2. But it wasn’t. I’ve heard stories like that more that once.

Why aren’t people with Type 2 treated aggressively? Why wouldn’t this woman be instructed to test more frequently, to figure out if the Metformin was enough? Where’s the meal planning information?

Diabetes is a challenging chronic illness. I am constantly out there researching what is new and possible for my management. I’m an informed member of my health care team.

I have friends that are not. They take the back seat in their diabetes management. When I suggest that they ask their doctor about new things, they are reluctant. Their control often reflects that.

Heck, I have a family practice doctor who is my "primary care physician." It's the rule to have a doctor to call that, and it can't be a specialist like my endocrinologist. I see her if I have an illness or injury. She has suggested, many times, that she just manage my diabetes. No way. Although I appreciate her willingness, I'm not settling for anyone but an endocrinologist who specializes in diabetes. I have friends that do see just a general practitioner for their Type 1. They are also often the ones who aren't aggressively managing their disease.

If health care providers aggressively helped manage people’s diabetes, would the rate of complications be so high? Is our health care team content with basic management?

It seems like people with Type 1 are diagnosed, and expected to make major life changes immediately. MDI, insulin pumps, carb counting, sick day management, ratios, etc are all started quickly. Why not with Type 2 diagnoses? Why is the management plan for Type 2 so gentle, so slow? First try and lose some weight, test a couple times a week, take a couple pills. Where’s the urgency?

Is it our society that has made Type 2 “not a big deal.”? Lose a little weight, exercise, and you will be healed. It seems so simple that I fear people don’t understand the seriousness and the complexity of diabetes. The woman I work with told her doctor that she “…didn’t want the needle.” I hope her doctor told her that diabetes isn’t really a disease where you can “choose” your treatment. Certainly your life choices will affect the level of intervention that is needed—whichever kind of diabetes you have.

I've certainly read other people's blogs who are living with Type 2, and they seem to be very educated about treatments, etc. Maybe I just know the people who aren't...

I hope that people with diabetes, despite which kind, get attentive medical care that gives them the chance at having a great quality of life.


Yesterday I got a hair cut. (as my students would say “you got lots of hairs cut.”) The woman called my name and walked me back to her station. She looked uncomfortable. She told me that she was afraid of dogs. I assured her that Dixie was well trained and had passed an exam that allowed her to be in public places without people having to worry about their safety. I don’t think that she bought it.

She was clearly nervous during the whole process. Dixie was perfect. She just lay on the floor with pieces of hair dropping on her. It’s awkward. It’s the first time anyone has ever said that to me.

It made for an uncomfortable 20 minutes.

(the photo of Dixie is from school. She had just alerted me - by jumping on the table and hitting me with her paws. It's her last behavior, when I've ignored all the other alerts.)


jill. said...

19.8!! Doesn't that correlate to an average blood sugar of almost 600?! I don't know too much about typical type 2 management, but not taking that high of a lab value seriously seems like a mistake to me. Ugh and meal planning is so important! I don't know why it isn't the first thing they teach to any new diagnosis.

cesnh said...

I agree, some people just get dropped into this with no support. It's awful.
Dixie is cool - it's the hairdresser's problem!

BetterCell said...

The irony is this.......Most of the $$, time, research, medical education, medical personnel, pharmaceuticals is geared to IRD(aka Type 2 Diabetes) rather than T1DM.
"Is it our society that has made Type 2 “not a big deal.”? Lose a little weight, exercise, and you will be healed."
I do not think that our society has made Type 2 not a big deal. However, it is the patient themselves who will not exercise and lose "A Lot Of Weight" that is the problem.
On the other-hand I have had lousy Physicians and other Healthcare Personnel be they Primary care Doctors or Endocrinologists. Because someone wears a white lab coat, it does not guarantee intelligence, awareness, capability or professionalism. You are your own best Medical Advocate, or should be.

Major Bedhead said...

Good grief! 19.8 - she should have been hospitalized. How is she functioning?

Most GPs don't know much about diabetes and they're not pushy with their patients because they don't understand the seriousness of the disease themselves. Some of them think that they're doing their patients a good turn by not pushing them into drastic lifestyle changes. But that push is what people need. You wouldn't get told to come back in a month if you had a tumour - you'd be seen right away and things would happen and you'd adapt. Type 2 should be handled the same way. As far as I'm concerned, it should be handled the same way that type 1 is handled - with urgency and aggressive treatment.

Lili said...

I am shocked at that story, but not very surprised. I've been on both sides of this. Since I became diabetic at 27, I was told I must be a Type 2. Because I caught it early (nothing over 270 mg/dl), I was sent home with nothing, not even a prescription for metformin. I insisted on seeing an endo, but even he told me I was too worried about nothing (diabetes is "nothing?"), that I shouldn't be testing my blood sugar, and who wouldn't give me *any* medication. If metformin isn't for people whose bg is in that range, who is it for? In my opinion, people whose bg is much higher should start first on insulin until they bring it down. Studies have shown this approach to be really successful (as in, the person doesn't walk around with high bg all the time). Metformin takes two weeks to even start working, and some people don't even fill the scrip, since they got NO education. Doctors don't tell them that they'll feel "low" when their numbers are normal at first, so people will eat to treat the "low" and end up being too high all the time. I could go on for hours about this!

Minnesota Nice said...

I don't see how someone could survive with an AlC that high?.......So many snags in the healthcare system. And, so tempting to turn the responsibility over to someone else rather than ourselves.

Gosh, Dixie looks sort of wiped out, or in a trance - I just love the way her paw is hanging over the edge of the table.

Molly said...

I agree with everyone above. 19.8 seems horribly high. I can tell you the woman is working, and says she is feeling better.
MN Nice, that photo was taken last Friday. Dixie is always so tired by Friday after working the whole week at school. She seems to be saying "o.k., I did my job, now just let me rest. I'm so tired I can't get off the table!" :-)

Krystal said...

Molly, it also seems to me that Type II are pushed aside when it comes to insulin therapy, diabetes education, etc. I personally tell people in my diabetic circle, even the II's, the importance of self-care and the responsibility that each person owes to themselves to make sure that their health care team (diabetes-related or not) is the best they can receive.

Then, I tell them to "CHECK YOUR COUNT". I think that if many people knew what their count was regularly, they would find a different doctor --and pass out a lot less.

I as much time as possible reading medical journals, diabetes blogs, books, studies, whatever I can get my hands on. Most of the information that I find in your common diabetes magazine, brochure, doctor's office waiting area, whatever, seems to be written for an audience that the publisher assumes cannot think for themselves (large cartoonish pictures, simple wording, minimal references, no research, just what has been out for the last 30 years plus a few pricey drugs advertisements). Sure, there are a few who do not want to be bothered by diabetes information, but having updated information widely available - might make a big difference - to a population who should still choose their medical care for themselves. and I quote a Deaf type I diabetic "...individual - individual - individual..."