January 16, 2008

You have a touch of cancer. . .

How would you feel if your doctor said:

1. "You have a touch of breast cancer. We'll keep an eye on it. Come see me in six months."

2. "You're only smoking one pack a day? That's fine."

3. "My scale says you weigh 200 lbs, but there's a 20% margin of error in the scale so you might weigh 180 or 220 lbs. It's not a big deal.

These sound bizarre and no doctor would say such a thing. Unless they were talking about Type 2 diabetes.

How many of you have heard:

1. "Your blood sugar's a bit high. We'll keep an eye on it. Come see me in six months."

Though diabetes is every bit as fatal and maiming as cancer, doctors have no understanding that as, with cancer, early diagnosis and aggressive treatment can prevent death and disfiguration.

A recent article in a family practice journal reported that most family doctors don't begin any drug treatment at all for patients diagnosed with diabetes until they have had an A1c over 8% for at least a year. That year is one in which nerve and beta cells die, retinal cells proliferate, glomeruli clog with protein, and the incidence--not risk, but incidence--of heart attacks is three to five times higher than normal.

2. "Your A1c is 7.3%. That's good control. Keep doing what you're doing."

Studies of "tight control" where tight control was defined as an A1c of 7% or less found that people with diabetes had fewer complications than those with A1cs even higher, but the incidence of complications at this A1c level was still extremely high. There was less blindness, but still a lot of blindness. And the heart attack risk at that level as mentioned above is many times that of normal.

Why do doctors continue to tell people to shoot for blood sugar levels we know cause significant death and disability? They don't tell people to keep smoking, but just smoke less. Doctors need to tell their patients the truth that only a normal A1c is safe and that with effort they can attain those normal A1c levels.

3. "The margin of error that we allow on your blood sugar meter may be up to 20%." That's customer service speaking. And if that means that you can't tell whether your blood sugar is 80 mg/dl, 60 or 100, well who cares.

On my recent trip to the hospital the nurse's hospital-issued blood sugar meter read 79 when mine read near 110. Mine turned out to be accurate, when compared to the lab's blood draw. The nurse admitted the meter was more than 5 years old but did not think this was a problem.

And did I mention we are paying $1 a pop for the test strips for meters that guarantee that kind of "accuracy?"

Isn't it time to do something about the Epidemic of Poor Medical Care?

4 comments:

Anne said...

I am one of those who have been told to ignore my slightly abnormal GTT's for years. At 2 hours my BG was only about 190. It had to hit 200 before the doctor would be concerned.

I can't believe that I listened to the doctors. I have told people many times to get copies of all tests because when the doctor says "Good", (s)he really means "your test results were not abnormal enough for me to worry about." I got the copies of my lab, but did not do enough invesitgation.

I have purchased a glucometer and on my "normal" diet I am getting those "slightly elevated" readings. I will see what the doctor says at the end of this month. I hope he has blocked off a long time for my visit - yeah, I am sure that will happen.

Red Sphynx said...

Jenny,

Patients get discouraged and give up on attempting to control their diabetes. Why? Because they're given outmoded, ineffective interventions. They try them and don't improve; gradually get worse.

Seems to me physicians get the same way. All the training the doctor has been given is to push the food pyramid and low-fat diet (for weight loss AND bg control.) He perscribes it over and over. It doesn't work and his patients don't stick with the regime.

For that matter, doctors mostly DON'T tell their patients to quit smoking. Doctors shirk their duty to counsel their patients to quit because their counsel is so rarely heeded.

Someday, doctors will have been trained to make effective interventions in diabetes. Then they'll quit shirking.

ItsTheWooo said...

If doctors demanded normal blood sugar control from diabetics, they would only depress the hell out of their patients when their recomendations fell flat of their goal (low fat, complex carbs, ADA horse doodoo).

Instead, the protocol is to expect that diabetics are going to get sick and die, recommend a diet that may or may not improve blood sugar (really all depends on whether or not they were eating more carbs before), and hope for the best. Define "control" as an abysmal a1c of 7%. This way, all of your poor starving reduced-fat whole wheat cracker eating diabetic patients are on target (or at least, they might one day become on target, hope of hopes).

If diabetic control were defined appropriately (normal blood sugars) every diabetic who listened to the doctor would fail.

virgomatic said...

Reading this is reminding me of the years my doctor ignored my "subclinical" thyroid scores, and let me live half a life, so exhausted and hopeless, relying on antidepressants and stimulants to get me through daily life, without letting me know I could benefit from a very simple (and much cheaper) hormone treatment.