September 20, 2006

Diabetes is NOT for Dummies

Thinking over the immense amount of study and work it takes to keep my blood sugar near the normal range, it's been striking me lately that what causes complications and death for most diabetics isn't just their blood sugar, it's their scientific illiteracy.

Diabetes is complicated, and the only people I've met who are able to get their blood sugars to truly normal numbers are those who are willing to read, study, test, and refine their treatment based on their testing results. Not so surprisingly, most of these are people with engineering or science backgrounds.

But people diagnosed with diabetes, no matter how intelligent, who can't read a graph, can't understand the statistics (or lack thereof) in a medical study, can't do computations in their heads, and don't know a thing about the physiology underlying their disordered blood sugars are in big trouble.

Why? Because each person's diabetes works differently and needs a different combination of treatments. My diet won't control your diabetes, and my lunch time insulin won't cover your lunch. But if you're scientifically illiterate, and rely on the people who understand this stuff--like your doctor--you're guaranteed to get a generic one-size-fits-most treatment that will not prevent complications, because your doctor and other experts you consult don't have the time to figure out exactly how your diabetes works and what you need to do to control it. So they give you a regimen that has been carefully crafted with one end in view--to keep you from getting hypos, at the cost of ensuring that you'll have "hypers" that destroy your body.

I used to wonder why the typical Type 2 on insulin has an a1c of at least 7% and usually more like 8% or higher, when insulin allows for complete control of blood sugars. But now that I'm using insulin, I can see that for someone who isn't good at math and who isn't able to memorize carbohydrate counts, and for someone who can't estimate a food portion size correctly and isn't willing to read up extensively on the subject, the only safe way to use insulin probably IS to use far less than is needed, because the combination of ignorance and insulin is eventually going to lead to a very severe hypo.

Just watching people without diabetes attempt to do a low carb diet shows me what we are up against. You know them--the people who eat that big bowl of pasta and tell you how they can't understand why their low carb diet isn't working. Or the ones who eat "low carb" bars which have 20 grams of carbohydrate per serving and wonder why their blood sugar isn't getting better. Combine that kind of dietary ignorance with an insulin regimen which matches carbs to insulin units, and you can see why tight control leads so many people to the ER.

It isn't that there's anything wrong with tight control. It is that you can't do tight control unless you know how many grams of carb you are eating, and how far one unit will lower your blood sugar, how long the insulin lasts, when it peaks, and what happens if you take a drug that raises or lowers insulin resistance while using insulin. That requires a lot of knowledge and understanding, and sadly, people who can't handle their own taxes probably aren't going to be able to figure this stuff out.

But people who can't do their own taxes are willing to pay an accountant to straighten them out, because they understand what will happen if their inability to work with figures gets them in trouble with the IRS.

Unfortunately, there is no corresponding understanding among people with diabetes who are scientifically illiterate that they need help to keep their diabetes from killing or maiming them. They trust their doctor, without understanding that their doctor can't fix them up in the 15 minutes every three months they are allotted (if they are lucky!) any more than that their accountant could do their small business taxes in 15 minutes.

I'm not sure there is a simple solution for this one. The medical establishment would prosecute anyone who attempted to help people with their diabetes for pay who wasn't a qualified doctor, nurse or pharamcist, but those people who have that qualification don't have the time or inclination to give people with diabetes the help they really need. And if they do, the cost of their time makes their help unaffordable to most.


George said...

I can identify with this post. For a very long time I just used the regimen that my doctor gave me and never thought twice about it. Until the day when I found my a1c at 12.5 did I finally decide that I needed to take this disease into my own hands.

I am still reading and learning and fumbling. And believe me, I am no scientist! :)