No Guidance for New Diabetes Patients

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For many patients with type 2 diabetesthat have had their diagnosis for several years, this news is notnew. A new study published online in the journal Primary HealthCare Research & Development says that patients that are newlydiagnosed with type 2 diabetes feel left in the dark and wonder whereto find information to give them guidance. Even though this is astudy done in the United Kingdom (UK), it is still applicable for newpatients in the USA and other countries.
With the increase in diagnosis of type2 diabetes, most countries do not have the necessary personneltrained to teach the new people what is necessary to manage diabetes. The patients is the USA may think that certified diabetes educators(CDEs) are available, but many areas of the country are without themand in other areas doctors will not make use of them. This is oftenbecause the doctors think they are the only source of information andothers have had conflicts with the CDEs.
The authors state, “Withtype 2 diabetes being most common in older patients it was commonlyreported that it was difficult "to break habits of a lifetime".This barrier to changing lifestyle is partnered with negative viewsof the 'new' diet, with it viewed as mundane and unappealing.” Ihave heard this said by many patients and the complaint is aboutbland food.
Recently I askeda woman complaining bitterly about the foods her doctor hadrecommended to her – why she had stopped using spices andcondiments to add flavor back. She looked at me as if to say “youra man and don't know how to cook.”
Her friend whohad been agreeing with her said their doctor had taken both of themoff highly processed foods and prepared meals from the freezersection. The doctor had ordered them to eliminate as much fat aspossible and eat more carbohydrates. He had also said to eat morefish and skinless chicken. I asked how long they had been doing thisand they both had been doing this for about six months. I commentedthat getting away from highly processed foods, was probably the bestadvice they had received. I then asked if they were testing to seehow different foods affected their blood glucose. Both looked at meand stated their doctors had not given them anything to test with orany information about testing.
The next questionI was hesitant to ask, but I asked how much weight they had gainedsince diagnosis. They did not hesitate in saying – one had gained15 pounds and the other had gained about 20 pounds. Both said theycould not keep the weight off even by walking and swimming. I knewthey were because they were not that much overweight for their sizeand bone structure. At that point, the one lady asked how I knewabout testing. I said I had type 2 diabetes and was using insulinand tested regularly. She then asked what my last A1c had been andwhen I said, she stated that hers had still been over 7.0% and theother lady said hers was about 7.0% also.
Since we were ina store that had a pharmacy, I suggested we go to that area and Iwould show them the meters. After seeing them, both asked how to usethem. The pharmacist had seen us and came over to answer questions. She asked which doctor(s) they were seeing after she learned they haddiabetes. After they answered, the pharmacist stated that the doctorthey were seeing would not give out meters and did not recommendtesting. I asked if they were determined to stay with their doctorand both said it sounded like they should consider other doctors. The pharmacist asked if they saw doctors in other areas and both saidthe same city as mine are located in and I suggested myendocrinologist. The pharmacist volunteered to call the office andsee if they could get appointments and she got their names andinformation and I said I would go home and get my meter and comeright back.
When I returnedthe pharmacist had received appointments for them and was coveringwhat Medicare and their supplemental insurance would cover. The onelady was asking what their out of pocket costs might be if theyneeded more strips. The pharmacist covered the costs for the metersthey had in stock and both agreed it could be worth the extra cost. At that point the pharmacist handed me a marker and said to show themwhere to use the lancet, which I did. I then used it and explainedhow to adjust the lancet device to set it to have the least amount ofpain and still get a sufficient amount of blood. I then took out atest strip and inserted it in the slot on the meter, explaining why Iwas doing it in the order I was. I then used the lancet and let themsee the blood while I took the meter and carefully pushed the tip ofthe test strip into the blood. My reading was 98 mg/dl. Thepharmacist asked how long since I had eaten and I said about fourhours.
Then I changedthe device in it to have a clean lancet and asked if anyone wanted totest. The pharmacist said wait and went to get a few alcohol padsand wiped the lancet device down and since the bathrooms were clearacross the building, wiped one of her fingers. She had me put a teststrip in the meter and while she adjusted the depth on the lancetdevice and pricked her finger. She took my meter and carefullypushed the tip of the test strip into the blood. The reading for herwas 76 mg/dl and she said that she does not have diabetes andtherefore it should be lower. Both women then said they would test. The pharmacist again wiped the device after I had replaced the lancetwith a new one. Then she adjusted the depth and I inserted a newstrip in the meter. The first try was insufficient blood and thepharmacist demonstrated the proper way to get enough blood. Thereading was 168 mg/dl for the first person and 198 mg/dl for thesecond. We talked about when they had eaten and what medicationsthey were taking. The pharmacist agreed that both readings were toohigh and that depending on their ability and what they desired, tostrive for much lower readings. We discussed the different levelsthat people should consider for the medications they were taking.
The pharmacistsaid she was busy and if they had more questions they could ask themanother day. The one woman said that since it was such a good day,we could adjourn to her place, which had a screened in patio, andthey had more questions for me. The other asked if she could stopand get her husband and it was agreed. The four of us would gettogether in about 20 minutes. Neither had purchased a meter at mysuggestion since the office for their appointment would probably givethem a meter and I wanted to discuss the different meters with them.
After we were alltogether, I started by talking about food. The hostess said we getit, we will get off the carbohydrates and back to bacon and eggs orsausage and scrap the bread until we have our meters. She continuedthat my talk about spices and condiments had given her ideas forother foods and they would be trimmed until they had their meters. Both women agreed and said I had given them ideas, and that theywould stay away from processed foods. I asked if anyone had taughtthem how to count carbohydrates and they admitted they had not hadanyone talk about that. I asked what cookbooks she had and if any ofthem were recent. She said her husband had just bought one they weregoing to give their daughter. She got up and brought it back. Shealso brought a diabetic cookbook. I took the Better Homes andGardens cookbook (must be the tabbed ring binder), flipped open tothe meats section, found a page with recipes on both pages, and laidit out for them. One recipe had servings for four and thenutritional information for one serving. We looked at theinformation and the light came on in both their eyes. Thecarbohydrates were listed as 22 grams and fat at 40 grams. Thehostess said that is as recipe she and her husband would eat andfolded the corner. I told her to look at the diabetic cookbook. Shesaid that most of the recipes were not something they would eat andno nutrition information was given. I gave them several morecookbook titles that I knew had nutrition information.
Both women saidthey were going to go shopping after their appointments the followingTuesday. When she returned the cookbooks, she brought her laptopback and asked for my email address. The other woman reached intoher handbag and brought out a pen and small pad. She copied my emailaddress and asked for potential web sites for reliable information. I pulled up several sites and those she was interested in shebookmarked. She said she would email the list to her friend later. I finally gave her my website and both looked at me. Then thehostess said that is the reason you were not afraid to speak out. Ishowed her my blog on cookbooks and she said no wonder you were notbashful in showing us the information. She looked through several ofthe blogs and said this was something she would have to read later. I had her bookmark several other blog sites and Health Central. Ishowed them where to join and this would allow them to selectbloggers the they might desire to follow.
Since we hadtalked about their medications. they were each on one of thesulfonylureas, I asked if they had been told abouthypoglycemia. They admitted they did not know what I was talkingabout. So I directed them to two of my blogs here and here. On thesecond blog, they followed the link to Joslin and both asked if Iknew why they had not been told. I asked if they had been instructednot to take the medication if they were not going to eat a meal andthey answered yes. I said then the chances were they may not havehad any problems with the number of carbohydrates they were told toeat. I suggested that they maintain that number until they met withthe doctor on Tuesday and definitely discuss different medications atthat time.
Both thanked me and said they wouldhave to thank the pharmacist also for recommending a change indoctors and making them aware of what they had not been told. Weparted company for the day, but they have stayed in contact andexpressed how much they appreciated their new doctor. They havechanged oral medications, are happy with their meters, and aretesting to see how the different foods affect their blood glucose. Yes, they are paying for extra strips out of pocket, but are happythat they are able. Both have been told to learn about insulin incase they do not get their A1c's to at least 6.5%. They areconfident they will, but they are asking me questions and are happythat I and others have written about insulin and the related issues. I asked them if they felt they were threatened and both answered no,they felt like the doctor wanted them to learn about insulin so theywould be ready if insulin was needed in the future. I said I washappy to hear that and that they were not discounting insulin.