October 13, 2011

More on the AADE Discussion

The challenges for the AADE are many and varied. Will they be able to rise to the challenge and meet many of their goals? This remains to be seen, but they are starting to make improvements, all be it at a snails pace. Of the five changes spelled out in Amy's article in 2007, all of them need further work although some of the changes are beginning to have progress. I would rate the progress to date as a D+.

Some of the new challenges for AADE have not even appeared on their radar, but must be strongly considered. Number one is a field that very few are giving any attention, prediabetes. They could suggest a new term to the ADA. They could lobby for Medicare, Medicaid, and medical insurance to enter the preventive medicine field and help people delay the onset of full-blown type 2 diabetes. This could result in cost savings for everyone. Along with this would be putting the use of Metformin before the FDA as approved for prediabetes. Failing that, at least working with physicians to use it “off label”.

Number two is a big one. Start discussing insulin at diagnosis. Eliminate the myths about insulin and show the physicians that you know how to handle insulin. You do it now for people with type 1 diabetes, and type 2 should be easier since early on after diagnosis, our bodies still have the ability to produce some insulin. Our highs are not as high or our lows are not as low. Yes, caution with hypoglycemia is important, but often not as dangerous people with type 2 diabetes.

Insulin can be an important tool in the early stages of type 2 diabetes as it allows for quicker management and can be temporary management until those that need to work their weight down have reduced their weight. Yes, insulin can add weight if they remain sedentary. Then once management had been in place and weight is dropping, movement to oral medication or no medications may be possible. Insulin should never be the medication of last resort. By then much of the damage has been done or started and diabetes management will be more difficult.

Third, because type 2 people vary so much in the carbohydrates they can consume and still maintain blood glucose levels – like a bell curve, some at each end of the curve, tolerance for different levels of carbohydrates is a must and not the mantra of 60 carbs per meal. In following the above, please be careful of the whole grains mantra, as wheat and many of the whole grains raise blood glucose more than many people are able to manage.

Fourth, instead of using fear like many physicians and CDEs are prone to do, take a positive attitude and explain what blood glucose levels above 140 mg/dl can cause and especially above 180 mg/dl. This would include the problems of cardiovascular disease, retinopathy, nephropathy, and potential hearing lose from high blood glucose levels and high blood pressure. Also, take time to explain other autoimmune disease and the signs and symptoms associated with each, like celiac disease.

People with type 2 diabetes are not exempt from these diseases and need to be aware of them. Then cover the tests needed that certain oral medications can cause like Metformin over time can cause a decrease in B12 levels and other medications can deplete to body of other vitamins and some minerals. Cover the thyroid and the signs and symptoms of thyroid problems and the TSH test.

It is important that the AADE become more patient centered and do more for the patient in education. We all need the above information and with the previous five blogs and this blog, I hope that I have offered some goals that can be met and some challenges for the future. I must admit that the attitudes I have encountered from many CDEs, has soured me on the profession. The CDEs that are doing great work are the ones that give me hope and as a patient with type 2 diabetes and on insulin, we need all the hope and positive attitudes we can get.

I will be watching the actions of the AADE and will continue to comment on the positive activity or lack of improvements.

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