November Is Past – Big Sad Sigh

This November was a big disappointment for an American Diabetes Awareness Month and World Diabetes Day. Number one, none of the US diabetes groups or organizations seems to want anything to do with the International Diabetes Federations blue circle. This is a disappointment for many in the DOC. This should mean that we will need to lobby the entire year to convert any organization.

Another disappointment for me is the total lack of promoting diabetes month or diabetes day on the HealthCentral website. We were regaled about Alzheimer's National Alzheimer's Awareness Month on the home page and Alzheimer's page. Only one diabetes blogger, Amylia Grace mentioned the diabetes day or month with no mention of anything by Health Central.

The bloggers that decided to write a blog each day, well that was somewhat better, but those that followed other's guidelines for daily topics, it was a little disappointing. There were some excellent blogs and I applaud those that took on the challenge. I like writing, but definitely happy that I choose my own topics and did not write for 30 days on topics of little interest to me.

I had hoped that the American Association of Clinical Endocrinologists would have added to the approved and vetted type 2 diabetes resource sites. Since the original publication on September 27, 2011, nothing has been added to the list of 15 sites.

To pass out grades on the American Diabetes Month would be unfair. Activities are so disjointed and each organization has its own agenda. Forget about finding a common ground for increasing diabetes awareness, everyone wants to think their way is the best. So as a group, nothing of value is generated to aid in the fight against the increasing rate of diabetes diagnosis.

Until the people start demanding action and the medical communities realize that the diabetes pandemic will not go away, little will be accomplished. The divided we fail signs seem to have no meaning to the diabetes community. In addition, since diabetes seems to be such an invisible disease, people in general tend to ignore our cries for help.

I fear that until there is a change in culture, one that can get past the politics, uncaring people within the medical community, and the handouts and influence of the large pharmaceutical companies, there will be little accomplished in the near future. I hope that I can be proven wrong. At present, everyone is so enamored with his or her corner of the world; they seem to accomplish little for the education awareness about diabetes or making a change in the culture of diabetes.

How to Educate Those That Do Not Want to Learn

I am going to start this topic and maybe others will be able to help me along the way.  Yes, how do you educate people with type 2 diabetes that refuse to learn, or for that matter tune you out? I have had minor successes along the way, but few as difficult as one gentleman that just refused to listen or pay attention to anything I said for almost a year. He told me point blank that if he wanted information, he would ask his doctor.

Okay, a small crack in the armor was showing itself. I started asking him questions about what his doctor was telling him. How often does he see the doctor? Answer: once a year. What medications was he taking? No Answer. How old was he? Answer: 73. Did he feel like he was seeing the doctor often enough? Answer: No. How often did he think he should see the doctor? Answer: at least once a quarter. Was he getting his questions answered? Answer: No. How long had he had diabetes? Answer: almost 4 years.

I kept the questions flowing and got very short answers, but I had him talking and thinking and I came back to some of the above questions and got mostly the same answers. I then asked him if he would like some of his questions answered? Surprise, he answered yes. So, I asked what he asked that he never had answered. Again a surprise. He asked what he should be eating with diabetes? Now we were getting somewhere.

I again asked him if he had seen a dietitian on referral from the doctor? Answer: No. Had he ever asked for a referral? Answer: No, and he asked was this possible and would his insurance pay for it. My answer, it should be possible and Medicare does cover it in most cases. Now the tables turned and he was asking the questions. I answered them to the best of my ability and did get a question in. Did he use a computer? He looked at me surprised and said, yes. I asked him if he did any research on the computer? Now I had a questioning look and no for an answer. He stated that all he used it for was emails with his children and grandchildren.

His three children had purchased a computer for him and only showed him to use email. I asked him if he wanted to learn more. He asked, like what? At that point, I asked him if this was something his children wanted him to do. So we went to his home and he sent them an email. The answers back were yes, that is what they had hoped he would do on the computer and find answers he was not getting from his doctor.

Now he was full of questions and wanted answers. So I examined the computer and found out what he had and how much storage he had. Plenty, I could only dream about this for a computer. I asked him if he had finances for a few tools and he answered yes. So we started looking and I found several programs he should be able to use, a virus checker, and several other tools. I explored what he had on the computer for programs and found several programs that he could learn and set them up so he could access them and at least explore and become familiar with them. I downloaded a free program and set that up for him to use. I also showed him several sites and he did bookmark them to go back and look at them and possibly subscribe to their free newsletters.

I knew I had a book for one of the programs, so I offered to lend it to him. He accepted and said it would be a big help. I promised to return and help him on another day. I left him with my email address and telephone number. He is now full of questions and I will admit I am enjoying my time with him and educating him about diabetes, via email, at his home, and on the telephone.

Yes, he is now a willing student, and set to see his doctor quarterly. He has an appointment with a dietitian knowledgeable about diabetes. I know my method worked this time, but I have not been able to get it to work on any other persons. I keep hoping to find a way, but of the several tactics I have tried, none have succeeded. So if anyone has other suggestions, please let me know. One person does not have a computer and as such, I am working on getting him to work with my first friend, but he does not want to do this.

Outpatient Care – The Good and Bad

On 15 November, I experienced what I consider to be both sides of outpatient care, the good and bad. I was pleasantly surprised to be told when scheduled for my surgery that I must bring my own sleep apnea equipment. In my blogs before this, I had warned people that they may need to get prior approval from the hospital to use their own equipment. At least in my case this is no longer necessary.

I had to think about this for some time, but I think I can answer this now. With the new health care laws and the fact that Medicare is clamping down on expenses, it makes good sense for hospitals to have people bring their own sleep apnea equipment. First, because they are familiar with the equipment and know how to use it, and second, the hospitals can avoid using expensive equipment and maintaining it, having people knowledgeable in setting the equipment requirements for different patients. This means cost savings. It also means cost savings because people generally do better and leave the hospital sooner when they use their own equipment.

This is a positive for the hospital and the patient. Did I need the equipment with me? Turns out, I did not, but this is now a standard for outpatient surgeries to have the equipment present in the event that you are admitted to the hospital or have troubles in the recovery area. A few years ago, this was seldom considered and is good procedure saving the patient problems and requiring someone to make an extra trip to locate and bring the equipment back.

Now the not so positive side. The reception area for the incoming outpatients was almost too friendly, like they were trying to put you at ease so you would forget and not keep your wits about you. Yes, indeed and in the following hours, I could see why. Talk about like being treated like cattle and the impersonal nature in which you were treated. I have been a patient for very few hospital stays or even outpatient surgeries not counting colonoscopies, but this was one experience I do not want to repeat unless there are some changes in the way I am treated as a patient.

From the patient in processing room to the recovery room, I felt like the more they could keep from me, the better off for them. Why? That probably will never be answered. I do know I made some statements that I did not want an intern or new resident doing the procedure. I also asked that the IV not contain any dextrose because I was a diabetic. Can I say with any certainty that these requests were followed? Maybe and definitely no.

The anesthesiologist was around and said he would be the one administering it, but did I see him in the surgery – again no. There were several people in the surgery room, but no one wanted to introduce themselves and explain what they would be doing. I forced the issue, but never was allowed to complete it as they opened the spigot on the IV tube and put me under very quickly. I remember six people in the room and could not identify any of them other than the first person who would only admit that he was a nurse. My doctor was there, but other than this, I felt like I was being ignored.

Then when things went blank, I do not remember anything until I was seeing several nurses around the cart I was on. Next thing I was wheeled into the room where my wife was waiting and a nurse rapidly asking questions and giving me a pain pill and saying I could get dressed. Dismissed and that was it. Sort of had the feeling of being on a belt moving me through the system.

Now comes the part where I became very angry. I was assured that the IV was dextrose free and that I would receive a minimum of two doses. Well from the meter test results after being shuttled out and in the vehicle, my blood glucose reading was over 300 mg/dl. Therefore, from a reading of 106 mg/dl at entry to 309 mg/dl after leaving, I would conclude that one or both IV's had dextrose in them. Not a comforting thought about how they are concerned about patient safety. I would rate them a flunking grade for several reasons.

The previous time I had the surgery, I was introduced to all people in the room and made to feel like they were interested in the outcome that would be best for me. This time was very impersonal and like they were herding cattle through the vaccination chute and could care less about the outcome. True, the first time for this surgery was before diabetes, but even when I have had colonoscopies since diabetes, I still knew who was in the room, their names, and given reassurances. There will be some changes made before I will willingly submit to surgery in the future.

Using Social Media for Diabetes

This is a topic that more bloggers are writing about, and some are covering it very well. They cover some of the more popular social media sites and give some excellent pointers for people that want to get involved, but are either very timid, or become overwhelmed in their search. Spend some time looking at the different aspects of social media.

This blog says a lot and introduces you to some of the products, blogs, Facebook, Google+, Twitter, forums, and others. This blog covers some of the forums and a few of the social media sites. To include all of the sites would make this a very long blog and could take days to sort out those that still exist from those that have ceased to exist.

I participate in very few sites because of my interests. I would suggest that to start, you read the two blogs already mentioned and use your search engine to search for others. I am on Facebook, but not that active. I am slightly more active on Google+, but that is not saying much. I have a Twitter account and seldom use it. I personally am more comfortable here and enjoy blogging about different topics of which most relate to diabetes. Yes, occasionally I write about other topics, but only because I feel there is a need to bring it to my reader’s attention.

I do participate on one site,MyDiaBlog, which suits me fine. There are others, but I will let you find the one that suits your needs. My one warning is to be very wary of sites that proclaim a cure. These are only interested in separating you from your money and presently there is no cure for diabetes.

Failure of Communication Increases Risk of Malpractice

This is a study everyone should be aware of and not just the doctors even though it is directed at them. The first sentence of the article states, “Failure to communicate diagnostic test results increasingly puts physicians at greater risk for medical malpractice claims, researchers report in the November issue of the Journal of the American College of Radiology (JACR).”

Then they go on to say “taking advantage of available "semiautomated critical test result management systems" could improve patient safety, shorten hospital stays, and reduce risk by providing legal documentation.” This is clearly saying communications can lower your malpractice claims, and doctors need to start communicating with their patients.

When US malpractice payouts including all medical specialties related to communications failures, yes, communications failures increased from $21.7 million in 1991 to 91 million in 2009, this means that doctors should take notice and start communicating. What types of communications does the study identify? The study states that miscommunication or non-communication among physicians and failure of physicians to instruct or communicate with patients or families. This would seem to include all necessary communications.

The authors point out that part of the problem is the large increase in the number of diagnostic tests ordered by physicians over the last decade and cited a 2010 paper in the journal Radiology titled, “Addressing Overutilization of Medical Imaging.” In that paper, they stated that the use of defensive medicine to avoid malpractice claims a reason for the increase of diagnostic tests.

Then the authors went on to say that modern technology including improved diagnostic methods, the Internet, numerous new communication channels may have raised the bar for societies expectations for communication of medical data. This is true in so many ways as patients are learning that maintaining test results records and watching trends on test results for warnings of declining health conditions or the steady numbers of good health become more valuable for patients.

As patients, we need to hold the physicians' feet to the fire and make them communicate with their fellow physicians and us. I am not saying let them not communicate and then sue, but to force them to communicate and make a habit of communicating for our well being and the well being of our fellow patients.

ADA Testing Method Has Failures for Our Children

Am I surprised at this, not at all, because at the time this decision was made by the ADA, there were many dissenting voices.  They were saying that other tests were needed for accurate diagnosis.  They were concerned that many labs did not have standardized testing procedures and the HbA1c did not account for ethnic differences.  Granted this was mostly about using the A1c for adults, but studies are slowly chipping away at the ADA's decision.

The American Diabetes Association seems to have jumped on this too early and other problems are surfacing on a regular basis.  The HbA1c has proven ineffective for people on dialysis, and this study shows that it is unreliable for diagnosis of diabetes in children.

The ADA recommended in 2009 that the HbA1c be the test for the diagnosis of diabetes in children.  Now a study at the University of Michigan C.S. Mott Children's Hospital shows the HbA1c ineffective for diagnosis of diabetes in children.  "We found that Hemoglobin A1c is not as reliable a test for identifying children with diabetes or children at high risk for diabetes compared with other tests in children," says Joyce M. Lee, M.D., M.P.H., lead author of the study and a pediatric endocrinologist at U-M's C.S. Mott Children's Hospital. "In fact, it failed to diagnose two out of three children participating in the study who truly did have diabetes."

Sounds like the ADA needs to reconsider their position. When 2 out of every 3 children are not diagnosed, that more harm is being done, and our children are at risk, the ADA should act in a timely fashion.  Will they?  This remains to be seen, but they should be held accountable and have their feet held to the fire.

When results of the study show that the HbA1c missed more cases of pre-diabetes or diabetes than other tests, then it is time to reevaluate.  Of the 254 overweight children tested, they were first tested using the HbA1c and then the following day after fasting for 12 hours, they were retested using the fasting test.

Based on the results, researchers are urging a non-fasting one-hour glucose challenge test, or a random glucose as being best for identifying children with pre-diabetes or diabetes.  The researchers are continuing to study if the non-fasting tests, including the one-hour glucose challenge test or the random glucose test could be used in combination with clinical indicators to better identify which children have pre-diabetes or diabetes.

Either way, the ADA needs to reconsider their position and recommendations.  Read the press release here.