Where this will go, I don't know, but
those of us with type 2 diabetes need to be able to test our blood
glucose and not feel restricted by when and how often we are able to
test. Yes, people do need the education about testing. They also
need to be taught how this will help them be better able to manage
diabetes. While I do not want to vent, I have had conversations with
several doctors that agree with me and wonder how we are best able to
turn this around and get more people to test on a regular basis.
Yes, Medicare, give us back our test strips!
Read carefully as I don't plan on
pulling back in some areas and I honestly feel that there is some
truth as I am getting emails that agree and some medical
professionals that agree in part. Some do very carefully state some
ideas, as they are not sure they can rely on me not to use their
names and quote them. So continue reading about self-monitoring of
blood glucose and related educational ideas.
First, I must point out that much of
the research for self-monitoring of blood glucose (SMBG) is suspect.
Not only are the participants carefully selected, but also most
studies seem to exclude people with type 2 that have an interest in
or knowledge of SMBG. Many of the studies are observational in
nature or rely in participant-completed surveys, which are not
reliable for scientific accuracy. In the USA, many of the studies
are funded by the National Institutes of Health (NIH) or the Centers
for Medicare and Medicaid Services (CMS). Then on the unscientific
information, Medicare takes more test strips away from us.
I have made this accusation before and
I will again. This is based on my research and in no way is it
scientific. There is a conspiracy happening in the USA between
government agencies and medical organizations to keep many people
with type 2 diabetes unaware of the damage being caused by our grain
industry and low fat mantra, which is promoted by the US Department
of Agriculture (USDA). In turn, the NIH and CMS have cooperated by
funding non-scientific studies giving Medicare the incentive to
reduce our testing supplies.
Then the America Diabetes Association
(ADA), the American Association of Clinical Endocrinologists (AACE)
promote the USDA line of thinking – whole grains, low fat, and
people with diabetes that do not know better listen to them. Then
the American Association of Diabetes Educators (AADE) and the Academy
of Nutrition and Dietetics (AND) which follow the ADA and AACE do
little do encourage people to think for themselves. They are pushing
mantras and mandates and expect people with type 2 diabetes to accept
the dogma blindly.
The AADE does nothing to promote and
teach diabetes self-management education (DSME). They give mandates
and mantras that patients are learning is bad for their diabetes
health. Most CDEs will not teach patients about self-monitoring of
blood glucose (SMBG) for fear that patients will discover the truth
about whole grains and low fat. The monopolistic workers for the AND
mandate that we consume a minimum number of carbohydrates per day and
go ballistic when we do not and literally call us noncompliant and
often refuse to work further with us. This refusal is the one good
thing for us as patients.
Now some will say that the AADE does
promote DSME, which in a small way they do, in some sources and
pamphlets, but very little of the information ever reaches the
patients. A few conscientious CDEs do teach DSME and even fewer
teach SMBG until they are confronted by older CDEs and encouraged to
stop. So please Medicare give us our test strips back and find us
doctors willing to teach us the truth. We know there are doctors
that are breaking ranks with the ADA and AACE because of the lack of
diabetes education being taught.
I am also aware of doctors attempting
to use peer mentors to dispense some diabetes education when CDEs are
not available or have taken positions in conflict with the doctors.
This may become more common as the increasing numbers of patients
diagnosed with diabetes come into existence and the numbers of CDEs
entering the field continues at a snails pace. With this gap
widening almost daily, is it not surprising that doctors are
exploring other avenues to assist in diabetes education. Even more
doctors are investigating shared medical appointments to expand
education by presenting it to groups of patients when there is not
time to do it individually.
The controversy about the registered
dietitians will need to play out in the court system before we will
know whether their numbers will decline. Nutritionists that are
joining other organizations to continue being able to dispense
nutrition information may be able to step in and fill the widening
gap. This should be great for those of us with diabetes as my experience
with these nutritionists has been positive. They are interested in
balancing nutrition and not issuing mantras and mandates for us to
follow. They will suggest ideas that some of us may disagree with,
but will work with us to help us balance our nutrition whether we
follow a low carbohydrate, medium fat diet, a paleolithic diet, or
even other diet plans. They are not locked into telling us we must
eat a required number of carbohydrates.
Patients around the globe need
education about diabetes and how to apply this to their daily lives.
In the USA, we need Medicare to give us back our testing supplies in
sufficient quantity that newly diagnosed patients can determine how
the different foods and food combinations affect our blood glucose
levels. Then allow enough test strips for people to use on a daily
basis and to do random checks when adding new to them foods.
Okay, why do I use Medicare as the
scapegoat? Because the medical insurance industry generally follows
the lead of Medicare in lock-step. If NIH and CMS are going to do
studies, let’s have them do studies for three to five years and
give continuous education during the studies. Have the
education reinforce the principals set out at the beginning and ask
the participants what they need in more information to help them.
And, have the studies be scientific studies with the proper
scientific methods applied and not the observational and survey
format from the past. Do not exclude study participants that are
interested or have knowledge of SMBG, Teach the study participants
SMBG or DSME. Medicare, give us back our test strips!
I might also suggest that if doctors
are going to be paid incentives, they must provide education on a
continuous basis to be eligible. This should be audited for
verification.
If insufficient CDEs are available,
make use of peer mentors and even retired doctors if this is needed.
The only way to put a halt to the increase in the diabetes epidemic
is to educate the current patients and make sure they have the
testing supplies to make it happen. Educated patients will not be
afraid to spread the education.
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