For many patients with type 2 diabetes
that have had their diagnosis for several years, this news is not
new. A new study published online in the journal Primary Health
Care Research & Development says that patients that are newly
diagnosed with type 2 diabetes feel left in the dark and wonder where
to find information to give them guidance. Even though this is a
study done in the United Kingdom (UK), it is still applicable for new
patients in the USA and other countries.
With the increase in diagnosis of type
2 diabetes, most countries do not have the necessary personnel
trained 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 them
and in other areas doctors will not make use of them. This is often
because the doctors think they are the only source of information and
others have had conflicts with the CDEs.
The authors state, “With
type 2 diabetes being most common in older patients it was commonly
reported that it was difficult "to break habits of a lifetime".
This barrier to changing lifestyle is partnered with negative views
of the 'new' diet, with it viewed as mundane and unappealing.” I
have heard this said by many patients and the complaint is about
bland food.
Recently I asked
a woman complaining bitterly about the foods her doctor had
recommended to her – why she had stopped using spices and
condiments to add flavor back. She looked at me as if to say “your
a man and don't know how to cook.”
Her friend who
had been agreeing with her said their doctor had taken both of them
off highly processed foods and prepared meals from the freezer
section. The doctor had ordered them to eliminate as much fat as
possible and eat more carbohydrates. He had also said to eat more
fish and skinless chicken. I asked how long they had been doing this
and they both had been doing this for about six months. I commented
that getting away from highly processed foods, was probably the best
advice they had received. I then asked if they were testing to see
how different foods affected their blood glucose. Both looked at me
and stated their doctors had not given them anything to test with or
any information about testing.
The next question
I was hesitant to ask, but I asked how much weight they had gained
since diagnosis. They did not hesitate in saying – one had gained
15 pounds and the other had gained about 20 pounds. Both said they
could not keep the weight off even by walking and swimming. I knew
they were because they were not that much overweight for their size
and bone structure. At that point, the one lady asked how I knew
about testing. I said I had type 2 diabetes and was using insulin
and tested regularly. She then asked what my last A1c had been and
when I said, she stated that hers had still been over 7.0% and the
other lady said hers was about 7.0% also.
Since we were in
a store that had a pharmacy, I suggested we go to that area and I
would show them the meters. After seeing them, both asked how to use
them. The pharmacist had seen us and came over to answer questions.
She asked which doctor(s) they were seeing after she learned they had
diabetes. After they answered, the pharmacist stated that the doctor
they were seeing would not give out meters and did not recommend
testing. I asked if they were determined to stay with their doctor
and both said it sounded like they should consider other doctors.
The pharmacist asked if they saw doctors in other areas and both said
the same city as mine are located in and I suggested my
endocrinologist. The pharmacist volunteered to call the office and
see if they could get appointments and she got their names and
information and I said I would go home and get my meter and come
right back.
When I returned
the pharmacist had received appointments for them and was covering
what Medicare and their supplemental insurance would cover. The one
lady was asking what their out of pocket costs might be if they
needed more strips. The pharmacist covered the costs for the meters
they 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 them
where to use the lancet, which I did. I then used it and explained
how to adjust the lancet device to set it to have the least amount of
pain and still get a sufficient amount of blood. I then took out a
test strip and inserted it in the slot on the meter, explaining why I
was doing it in the order I was. I then used the lancet and let them
see the blood while I took the meter and carefully pushed the tip of
the test strip into the blood. My reading was 98 mg/dl. The
pharmacist asked how long since I had eaten and I said about four
hours.
Then I changed
the device in it to have a clean lancet and asked if anyone wanted to
test. The pharmacist said wait and went to get a few alcohol pads
and wiped the lancet device down and since the bathrooms were clear
across the building, wiped one of her fingers. She had me put a test
strip in the meter and while she adjusted the depth on the lancet
device and pricked her finger. She took my meter and carefully
pushed the tip of the test strip into the blood. The reading for her
was 76 mg/dl and she said that she does not have diabetes and
therefore it should be lower. Both women then said they would test.
The pharmacist again wiped the device after I had replaced the lancet
with a new one. Then she adjusted the depth and I inserted a new
strip in the meter. The first try was insufficient blood and the
pharmacist demonstrated the proper way to get enough blood. The
reading was 168 mg/dl for the first person and 198 mg/dl for the
second. We talked about when they had eaten and what medications
they were taking. The pharmacist agreed that both readings were too
high and that depending on their ability and what they desired, to
strive for much lower readings. We discussed the different levels
that people should consider for the medications they were taking.
The pharmacist
said she was busy and if they had more questions they could ask them
another 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, and
they had more questions for me. The other asked if she could stop
and get her husband and it was agreed. The four of us would get
together in about 20 minutes. Neither had purchased a meter at my
suggestion since the office for their appointment would probably give
them a meter and I wanted to discuss the different meters with them.
After we were all
together, I started by talking about food. The hostess said we get
it, we will get off the carbohydrates and back to bacon and eggs or
sausage and scrap the bread until we have our meters. She continued
that my talk about spices and condiments had given her ideas for
other foods and they would be trimmed until they had their meters.
Both women agreed and said I had given them ideas, and that they
would stay away from processed foods. I asked if anyone had taught
them how to count carbohydrates and they admitted they had not had
anyone talk about that. I asked what cookbooks she had and if any of
them were recent. She said her husband had just bought one they were
going to give their daughter. She got up and brought it back. She
also brought a diabetic cookbook. I took the Better Homes and
Gardens cookbook (must be the tabbed ring binder), flipped open to
the meats section, found a page with recipes on both pages, and laid
it out for them. One recipe had servings for four and the
nutritional information for one serving. We looked at the
information and the light came on in both their eyes. The
carbohydrates were listed as 22 grams and fat at 40 grams. The
hostess said that is as recipe she and her husband would eat and
folded the corner. I told her to look at the diabetic cookbook. She
said that most of the recipes were not something they would eat and
no nutrition information was given. I gave them several more
cookbook titles that I knew had nutrition information.
Both women said
they were going to go shopping after their appointments the following
Tuesday. When she returned the cookbooks, she brought her laptop
back and asked for my email address. The other woman reached into
her handbag and brought out a pen and small pad. She copied my email
address and asked for potential web sites for reliable information.
I pulled up several sites and those she was interested in she
bookmarked. She said she would email the list to her friend later.
I finally gave her my website and both looked at me. Then the
hostess said that is the reason you were not afraid to speak out. I
showed her my blog on cookbooks and she said no wonder you were not
bashful in showing us the information. She looked through several of
the blogs and said this was something she would have to read later.
I had her bookmark several other blog sites and Health Central. I
showed them where to join and this would allow them to select
bloggers the they might desire to follow.
Since we had
talked about their medications. they were each on one of the
sulfonylureas, I asked if they had been told about
hypoglycemia. They admitted they did not know what I was talking
about. So I directed them to two of my blogs here and here. On the
second blog, they followed the link to Joslin and both asked if I
knew why they had not been told. I asked if they had been instructed
not to take the medication if they were not going to eat a meal and
they answered yes. I said then the chances were they may not have
had any problems with the number of carbohydrates they were told to
eat. I suggested that they maintain that number until they met with
the doctor on Tuesday and definitely discuss different medications at
that time.
Both thanked me and said they would
have to thank the pharmacist also for recommending a change in
doctors and making them aware of what they had not been told. We
parted company for the day, but they have stayed in contact and
expressed how much they appreciated their new doctor. They have
changed oral medications, are happy with their meters, and are
testing to see how the different foods affect their blood glucose.
Yes, they are paying for extra strips out of pocket, but are happy
that they are able. Both have been told to learn about insulin in
case they do not get their A1c's to at least 6.5%. They are
confident they will, but they are asking me questions and are happy
that 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 they
would be ready if insulin was needed in the future. I said I was
happy to hear that and that they were not discounting insulin.
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