SMBG – A Right Being Denied

Why are our insurance companies, doctors, and medical researchers focusing so heavily on self-monitoring of blood glucose (SMBG) and trying to discredit the good that it can do? I may not have the answer, but I will propose at least two possible theories.

Most people associated with the medical field including insurance are supportive of prescribing medications on top of medications. This I did not understand until I remembered Big Pharma and the ACCORD studies. Are our doctors so comfortable in bed with Big Pharma that they will not consider other approaches? Are the payoffs so great for them that the patients' well being is put on the back burner? Is the American Diabetes Association (ADA) so beholden to Big Pharma that they do not want to back potential patient centered aids that could reduce dependence on medication?

Is the above reason enough that doctors for the ADA want to do nothing about pushing a clear status for prediabetes and clearly recommending a strong course of action? Alternatively, is it our medical insurance companies that are pushing for inaction to keep current profits up in hopes that the profits will continue to go up? It is plausible, but not as sound as the above paragraph.

My second theory is that the current generation of doctors is so intrenched in the past and only want to treat something that is clearly a disease, that they do not want to promote preventive medicine. They want patients that are sheep, and not capable of thinking for themselves. When patients with diabetes do self-monitoring blood glucose (SMBG) they are not taught what the readings can mean or how to interpret the readings, or even when to test.

It is no wonder that knowledgeable people with type 2 diabetes become alarmed with these doctors. They search the internet for information that will assist them to learn how the test, when to test, and how to interpret the readings. Some will become successful at SMBG. The rest will become discouraged and continue testing, but not understand why. Then when their doctor ignores the readings, they may look further or give up completely.

The people that give up completely or are not interested in SMBG are the group that studies look for to participate and give the insurance companies and Medicare reasons to reduce the testing supplies. As a patient and a person with diabetes, I consider this criminal and demeaning toward patients.

While it may seem that I am overstating the above, please read this study, which clearly states the same accusation. I quote “The Cochrane review is a review of previously run studies, across a number of different countries, which have analyzed self monitoring and its effect on HbA1c levels. People with type 2 diabetes have previously noted the various limitations of the studies included in the review. Studies, included in the Cochrane review, have notably excluded participants who had previously demonstrated interest in self monitoring.” I added the emphasis. Please read the short article for further revelations.

Even though I write about some of the problems on diabetes forums, there is much good that can be had on some of the better forums. The problem is that you cannot be a timid participant on these forums. You must ask questions, but be sure to give enough information for people to make reasonable answers. If you do not, some will ask for additional information. Others will make assumptions and try to answer based on what their experience is.

The following are web sites that may be of value to you. They are not in a particular order or personal preference.

http://www.diabetesforum.com/forum.php

http://forums.about.com/n/pfx/forum.aspx?nav=messages&webtag=ab-diabetes

http://www.diabetesforums.com/forum/

http://www.tudiabetes.org/forum

http://diabetescommunity.dlife.com/go/forum/viewboard

Please remember that these forums are not chat rooms and you cannot expect an immediate answer. It may take several hours to receive several answers. I think a couple of the forums may have chat rooms, but finding people using them that will answer your questions may be problematic. Normally chat rooms are used by several people that invite each other and they want to discuss one topic among themselves.

Stop Wasting Your Test Strips

This is not related to self-monitoring of blood glucose (SMBG). This is about the ways we as diabetes patients take care of our test strips and to avoid wasting them in other ways. Each test strip we waste costs us money. They are expensive so we do not need to waste them carelessly.

Yet people do just that. They do not store them properly, jam them into the meter carelessly, and do not wait until the meter says the strip is ready. These errors occur all too frequently and that is wasting money. Errors will happen, but a few precautions can save strips and save your hard-earned money.

First, make sure that you store your strips properly. The containers they come in are the proper container to keep them in. Do not transfer the strips between containers as this can damage some of them. If you are like me and have large fingers, the first few strips are often hard to remove from the container. I keep a small plastic tweezers handy for getting out the first few. No, I did not say metal tweezers, a good way to damage the delicate strips. Check with your pharmacist for a plastic one, they are available, but may need to be ordered.

The original containers are made of special materials that help preserve the test strips and keep them dry. Keep the test strips in the original container and do not transfer them between containers. It is important to use the strip as soon as possible after removing it from the container. Close the container after removing the strip to use. Keep the container out of direct sunlight especially when taking strips out and do not expose the strip to direct sunlight. Please do not put a few test strips in a baggie or in your purse to carry them. The test strips are delicate and can be damaged beyond use.

Keep the container of test strips in a dry place. The bathroom or the kitchen is often the worse place to store your test strips. Please wash your hands with warm soapy water and dry carefully before handling test strips. Never use wet or damp hands or fingers to handle the strip container or for removing a strip from the container.

It is important to perform tests with the meter and strips as close to room temperature as possible to get accurate results. Do not freeze your strips or store them in extreme cold, as this will probably produce errors or false readings. This applies to extreme heat or direct sunlight. I have seen people store them on the car dash in direct sun and then they wonder why they get weird test results.

Now that I have explained proper storage, I will return to proper use of the test strips. When you are ready to test, always have your meter out and ready to insert the test strip carefully. Push it straight into the slot provided. Then use your lancing device to prick your finger and get an adequate amount of blood available. By this time, your meter should be ready to have the test strip receive the required amount of blood. Hold the meter with the test strip inserted properly and slide the strip at an approximate 10-degree angle that will allow the strip to wick sufficient blood to get an accurate reading and move it into the blood. Do not hold the meter and test strip at a 90-degree angle to the blood spot as you may shut off the wicking of your blood before it has enough for a reading. This will get you an error message.

Good luck and may your readings be good and not receiving error messages. The test strips are important and you need to make efficient use to prevent waste.

Are Physicians Correct in Not Following ADA Guidelines?

This is one article that gave me a different message than I was expecting. When I read the headline “Many Physicians Do Not Follow ADA-recommended Prescribing Guidelines,”  I actually thought this may be a good thing. However, the article did not give me any of what I was thinking.

I had hoped that the discussion may have been about starting newly diagnosed patients with type 2 on insulin to gain maximum management quickly. No, the article was about prescribing oral medications only and not the use of cheaper, generic medications, but the more expensive oral medications. When doctors force patients to use oral medications that are more expensive by $1,120 (or more) per year, this is the wrong way to proceed.

These doctors do need to be called on the carpet and asked to explain their reasons.  There is one very effective generic that these doctors were not prescribing. It is the drug metformin that is recommended as the first line of treatment by the American Diabetes Association (ADA) and another Professional Group for persons newly diagnosed with type 2 diabetes.

This study was the work of researchers from CVS Caremark, Harvard University, and Brigham and Women's Hospital. It looked at data from pharmacy claims for 254,000 patients started on diabetes medications between January 1, 2006, and December 31, 2008. You know that insurance companies will review their records to see what the doctors are prescribing and whether they should revise their formulary.

After reading this blog and the linked article, you may wish to review your medications with your doctor to determine if you are using the correct medication and not one that is overly expensive. If your doctor has you on one of the brand medications and refuses to change to a generic, you may want to have a pointed discussion with the doctor or consider a second opinion.

Many Ways That Diabetes Is Worse Than Cancer

Every so often, another blogger writes a blog that sets off light bulbs for you. Tom Ross wrote a blog on February 24, 2012 that did that for me. He called the blog he was reading and writing about a rather inflammatory blog. That may be true for some people and the way they see the world, but the title was spot on for me. I am not sure how many ways I can come up with reasons diabetes is worse in some ways than cancer, but I have to agree with the “Well Done Chef” and what he wrote over a year ago.

I agree with the six reasons Jason Sandeman used in his blog (sorry link no longer exists) and I would like to add some of my own to his. Therefore, you may wish to read his blog before finishing mine. In addition, you may like to read Tom Ross's blog while you are at it. All have the right things to say. I will wait for you to return.

Some of my additions are:

1. In the USA a diagnosis of prediabetes, or for that matter diabetes, gets little attention from the doctors. You are told to watch you diet, eat low fat, and eat carbohydrates per the American Diabetes Association (ADA). This for many is poor advice. At least the American Cancer Society (ACS) is saner in their advice. I do not say the ACS is perfect, but compared to the ADA, the ACS has their act together.
2. Most medical insurance companies in the USA do nothing to assist anyone with a diagnosis of prediabetes. No supplies or medications are covered. Cancer is cancer, and the medical insurance companies are there to pay the bills although they may not fully reimburse some of the newer procedures.
3. Most doctors will insist on oral medications for diabetes, but give no sound dietary advice. Many will not prescribe testing supplies because they do not wish to make their patients become depressed by high blood glucose readings. Most do not even mention the complications that may develop if diabetes is not managed properly. If the diagnosis is cancer – all stops are pulled out to rid you of the cancer or at least put it into remission.
4. The ACS is united in their support of all types of cancer and united in their fund raising efforts. Whether it is breast cancer or prostate cancer, the support is there along with a unity of symbols and support. Not so, with the ADA, JDRF, AACE, and IDF as they each have their own agenda and guard it zealously. No cooperation there and they scream bloody murder if another organization tries to usurp any credit for their work.
5. It seems that physicians today do not know what to do with a patient diagnosed with prediabetes any better than in the past. They look to the ADA for guidance, which is not available. Unlike the ACS, the ADA has their heads where they cannot see the light, refuse to recognize that prevention could be a huge benefit, and possibly delay the onset of full diabetes for many years or possibly decades. Occasionally some medication may be needed initially while exercise and diet changes are made. The goal should be to get off the medications as soon as reasonable. The doctors do not project the importance of doing anything and the patient wrongly assumes that there is nothing to be worried about, and does nothing that could help manage the prediabetes.

The following points may have comparisons to other diseases, but for my purpose, I want to list them standing on their own. The purpose is to highlight the problems we as type 2 diabetes patients have to put up with in finding things that help us manage our diabetes.

1. If the ADA would position their heads where they could see the light and issue guidelines for medication and treatment, the medical insurance companies would follow suit and prevention could begin. This would probably mean that the patient could delay diabetes and therefore not have the costs, which puts money in the coffers of Big Pharma. Therefore, if you think the doctors at ADA are influenced by Big Pharma, you may be right. This means that the less said about prediabetes and prevention, the better for Big Pharma, as diabetes will happen sooner and require medication.
2. If the ADA could issue more up to date guidelines that fit the real world, maybe more people with type 2 would benefit. They have made some allowances recently, but the other medical professions that are required to follow them have not followed them and as a result, certified diabetes educators (CDEs) continue to follow out-dated guidelines and make life more difficult for type 2 patients. Many people do wish to determine for themselves whether a low-carb diet works for them. This normally means more protein and higher fat in the diet. The CDEs just will not accept this and use the mantra of whole grain, low fat and will not move from this stance.
3. Even many dietitians follow the guidelines of the ADA and American Medical Association. This also creates problems for those wishing to adapt their diet to low carbohydrate diets. Many need guidance for nutrition about keeping their daily diet reasonably balanced. This is often difficult to obtain good advice from dietitians that are afraid of losing their certification.
4. Education about the different aspects of managing diabetes is almost non-existent and most doctors will not spend the time necessary and most CDEs do not care enough to spend the time necessary to emphasize the importance of testing and teaching the patients how to interpret the test results and watch for trends. Because they want us to eat a set number of carbohydrates, they will not tell us to use our meter to determine how the different foods will affect our blood glucose numbers.
5. Most doctors do not understand the management of diabetes. If they have their choice, they will push oral medications on top of oral medications. If this does not work, they think that by threatening insulin they will get the patients to do better. How, the CDEs and dietitians are inept and have their mantras they follow which does not help the patients with type 2. It is up to the patient to make the changes necessary and do trial and error to arrive at what works for them.
6. Because the ADA will not issue guidelines for prediabetes, patients are unable to get testing supplies unless they pay for them. The same applies to adequate testing supplies for type 2 patients as well. In order to learn how different foods affect their blood glucose, they must purchase the additional testing supplies on their own.
7. The odds are stacked against people with type 2 diabetes, first by the ADA, next by the doctors, CDEs, and dietitians. Then add the insurance companies to keep costs down and prevent patients for learning how to manage diabetes for maximum benefits and prevention of the complications.

The only areas diabetes and cancer have in common, but are not exactly the same is dealing with big pharmaceutical companies. Cancer drugs are placed in short supply to up the price of drugs that become generic while diabetes drugs that become generic generally just ceased to be produced, forcing everyone to the more expensive drugs.

The second common area is that most medical insurance companies put cancer and diabetes patients in managed care programs to clamp down on excessive costs where possible and control the treatments. You may be well treated if the need is there, but if the insurance company feels something is excessive, they will force the doctors and hospitals to limit the services.

At least with a cancer diagnosis, you know there is a plan of real action, not the namby-pamby crap handed out with a diagnosis of prediabetes or even type 2 diabetes – if you are lucky to get any assistance. Blame must fall on the medical profession for not learning about diabetes. Then treating it properly, and educating the patients to do their due diligence with self-monitoring of blood glucose. The patients must also be trained to understand what the readings mean and when to test.

Patients should learn that they are their own laboratory experiment and act accordingly as the lab rat. Learn what the different foods do to your blood glucose levels and why you must eliminate certain foods from your menu and greatly reduce the consumption of other foods. Why can I not give you a list to remove, because each person is different, you must determine for yourself what you can eat and not eat.

Yes, I can say eat more protein, but not a lot more. Learn not to follow past mantras of the medical profession. These include, whole grains, low fat, and low cholesterol foods. You must now learn that carbohydrates are very likely your enemy, moderate to high fat meals may be your friend, and some (but not all) cholesterol-laden foods may actually help reduce your overall cholesterol levels. Generally, you will want to avoid the highly processed packaged foods.

When Is AACE Going to Update Type 2 Sources?

The AACE has removed the AACE/Takeda Link

On September 27, 2011 I blogged about AACE/Takeda web site being operational. This was a good thing because it would provide us with reliable sources for diabetes information. Now we are about five months later and no additional sites have been added to the original list. This makes me wonder what is happening at the American Association of Clinical Endocrinologists.

I had thought that this could be an excellent site to give people much good information about diabetes and give people comparisons for many of the snake oil web sites full of false information. Apparently, the AACE does not agree. Why else would it take so long to post sources that are reliable? Even the addition of a few sites per month or even every other month should not be asking too much. Unless they have to completely approve a site beyond the committee of experts.

If they are not going to approve any more web sites, why will they not say so? First, I would doubt that they have exhausted the reliable sites. There are many sites that I seriously doubt will able to satisfy their stringent guidelines, but this still leaves many that can meet their requirements.

If there are no more sites that meet their requirements, certainly they have a host of web sites that could fit under some category that lists the weakness of the sites. To have waited five months from the announcement of the site to its debut and now another five months without any additions to the original list of approved sites is very disheartening.

If you are looking for good sources, I suggest joining Google+ and adding Dr. Bill Quick (Bill Quick) to your circle. He is listing a “D” site at least five days a week and they should be reliable. He does cover the types of diabetes in the sites he lists, so it is not a listing for one type of diabetes only.

Another good source of information on Google+ is Scott Strumello. He posts links to much good information and especially for type 1 readers. He covers a variety of topics and does include the occasional tidbit for type 2.

Therefore, if you are like me and tired of the pace of the AACE in posting approved web sites, explore and read carefully. There are many good sites available that AACE and their snail's pace may get around to listing sometime in the distant future.