Part 3 of 3 Parts
Are you ready for you doctor
appointment? The following is the rest of the questions to ask your
doctor if you suspect diabetes or if you have just received a
diagnosis of diabetes, type 2. The 14 questions can be read here. I
am quoting the questions and adding my comments to give possible
solutions. I have split the two-part questions.
Will I always need
medications/insulin? It is always too early to be sure, but
if possible, the goal should always be to get off medications if
possible. Until you have attempted this, there is no way of knowing
if you will always need medications and insulin is a medication and
should not be considered the medication of last resort or as a
punishment as many doctors are prone to do. If you have a doctor
that does this, please do your health a favor and find a different
doctor.
How will you evaluate whether
these medications are the best treatment for me?
Your doctor should do a complete
evaluation, noting any allergies, foods that cause problems, and
several tests to determine kidney health, and heart health before
prescribing medications for diabetes. Then the doctor should discuss
with you what the findings recommend and then discuss the side
effects with you so that together you can make a decision. A doctor
that does not do any of this is not a doctor to be retained.
What are the long-term
complications of diabetes, and how can I avoid them?
There are not long-term or short-term
complications. They are complications and they need to be avoided if
possible.
Complications don't cause themselves.
Poor or no management of diabetes – meaning not testing, not losing
weight, not eating balanced meals, not making other lifestyle
changes, and no blood glucose management is what causes the
complications. So what are the complications? Retinopathy,
neuropathy, nephropathy, atherosclerosis, and deafness are the most
common, and many don't include deafness. The first three and deafness
are grouped together under the term microvascular complications
because they result from damage to the small blood vessels. The
macrovascular complication is atherosclerosis, which is caused by
damage to the large blood vessels.
Retinopathy causes damage to the
retina, which may lead to poorer eyesight or blindness. Neuropathy
causes damage to the nerves, which cause pain and can be more than
annoying pain. Nephropathy causes damage to the kidneys or increased
renal problems leading to kidney failure or chronic kidney disease
(CKD). Deafness or hearing loss is caused by the eardrum losing the
ability to transmit sound because of short blood supply.
Atherosclerosis can lead to heart attacks, stroke, or poor healing of
wounds in the feet and legs. This is the cause of amputations.
Although these are not complications,
there is a strong relationship with diabetes and as such, they are
called comorbidities. The 2012 ADA guidelines listed the following:
1. Hearing impairment,
2. Obstructive sleep apnea,
3. Fatty liver disease,
4. Low testosterone in men,
5. Periodontal disease,
6. Certain cancers,
7. Fractures, and
8. Cognitive impairment.
Then for the 2013 guidelines, they
added depression, almost as an afterthought.
How do other factors such as high
cholesterol and high blood pressure affect me if I have diabetes? As
studies are beginning to prove, some types of cholesterol are less of
a problem than thought and even the ADA has raised the blood pressure
threshold for blood pressure for people with diabetes. I will not
quite go to the extreme to wish statins away, but their usefulness
may be in doubt, but at present are still needed. Extremely high
blood pressure should be lowered with medications until changes can
be made in lifestyles that make high blood pressure normal.
How often should I be seeing my
doctor to optimize my diabetes management?
This will be determined by your doctor
and the medication(s) you are taking. People with type 2 diabetes
and not on medications may be limited to one time per year. People
on most oral medications will probably be seeing a doctor only twice
a year. And, people with type 2 diabetes and using insulin will
probably be seeing a doctor four times per year or maybe less. The
American Diabetes Association in their efforts to deny people with
type 2 diabetes the treatment they need have lowered treatment
expectations and some of those that are in positions of authority are
making statements that some people with type 2 diabetes only need to
see a doctor once a year and may not need to test at all. See my
blog here for what some ADA officers are saying. You may also read
this about the position of ADA and how Joslin may have affected the
situation.
How often you see your doctor may also
depend on how often your insurance company will reimburse the doctor
for office visits.
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