April 5, 2013

Diabetes Questions to Ask Your Doctor – Part 3

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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