We have had several meetings in
September and October, but we felt this was important because of what
the endocrinologists had to say about their choices in “Choosing
Wisely.” At least they did not outright cut us off from testing.
They did not do us any favors in discouraging people with type 2
diabetes from testing and in the process maybe discouraging education
for their patients. We included the local doctor and his group in
our early November meeting.
I was surprised at the amount of
discussion we had on the topic and one of the members, Rob, had
written the primary spokesperson for further clarification and
received a very lengthy reply (a five-page email). It appears that
the American Association of Clinical Endocrinologists (AACE) and the
educational arm (ACE) are even more supportive of patients than the
Medscape article might lead you to believe. They firmly believe that
if you are on an oral medication that can cause hypoglycemia, which
the sulfonylureas are, that you should have the necessary testing
supplies on hand to test if you suspect a low and to be able to test
until you are back within the normal range.
This it what I felt and I thought I had
written this in my blog here, but it was still good to have him
address this directly. The other point he made was that with the
American Diabetes Association change away from the word diet to food
plans and food preferences, the AACE will need to assess patients
more closely and take into account the carbohydrates generally
consumed by patients before and after education. This will
necessitate making sure that medications are prescribed in a manner
that will not over/under medicate diabetes patients and cause
hypoglycemia or hyperglycemia. The members of the AACE will need to
monitor what patients are taught for food consumption to be able to
tailor the dosage of medication.
Plus, another point he was kind enough
to include was pointers on when not to take a medication if the
patient is ill or will not be able to eat as normal. The doctor
asked all of his patients to be sure to keep the copy of the letter,
as this could be very valuable to those on oral medications. He
would make sure to cover this in their next appointment to make sure
everyone was on board and understood what he had advised people to
consider. Even the doctor admitted that occasionally this was
something he could forget to cover and with this letter, he now had a
reminder to cover this.
At that point, the doctor thanked us
for including his group and suggested we might wish to present this
to the other two groups. Tim said this was on his mind as well and
wanted to talk to the group about this after the meeting. Sue asked
to speak then and discussed the need she was feeling to repay our
group by speaking to other groups about how she had been able to get
off medications. A.J. said he would like to do the same and the two
of them could cover the topic because Sue had only been on oral
medications and he had started on insulin, which should help people
know that it might be possible.
Tim asked for a show of hands for any
that might be interested from the doctor's group and there were
three. The doctor said they had approached him about this and it
would be good to hear this now. Tim asked Sue if she was ready and
Sue said she was and A.J. felt that he could follow Sue's lead. Sue
took the lead and said it was good to know that those interested had
talked to the doctor as this was an important first step and without
the doctor's consent, she felt that people would not be prepared to stop
all medications.
Sue then stated that anyone interested
should attempt to get extra testing supplies as they could greatly
benefit from the extra testing for up to three months. Next, she
said that an exercise regimen was necessary that they could adhere
to. She felt this also should be discussed with their doctor. She
and her husband used jogging and walking, swimming, and dancing. Now
that the weather is changing, they have two exercise machines
available for them to use when the weather is too cold or snow would
be difficult to run or walk in outside.
A.J. continued that he was running
about 4 miles during the evening and up to 10 on the weekends. He
said that he occasionally sees Sue and Bob swimming when he uses the
pool as well. He said also has a machine for when the weather is
such that he will not be able to run. He said his doctor had
approved of his regimen and felt this was important. He said some
would need to reduce the amount of food consumed until they build up
their routine and become used to the amount of exercise.
Sue confirmed this and said it was good
that her husband was participating with her and admitted this may be
necessary for some people to become committed to a routine. She said
A.J. has been able to do this alone, but they do see each other from
time to time and she said this is good even if a group wants to
exercise together. She said that some are able to get off of all
medications and in her correspondence, she has found that some are
not able to develop the regimen strong enough to be successful in
staying off medications. This is part of the reason for the
additional testing and to make sure that if you need medications, you
do not let your diabetes get out of hand before getting back on
medications. Her husband, Bob confirmed this and said he almost went
back on medications until the period of travel for him ended this
fall as his readings were starting on an upward trend until he was
able to stop traveling and spend the time needed to exercise with his
wife.
At that point, Sue said it takes
dedication and work and for some people that don't have support from
family, friends, or a support group like she has, it may not be for
everyone. There were a few questions and the doctor said that he
agreed with what had been said and felt that for some it would be
possible, but not to consider themselves as failures if they could
not stay off of medications. A.J. agreed and the meeting ended.
The doctor asked to talk to Tim, Rob,
and I about going with us to any meetings we were able to schedule.
I stated that I already had one scheduled for the third Friday in
November and wanted Rob to go with me. I said I would be back in
contact with them now about Sue and A.J. presenting as well. The
doctor said he would like to go with us as he had not known about
this group and felt it could be good to meet their doctors and
exchange ideas. I asked Sue and A.J. if they could go if the group
approved their presenting and both felt they could. Tim said he
would drive and the doctor volunteered if there was approval for Sue
and A.J. Then we left it at that point.
In the following week I could not get
approval for Sue and A.J. for this meeting, but they said this would
be considered for their March meeting. The rest of us were approved,
so Tim will drive then.
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