November 7, 2013

Our Group's November Meeting

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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