I am surprised that I have been asked
to do this blog. Two of our support group, Barry and Jack had an
unusual meeting with a certified diabetes educator (CDE) and were
both told to go back on oral medications. Both questioned why and
were told that they were managing their diabetes too well and this
CDE felt they should come off insulin and return to oral medications.
In addition, they were told that they
were not consuming enough carbohydrates and would have problems if
they didn't start consuming more. They she had quizzed them about
the amount of fat they were eating and said they should be eating low
fat as fat was not good for them. Jack said they both laughed at her
and said they were not going to change. The low carb/high fat food
plan they were eating was making their diabetes easier to manage and
the insulin was helping them manage their diabetes.
Barry asked her why they should change
when they were having success and their latest A1c's were both 5.4%.
She promptly asked if they recently had a hypoglycemia episode. Both
had answered nothing below 65 mg/dl and both declared they realized
that the upper limit was 70 mg/dl, but they were not concerned about
a few readings in the 65 to 70 range.
Jack said that she chastised them for
being under 90 mg/dl. She felt that for their age this should be the
lower limit. Barry said she continued that they should both have
A1c's near or above 7.0%. Jack said he became a little hostile and
told her she was out of line and that her one-size-fits-all solution
meant that she had not properly assessed them and their abilities to
manage diabetes on an individual basis.
When she would not back down from her
decision, both got up and left saying they were not round pegs she
could fit into her square holes. They knew from testing that they
were capable of managing their diabetes and would not listen to what
she was mandating.
Barry said he remembered a blog I had
written back June 2012 and said something about CDEs not having a
proper perspective on people with type 2 diabetes. I had him look at
this blog, and he said that is the one. Jack read it and said that
summarized his feelings as well and that is why he was intending to
ignore her advice. Jack added that her one-size-fits-all advice was
not for them and he did not like the way she had come across to them.
Jack added that I had another blog back
in 2011 that said something about knowledge about diabetes being
power. I pulled this blog up and he said yes. He said that if I
would put the URLs in an email to him, he would email our group about
what had transpired and how we should avoid CDEs that could not
individualize plans or do proper assessments.
Barry said that their doctor had
suggested seeing her because she was new to the area and they could
make use of the two hours of education allowed by Medicare. Barry
said they had only used less that an hour and they were going to tell
their doctor not to send other patients. People with type 2 diabetes
and well managed were going to be very disappointed. I suggested
that they explain her push for high carb/low fat when the were doing
the opposite. Jack said he would as it was the doctor that had
suggested this in the first place.
Late the next day, Barry called to say
that was exactly what his doctor wanted to hear and now he would not
be sending other patients. Barry said that was why he sent two of
his well managed type 2 patients. Barry said he had even sent one of
his type 1 patients and the CDE wanted him to consider stopping the
pump. Barry asked if this was for a short vacation and the doctor
had said permanently.
Barry told me the doctor had said there
is a need for a CDE, but not one so far behind in her education, out
of touch with doing an accurate assessment, and one that would advise
a patient to abandon a pump.
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