April 2, 2014
Diabetes, Seek out Information for Power
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.