July 4, 2014
Study Claims VA Elderly Overtreated for Diabetes
If you guess that I am upset, you would be correct. More articles are being promoted in newspapers, magazines, and on the internet that are telling the elderly to roll over and die. The New York Times is no exception and the author really sensationalizes and shows her ignorance of diabetes. Among the comments, most agree with the article, but one says what I believe.
The current comments and the one I agree with is the one by Bill from SF, CA. There is one from a doctor from East Lansing, MI, that uses a lame excuse that he will be labeled a bad doctor if he does not keep his patients under an A1c of 7.0. I would not think much of this, but the study used by the NY Times is a study published on February 1, 2014, and the author had to be looking for something to sensationalize.
What many forget is that most doctors and doctors of the VA keep piling oral medication on top of oral medication until insulin becomes necessary. The elderly then pay the price for their doctor's negligence. Then we have the Centers for Medicare and Medicaid Services (CMS) limiting test strips preventing patients with diabetes from knowing what different foods or combinations of foods is doing to their blood glucose levels. Even the VA limits the number of test strips for patients on oral medications and on insulin, not as severely as CMS, but not a lot more.
Naturally, all doctors are worried about hypoglycemia and this permeates their thinking and actions. This is one reason they will not start people on insulin when they are diagnosed at a younger age and would better understand what needs to be watched to prevent hypoglycemia. This would also give the pancreas a rest and possibly a chance to repair itself. This could mean that insulin might not be needed later when cognitive issues may be in play.
The other issue not discussed is how many VA physicians actually know how to prescribe insulin correctly. The NY Times article makes it sound like the VA prescribed a fixed amount of fast acting insulin and don't instruct patients how to titrate up or down to prevent hypoglycemia. I know this problem and am thankful I also see an endocrinologist that has worked with me.
The other missing factor is carb counting. I have had VA physicians that have a difficult time explaining carbs. Most calculate one carb as being 15 grams of carbohydrates and prescribe medications based on this. This does not work for people with insulin resistance like I have. I even need to disagree with the endocrinologist when she tries to adjust my insulin. I constantly need to remind her that I calculate on grams of carbohydrates and not carbs.
I can understand that doctors need to be very concerned about older VA patients that live alone and have no one to look in on them daily. If they are having memory problems or early stages of dementia, then there is real concern and other steps need to be considered. Social services should be contacted to find out what services can be offered.
For more reliable information, read this blog by Dr. Bill Quick. He has information that was behind the pay wall and makes more sense of the issue. The study is greatly distorted by the author of the NY Times.