April 14, 2016

Doctors Are Not Treating Prediabetes

Barry called me earlier this week, said he had something to talk to me about, and asked if I could come to his place. I said yes and headed out the door. When I arrived, I had expected Ben, but Allen and Tim were there also, plus another person we all were introduced to by Barry. Barry said his name for the group was Jay.

Barry then continued that Jay had a doctor appointment this morning and after the labs were discussed, Jay asked for a copy and the doctor had his nurse run a copy. Next, he wanted to prescribe a statin, a blood pressure medication, and another medicine that they talked about but he decided not to prescribe. Barry then said his plasma glucose was at 136 and his A1c was 6.4%. All that was said by the doctor was your sugar level is moving up and to watch what he ate. He said this is the main reason I called everyone here.

I asked Barry what he had discussed with Jay. Barry said he had looked at the lab results and from the lab results and asking Jay what his blood pressure was, he could see that he needed the blood pressure medication. He said that he wanted the rest of us to look at the cholesterol numbers, as he didn't think a statin is warranted. Jay handed the report to Allen and Allen read it to the rest of us. HDL 58, LDL 84, Triglycerides 70 and a few ratios. All agreed that statins should not be needed.

I added that the reason for the statin prescription is obvious – his A1c is 6.4% and this tells most doctors to prescribe a statin. Tim said he agreed with me and that is the reason for not diagnosing prediabetes and prescribing metformin or insulin to help the pancreas heal and possibly delay or prevent diabetes.

Ben spoke then and said he agreed and said that we should get him to a doctor that will diagnose and is not afraid of prescribing. Allen said he was on the fence, but with the A1c, he could understand and would support us. Jay started asking questions then and said he did not want to go to another doctor. Barry then asked if he wanted to know about prediabetes. Jay said if it was serious, the doctor would have said something.

Tim and I looked at each other and Tim said to Jay, that it was his choice, but when he actually has diabetes, he cannot say he did not have a warning, unlike the rest of us that did not know until diagnosis. With his plasma glucose reading and the A1c, he should know that he is moving toward type 2 diabetes rather rapidly.

Jay asked Barry if this was true. Barry said yes, and if you continue to ignore it, you will soon have diabetes. Barry then added that it may be too late with an A1c of 6.4%. Ben added that the doctor sees this and knows he will soon have a patient with type 2 diabetes that he will be able to treat. Allen said the comment he made “your sugar level is moving up and to watch what he ate,” is what we understand now as code for prediabetes.

I said that is the reason most doctors will not diagnosis prediabetes is because they know that they will soon have a patient to treat and possibly more regularly if they don't manage it properly. Doctors in general, believe diabetes is progressive and people will develop some of the complications and they will be able to treat many of the complications.

Jay asked what complications? Barry started with blindness; kidney failure, meaning dialysis; heart disease; nerve damage, meaning pain for many people; and possible organ failure. I could see Jay looking very worried. I said this does not have to be this way, but it does require action by you to change your way of eating, exercise regularly, if able, and test regularly. I said some people go through stages – anger or shock, denial, and finally acceptance before they take action.

Tim said if you will let us get you to an endocrinologist that knows diabetes, he can give you medication(s) that will help manage your blood glucose problem and possibly prevent diabetes from developing. Your A1c does indicate a serious problem with blood glucose and does need to be treated now. Jay finally admitted he was concerned and asked Barry who he would recommend. Barry said he would take him if Allen would go with him once he had an appointment. Allen said he had the phone number, started the call, and then handed he phone to Jay and we could hear Jay giving the receptionist his information. Jay finished and told Barry his appointment was for April 29 at 2:20 PM.

Tim asked Jay if he had a computer and he said he did. Barry said he would give Jay some of my blogs, some by David Mendosa, and other areas to read. Tim thanked him and we excused ourselves and left.

I forgot to say anything about the public service advertising about predicates, as this is an on target promotion and deserves our attention. I have now seen four of their ads and the last two were not over the top and were on target to wake people up about prediabetes.

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