July 15, 2016
Knowing Your Diabetes Goals
A.J called several others and me last Sunday to meet with him and Jerry. When we were all gathered, Tim, Allen, Ben, Barry, Jason, and Max were in attendance. Tim asked what was happening. A.J said that Jerry and he were talking to several people new to type 2 diabetes and they were upset with the doctors they had. He continued that the doctors were setting the goals for them and demanding that they achieve them.
Jerry said the two people he was talking with were both over 70 years of age and one doctor had told the person to achieve an A1c of 7.5 percent (at diagnosis the A1c was 11.8 percent) and at the same time consume 50 grams of carbohydrates per meal and eating three meals per day. Jerry said the fellow was overweight by 50 pounds and wanted to lose the weight, but the food plan he was on was keeping him from losing any weight.
Jerry said the second person was about Allen's age and his doctor told him to achieve an A1c of 8.0 percent. His A1c at diagnosis was 12.7 percent. He was told to consume 55 grams of carbohydrates per each of three meals. Jerry said this person was almost 80 pounds overweight and had also been counseled to consider bariatric surgery.
I suggested that we invite the persons to a meeting with us and really get down to business when we could ask them questions directly. Tim said he agreed and unless A.J and Jerry had objections to this, we should do this. A.J said he agreed and he had three people he was talking to and they were all over 67 years of age. Jerry agreed and said he could call his two people and A.J said he would call his people.
Max said he was happy that the two of us were there since we were overweight and this should help them feel more at ease. I agreed and stated that we should find out what medication or medications they were taking before going too far into the discussion.
While we were waiting for them to arrive, we discussed what some of our objectives should be and how far were should promote them. All of us agreed that we should ask them what they felt like and depending what they thought should encourage all of them to consider insulin. We all agreed that a reasonable A1c for them would be between 6 percent and possibly 7 percent but preferably below 6.5 percent.
They were all present after 30 minutes and the discussion started. They surprised us by asking questions about what medications we were using. When they found out all of us except Jerry and A.J were on insulin, they were asking why and what was our latest A1c was. When Allen said his was 4.6 percent, they wanted to know how this was possible. Allen said he follows Dr. Richard Bernstein and his “law of small numbers”. Small numbers of carbs consumed require small amounts of insulin which helps prevent hyperglycemia (highs) and hypoglycemia (lows) which are both dangerous. These can still happen, but are fewer than if we eat larger numbers of carbohydrates.
They then asked why the doctors were pushing the large number of carbohydrates and Tim said because they are not comfortable with our way of eating and still believe in low fat. Tim said we all consume lower carbohydrates and most of us eat less than 50 grams of carbohydrates per day and higher amounts of fat. Most of us consume a mid-range amount of protein, but the exact percentage each person eats will vary as we test to find out what works best for each of us.
This brought a look of surprise and two asked how we test, as their doctors had not said anything about testing anything. At that point, Barry asked if they had any lab results from their diagnosis. All shook their head and one said how do we obtain these. Tim said that they needed to request in writing for the information. You should put the information on paper, then go to the doctor's office, and ask for the information. You will be given a form to complete and sign. This will mean transferring your information to their form. Then write the date your requested the information on your paper, as you may need this later. Expect most doctors to take the full 30 days to respond and you may need to remind them that the 30 days have passed and they you are filing papers with the Department of Health and Human Services, Office of Civil Rights (OCR).
We talked for another two hours and I will have another blog on this.