Are You a Fighter or An E-patient?

First, I take umbrage with the term fighter. Until a few years ago, I would probably have agreed with you or used the word manager. I now prefer the term e-patient. This means empowered patient. It takes the aggressive nature that fighter implies out of the equation. In its place we use empowered. This equates to being a patient with knowledge of the chronic disease or illness, knowledge of the medications utilized, and a desire for more knowledge. It indicates a willingness to be in charge of or take ownership of the disease and work with the medical profession where possible.

I say where possible because there are doctors that are unwilling to work with or even treat patients that are proactive to say nothing about being empowered. When empowered patients interact with excellent doctors that want them as patients, the relationship for both can be very rewarding. Respect for each other is apparent and discussion is the hallmark of this relationship. There is give and take, but neither is trying to out do the other. They each know their place in the relationship and work together. It may not be complete harmony, but the respect is present at all times.

Even though this blog by David Spero is from August 1, 2012, and I may not like his word usage, the ideas he presents need discussion. David highlights a topic I wrote about recently. I know that many patients take medications blindly following their doctor. David says that they do not understand why they are taking the medicine(s) or what the side effects may be. This is true for many patients across all ages. This is a case for what you don't know can kill you in today’s medicine.

This is why we need to become proactive in our diabetes care and then become e-patients. We need to learn all we can about the medication(s) we are taking and even those that we are not taking. We need to know the possible side effects and what the medication(s) do for us. It does not bother me that you may not be able to pronounce the name of the medications. It does matter that you know what each is for and how they may affect your body. It is even more important that you know that you are experiencing a side effect and whether it is a minor side effect that has little consequence to your overall good health, or is a serious side effect that may be life threatening or debilitating. Then you must contact your doctor immediately and discuss the side effects and be knowledgeable about the possibilities of changing medications.

Too many people end up in the hospital because they don't know the possible side effects or ignore what could be a side effect until medical intervention is necessary. With most medications on the market today, it is not wise to assume that your doctor will give you the information necessary or even prescribe the correct medication in every instance. With the growing shortage of physicians, more physicians employed by profit driven hospitals, and many medications entering the market that have more severe side effects, patients of today would be well served to become more proactive in their care. This means using Internet sites like WebMD to check out your medications and learn about the side effects. Or, you may try this website. You may also use your search engine for several terms like “learn about medications” or “learn about rx medications.

This may be a lot of information to digest, but you have the time to do your research and learn. You will need assistance for diet and nutrition unless you have a lot of knowledge or a degree in nutrition. It is best to get professional help. Most physicians do not have the information and most educators do not have enough. I would recommend considering a nutritionist from one of these groups - Alliance for Natural Health, USA, or the American Nutrition Association (ANA). I have only had dealings with nutritionists from the ANA. While they will suggest plans, they will normally work with you and develop a plan based on your needs or what you want to accomplish. They will generally work to make sure your meals are nutritionally balanced or that the meals for that day are balanced. There are other nutrition groups as well that do not operate on mantras, mandates, and dogma.

I challenge you to become an e-patient. This means listening with respect to your doctor, but not being afraid to respectfully disagree or challenge your doctor if needed. Learn about the medications you are taking and the reason you are taking them. Discuss these medications with your doctor and become familiar with his reasons for prescribing each. Then research each to see if you agree with your doctor's decision. Then learn about the other medications that could work for you. Learn about the side effects of those that you are taking and those you could take. Research medications in the same class of each and see if something might actually fit your circumstances and possibly be more effective.

Please consider becoming an e-patient and realize the benefits. Good doctors will appreciate that you are taking ownership of your disease or illness and become more willing to discuss the different treatments. You will be less likely to need to be a fighter as your doctor will be more willing to fight for you instead of with you.

Reasons Diabetes Patients Need To Be Proactive

Proactive you say? Yes, we as patients need to become more proactive in our care and learn about diabetes, diabetes medications, and the care of ourselves. This means that we should learn and review. The new medications that may be coming to market in the next few years will need to be reviewed, as there could be some side effects and some positive results. Just letting your doctor prescribe a new medication may not be in your best interest. You will also need to check with your medical insurance company to see if they are covering it. You should know that the cost will be higher than the current medications on average or even significantly higher. Those on Medicare will still have the “doughnut hole” (though smaller) for a few years and this could be a budget buster for some.

With hospitals continuing to employ more doctors, you can bet the time you will have with your doctor during appointments will continue to shrink. This means less time will be available for the doctor to dispense education and even cover the topics necessary.  The recent guidelines from the American Diabetes Association (ADA), which shows a lot of stacking of medications, may not work for many patients. See this blog by Tom Ross for the chart, or follow his link to view how ADA is stacking oral medications. This makes it even more important for patients to educate themselves to know what the side effects of medications are. It is also important that patients learn self-monitoring of blood glucose (SMBG) and other important management skills.

It is also important to understand that just because a doctor does not mention or talk about something, there are areas that are important and should not be ignored. Exercise is one of these areas and I admit that I am tired of hearing other patients with type 2 diabetes saying, “It must not have been that important as the doctor never talked about it.” This phrase just seems to roll of the lips of patients and I can understand as either they don't wish to follow some recommendation, or in fact, the doctor did not have time to talk about it. Nutrition is also a topic most doctors do not talk about, yet for people with type 2 diabetes, nutrition is very important to great diabetes management.

Another topic doctors often don't talk about unless they are prescribing insulin is hypoglycemia. They seem to overlook the fact that this can happen and does happen to patients with type 2 diabetes on oral medications, especially sulfonylureas. A recent blog should also raise this concern. Even this short article talks about hypoglycemia, but other than list the symptoms, gives no indication of what to watch for in your blood glucose readings. This is important and many of the symptoms could be indicators of other medical problems. One check of your blood glucose will resolve this issue. If your blood glucose reading is below 70 mg/dl (3.9 mmol/L), you are in the hypoglycemia area and should take action immediately by chewing on a glucose tablet.

Just to keep this in front of you as a reminder, here are many of the symptoms of hypoglycemia,

Feeling dizzy or shaking,

Sweating and having pale skin.

Developing a headache.

Feeling hungry.

Showing sudden changes in behavior.

Moving clumsily.

Having a seizure.

Feeling confused or having difficulty paying attention.

Feeling a "tingling" sensation around the mouth.

This blogger believes we will need to become e-patients, meaning empowered patients. Her book e-Patients Live Longer, helps explain her and her beliefs, but it is a good read. Whether you have diabetes or breast cancer, it helps to be an e-patient.