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.

Reference to My Blog of May 8, 2013

It has been longer than I thought, but finally the person I blogged about in this blog has received her notification letter and had her appointment with the VA. She apologized for not returning my email sooner, but she had her appointment almost immediately after receiving her notification letter. She needed to coordinate with her endocrinologist and her VA doctor to get the correct amount of each insulin and was happy that her doctor worked so well with the VA.


In addition to her insulin, she received a flu shot and was advised to have a Vitamin B12 shot because she was deficient. They suggested that she should have the endocrinologist check her in a month and give a second shot if needed. She said she had read one of my blogs about Vitamin B12, but could not find it. She remembered that it listed some of the sources of Vitamin B12. I sent her the URL and in the return email said she could eat some of them, but did not like liver, kidney, sardines, salmon, and was lactose intolerant.


I said that she should talk to the endocrinologist about taking Vitamin B12 supplement and she said she would. Then she talked about her VA benefits and thanked me for pushing her to get the paperwork in. She said what I knew about the help of the Veteran Affairs officer and that made everything go very smoothly. Then she thanked me again and wished she had contacted me earlier as this would have helped with the oral medications as well.


She said she had been to her doctor and he had a copy of the VA test results now. She commented that she was surprised that he had advised her to take a daily multivitamin after looking at that page. The next question I had correctly anticipated as it was about statins. She did include the results of her lipid panel and they were within range, but near the high side. She did ask if she could avoid statins as she had been reading some of my blogs and other sources and had discouraged the doctor this time.


I sent her several URLs about them and the troubles women seem to have with them. I would only say that my thoughts were similar to the articles and that she did need to have a good talk with her doctor if the lipid panel showed an increase at her next appointment. I told her that only her doctor that knew her history was qualified to advise her. She did say that she had asked because she knew I would give her something to read and said they had answered many of her questions.


We will be staying in contact, but I doubt I will blog about her situation unless she raises some issues that should be blogged about.

Are You Communicating with Your Doctor

Is Your Doctor Listening to You?

Establishing a strong doctor-patient relationship often depends more on you, the patient. This is sometimes difficult during the first few times you meet with the doctor. There are several steps you must accomplish to know that you have the right doctor and can establish a good communication between you. This will also determine the extent of your trust and desire to build a relationship with the doctor.

Probably one of the first steps will be in finding out during the first visits if the doctor uses the “cookbook medicine approach” or the “your story first approach.” It is important to know these as this will determine how you prepare for your visit. Both are polar opposites in their approach and you need to determine which is a better fit for you. I know I prefer the second approach, but I do have one doctor that uses the first approach. There are variations on both approaches and this can be a challenge. I know this because another doctor lets you tell your story first and then goes into the cookbook medicine approach and I had better answer his questions with a yes or no. When he has finished, then I can normally fill in the blanks that he has missed. This may or may not start another round of questions.

His method has resulted in my being more specific when I start and leaving the unrelated material for his questions. As we have perfected this over the years, he has modified his questions to allow for some detail and I give it to him as briefly as I can. One day when I was there for a checkup, or semiannual appointment, nothing was bothering me and I said as much. He stopped, looked at me, and casually asked what to do next. I said cover the lab results and we did, in more detail than he has ever done before. When he finished this, he asked if I had any questions. I told him that he had answered the questions I had as he covered the lab results, and I said we were done. He looked like I had just defeated him in an extended tennis match. I told him to take advantage of the extra time for his next patient and he seemed to recover immediately. He thanked me and told me to set up my next appointment in six months, and handed me the lab request sheet for the next appointment to give the person setting up the next appointment. Then he headed for the next exam room.

The next appointment started out the same and this time he handed me my copy of the lab results saying everything was good and did I have any questions. I said no and he handed me the lab request sheet and said to set up the next appointment in a year. He stopped and then said if I did need to see him before then, paused, and decided to walk out with me to the desk for the next appointment and gave her the instructions and told her to note on my record that if I needed to see him before the next appointment – to schedule an appointment. She put her name and extension number on the appointment slip to use if I needed an appointment earlier than scheduled. It is this type of relationship that I have learned to treasure, but it took some time and learning how the doctor functioned.

I have another doctor that is all together different. He enters the exam room and asks me questions related to the reason for my appointment. Once he is sure I am there for the stated problem, it is all business of my explaining what has happened and when. Sometimes, because of the problem, I have had tests done beforehand and at other times after he is sure I need the tests. While he is waiting the test results, he moves onto another patient and then returns with the completed test results. Most of the time he tells me that here is a prescription for 10 days and communicates with me about calling for another appointment if this does not correct the problem. Because this has been a lifetime problem, he knows I know what to do and is very careful about repeated episodes.

The most interesting of my doctors has been the person I see for diabetes. There it is discussion of my A1c and the meter readings. She could spot trouble areas in a glance and knew what to ask. I am very sorry to see her leave the diabetes clinic. Now I will need to see how the next person handles the appointment. I will need to be on my toes to discern how I will be treated.

I am concerned about the new procedures being handed me by several of my doctors and I sense I am being slowly being pushed out of their practices because of Medicare. It may be because of the 2% cut or for other reasons that are being implemented in the affordable care act. Tests are being cut and I am being directed to the VA for more of my care.