This is not about diabetes, but may affect treatment of diabetes in the future. Telemedicine has been around for a few years, but with many of the advances in recent years, there is now cause to feel more confident about its use and the good that it can do to help areas without large medical centers and specifically rural areas.
Telemedicine is finally getting the light it seems to deserve. In three articles appearing on May 3, 2011, advances in telemedicine are moving forward. The Centers for Medicare and Medicaid Services (CMS) has open the door to make it easier for smaller hospitals to take advantage of doctors with specialties they can not afford. Prior to the new rules, they were required to perform medical checks on all doctors they used as if they were employing them.
Now they are required to do this only for doctors not employed by hospitals elsewhere. If the doctor is already on a hospital staff, they are deemed eligible to operate via electronic means in any hospital that needs their services and Medicare and Medicaid will cover the costs when there is a proven need. The full article covering this is here.
The more important one for me is that our veterans will now get the attention they deserve for PTSD (post-traumatic stress disorder). This will allow veterans to avoid long travel times to centers distant from where they live to get the care they need in dealing with PTSD. Previously the veteran was required to travel to major medical centers for the care they needed.
This was not conducive to many veterans because of cost, and for many the fear of traveling and going into places that may be crowded. The studies have shown that costs are less, patients are happier, and the long-term benefits have increased. Not measured is the improvement in the quality of life for the veterans receiving treatment via telemedicine. Read this article here.
The third article is from Florida and also showed improvement in patient care for trauma patients and those needing medical attention immediately. Instead of automatically transporting the patient to the local hospital to have them forward the patient on the the trauma center at a cost of approximately $10,000, telemedicine can determine with the medical personnel on the scene where to send the patient.
This saves time and some monies as if the trip to the trauma center is necessary assistance can be provided en route to the emergency personnel. The center can also assemble the team necessary to treat the patient more effectively upon arrival.
These three articles emphasize the importance and possible cost savings of telemedicine for the advantage of the patients. Expect to hear more about telemedicine during the coming year. Read the last article here.
May 8, 2011
May 6, 2011
Walgreens Now in Minimal Primary Care Mode
When I wrote about this back in November, I thought this was going to be a lot more comprehensive primary care. It may well get there, but for now Walgreens is doing something positive and at a reasonable cost. For people without insurance, this could be very beneficial. And time will determine if this is successful.
Walgreens is advising people that test over the limits to consult their doctor and share the results with the doctor. The one question bothering me is whether they require fasting before the taking the tests. If people can just walk in and have the tests done, then this could be a weakness in the system that needs to be corrected to make the tests more reliable.
The press release did state that the tests are not for diagnostic and treatment purposes and they are not conclusive as to the absence or presence of any health condition. Since the pharmacists administer the tests by finger stick this would have to be the case. The costs of the tests are - total cholesterol and HDL - $30; blood glucose - $20; A1C (for self-identified diabetics only) - $35; and blood pressure - free with every health test. This totals to $85.
While the tests are not cheap for the finger stick method, this could give people an idea about whether to schedule an appointment with their primary care physician. Not all Walgreens stores and outlets are doing these tests, you can look here for one near you that does the tests.
This if nothing more is doing some preventive care and for people over certain ages should at least have these test on a regular basis. This is explained in the article here, and should be read by everyone. One age requirement is that the person must be at least age 18 or older.
At present, I have not read about any other national or regional pharmacies offering these tests, but I am sure we will hear about this if and when it happens.
Walgreens is advising people that test over the limits to consult their doctor and share the results with the doctor. The one question bothering me is whether they require fasting before the taking the tests. If people can just walk in and have the tests done, then this could be a weakness in the system that needs to be corrected to make the tests more reliable.
The press release did state that the tests are not for diagnostic and treatment purposes and they are not conclusive as to the absence or presence of any health condition. Since the pharmacists administer the tests by finger stick this would have to be the case. The costs of the tests are - total cholesterol and HDL - $30; blood glucose - $20; A1C (for self-identified diabetics only) - $35; and blood pressure - free with every health test. This totals to $85.
While the tests are not cheap for the finger stick method, this could give people an idea about whether to schedule an appointment with their primary care physician. Not all Walgreens stores and outlets are doing these tests, you can look here for one near you that does the tests.
This if nothing more is doing some preventive care and for people over certain ages should at least have these test on a regular basis. This is explained in the article here, and should be read by everyone. One age requirement is that the person must be at least age 18 or older.
At present, I have not read about any other national or regional pharmacies offering these tests, but I am sure we will hear about this if and when it happens.
May 4, 2011
Will We Gain An Advantage Over Diabetes Misinformation?
This is something that many should watch for in the following months. It could be a huge advantage for us or for some of us it may be a bust. It will depend on whether the American Association of Clinical Endocrinologist (AACE) follows their own recent guidelines allowing for individualized goals or if that will not be a part of this and individualized goals will be ignored for safety reasons.
We will need to watch for when this will happen on the AACE web site. The information that will be presented will be the AACE, cosponsoring the new online resource with Takeda Pharmaceuticals. The launch date is to be sometime in June. At present the emphasis seems to be for Type 2 diabetes. If this can fill the gap in education needed by people unaware of hypoglycemia mentioned in my last blog, then it will have succeeded quite well.
According to the spokesman, this will be a valuable resource for patients and health professionals as it will direct them to sources for new research and patient education. Whether the site will allow both sides to be seen by patients will remain to be seen.
The purpose of the new web site is to direct patients to educational resources that provide credible information about diabetes. It will not be there to provide a new patient information about diabetes, but assist them in avoiding unreliable information. It will be available for patients, caregivers, and healthcare professionals to aid all in forming a foundation for treatment and care decisions.
The sites they will be directed to will be vetted by AACE diabetes experts and the sites will be evaluated for quality and accuracy in the information it provides to patients and health professionals. The experts say that about 90 percent of people get their information from the internet and that on good days, 20 percent at most is reliable.
They also state that 90 to 95 percent of diabetics never see a specialist. So this is a resource of for thousands of physicians who provide healthcare to people with Type 2 diabetes. They want the online resource to help these healthcare professional to give them the most current guidelines for Type 2 diabetes treatment and methods for establishing individualized care plans for their patients with diabetes.
There is a lot to be done and it is going to be interesting to see the outcome of this effort. We do need this, if nothing more than a way to start eliminating many of the “cure” sites and sites that propagate much misinformation. It will also be interesting to see of the media picks up on this and does any research to improve their reporting.
Read the article here.
We will need to watch for when this will happen on the AACE web site. The information that will be presented will be the AACE, cosponsoring the new online resource with Takeda Pharmaceuticals. The launch date is to be sometime in June. At present the emphasis seems to be for Type 2 diabetes. If this can fill the gap in education needed by people unaware of hypoglycemia mentioned in my last blog, then it will have succeeded quite well.
According to the spokesman, this will be a valuable resource for patients and health professionals as it will direct them to sources for new research and patient education. Whether the site will allow both sides to be seen by patients will remain to be seen.
The purpose of the new web site is to direct patients to educational resources that provide credible information about diabetes. It will not be there to provide a new patient information about diabetes, but assist them in avoiding unreliable information. It will be available for patients, caregivers, and healthcare professionals to aid all in forming a foundation for treatment and care decisions.
The sites they will be directed to will be vetted by AACE diabetes experts and the sites will be evaluated for quality and accuracy in the information it provides to patients and health professionals. The experts say that about 90 percent of people get their information from the internet and that on good days, 20 percent at most is reliable.
They also state that 90 to 95 percent of diabetics never see a specialist. So this is a resource of for thousands of physicians who provide healthcare to people with Type 2 diabetes. They want the online resource to help these healthcare professional to give them the most current guidelines for Type 2 diabetes treatment and methods for establishing individualized care plans for their patients with diabetes.
There is a lot to be done and it is going to be interesting to see the outcome of this effort. We do need this, if nothing more than a way to start eliminating many of the “cure” sites and sites that propagate much misinformation. It will also be interesting to see of the media picks up on this and does any research to improve their reporting.
Read the article here.
May 2, 2011
Why Are You Not Wearing Medic Alert Jewelry?
The DOC (diabetes online community) keeps bringing up the topic of people with diabetes getting into trouble in our hospitals. This is not a good thing, but if people learn from this and want to apply the added knowledge to prevent problems for themselves and others in the future, then the experience, while not desirable, has given them a good lesson.
Many of the situations are crying for solutions. When entering the hospitals for a scheduled event, and when entering the hospitals in emergencies, all seem to have problems with hospital staff not caring about the fact that they have diabetes or lack of education by the hospital staff in caring for people with diabetes.
Many people are calling for education, but this will not work until the hospitals develop a more caring attitude and pass this down to the staff. This is a top down problem and can only be solved when hospital administration enforces a caring attitude and assists in education for the weak areas. Presently, hospitals are more interested in profits and the new laws coming into effect over the next few years and how the laws will affect hospital profits than they are in patient care or safety. A few hospitals are in the minority in putting care and patient safety first. Many of these are the non-profit hospitals.
Many people are correct in their complaints. What I am not seeing is what actions are being taken to prevent problems in the future. No one is talking about patient rights. No one is talking about having patient advocates available. No one is talking about wearing any medical alert jewelry to alert medical personnel from EMTs to doctors in the ER to the fact the person has diabetes and which type.
So I will take this opportunity to suggest a little education of friends or a trusted friend, if you do not have a family member that can act for you, should be high on the list of things to do. If the same person can act as an advocate for you so much the better. Just make sure that the trusted family member or trusted friend knows what is required and has the necessary papers to act on your behalf if needed. Make sure that you carry a list of contacts that hopefully will not be lost in an accident.
Then make sure that you are wearing a piece of jewelry that had the medical information necessary for law enforcement, emergency medical personnel, and hospital staff will know that you have diabetes. If you have alert jewelry and if people call the number listed, you should have help.
If you do not do any of the above and an emergency happens, then you will have to be satisfied if something goes wrong. Many people with Type 2 diabetes will not disclose to others that they have diabetes. It is this that gets them into problems. Vanity also gets people into trouble because they will not be seen wearing medic alert jewelry, or as some people are now doing, having medical alert tattoos on different places of their body.
It is the people that do everything right and still have problems that I can sympathize with and agree they have been wronged.
Many of the situations are crying for solutions. When entering the hospitals for a scheduled event, and when entering the hospitals in emergencies, all seem to have problems with hospital staff not caring about the fact that they have diabetes or lack of education by the hospital staff in caring for people with diabetes.
Many people are calling for education, but this will not work until the hospitals develop a more caring attitude and pass this down to the staff. This is a top down problem and can only be solved when hospital administration enforces a caring attitude and assists in education for the weak areas. Presently, hospitals are more interested in profits and the new laws coming into effect over the next few years and how the laws will affect hospital profits than they are in patient care or safety. A few hospitals are in the minority in putting care and patient safety first. Many of these are the non-profit hospitals.
Many people are correct in their complaints. What I am not seeing is what actions are being taken to prevent problems in the future. No one is talking about patient rights. No one is talking about having patient advocates available. No one is talking about wearing any medical alert jewelry to alert medical personnel from EMTs to doctors in the ER to the fact the person has diabetes and which type.
So I will take this opportunity to suggest a little education of friends or a trusted friend, if you do not have a family member that can act for you, should be high on the list of things to do. If the same person can act as an advocate for you so much the better. Just make sure that the trusted family member or trusted friend knows what is required and has the necessary papers to act on your behalf if needed. Make sure that you carry a list of contacts that hopefully will not be lost in an accident.
Then make sure that you are wearing a piece of jewelry that had the medical information necessary for law enforcement, emergency medical personnel, and hospital staff will know that you have diabetes. If you have alert jewelry and if people call the number listed, you should have help.
If you do not do any of the above and an emergency happens, then you will have to be satisfied if something goes wrong. Many people with Type 2 diabetes will not disclose to others that they have diabetes. It is this that gets them into problems. Vanity also gets people into trouble because they will not be seen wearing medic alert jewelry, or as some people are now doing, having medical alert tattoos on different places of their body.
It is the people that do everything right and still have problems that I can sympathize with and agree they have been wronged.
April 30, 2011
Patients Lack Knowledge About Hypoglycemia
I have to take my hat off to the endocrinologists. They took a survey which puts them in a bad light and published it. Most organizations would have put this information through the shredder. Few in the medical profession are willing to to look problems in the eye and address it head on. Will they succeed? – that remains to be seen. There are a lot of hurdles to over come, the biggest is our medical insurance industry, Medicare, and the complexities of the new healthcare law.
Why are patients with diabetes unaware of hypoglycemia and what causes hypoglycemia? To me the broader implication is the lack of time by the medical community at large. Many primary care physicians and doctors in family medicine do not have the time or resources to educate patients. Many are in rural areas, small towns, and even many small city settings that do not have diabetes educators available. Many do not even have diabetes support groups to get support from.
Then add to this our medical insurance industry led by Medicare, that is cutting costs where ever possible and we have a situation ripe for failure. Many patients when they are newly diagnosed are in shock, causing very few to listen carefully to what they are being told by the doctor. Therefore, the doctors should be able to schedule another appointment shortly thereafter to do some education, but most of our insurance companies will not reimburse for the time.
The results of a survey conducted by the American College of Endocrinology therefore does not surprise me. This also shows just how reluctant our medical professionals are to recommend good web sites and help their patients get the information needed. One site listed here has some information; however, there could be a better presentation and one that is more patient oriented and not so sterile and written for doctors. The information is presented in PDF files that can be downloaded and printed for reference.
The other part of the survey, not mentioned, is where the survey was taken. If it was taken from a cross sample, then good. Otherwise from only rural areas, or only large metropolitan areas could also greatly affect the outcome of the survey. National online surveys can be notoriously misleading and little reliance should be placed on them.
The only real part of this survey is that the numbers, regardless of the method of obtaining them, show that the USA has a serious problem and needs to find a way to educate people with diabetes. Read a doctors interpretation of the survey here and the news release here. The PDF file for low blood sugar is here and the PDF file for high blood sugar is here.
Why are patients with diabetes unaware of hypoglycemia and what causes hypoglycemia? To me the broader implication is the lack of time by the medical community at large. Many primary care physicians and doctors in family medicine do not have the time or resources to educate patients. Many are in rural areas, small towns, and even many small city settings that do not have diabetes educators available. Many do not even have diabetes support groups to get support from.
Then add to this our medical insurance industry led by Medicare, that is cutting costs where ever possible and we have a situation ripe for failure. Many patients when they are newly diagnosed are in shock, causing very few to listen carefully to what they are being told by the doctor. Therefore, the doctors should be able to schedule another appointment shortly thereafter to do some education, but most of our insurance companies will not reimburse for the time.
The results of a survey conducted by the American College of Endocrinology therefore does not surprise me. This also shows just how reluctant our medical professionals are to recommend good web sites and help their patients get the information needed. One site listed here has some information; however, there could be a better presentation and one that is more patient oriented and not so sterile and written for doctors. The information is presented in PDF files that can be downloaded and printed for reference.
The other part of the survey, not mentioned, is where the survey was taken. If it was taken from a cross sample, then good. Otherwise from only rural areas, or only large metropolitan areas could also greatly affect the outcome of the survey. National online surveys can be notoriously misleading and little reliance should be placed on them.
The only real part of this survey is that the numbers, regardless of the method of obtaining them, show that the USA has a serious problem and needs to find a way to educate people with diabetes. Read a doctors interpretation of the survey here and the news release here. The PDF file for low blood sugar is here and the PDF file for high blood sugar is here.
April 27, 2011
Hospital and Medical Mismanagement of Diabetes
Some people with diabetes are being medically mismanaged while in the hospitals in the USA. Why? Because of lack of diabetes education by the hospital staff and outdated hospital management rules for diabetes. Scott Johnson posted an excellent example of this on his blog scottsdiabetes and you should take time to read it now. Some of the comments also bring out some of the problems faced by people with diabetes in the hospital setting.
Disturbing? Most definitely! Why is this happening? In addition to the above reason, patients also need to shoulder some of the blame. Most are not aware that there are patients' rights that must be adhered to by hospitals and many hospitals ignore these rights and enforce their own rules and regulations which most often are not in favor of the patient and the patients' rights. When the day comes that these hospitals are sued for patient neglect and failure to serve the patients and their rights, then maybe, just maybe, some of these highhanded hospitals will get the wake-up call they so desperately deserve.
When I wrote about this back on July 19, 2010, I had not anticipated the extent of medical malpractice that exists in some of our hospitals when dealing with patients with diabetes – and not just those with Type 1 diabetes. Fortunately, not all hospitals are this bad, and some are very accommodating to people with diabetes. Therefore, if at all possible, you need to do your homework before entering the hospital yourself or if a family member or relative with diabetes enters a hospital.
Learn from the experience of others like Scott Johnson writes about. Then talk to your doctors, preferable you should have an endocrinologist, but many people do not. Learn about your patient rights by reading this and related articles this article refers to. Make sure that you ask your doctor for a "self-management order," a document that will permit you to take care of your own testing and diabetes management if you are capable during your stay in the hospital.
If you know when you are entering the hospital, be sure that the hospital will accept the self-management order and that you are capable of using your own testing supplies and medications. I urge you to take time to read my previous blog above as there are some important points in it.
Now is also an excellent time to determine if you have a family member(s) or a trusted friend(s) that will be able to advocate for you if you are admitted to the hospital under emergency circumstances and make them aware of your needs and the paperwork they need to have available. This would include a limited medical power of attorney, a self-management order when you become capable of managing your own care. Do not leave this step unattended to as you cannot know when an emergency will arise.
A little planning now can actually get you better care when you desperately need it. Do not wait for mistakes and mismanagement of your health care to happen when in a hospital, it can and does happen more than we would like. Take time to read the referenced articles and blogs above to avoid many of the problems. Get the necessary paperwork completed and copies available to those that may need it!
I realize that many people will still not have taken these steps to assure their hospital stay is handled properly and I sincerely hope that I will not continue to read many more of these disturbing problems for others with diabetes that happen while in the hospital.
Disturbing? Most definitely! Why is this happening? In addition to the above reason, patients also need to shoulder some of the blame. Most are not aware that there are patients' rights that must be adhered to by hospitals and many hospitals ignore these rights and enforce their own rules and regulations which most often are not in favor of the patient and the patients' rights. When the day comes that these hospitals are sued for patient neglect and failure to serve the patients and their rights, then maybe, just maybe, some of these highhanded hospitals will get the wake-up call they so desperately deserve.
When I wrote about this back on July 19, 2010, I had not anticipated the extent of medical malpractice that exists in some of our hospitals when dealing with patients with diabetes – and not just those with Type 1 diabetes. Fortunately, not all hospitals are this bad, and some are very accommodating to people with diabetes. Therefore, if at all possible, you need to do your homework before entering the hospital yourself or if a family member or relative with diabetes enters a hospital.
Learn from the experience of others like Scott Johnson writes about. Then talk to your doctors, preferable you should have an endocrinologist, but many people do not. Learn about your patient rights by reading this and related articles this article refers to. Make sure that you ask your doctor for a "self-management order," a document that will permit you to take care of your own testing and diabetes management if you are capable during your stay in the hospital.
If you know when you are entering the hospital, be sure that the hospital will accept the self-management order and that you are capable of using your own testing supplies and medications. I urge you to take time to read my previous blog above as there are some important points in it.
Now is also an excellent time to determine if you have a family member(s) or a trusted friend(s) that will be able to advocate for you if you are admitted to the hospital under emergency circumstances and make them aware of your needs and the paperwork they need to have available. This would include a limited medical power of attorney, a self-management order when you become capable of managing your own care. Do not leave this step unattended to as you cannot know when an emergency will arise.
A little planning now can actually get you better care when you desperately need it. Do not wait for mistakes and mismanagement of your health care to happen when in a hospital, it can and does happen more than we would like. Take time to read the referenced articles and blogs above to avoid many of the problems. Get the necessary paperwork completed and copies available to those that may need it!
I realize that many people will still not have taken these steps to assure their hospital stay is handled properly and I sincerely hope that I will not continue to read many more of these disturbing problems for others with diabetes that happen while in the hospital.
April 19, 2011
How Much Fiber Is Enough?
I do have to wonder when the different medical groups are going to become unified in their recommendations for daily dietary fiber intake. I see different ranges quite often. One group orders 31 grams of fiber for everyone, another claims that women only need 25 grams, and men need 38 grams of daily dietary fiber. Most seem to recommend within this range, but I have seen more precise suggestions based on age and other factors.
Do we need standardization? It would seem wise as too many medical groups recommend on one number fits all. They do not specify what age range they are talking about or even if there are other factors involved in the determination. I am not sure whose recommendation to use. People may have their own opinion, but I find the best table for dietary fiber is this table by the World Health Organization and you can find it here. You may wish to bookmark it for future reference. It does account for children and the table is about one third down the page.
The recommendation (2nd page) from the Mayo Clinic does not account for children for which I fault the National Academy of Sciences' Institute of Medicine, and Mayo Clinic for using the IOM table which does not take into consideration fiber levels for children. The IOM does say that age 50 and younger for women the amount of daily dietary fiber should be 25 grams and for women age 51 and older the need drops to 21 grams. For men age 50 and younger the amount of daily dietary fiber should be 38 grams and for men age 51 and older the need decreases to 30 grams.
Dietary fiber is sometimes referred to as bulk or roughage. Dietary fiber is found in plants, fruits, vegetables, and grains plus part of a heart-healthy diet. It adds bulk and the full feeling quicker which helps control weight, aids digestion and makes bowel movements easier.
Dietary fiber is of two types – soluble and insoluble. Insoluble fiber facilitates easier movement through you digestive system and increases stool bulk. Soluble fiber dissolves in water and forms a gel-like material. This helps lower blood cholesterol and glucose levels. The amount of each type of fiber varies by plant foods. This is why everyone recommends eating a wide variety of high fiber foods.
Benefits of a proper level of fiber in your diet are many and this is the reason for making this known over and over to people. Of course, the correct amount of fiber in your diet makes bowel movement easier and can help with preventing loose stools and for some people it may provide assistance from irritable bowel syndrome. Other benefits of a proper fiber diet is that it may lower your risk of developing hemorrhoids, and possibly other colon diseases.
I was intending to have a two part series, but upon closer reading of the study I had in mind, I decided to let you read it here. I do not like studies that try to factualize estimated values of cardiovascular risks and have a cardiologist state that the “results of this study make a lot of sense”. This to me just invalidates the purpose of studies and indicates that what they were after did not come to be fact. It indicates that the study was inconclusive.
You need to read this just to see an example of what lengths they will go to to justify a poor study.
Do we need standardization? It would seem wise as too many medical groups recommend on one number fits all. They do not specify what age range they are talking about or even if there are other factors involved in the determination. I am not sure whose recommendation to use. People may have their own opinion, but I find the best table for dietary fiber is this table by the World Health Organization and you can find it here. You may wish to bookmark it for future reference. It does account for children and the table is about one third down the page.
The recommendation (2nd page) from the Mayo Clinic does not account for children for which I fault the National Academy of Sciences' Institute of Medicine, and Mayo Clinic for using the IOM table which does not take into consideration fiber levels for children. The IOM does say that age 50 and younger for women the amount of daily dietary fiber should be 25 grams and for women age 51 and older the need drops to 21 grams. For men age 50 and younger the amount of daily dietary fiber should be 38 grams and for men age 51 and older the need decreases to 30 grams.
Dietary fiber is sometimes referred to as bulk or roughage. Dietary fiber is found in plants, fruits, vegetables, and grains plus part of a heart-healthy diet. It adds bulk and the full feeling quicker which helps control weight, aids digestion and makes bowel movements easier.
Dietary fiber is of two types – soluble and insoluble. Insoluble fiber facilitates easier movement through you digestive system and increases stool bulk. Soluble fiber dissolves in water and forms a gel-like material. This helps lower blood cholesterol and glucose levels. The amount of each type of fiber varies by plant foods. This is why everyone recommends eating a wide variety of high fiber foods.
Benefits of a proper level of fiber in your diet are many and this is the reason for making this known over and over to people. Of course, the correct amount of fiber in your diet makes bowel movement easier and can help with preventing loose stools and for some people it may provide assistance from irritable bowel syndrome. Other benefits of a proper fiber diet is that it may lower your risk of developing hemorrhoids, and possibly other colon diseases.
I was intending to have a two part series, but upon closer reading of the study I had in mind, I decided to let you read it here. I do not like studies that try to factualize estimated values of cardiovascular risks and have a cardiologist state that the “results of this study make a lot of sense”. This to me just invalidates the purpose of studies and indicates that what they were after did not come to be fact. It indicates that the study was inconclusive.
You need to read this just to see an example of what lengths they will go to to justify a poor study.
April 18, 2011
New AACE Guidelines Emphasize Individualized Care
I know why many diabetes professional groups fear recommending that individuals strive to attain lower HbA1c's; however, I have to disagree with the way they do it. Here the American Association of Clinical Endocrinology (AACE) does recommend individualized care plans at least. They get very shy when it comes to recommending anything lower that an A1c of 6.5 for fear of hypoglycemic episodes. This is standard practice among the diabetes professionals.
The comprehensive individualized care plans for patients with Type 1 and Type 2 diabetes was developed by a panel of 23 leading diabetes experts. They wisely set the care plans to account for the patients' risk for complications, other chronic health conditions, and the psychological, social, and economic status. Because of that fact that they are concerned about the safety of people being able to achieve an A1c of 6.5 all recommendations emphasize taking into account a patients risk for development of severe hypoglycemia.
For once the recommendations do take into account the use of technologies such as insulin pumps, and continuous glucose monitoring. They they surprise me with adding the importance of other conditions that sometimes may not be obvious to the treating physicians – sleep and breathing disturbances and depression. These conditions have been neglected to the detriment of diabetes patients in the past.
Now if they will take this information and work to alleviate sleep disorders, sleep apnea, and minimize depression, this could work to make life a lot better for people with diabetes. Other factors missing from the guidelines is handling other illnesses such as the occasional cold, flu, and other common maladies.
The guidelines do stress hyperglycemia but also the associated cardiovascular risk factors. Also in the guidelines is the recommendation for comprehensive diabetes lifestyle management education at the time of diagnosis and to continue this throughout the time the person has diabetes. Other topics of the education is medical nutrition therapy, physical activity, not using tobacco, and importance of adequate sleep.
I applaud the latest guidelines as far as they go. It seems that individualized care plans should include other objectives. No provisions have been made for those of us desiring to attain lower A1c goals. So again the diabetes professionals are ignoring many patients that can and do work to attain A1c goals lower than 6.5. So it is still up to us to work independently of these medical professionals who have no desire to support us in achieving better health, avoiding complications, and in general doing better that others in our treatment of diabetes.
Why do I say we have to work independently? I am slowly discovering that the diabetes medical professionals are working to reduce the time spent with us, stopping continuing education for us, and just praising us and ushering us out of the office. This is a shame that the guidelines do not make provisions for those of us that wish to attain A1c's lower than 6.5.
Then our medical insurance companies take these results and are searching for ways to cut testing supplies, necessary related tests, and other procedures because we work to have better health. We must fight an uphill battle with no support from either group and chances that in the drive to curtail rising medical costs, we will be discriminated against and have necessary medical support withheld in the name of health care rationing. Just does not seem fair.
Read the two articles here and here.
The comprehensive individualized care plans for patients with Type 1 and Type 2 diabetes was developed by a panel of 23 leading diabetes experts. They wisely set the care plans to account for the patients' risk for complications, other chronic health conditions, and the psychological, social, and economic status. Because of that fact that they are concerned about the safety of people being able to achieve an A1c of 6.5 all recommendations emphasize taking into account a patients risk for development of severe hypoglycemia.
For once the recommendations do take into account the use of technologies such as insulin pumps, and continuous glucose monitoring. They they surprise me with adding the importance of other conditions that sometimes may not be obvious to the treating physicians – sleep and breathing disturbances and depression. These conditions have been neglected to the detriment of diabetes patients in the past.
Now if they will take this information and work to alleviate sleep disorders, sleep apnea, and minimize depression, this could work to make life a lot better for people with diabetes. Other factors missing from the guidelines is handling other illnesses such as the occasional cold, flu, and other common maladies.
The guidelines do stress hyperglycemia but also the associated cardiovascular risk factors. Also in the guidelines is the recommendation for comprehensive diabetes lifestyle management education at the time of diagnosis and to continue this throughout the time the person has diabetes. Other topics of the education is medical nutrition therapy, physical activity, not using tobacco, and importance of adequate sleep.
I applaud the latest guidelines as far as they go. It seems that individualized care plans should include other objectives. No provisions have been made for those of us desiring to attain lower A1c goals. So again the diabetes professionals are ignoring many patients that can and do work to attain A1c goals lower than 6.5. So it is still up to us to work independently of these medical professionals who have no desire to support us in achieving better health, avoiding complications, and in general doing better that others in our treatment of diabetes.
Why do I say we have to work independently? I am slowly discovering that the diabetes medical professionals are working to reduce the time spent with us, stopping continuing education for us, and just praising us and ushering us out of the office. This is a shame that the guidelines do not make provisions for those of us that wish to attain A1c's lower than 6.5.
Then our medical insurance companies take these results and are searching for ways to cut testing supplies, necessary related tests, and other procedures because we work to have better health. We must fight an uphill battle with no support from either group and chances that in the drive to curtail rising medical costs, we will be discriminated against and have necessary medical support withheld in the name of health care rationing. Just does not seem fair.
Read the two articles here and here.
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