An Unplanned August Group Meeting – Part 1

Part 1 of 2 parts


The only persons unable to attend because of travel were Jason and Brenda. The topic was all about Barry's friend, George. George was happy to meet everyone and really felt he was in the honor chair, which in a way he was. It was because of him that we were having this meeting and to welcome him to Iowa. He was full of questions and why we stayed together as a group.


Tim explained that we had started out as a group of three originally and had added the next three quite by accident later. Tim and I had been in our favorite restaurant and waiting for Jason, and just before we had started a conversation with Lilly and her mother, Jason had called to say he could not make it. The three of us had met together the prior week. That day was probably the most interesting as Lilly had just been diagnosed with type 1 diabetes that morning and was full of questions. Tim and I had done our best to answer. Her mother was also asking questions that were more difficult to answer, but we did not fumble although we had to correct ourselves a few times.


We had been getting together every Saturday or Wednesday since the first of the year, depending on our schedules. This was just after the Memorial Day holiday two years ago, and Jason was not able to make it back in time. So Tim and I had been discussing getting together on Saturday as well. We did get together that Saturday and because the restaurant was busy, we offered our table to three others. As they were getting ready to be seated, the table next to it opened up as the people were leaving. Little did we realize as we were talking that we had ears on us.


It was Brenda, Rob, and Max that ware seated at the next table. Finally, Brenda got up, came to our table, and asked if the three of us had diabetes. We all answered yes, and Brenda turned to the others and asked them to move the two tables together. Yes, Brenda is that way and that is why we appreciate her. After introductions, we finished our food and started to talk. The three of them had been getting together on Fridays for a month and that was why we had not seen each other previously. We decided that Fridays could work for us, but they felt that Saturdays would be better for all of us.


Tim suggested that we exchange email addresses and telephone numbers to make it easier to stay in contact. Brenda did say that the month of August would be out for her as she had plans. Max and Rob said they would be available if we wanted to get together so we set up a schedule for the rest of June, July and into August and that the following week we would confirm if we would be able to attend. The following week we agreed to the schedule with Jason also being absent for two weeks during early August.


Allen said the rest had joined as they were discovered and or needed help as Ben and he had. He said Barry could fill in the rest later as we should get to the situation with George that had transpired the previous Wednesday. Barry agreed and admitted he had been slow on the understanding of why his friend had been using generalities in his discussion about diabetes. He said that finally about noon on Wednesday, he started asking some specifics about George's diabetes and that is when he discovered that his friend knew essentially nothing about his diabetes. He did not even get copies of his lab reports, have any testing supplies, and did not know his A1c results.


His friend could only say that the doctor was concerned that his A1c was climbing again, but climbing from what. George spoke up and said he had never been shown anything about testing so he did not even realize there was a way to monitor his own blood glucose. All he could remember was the pain when his doctor's nurse pricked his finger as she did it on the tip of a finger. He continued that Ben showing him how he did it eased it somewhat for him and he finally allowed Barry to prick his finger and he said he felt no pain. After the reading, they had tried to call Tim, but he was not answering his phone, so they called Allen and waited for him to arrive.


Barry said he was at a loss about what to do and did not do anything until Allen arrived. Tim explained that he was in a meeting and had his cell phone off. Allen said he had called me and I was on the interstate and would call when I could get off and be able to talk. Allen said he was ready then and was happy that I had my thinking cap on and by that time, they had contacted George's insurance and knew what he could be reimbursed for and would be covered under his insurance. They knew from taking to the local doctor that he was out of A1c kits and that we needed to find one. Since I was still not at the town where we see the endocrinologist, I said I would have Allen call there first, ask some questions, and have a prescription for the test strips. By the time I arrived, Allen had the information and I was able to obtain the A1c kit and get the test strips and head home.


After I arrive, Allen and Barry took George to the doctor appointment. Ben and I had time to talk and Ben had said this was all new to him and we all had to learn from this. I agreed and said this was something we all needed to know and we had better learn from this. George spoke up and said he now understands how serious his A1c is and that an 11.3% is not good. He said the doctor was very emphatic about him going on insulin and was able to get an appointment with an endocrinologist about two miles from where he lived. Therefore, he would be leaving earlier that he had intended, but he would be back one more time this year when he had the insulin down and knew how to handle it. He thanked everyone for what we had done and said he came to the right place to go on vacation.


We talked about what could have been done better and why things like this needed to be built on for future instances. Allen and I both talked about the VA and George asked how he could sign up. I said I am not familiar with his state, but he needed to look up where the nearest VA office was located and start asking questions. Ben said why not go to our local VA office and ask if they knew whom to contact. Allen and I both agreed and told Ben and Barry to do this early Monday. Allen said that with the VA he should be able to obtain his testing supplies at no cost and pay less for his insulin and other prescription medications. George then stated he sure picked the right place to go for a vacation and then asked what else he should know.


Several of us needed to leave and Tim said he would cover as much as he had time for and then send out an email for George to read when he arrived home. George said you would do that. All of us said yes, that is how we also help each other. He asked George for his email address and said he would see to it that until he came back, he would be included in the emails. Then he could decide if he wanted to continue. He would be welcome to ask questions and we would do our best to answer them. Barry said he would explain how it worked and to send him the questions and he would distribute them where he felt best. Therefore, those of us needing to leave left and they continued talking.


Tim said they covered many topics and George was asking how much research we did and Barry said he would help him get started after he had his appointment and was comfortable using insulin. Tim had said that was probably best so that he could concentrate on his health first and then start his research. Tim told George to take care of himself first and the rest would come. That was why he would be sent emails that everyone received and he could ask any questions he had.


Barry sent out an email saying that Monday morning he had found out whom to contact for getting his VA application started after his endocrinologist appointment. He stated that George was on his way home.

A Problem for a Friend of One of Our Group

Problems can happen when you least expect them. Barry was having a friend from his previous town on a visit with Ben and himself. They had discussed and talked about diabetes, but nothing had been discussed in specifics. Then the second day, Barry did ask his friend what his last A1c had been. His friend said he did not know as the doctor had not told him. Barry said the only comment he could remember was something to the effect of watch what he was eating as it was creeping back up.


This caused Barry to ask what his blood glucose reading had been that morning. He got a puzzled look and a question about what was a blood glucose reading. Barry patiently took out his testing supplies and showed his friend. His friend did not know anything about what he was seeing. Barry asked if he could do one test as it was about time for the noon meal. His friend said okay, so Barry pulled out the lancet, inserted a new one, put the device back together, and armed it. His friend hesitated and said you aren't sticking me with that.


At that point, Ben took his out and asked Barry's friend to watch him. Ben pricked the side of his thumb, set the lancet device down, and reached for the meter he had previously inserted a test strip in, as it was now ready to receive the blood. After the blood was wicked into the test strip, the meter took about five seconds to give a reading of 96 mg/dl. Ben recorded the reading, with a tissue, wiped the excess blood from his thumb, used the tissue to pull the test strip out of the meter, and discarded both in a wastebasket.


Barry's friend asked why he had used the side of his thumb and not the tip or sole. Ben explained that the side had less nerves and he had little or no pain on the side and that he could use the tip or sole of his thumb or any finger as he had pain insensitive fingers at his age. Ben said that yes, he occasionally hit a nerve and could have a little pain, but in general he was not concerned. Barry's friend said that the doctor he went to, the nurse always used the tip of a finger and it always hurt, but if there was less pain on the side, he would give it a try.


Barry said he put a strip in his meter and adjusted the lancet device to the lowest setting. His friend held out his hand and Barry said he rested the device on his small finger and pressed the release. When Barry lifted the lancet device, he said his friend was still expecting a sting. There was sufficient blood with a small squeeze so he inserted the test strip to wick the blood and when the meter reading showed it was 298 mg/dl. Ben asked if he had taken his medications to which he stated not until the noon meal. Barry asked if he could see the medication and his friend hauled out the container. The directions said one at the noon meal and one at the evening meal. It was for one of the sulfonylureas and the dose was small.


After the noon meal, Barry called Tim who was not available. Then he called Allen who was also out of town but would be home shortly. Allen told Barry to call the local doctor and ask him the questions. Barry was hesitant, so Allen said he would call after he had talked with them. When Allen arrived about 2:30, he was given the information and Allen asked them to call Barry's friend's insurance company to find out which meters and test strips were on the approved list.


Then Allen called the local doctor and asked if he could do an A1c test and go over the medications Barry's friend was taking. The doctor could see him that afternoon, but did not have the A1c kit as the order had not arrived that day. That was when Allen called me. I told Allen where I was and that I would call back when I could get off the interstate which I did. That was when I started to hear of the problems. I suggested that they start calling the pharmacies starting with the pharmacy near the clinic at the hospital and ask for the Bayer A1c kit. Then if they did not have any to go to another pharmacy until they found one. Then I remembered and suggested he call the diabetes clinic first to see where to find one. Allen said he was grateful I knew where to start and said he would wait until I called to tell me where to go first.


When I got near the diabetes clinic, I called Allen and he said the clinic could sell me one and to go there first. Then I would need to go to the pharmacy to get a meter and two containers of test strips for which Allen gave me the name. I made the stop at the clinic and I asked if they could sell me a meter and if I needed a prescription for the test strips. I briefly explained the situation and was given the meter and a prescription for two containers of test strips. I paid for the A1c kit and went to the pharmacy to get the test strips and headed for home and Ben and Barry's residence.


At that time it was time to take Barry's friend to the doctor, so Allen, Barry, and his friend left with everything while Ben and I talked and waited. When they returned, Barry said the two of them would go to the pharmacy and get his new prescription filled and then he would pay me. Allen said the doctor had received permission for the charges to his insurance and for his prescriptions. Allen also stated that the doctor agreed that he should start on insulin and that was the prescriptions plus metformin. The doctor had also stated he knew an endocrinologist near him and would be calling him to set up an appointment as soon as possible.


When Barry and his friend returned, his friend said this is quite a community you have here. Barry said he hoped so as we had saved his hide. Barry's friend asked how we came together as he did not know of anything like this where he lived. Allen stated that most probably wanted to keep it a secret and therefore very few even talked about diabetes. Barry had to agree and said this was a unique group and he was happy to be part of it. At that point Barry's friend, thanked me and paid me saying that the delay was so he could get the extra cash when he used his debit card.


Barry asked how I knew where to find things so fast and I said it is just knowing who to ask. I explained that the meter had not cost him anything as my clinic had supplied that because of the people using it. I said knowing what his insurance covered also was a great help. Allen said that was good and he asked Barry's friend if he could remember this for the future is it became necessary. The answer was yes, and that he had learned a lot in about five hours and he would be working on reinforcing his memory. I said that with Ben and Barry he could learn quite a bit.


Tim arrived then and was introduced. Allen and I made our exit and received profuse thank you's for our part and it was agreed that those of us that could, should get together on Saturday to cover the events. Barry said he and Ben would send out emails about the events and lessons learned. Allen said he would add another if necessary.

Staying Positive with Diabetes

I cringe when I read blog titles like this “Five Big Diabetes Fears—and What to Do About Them.” Yes, I know, writers prerogative to bring readership, but I still cringed and went on to something more positive to read, which there were a few articles and blogs. I did not need to do much searching. I discovered some positive or what I would term semi-positive news on Medscape titled “Diabetes Not Linked to Dementia.” This does not agree with many previous articles saying that there is a link to Alzheimer's disease, but this study seems very sure of itself.


After reading several more semi-positive articles, I decided to return to this negative blog. I will take the five supposed fears and see if I can make something positive out of them.


#1. Low Blood Sugars This is the one that can cause the most fear for some people. Since I am an insulin dependent type 2, why does this not create fear for me you may ask. Probably because I have not had that many severe episodes of hypoglycemia – only two that were below 50 mg/dl, one at 48 and another at 42. I was able to recover very fast with glucose tablets and did not worry further. Yes, I have had another couple of episodes below 60, but at 58 and 59, I never was overly concerned.


I do understand type 1 people getting concerned when they “rage bolus” with their pumps and don't know how much insulin they may still have had in their systems. I read several type 1 bloggers that seem to be on a yo-yo string of highs and lows in a day and that would scare the dickens out of me. This is why I will stay with my multiple daily injections and think nothing of it.


I have been fortunate to have been supplied with one of the best names in test strips and the meters to compliment them. My episodes of hypoglycemia mentioned above have come when I inject my short acting insulin too close to the last injection of the long acting insulin. I normally realize this as soon as I have put the syringe down and then I take immediate action to prevent the oncoming hypoglycemia. I start testing in the next 15 minutes and repeating at 15-minute intervals. Once I know that a low is happening, I start taking my glucose tablets. I repeat this until the trend is back to the positive side and continue until I am back above 70 mg/dl.


Only one time did I get the shakes so bad that I had trouble wicking the blood into the test strip. Once I drop near 65 mg/dl, I start sweating profusely and I reach for the meter and test strips and start testing. Most of the time, I can correct it with one 15 gram tablet of glucose. But be careful as there are several different types of tablets – from 4 gram to 15 gram tablets. I have been able to locate 15 gram tablets and prefer using them.


#2. Microvascular Complications This is no longer for most people a concern because of our equipment that we have available today. Yet, I look at those that are not managing their diabetes and wonder if they aren't having some real fears. Most type 1 people are trained how to manage their diabetes, as are most type 2 that use insulin. The microvascular complications of loss of sight, nerve pain, and kidney disease are often not a problem for these people unless they are not managing their diabetes.


Now I would be remiss in not being concerned about the type 2 people on oral medications. These are the people that our “experts” degrade and say they should depend on their A1c results for knowing how they are progressing in their diabetes management. Talk about the blind trying to lead. They are slowly forcing these people with type 2 diabetes into the dark because they have no idea of how they are managing their diabetes until they receive their A1c results. Many still don't know because their doctors don't tell them what the results are.


Recently, I was not aware of the panic in our support group when one of Barry's friends came for a visit. He and Barry had been talking about diabetes, but not being very specific. Then the second day Barry asked his friend what has last A1c had been. His friend said he did not know as the doctor had not told him. Barry said the only comment he could remember was something to the effect of watch what he was eating as it was creeping back up. I had been out of town that day and several had been called to see if they could locate an A1c test as the local doctor was out and had not received his order yet. When they finally called me, I was able to stop on my way home and found an A1c testing kit. More about this in another blog.


#3. Macrovascular Complications This is more of a concern than many will admit. Anyone with diabetes is at an increased risk for heart problems, but we still need to be concerned as most doctors shove statins and other medications at us and fight to keep us on them. Why the author did not cover the one area of greatest concern is beyond me. We all need to be aware of atherosclerosis. This can cause poor healing of wounds in your legs and feet. This is the cause of most amputations because they become infected and even more difficult to heal.


#4. Food Changes Many people get all tangled up in the panic panel on this one. Most are type 2 people on oral medications are not given the testing supplies necessary to help them discover what the different foods do to their blood glucose levels. By testing and eating to their meter, they could discover what foods to curtail, eliminate, reduce in quantity, and which they are able to consume in their meal plan. Since there is no specific diabetes diet, food plan, or even guidelines, many people return to eating what they had been eating and away goes their diabetes management.


Each person needs to determine what their bodies can handle and by using their meter can develop a food plan that allows them to manage their diabetes. In this determination, what another person is able to consume may not be what they are able to consume. I will always urge each person to see if their doctor will attempt to get approval for the first six months to be allowed extra test strips or if they are able to purchase the extra.


People on insulin would be better served by finding out what they are able to include in a balanced meal plan and what their meter tells them as well.


#5. Medication Issues Many people become highly agitated when they are told they must take insulin or a pill to help manage their diabetes. Those with type 1 diabetes must inject insulin and they have no choice if they wish to live. Yet, many people with type 2 diabetes, take the prescriptions, stuff them in a purse or pocket, nod to the doctor and as soon as they are outside, head for the nearest health food store, or natural supplement shop and spend money by the fist full for something “natural” that the sales clerk recommends.


What they don't admit is that they have substituted one medication for another medication. Unfortunately, the natural medications will not help them make any improvement in their diabetes and they may or may not return to their doctor until they start to develop some of the complications. But they don't care, they haven't taken any of the prescribed chemicals, so they are happy. I can only say, good luck and don't complain when the complications start.


Then I haven't mentioned those with literacy problems and can't follow medication directions and wonder what is happening when the doctor asks if they have been taking their medications because of little or no improvement in their A1c levels. Most doctors are not working to help those with any type of literacy problems.


In addition, please read these two blogs. The first is about what you need to know immediately after diagnosis and the second is about the best level of blood glucose management.

Doctors That Will Not Give You Record Access

Even if physicians think we can be a pain in their backside, we as patients have to wonder what they are trying to conceal when they will not allow us access to medical information about us. Caveat – I have no problem when the patient has mental problems of not allowing them access to their medical records.


However, for the rest of us, come-on doctors, what are you hiding? Yes, many physicians treat us as mental patients in their minds and have entered information in the medical records about us that they would be in the courts for years trying to explain and defend as not being libelous or maliciously defamatory. What causes them to do this?


One answer is because they are human and the medical profession has conditioned them to feel that they are god-like. When we rock the pedestal on which they are perched, they become very upset and since the medical record they maintain about us is the one supposedly safe place, they make some unwarranted statements part of the medical record.


Notice, I have carefully avoided saying who owns the medical records. This had been for the courts to decide and in general, they had favored the doctor. Now under the Patient Protection and Affordable Care Act (ACA), this may be changing. The patient will supposedly have access to the records. I say this cautiously, because several medical professional organizations are working to prevent this from happening. I have a feeling that this is headed for the courts for a final decision. Again I ask – doctor, what are you hiding?


I have been made aware of a work-a-round created in many electronic health record programs which will allow doctors to have their own confidential area. Some physicians are refusing to use this area while others look for it. More physicians are discovering that patients who are educated have a better outlook and desire to improve their health. This often causes a big reduction in medical costs and improved efficiency. The reason for this is that the patient is working for better prevention and when the doctor and patient work together, this often happens.


I would like to continue the doctor-patient discussion, but that will wait for another blog, as another area needs to be included here. This is the problem proactive to participatory patients are having accessing medical information that is obtained from remote patient monitoring. Presently, this is next to impossible for patients. Unless you have a doctor that is very forthcoming, the manufacturer of the device and many physicians will not allow patients to have access to this information. Even those doctors willing to share this information are often prevented from doing so by the device manufacturer. Many doctors that share the information do so at their own risk. So hopefully you as a patient will help guard this when it happens.


For more information from a different perspective, read this by Trisha Torrey. It explains what may happen to very proactive patients when they have doctors that don't like or appreciate patients wanting to learn and be proactive or have knowledge of their chronic condition. Hopefully, under the ACA these doctors will be put out of business permanently and their medical organization greatly weakened.

Problems with A1c and Obtaining Insulin

Before starting this blog, I must state that it is for people with type 2 diabetes only.  What was your latest HbA1c result? If it is like many of the people with type 2, it was probably 8.0% or higher. There are only a few reasons to have an A1c this high and actually an A1c higher that 6.5% should concern you. The only (in my humble opinion) reason to have an A1c this high is if you are very elderly, in poor health, and having difficulty taking your medications when you should.

Unless you have trypanophobia (a fear of injections) or aichmophobia (an intense or morbid fear of sharp or pointed objects), you need to learn about insulin and what it can do for your diabetes management. If you have these fears, consider reading this.

There may be other reasons, like having hypoglycemia too often which may be a good reason to have a higher HbA1c. Other reasons I don't consider as valid for letting your A1c reading become this high. They are:


#1. You have a doctor that will not prescribe insulin. If this happening to you, seriously consider finding another doctor. Your health is worth this. You will need to consider if there are other doctors available in your area. You will need to ask your doctor why he will not prescribe insulin very politely. If your doctor won't talk to you about insulin, then the decision will be difficult if there are no other doctors near you. I have had one person tell me that he had to question the doctor about why he would not prescribe insulin. He explained that he wanted to be on insulin and wanted a doctor that would prescribe insulin. When the doctor would not talk about this, he suggested that they could learn together. The doctor started to answer, but stopped. At that point, he knew he was going to need to drive about 75 miles one way to another doctor, but he asked the doctor for a referral and the doctor did give him a referral for the doctor he had thought he would be seeing.


#2. Your doctor has not given you any education. Most doctors do not have the time except for minimal education. Most doctors do not have access to certified diabetes educators (CDEs) or even registered dietitians (RDs) so this would not be a surprise. Self-education is often the only avenue open to you. This is part of the reason I have been writing blogs about sources for you to read. No. 1 and No. 2.


#3. Your doctor is stacking oral medications and they are not working. You started on one oral medication and then when your A1c did not come down enough or when it started to rise, your doctor added a second medication. When those results deteriorated, a third medication was added. With the side effects of each medication, this could have become intolerable. But you wanted to get your A1c level down. You may have even asked for a stronger medication, but the doctor refused.


#4. Are you not managing your diabetes? I don't like to use accusations, so I will ask some questions. Have you reduced your carbohydrate consumption? Have you been able to test enough to know what the different foods do to your blood glucose levels?


#5. Are you not taking your medications? Do you take them when directed or do you forget occasionally? Do you have a schedule for taking your medications? Have you talked to your pharmacist about what to do if you remember you forgot the previous dose? How often do you forget? For help you might want to read this blog.


#6. Are you able to exercise and what is your routine? When your blood glucose levels are higher than they should be, are your able to exercise for a longer time? What exercises do you do or are you limited in what you can do?


I could continue to list reasons, but this could only serve to discourage you and cause you to stop your self-education. What you need to do is have an honest discussion with your doctor. Do this after you have given a lot of thought whether you wish to stop the complications and manage your diabetes. Unfortunately, only you can make this decision. Yes, you may ask for help if you have someone that can and will assist you, but you will need to ask.


If possible, you need to honestly assess your situation and decide what you are capable of doing, how you can better manage your diabetes, and whether insulin is the medication you need. Some of my blogs that may be of assistance for using insulin include – blog 1, blog 2, blog 3, blog 4, blog 5, and blog 6

Intensive BG Monitoring Is Useful

Granted, I have changed the title from a question to a positive statement. I firmly believe that if the study had been properly set up and too many variables not tracked that should have been accounted for, the results could have been much more positive.  Patients were eligible if they were 35 to 75 years of age, had type 2 diabetes not treated with insulin, and HbA1c levels between 7% and 9%.


Yes, the “experts” said, “They were not convinced the extra cost of SMBG (self-monitoring of blood glucose) was worth the marginal added benefit. Also, this approach may not be generalizable outside of a clinical-trial setting, they said, noting that patients tend to tire of such self-monitoring in the long run.” None of the “experts” participated in the study. The problem with most studies of this type is that no education is given to the participants beyond a minimal amount.


Yes, some are taught more, but many are not given enough practice to have this become a habit. And this is a must to make the desire become important and make a person want to manage their diabetes. No, I do not think that intensive blood glucose monitoring needs to be done long-term, but at diagnosis, the first six months are critical to determine how the different foods or food combinations affect your blood glucose. This is one way to know which foods may need to be eliminated or reduced in the meal plan.


Then over time, you will need to up the testing intensity again when you add new to your meal plan foods, when you are ill, and when you are having problems for which you have no easy answers. What the “experts” do not realize is that by cutting to testing supplies over the years, people are less likely to maintain A1c's below 7.0% and this is the reason many people end up with progressive diabetes. People do need the education and encouragement to test more than twice per day, but testing for most people with type 2 diabetes should not require more than five times per day once a routine has been established.


Yes, there will be days when more testing may be required, and there may be days when less testing may suffice. With education and support, many people should be able to prevent their diabetes from becoming progressive. Yet, the “experts” don't care about the desires of patients and look at diabetes as progressive when it does not need to be. Because of the pronouncements of the “experts”, the insurance companies are happy to increase their profits by limiting the testing supplies for diabetes.


Please read about the study here and make your own analysis.

Dramatic Results When Treatment Tailored for Elderly

See what happens when the elderly are the only group in a study? This proves that the elderly should not be excluded from research studies and that they may be successful in managing their diabetes. This study was done in the United Kingdom, but provides a great example of what is necessary and may be accomplished by the people over the age of 70. Can the feeble minds at our leading research facilities wrap their heads around this study and end the discrimination against the elderly?

All patients were over the age of 70, and were included in the trial because their GP (general practitioner) thought they needed more medication. Oh really, doctor, elderly patients need more medication and it is your job to over medicate them? The findings were stark because those patients who were given the drug were three times more likely to reach their target than those who were not involved in the study, and received standard treatment. But researchers were particularly excited by the result from the placebo group, in which 27 percent met their targets without any medication.

This shows what can happen when great studies are undertaken for the benefit of the elderly. Presently, patients over the age of 70 are treated using a blanket method of aggressively reducing blood glucose levels, but that does little to take their complex needs into account.

Dr. David Strain, from the University of Exeter Medical School, who led the study, said: "People over the age of 70 are more likely to have multiple complications, such as heart disease, as well as type 2 diabetes. Yet perversely, these patients have so far been excluded from clinical trials, precisely because of these complications. It means they are generally treated with a 'one-size-fits-all' approach. We found that simply by individualizing goals and setting realistic targets, then spending time talking to patients rather than aggressively chasing targets resulted in nearly a quarter of patients achieving better glycemic control, without the need for medication."

Dr. Strain said: "This was a small trial, but the results were quite dramatic, and it is the first strong evidence that individualized care can make a huge difference to the lives of older patients with type 2 diabetes. We now need to build on this evidence with further research."

Yes, further research may be required for the dense American researchers to understand what their discrimination is doing to the lives of the elderly that are in essence just being written off and given the one-size-fits-all treatment. It may be even possible to reduce the medical costs and give pride back to the elderly population.

The points that are unclear to me that could be disconcerting are the A1c's at the start of the study and what the individual targets became during the study. If they are above 9.0% and the lower targets were still above 7.5%, then there may be some other concerns about individualizing treatments.

I had written and asked for a copy of the study, but none was forthcoming. This is a shame. I sincerely hope that the USA researchers learn from this study and don't continue to stick their nose in the air. Someone may flatten it for them.

Does Type 2 Diabetes Have Subclasses?

Before getting started on this topic, I must state that these are my opinions only, based on my reading and are no way official opinions. While some people have been alluding to sub groups or subclasses of people with type 2 diabetes, I believe the evidence is mounting for more people to come out in support of this idea. We now know that ethnicity is a factor and I am not sure how to list the young type 2's that have more deadly type of diabetes than children with type 1.

I personally feel that an apples to apples comparison is not totally accurate for those adolescent and young adults with type 2 diabetes, but I could be in error. “The study population was derived from the Royal Prince Alfred Hospital Diabetes Database and focused on individuals diagnosed with diabetes between the ages of 15 and 30 years. Records were matched with the Australian National Death Index to establish mortality outcomes for all subjects until June 2011. Clinical and mortality outcomes in 354 patients with type 2 diabetes (mean age at diagnosis, 25.6 years) were compared primarily with 470 patients with type 1 diabetes with a similar age of onset (mean age at diagnosis, 22.0 years) to minimize the confounding effect of age on outcome; disease duration was 11.6 vs 14.7 years.”

While type 1 diabetes is generally considered a more severe type of diabetes, the results highlight that young people with type 2 diabetes have double the risk of dying when compared to those with type 1 diabetes and after a much shorter duration of having diabetes.

Therefore, I would think this should be considered one subclass of type 2 diabetes. Studies are finally being done to compare how different ethnicities are affected by type 2 diabetes. While much more study is need for those in Africa, they tend to have a lower insulin sensitivity, but seem to compensate by releasing greater amounts of insulin.

Among those of East Asian origin, they have very good insulin sensitivity, but seem to have a harder time releasing insulin when it is needed. This means in the clinical settings, they develop diabetes more easily and do so at a lower BMI. Because East Asians have more difficulty releasing insulin, generally they need to start insulin therapy at an earlier stage of diabetes.

Caucasians fall between the two extremes in both insulin release and insulin sensitivity. Now in addition to the above subclasses there are probably more that have not been studied, such as the Eskimos and American Indians, but until there are studies verifying this, we can only guess. I would even hazard a guess that the African Americans could also be a subclass separate in part from those from Africa itself.

I also believe that even among Americans, there could be several subclasses of type 2 because we have thin type 2's and obese type 2's. We have many people that are able to manage their diabetes with nutrition and exercise and others that have a difficult time even on low levels of medication.

Will we have any discussion within the ADA about this? I highly doubt this and would be more inclined to believe that with the current attitude of physicians wanting cut and died answers, that it will require a much stronger voice than mine to give them a wake up call. Plus, with their conflicts of interest, unless some of their corporate sponsors raise the question, this will never see the light of day in the American Diabetes Association discussions.