September 3, 2010

To wear or not to wear a medic alert ID

Many people on the forums are asking about wearing a medic alert bracelet or carrying a medic alert card.

First, there is nothing that requires that you wear anything. Now that I've written that, I would like to give you a few reasons for wearing one.

Every day, somewhere in the USA, an officer of the law stops someone that appears or acts like they have had too much to drink. While many are overly full of the spirits, some are having hypoglycemia. Since the symptoms are very similar, erratic driving, slurred speech, etc., they often get locked up in the local jail. Some have problems and actually go into a diabetic coma, a few die, and others are able hang on until someone recognizes that they have hypoglycemia and they get treatment. Not the outcome that is desired for all concerned.

To begin with, people should test their blood glucose (BG) before turning the key in their car. If they are below a certain number, they should take a glucose tablet or more and retest at 15 minute intervals. When the BG is at an acceptable level, then they can drive. The only people that should be exempted from this requirement are people that are able to control their diabetes with nutrition and exercise or that the doctor has given a written permission to drive without testing because the medications they are on will not cause lows – which are very few. Many or in reality most oral medications can and will cause hypoglycemia especially when in combinations. Insulin will cause hypoglycemia.

A few states are starting to recognize this problem and are treating these people like drunk drivers and fining them and suspending their drivers licenses. I honestly hope more states follow suit. There are far too many accidents resulting in deaths caused by people with hypoglycemia. And we should take this seriously.

Now, I have to attack our insurance industry for their restrictions on covering testing supplies. People that drive a lot, should not need to be afraid of testing as often as needed nor have constraints from an insurance company that because they are people with type 2 diabetes, they should only be allowed to test twice a day. If they are on oral medications that can cause lows, they need to test more often. Of course if they are on insulin, they are allowed more testing supplies, but this still may not be enough if this person does a lot of driving. This is where a doctors orders should be allowed to increase testing supplies when needed and insurance companies should allow for these cases.

This is probably one of the biggest reasons to wear a medic alert bracelet. Some will say necklace, and others will say carry a card. A few will say that they want tattoos with the information in them. Another item to consider is a medical identification microchip as is being promoted in some parts of the country. All are reasonable and all should be considered and even in possible combinations. There are pros and cons for each, but this is a topic for another blog. I would also suggest that a medic alert sticker should be available for motor vehicles that would be visible to law enforcement.

The State of Iowa at their Police Training Academies does cover many of the medical topics since our state trains them to be first responders for all 911 situations. Hypoglycemia is one of the topics covered as is hyperglycemia.

In my talks with the local police department and ambulance service manned by Emergency Medical Technicians and paramedics, all have been in agreement that they look for medic alert bracelets, necklaces, and cards. Normally the police are first on the scene and if the patient is conscious they ask questions and if unconscious, look to get information as quickly as possible from medical alert jewelry and contact sources as rapidly as possible. This way when the paramedics, (EMT's) arrive, they have as much information as possible for them to better preform their duties.

They are trained to look for glucose tablets, orange juice, or other items that can quickly raise blood glucose or be prepared the inform the EMT's that glucose need to be administered with the IV. But they cannot do this unless they have the medic alert information available. They even suggest having medical data in the refrigerator in plain view as some people have had.

It is surprising how many people with diabetes do not even consider wearing medic alert jewelry and won't. Probably because they are wanting to be private about their diabetes. I say that this is a poor reason and you life may depend on people being able to get information quickly when it may be your life that is at stake.

I have been wearing a necklace with information on a pendant, but after reading more in preparation for this blog, I am going to get a medic alert bracelet and get registered with Medic Alert Advantage program for $30 per year with a $9.95 initial set up fee. I am not sure which jewelry I will select yet, but this is on my to-do-immediately list. I do encourage everyone with diabetes to do the same. It could be a lifesaving move. There is other medical alert jewelry, but none is part of the system by Medic Alert Organization.

You need to talk to your local ambulance service and police department in your state to find out how they handle these situations. It could save your life.

August 29, 2010

Pre-diabetes vs what?

Some bloggers have done an excellent job of defining pre-diabetes. Our professionals have said that 126 and greater is diabetes and 125 and lower is pre-diabetes. This makes for a good reference point; however, I am not willing to accept that the numbers are right or wrong.

Many doctors are doing us a disservice when they do not investigate further. Tom Ross got me to thinking in his blog of Aug 16, 2010. My thoughts before were - either it is or it isn't diabetes. I still cling to this because I do not like what our medical community is doing with the term pre-diabetes. Patients are not being properly informed nor educated about what to do to prevent or at least delay for the short or long-term, the progress of diabetes.

At the same time, Tom is right that being arbitrary does nothing to improve the situation as both do have problems with blood glucose control or a pancreas that is not able to react properly as it needs to.

A large problem is that our insurance will not cover anything that is less than 126, but will at 126 and above. To them if you are below 126, you do not have diabetes and therefore most insurance companies will deny your claims. But that is fodder for another blog.

Bob Pedersen does very well to lay out his case. He does not accept the analogy some have loosely used about the woman being a little bit pregnant and applying this to diabetes. I like the analogy and I will use it as I believe above 100 to be indicative of diabetes.

Michael Hoskins does not like the term “pre-diabetes” and I agree with him. Why? The medical community is too quick to use terms that let themselves off the hook for not following recommended procedures. This is where Tom's line of thought becomes important. Arbitrary values often miss the underlying problems that our pancreas is having problems that need to be addressed. And our medical community does little to address this issue other that saying that below 126 you have pre-diabetes and often leaving the patient to wonder what that means.

They leave the doctor's office wondering just what the doctor was talking about and why if it is serious, didn't the doctor issue a prescription to help control things or give them more information to make a sound decision of their own about halting the progression to diabetes and larger future problems.

To many the term pre-diabetes is more descriptive that “borderline diabetes” and I have no quarrel here. I will continue to disapprove of the term pre-diabetes and hope that another term, label, or description will evolve that defines the area that means that diabetes is likely and causes doctors to better inform their patients about the seriousness of their medical status.

Now with this written, we should all take the time to read a book by Gretchen Becker titled “What You Need to Know to Keep Diabetes Away – Prediabetes”. She writes an excellent discussion of diabetes and why we get it or don't, and why we should take the steps necessary to prevent diabetes from developing. If you are likely to get diabetes, Gretchen tells us what to do to postpone it from developing or to do for early control to delay the onset of complications for many years.

After reading Gretchen's book, if you decide to use the term Prediabetes, then I will say that you at least have a more thorough understanding of the term.

Even more important is Dr. Bill Quick's blog published August 22, 2010. In it he discusses the various medications being studied for use to treat prediabetes. As of then, there are no medications approved by the Federal Drug Administration (FDA) for the treatment of prediabetes.

Dr. Quick uses the term “off label” to describe the use of diabetes medications being used by patients before diagnosis of diabetes that insurance does not cover and therefore is at the patient's expense. These medications are also not approved by the FDA for use by these patients. His blog is worth reading.

So while the term “prediabetes” is not an official designation by the American Diabetes Association, it is appearing more and more in blogs, articles, and print both on and off the internet. Either the ADA should recognize this term or preferably designate another term which reflects the seriousness of those that are not classified as type 2 diabetes.

Tom Ross is correct in his analysis that below 126 blood glucose readings do indicate cause for concern as the pancreas is not functioning like it should and this needs to be taken seriously.

I am feeling much happier after the article from the August 25 issue of WebMD. The term prediabetes has been discredited by a consensus panel of diabetes experts. I know that this is not the end of the discussion, but the new approach recommended does make good sense. However, the author of the article does not agree and several of the comments agree with him.

I have a feeling that this debate will continue for some time until the American Diabetes Association starts exercising and gets off their lazy sedentary backside and makes a decision. They do not realize how many doctors are not taking numbers below 126 seriously. It is no wonder the patients don't understand.