You will have to excuse me if I seem to
be on a rant. Headlines lately have been so misleading and down
right sensationalized that I have thought to bypass the articles. In
reading the articles further, I felt that rather than pass them by,
maybe there were some lessons to be learned.
The headline for this one is rather
tame, but still somewhat misleading - Hypoglycemia in Insulin-Treated Patients. The summary to get your attention says
the following - “The elderly with diabetes now experience episodes
of hypoglycemia more frequently than hyperglycemia.” Oh really!
Since this is Dr. Andrew Geller, a medical officer at the Centers for
Disease Control and Prevention (CDC), I had hoped to get some facts
and perspective. Instead, it is mainly misinformation and highly
misleading.
I admit that when I am told that this
is an expert commentary, I become skeptical about the accuracy of
what I am being told. Most of the time information to inform readers
and explain what they are talking about is missing. General terms of
severe hypoglycemia bother me. Does this mean anything below 50
mg/dl or a number below that? I will also think when they are
talking hyperglycemia they are talking blood glucose levels above 180
mg/dl. Yet we are not informed and cannot therefore draw any
accurate comparisons.
The only statement of substance comes
in the fourth paragraph when Dr. Geller states, “Insulin-treated
patients who are 80 years of age or older are more than twice as
likely to go to the emergency department as patients between 45 and
64 years old. They were also 5 times more likely to be hospitalized.
These findings underscore the importance of taking the risks for
hypoglycemia into account when making decisions to prescribe or
intensify insulin, especially among older adults.”
The expert missed an opportunity, in my
opinion, to alert other doctors about checking for memory problems.
Instead he just regurgitated what was supposedly reported about meal
planning saying, “Meal planning is a well-recognized component
of diabetes education. However, among the emergency department
visits involving medication errors, a meal-related issue was the most
common problem that brought patients to the emergency department.”
In the example he used of the patient
injecting the short or rapid acting insulin and then forgetting to
eat the meal timely, hypoglycemia caused them to go the emergency
department. To me this means that memory problems should be
investigated, but there is no mention of people over 80 often having
these problems. Even distractions could be a problem, but instead
meal planning is the only culprit.
This is what the expert says, “It's
essential for diabetes patient education to continue emphasizing the
importance of meal planning, and encourage patients to pay close
attention to the insulin product that they administer.” Even I
have made that mistake, but not often and normally (only three times
in ten years) I inject the rapid acting too close to the injection
site for the long acting. This causes the long acting to be
converted to short acting and hypoglycemia did result. Fortunately,
I recognized the problem as soon as I took the syringe out.
Therefore, I had glucose tablets at the ready and started testing in
30 minutes. I tested about every 15 minutes and took glucose tablets
accordingly until my glucose levels were at the proper level.
Granted the Medscape article was
written for doctors, but as a patient, I feel that the information
given was fair, but missed several points and alerts that should have
been covered.
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