With the growing shortage of primary care physicians in the US, expect to see more NPs (nurse practitioners) and PAs (physician assistants) in the years ahead if you are not already seeing them. Those NPs that have specialized in diabetes and become proficient are having good success in this area.
The study uses the term “mid-level providers” which the NPs find demeaning. This term is used because they are not doctors, but the successes NPs are achieving shows that once they have the training, they are more effective than the PCPs. The study data was mainly from the hospital-affiliated and free-standing Veterans Administration primary care programs. It involved 198 care programs and more than 88,000 diabetes patients.
The significant data points out that NPs helped patients reduce their A1c's and this translated into a seven percent reduction in diabetes complications and deaths in VA patients with diabetes. This is consistent with previous studies and this study having been done be a groups of epidemiologists, medical sociologists, and physicians supports previous findings of nurse researchers that had been discounted by other healthcare professionals.
The fact that NPs are getting better results than PAs is the result of the training program they had to submit to to become eligible to work as NPs in the VA system. There should have been more data, but even with the data explanation given in this study says a lot about the care veterans with diabetes are receiving under the direction of NPs.
Read the article here.
May 21, 2011
May 19, 2011
'Natural' Doesn't Always Mean Safe
Another kick in the pants for homeopathic medicine, but is it good enough? With some added regulations was put into place on May 1, 2011, the European Union took a step in the right direction in regulating herbal products, but fell far short of the regulations needed to reign in the misuse and abuse of herbal products. The spokesperson said that it was a step in the right direction.
Whether a step in the right direction is sufficient remains to be seen. For the time being herbal remedies will now have to contain the correct ingredients, the right dose, and cannot be adulterated with other pharmaceutical products or heavy metals. The new Traditional Herbal Medicine Registration Scheme (THR) became effective on May 1, 2011. Unregistered products will continue to be available to the public as food supplements.
It is important for consumers in the EU to understand that manufacturers of products registered through the THR will not have to prove that they work for a particular condition. Consumers will have to rely on the concept of “traditional use”. Unregistered products will continue to be available to the public as food supplements. So it seems that the situation really has not gotten easier for people to discern whether a product is good for their health.
The spokesperson for the Royal Pharmaceutical Society added that herbal medicines should only be used for minor health conditions and those remedies claiming to cure serious illnesses should be avoided at all costs.
Anyone wanting to use herbal remedies should speak to a health professional first in order to receive the right information about a product. Never stop taking a prescribed medicine to replace it with an herbal remedy.
Does this sound like something we hear in the US? It certainly does and the outcomes will probably be very similar. Prescription medicines will be deferred to herbal remedies if the homeopaths have their way. Read the article here.
Whether a step in the right direction is sufficient remains to be seen. For the time being herbal remedies will now have to contain the correct ingredients, the right dose, and cannot be adulterated with other pharmaceutical products or heavy metals. The new Traditional Herbal Medicine Registration Scheme (THR) became effective on May 1, 2011. Unregistered products will continue to be available to the public as food supplements.
It is important for consumers in the EU to understand that manufacturers of products registered through the THR will not have to prove that they work for a particular condition. Consumers will have to rely on the concept of “traditional use”. Unregistered products will continue to be available to the public as food supplements. So it seems that the situation really has not gotten easier for people to discern whether a product is good for their health.
The spokesperson for the Royal Pharmaceutical Society added that herbal medicines should only be used for minor health conditions and those remedies claiming to cure serious illnesses should be avoided at all costs.
Anyone wanting to use herbal remedies should speak to a health professional first in order to receive the right information about a product. Never stop taking a prescribed medicine to replace it with an herbal remedy.
Does this sound like something we hear in the US? It certainly does and the outcomes will probably be very similar. Prescription medicines will be deferred to herbal remedies if the homeopaths have their way. Read the article here.
May 13, 2011
Are You Ready for An Emergency?
In an email I received this week, the American Diabetes Association had a short list (too short for me) of diabetes supplies that you should have available in case of an emergency. Yes, those of us especially in the US, with the problems across the south with tornadoes and along the flooding Mississippi and other rivers need to take heed and be prepared. Other disasters can happen as well.
On August 27, 2010, I wrote about disaster preparedness and it is always good to review your plan. What bothers me about most plans, is the lack of cautions when they say to have the supplies where they can be gotten to in an emergency. For those of us on insulin, no caution or warning is made to make sure to keep the insulin refrigerated, or if not, that the insulin vials be rotated out and used before they can go bad. Insulin vials can be kept unrefrigerated for up to 28 days. Even if they are kept in the refrigerator, once the plastic cap is removed, the shelf life is 28 days.
This means that you must be able to use the vial before the end of 28 days. I normally use a vial in 7 to 10 days of one type and about 14 days of the other type. You will have to know your own usage rate to be able to rotate and use before they expire. The same would apply for other medications you inject. Normally 28 days is the unrefrigerated life for these unless clearly stated otherwise on the package. If not stated, ask your pharmacist about the unrefrigerated shelf life.
The ADA advice is still good for emergency preparedness. They suggest that a three day supply of diabetes supplies be kept in a clearly marked, and convenient, container to be carried with you when going to a shelter or evacuation. The ADA list which, depending on how you take care of your diabetes, could include oral medication, insulin, insulin delivery supplies, lancets, test strips, extra batteries for your meter, and a quick-acting source of glucose. Just don't forget to take the container with you and your meter.
The ADA did suggest something that a lot of others forget. They suggest putting a list of emergency contacts in the container and to wear a medical identification that will enable emergency medical personnel to identify and address your medical needs. They went on to say that while you are thinking about this to notify those around you about your diabetes as it could make a difference in a time of need, and how you might be treated for maintaining your good health.
To this, I would add a supply of other medications that you take, a list of each, and the purpose for taking them. Have this list in the container also. Also include a list of phone numbers for the pharmacy, doctors, and anyone else that could know where to get your supplies if the emergency extends for more than three days. A list of prescription numbers should also be considered and alternative pharmacies in the chain where you obtain your medications. Ask your pharmacist if there are other pharmacies that have access to your prescriptions within the chain of stores.
I would suggest reading my prior blog, ADA's PDF file and heeding the instructions that fit your needs. Some items can easily be overlooked, but I hope between this and my prior blog that you can put an effective and doable plan in place.
I have tried to post this the last two days, but this site has been read-only for a few days. Apparently their maintenance took longer or did not work as planned.
On August 27, 2010, I wrote about disaster preparedness and it is always good to review your plan. What bothers me about most plans, is the lack of cautions when they say to have the supplies where they can be gotten to in an emergency. For those of us on insulin, no caution or warning is made to make sure to keep the insulin refrigerated, or if not, that the insulin vials be rotated out and used before they can go bad. Insulin vials can be kept unrefrigerated for up to 28 days. Even if they are kept in the refrigerator, once the plastic cap is removed, the shelf life is 28 days.
This means that you must be able to use the vial before the end of 28 days. I normally use a vial in 7 to 10 days of one type and about 14 days of the other type. You will have to know your own usage rate to be able to rotate and use before they expire. The same would apply for other medications you inject. Normally 28 days is the unrefrigerated life for these unless clearly stated otherwise on the package. If not stated, ask your pharmacist about the unrefrigerated shelf life.
The ADA advice is still good for emergency preparedness. They suggest that a three day supply of diabetes supplies be kept in a clearly marked, and convenient, container to be carried with you when going to a shelter or evacuation. The ADA list which, depending on how you take care of your diabetes, could include oral medication, insulin, insulin delivery supplies, lancets, test strips, extra batteries for your meter, and a quick-acting source of glucose. Just don't forget to take the container with you and your meter.
The ADA did suggest something that a lot of others forget. They suggest putting a list of emergency contacts in the container and to wear a medical identification that will enable emergency medical personnel to identify and address your medical needs. They went on to say that while you are thinking about this to notify those around you about your diabetes as it could make a difference in a time of need, and how you might be treated for maintaining your good health.
To this, I would add a supply of other medications that you take, a list of each, and the purpose for taking them. Have this list in the container also. Also include a list of phone numbers for the pharmacy, doctors, and anyone else that could know where to get your supplies if the emergency extends for more than three days. A list of prescription numbers should also be considered and alternative pharmacies in the chain where you obtain your medications. Ask your pharmacist if there are other pharmacies that have access to your prescriptions within the chain of stores.
I would suggest reading my prior blog, ADA's PDF file and heeding the instructions that fit your needs. Some items can easily be overlooked, but I hope between this and my prior blog that you can put an effective and doable plan in place.
I have tried to post this the last two days, but this site has been read-only for a few days. Apparently their maintenance took longer or did not work as planned.
May 10, 2011
Who Is Responsible for Patients' Health Literacy?
Patients health literacy is a common theme lately in releases from the various medical associations. All are directed at the patients, caregivers, and healthcare professionals and attempting to provide more information of value to all concerned. What is generating this largess of information? Has all the poor web sites, studies showing lack of reliable information in the internet, or just good public relations finally driving the different medical professional organizations to get active.
Let's hope all of the above is true. Our medical insurance industry is doing almost nothing to help doctors in educating the new patients with diabetes or other chronic diseases. This would take too much from their profits. In many of the new websites and other information, it is the big pharmaceutical companies that are stepping forward to provide assistance as cosponsors or just financial support.
Our medical insurance companies may one day come to regret their greed and refusal to help. Federal and state regulations are already under analysis to determine if the medical insurance industry is violating moral as well as legal obligations in their rejection of patients' needs. I am not sure big pharmaceutical companies are innocent of charges either, considering the Vermont case awaiting a decision by the U.S. Supreme Court later this summer.
Yes, if patients are in cities that have diabetes educators and dietitians, medical insurance will cover a few classes, and then no continuing education for a period of years. Medicare is even less helpful.
The American College of Obstetricians and Gynecologists (ACOG) now states that physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment. They also emphasize the importance of patients taking their medications exactly as directed. We simply can't assume that a patient understands because she/he nods their head or because we think they seem educated.
One important point shows that that they are taking this obligation seriously. They state that asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend. This can help avoid the stereotype of noncompliant being applied. They also advise using technical translators to assist when there is a language difference.
Read their article on committee opinions here.
Let's hope all of the above is true. Our medical insurance industry is doing almost nothing to help doctors in educating the new patients with diabetes or other chronic diseases. This would take too much from their profits. In many of the new websites and other information, it is the big pharmaceutical companies that are stepping forward to provide assistance as cosponsors or just financial support.
Our medical insurance companies may one day come to regret their greed and refusal to help. Federal and state regulations are already under analysis to determine if the medical insurance industry is violating moral as well as legal obligations in their rejection of patients' needs. I am not sure big pharmaceutical companies are innocent of charges either, considering the Vermont case awaiting a decision by the U.S. Supreme Court later this summer.
Yes, if patients are in cities that have diabetes educators and dietitians, medical insurance will cover a few classes, and then no continuing education for a period of years. Medicare is even less helpful.
The American College of Obstetricians and Gynecologists (ACOG) now states that physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment. They also emphasize the importance of patients taking their medications exactly as directed. We simply can't assume that a patient understands because she/he nods their head or because we think they seem educated.
One important point shows that that they are taking this obligation seriously. They state that asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend. This can help avoid the stereotype of noncompliant being applied. They also advise using technical translators to assist when there is a language difference.
Read their article on committee opinions here.
May 8, 2011
Telemedicine Coming of Age?
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.
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 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.
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