Should people newly diagnosed with type 2 diabetes be prescribed insulin?

I have written about being on insulin and probably will again. It is a shame that more people do not use insulin and even more shameful that many doctors will not encourage their patients to use insulin. Probably the most disturbing is that fact that many physicians actually use insulin as a threat to keep their patients on oral medications and to get them to work harder at controlling their diabetes.

This failure as these professionals call it is of their own making and is making more patients wonder where these doctors got their medical license. When the current “pill cure” generation passes, these doctors are going to face an internet savvy group of patients that will call them out on their threats and stop using these deadbeat doctors.

A few doctors and some endocrinologists are starting to use insulin when some patients are first diagnosed. Though not enough are doing this, this will allow the pancreas to recover or rest, and bring a greater degree of control immediately. Doing this allows stopping the progression toward complications faster and this is a valid concern. Being on insulin at the start does not mean that you have failed or that you will need to be on insulin for the rest of you life. That will depend on the stage of your diabetes when diagnosed and the lifestyle changes you make.

Many patients started on insulin are able to get off and on to oral medications. Most are encouraged to change their lifestyle and be serious from the beginning about exercise and nutrition. A number of the patients have successfully gotten off all medications and are controlling with nutrition and exercise. In talking to a few individuals, they were very concerned when started on insulin, but with the faster lowering of their A1c and stricter control of their diabetes, they are satisfied that this was a way they would not have thought about, but did work well for them. Of the three persons I have talked with, only one was still on oral medications. The other two are off all diabetes medications.

One of the individuals I was able to talk with admitted that he had to overcome his extreme dislike for needles, but since he was always going to need to test, the needles were just another hurdle he had to overcome. He also felt that since the doctor was not threatening him, but encouraging him, that maybe he should listen and learn.

They did emphasize that it was important to receive from the start, the meetings with the nutritionist or diabetes dietitian to get the lifestyle change underway. This more than anything, they felt created the success they were experiencing. They admitted that it was difficult at the start, but as more of the changes were introduced with the reasons for the change also instilled with the change, they learned how to adapt and that they did feel better and wanted to continue what they were learning.

They were also happy that they had been allowed to experiment with lower carbs and different foods. I asked then, were they told they must eat a minimum number of carbs? All three agreed that they had been told that a number of carbs was suggested. Then all three felt that this was the last time the number of carbs was pushed. They felt that the nutritional value was more important than a set number of carbohydrates in all discussions. A balanced diet was the main topic and when a couple of them wanted to experiment with a lower carb restriction, only the nutritional values of what they wanted to eat was the topic.

Yes, the number of carbs was taken into account, but they felt that then the dietitian was more interested in teaching them the way to determine the nutritional values of the foods and where to substitute to not harm the overall nutritional value and still stay at the carbohydrate value they had chosen. This was a big eye opener for me and restores a little of my respect for some dietitians.

Just don't let a dietitian say I need a minimum number of carbohydrates, as at that point, I admit, I tune them out and forget the rest of the class. I am happy for the success these individuals were having and that they will remember what to do and the reasons for doing it. This is the place of the support people and this example should be more widespread than it is today.

Online sources of diabetes information – Part 3

The following sites are just small fraction of the sites available. I will continue to list more sites in the weeks ahead. Some of the sites listed resulted from a email request I received.

http://www.idf.org/  The website for the International Diabetes Federation. The one organization that seems to do more for diabetes patients than either the American Diabetes Association and the JDRF put together.

I also like that they are leading the ideas for universal diabetes symbol of a white area outlined by a blue circle. I will consider using there symbol as I doubt the ADA and JDRF will ever get behind one single symbol.

http://diabetes.about.com/  This is a decent site and has much helpful information for all types of diabetes. The link with take you to the type 2 diabetes area. When you have time, you may want to explore some of the other areas – I receive the weekly newsletters (some are almost daily and others are monthly).

http://www.mayoclinic.com/health/diabetes/DS01121/TAB=expertblog   I hesitated in supporting this site as in the past they have placed too much emphasis on too many carbohydrates. But, then they moved away from the topic and have had some reasonable information that is of value. Not always the best, but at least useful and can be adapted.

http://www.drugs.com/sfx/  This is not complete, but it does have its value for those who may need to look up the side effects of the medications they are taking.

http://www.cdc.gov/  This takes you to the main page and then you may research whatever you desire on the Centers for Disease Control.

http://www.cdc.gov/diabetes/projects/cda2.htm  This is a section of the above site that is aimed at the types of diabetes in children.

http://www.fda.gov/  This is the main page for the Food and Drug Administration.

http://www.childrenwithdiabetes.com/  One of the better sites for parents of children with diabetes. Mostly this is for parents of children for type 1 diabetes. This is still an excellent site.

http://www.childrenwithdiabetes.com/d_0n_d00.htm  This is the same site above, and is a section of the site aimed at children with type 2 diabetes.

http://forums.childrenwithdiabetes.com/  This is the forum site and is for parents of children with all types of diabetes. This is one of the best forum sites for this that I have come across.

http://integrateddiabetes.com/#  A commercial site aimed primarily for type 1 people with diabetes. The section for type 2 adults is not available presently.

http://kidshealth.org/parent/medical/endocrine/type2.html  This is another site and the section is aimed at children with type 2 diabetes.

While I have only scratched the surface for type 2 diabetes in children, use your search engine and enter “type 2 children with diabetes” or “juvenile type 2 diabetes” and this will display many sites and list other search possibilities at the bottom of the page.

If anyone wants more information or is looking for something about diabetes, contact me by my email on my profile page, and I will assist where I am able to help you find it.

Exercise is the key that makes things work

Tom Ross raises a valid concern and while I missed it originally on the forum, he is correct in his analysis in his blog of August 31, 2010. Exercise, diet, and drugs is the triad for strict control of diabetes. While I prefer to list them as exercise, nutrition, and drugs, most are using diet.

This points out one of the current problems facing us as advocates for greater participation and education of all people with diabetes. Our “pill cure” generation is still with us and do not want to learn what will help them the most. Finally, when the oral medications will no longer control their diabetes, they come to a forum and ask what they need to do nutrition-wise to get better control of their diabetes.

But this begs the question, oral medications are the first line of control, nutrition is the second line, but where does exercise come into focus. For many, this is not given any thought. These people with diabetes do not really want to change their lifestyle any more than is absolutely necessary. This is the group most needing education and guidance, but they are the most difficult to get cooperation from or even listen to us.

If these “pill cure” people with diabetes can control their diabetes within their reasonable expectations, they will look no further and continue their sedentary habits and ignore those of us trying to educate and provide some guidance to them. When we say that the key to strict control is exercise, they just ignore us. They have been able to use oral medications and some nutrition adjustments to have what they consider decent (but far from strict control) and are not interested in anything more.

Then in a few years, they find out that the control they thought they had is not there and the come back to the forums for more advice. They are now feeling like they have failed as the doctor is talking about insulin. Now they want more information to prevent them from needing insulin. They are reminded of exercise and still choose to ignore this. They attempt more nutrition changes in hopes that will be enough.

Then again they will be back when this isn't enough. Now the complications are starting to rear their ugly heads and insulin is no longer avoidable. Is exercise even considered now? Not if they can avoid it. And so it goes. Much of the “pill cure” generation will not accept exercise as the key to strict control and possible postponing of complications. Oh yes, a few will, but a majority will do no more than they absolutely need to.

When we are talking to the “pill cure” generation, we must remember to always mention exercise as the key that helps nutrition and diabetes medications work successfully. Just remember that it will probably fall on deaf ears, but even if we can get one person with diabetes to exercise, then it is worth every effort we have used to inform them.

We must also encourage our doctors to promote exercise and nutrition when ever possible, When they are able, doctors should avoid prescribing oral medications.

Conversations with the Medical Community

Some of you may have wondered when I was going to get called out for my harsh treatment (on-going tirade) of the medical community. Well, it has happened. And from a physicians assistant.

I was at an appointment because I am having some problems after a colonoscopy and being told that we were done for this meeting and she was already on the way to the door, she turned and quietly said, when are you going to be nice to the medical community and the medical pros. Since these are words I use with consistency, I knew that she had been reading. Being this was not an office I visit but once in a few years and not related to diabetes, I almost muffed it.

Then she said, we all can make mistakes. I finally got my tongue untied and asked if she thought I was referring to this office. No, she said, mainly to the people working with diabetes. Okay, but since I had just made a mistake which is forgetting to list all the medications and the one I missed was causing the problem I was having, her comment was well placed. We talked a couple of minutes more and we both went on to other things.

On the way home, I got to thinking about her comment and realized that it is not only the patients of diabetes that have problems with some medical pros. All patients with chronic diseases have these problems, whether it is in diagnosis or treatment after the diagnosis.

I know cancer patients have these problems. If any of you have seen the advertisements for The Cancer Treatment Centers, you will agree. My first wife had a doctor who basically threw up his hands and said he could do no more after giving her the news of uterine and cervical cancer, not even a referral to an oncologist.

In talking to a friend who has a grandson with autism, he expressed how little the local doctors were able to help and basically told them to find help from other sources. My friend expressed how much information he and his family have been able to find on the internet. His grandson has shown steady improvement after they found a doctor that was right for them. He will not be ready to start school this fall, but they are hoping that in a year, he may be able to attend school. They feel fortunate that they have this additional year to get him ready to start school.

So if you are a person with diabetes, do not take comfort from this information. It is up to you to become as educated as possible about your chronic disease and find support on the internet and where ever possible. Some of you will have a good doctor and some will need to change doctors to get one that fits your needs.

While it is not always possible to be your own advocate, you do need to learn as much as possible about your disease. If you need assistance, hopefully you have a family member that can also act as your advocate and if not a good friend that can assist you.

If you need a reason to be be more of an advocate or more proactive in your care, then take time to read the following blogs or articles as they are good examples of what you should do. They are part of the reason I am such a pain in the backside to some of my doctors and especially with the hospitals as they can make more mistakes that should be made. And I am not looking for reasons like some people to file a lawsuit, I just what things done correctly the first time and my way if I have any control.

No, I am not a doctor, nor do I pretend to be one, I just am a very proactive patient and advocate for myself, and I have a wife that is proactive as well and makes an excellent advocate for me if I become incapable of communication.

General Practitioners leaving the field

I was aware of some GP's not taking on new Medicare patients and that many were not considering any Medicaid patients, but I was surprised at the numbers that are leaving general practice for work in hospitals (become hospitalists) or even retainer practice or another term “concierge medicine”. An article in a southern Iowa paper stated that in the area about 40 percent were not taking on new medicare patients.

Then to see a sign on the counter of my doctors office scared me. I am not new for medicare and I asked him what his intentions were. He would only say that for now he was not accepting new Medicare patients.

This is being promoted by our insurance industry and reinforced by our Medicare system. Our congressional people are not opening their minds to what is happening, even though they have been told. When we the people finally wake up and start making demands because we do not have medical care, it may be too late and the costs will be astronomical.

Everyone, including myself have been complaining about the fraternization of our doctors with the people of big pharma (be sure to read the comments at this link). As a result, now I fear that we are driving them to cozy up to insurance executives as doctors are seeing more prior authorization requests forcing much more expensive drugs in place of the cheaper and just as effective, generics.

Diabetes resources

On October 15, 2009, I expressed my dissatisfaction in a new website. I wish I had been wrong, but with the passage with time, nothing has changed, except for the worse. More dead blogger sites are part of their listing. Some corrections have been sent to the owner, but that has not resulted in any changes.

We did need a site that had more for everyone about diabetes and other information. But when a website comes on line with errors and they expect people to flock to it and join to correct their information, then it is only fair that a site not succeed. People should not have to correct information that should have been correct before it was posted.

Why have I used it as a reference for people to check out? Because it is a source for those new to diabetes and that are looking for information. While I warn people of the problems in the sites information, it is a place to start and once started, they will find other sources of better information. So even a poor site has some value.