Diabetes Self-Management Blog

Thanks to everyone for their comments on my last post ("Sicker Than Sicko"). I think we agree that no medical system is perfect. But countries with national health-care systems cover everyone. They focus more on management and prevention, and less on high-tech treatments of complications that should have been prevented.

Still, I think that Michael Moore’s excellent documentary, Sicko, gives a wrong impression. He implies that, if everyone had access to care, our health-care system would be OK for us. But that’s not true. Even when Americans do have medical insurance, our doctors may do as much harm as good.

As I describe in my book Diabetes: Sugar-coated Crisis, the medical system can hurt people with diabetes in at least six ways. Four of them are:

  • Making people physician-reliant instead of self-reliant.
  • Sabotaging the self-confidence needed for self-management.
  • Focusing on drug therapies instead of on healthy living.
  • Isolating people as individual patients instead of bringing them together for mutual support.

We know that good outcomes in diabetes depend on people taking control of their own condition. But some doctors want to keep control for themselves, even though they know we’re on our own whenever we’re not in their office.

Richard Bernstein, author of Dr. Bernstein’s Diabetes Solution, tells this alarming story. When he was 35, he was slowly dying of poorly-controlled Type 1 diabetes. He had neuropathy, kidney disease, eye problems, chronic fatigue, and frequent hypoglycemia.

At that time, he was an engineer, not a doctor. He saw an ad for the first portable blood glucose meter, which was being marketed to emergency rooms for use at night, when labs were closed. He tried to order one, but they would only sell to doctors. Fortunately, his wife was an M.D. psychiatrist, and he ordered one in her name.

Bernstein started checking his blood glucose 6-8 times a day, carefully noting how each different food affected his blood glucose level. He learned that if he avoided almost all carbohydrate and gave himself very small doses of Regular insulin before each meal, he could keep his blood glucose at normal or near-normal levels 24 hours a day. Most of his complications disappeared. He felt great.

Excited and hoping to help others, Bernstein went to his doctor, author of several books on diabetes care and an official in the American Diabetes Association. Bernstein encouraged him to make the meters available to all his patients. The doctor replied, “What are you trying to do? Put me out of business?”

“Doctors couldn’t do much then besides check blood sugars and prescribe insulin,” Bernstein told me. “If patients could check their own sugars, what would that leave for the doctors to do?”

Blood glucose self-monitoring is now widely accepted. But it took over ten years of pushing before it became standard practice. Even now, many insurers deny benefits for monitoring equipment and training. As Ephrenia wrote in reply to my last post, doctors often refuse to prescribe diabetes education or self-management training. People with diabetes and their families often have to fight for the control they need.

Medicine often sabotages self-management in other ways. Health-care professionals may damage self-confidence by dumping large numbers of behavior prescriptions on you all at once. “Just eat what we say, exercise, check your blood glucose, take your medicines, check your feet, and see me every few months, and you’ll be OK. If you don’t, terrible things will happen to you. And oh, yes, don’t forget to reduce stress.”

Very few people can make so many changes all at once, and when they don’t, they may become discouraged and stop trying. Instead, providers should support people through making small changes and build on small successes. Few people go from being couch potatoes to walking briskly three miles a day. But they can start with smaller steps and build up.

I had a client who started with a program of walking down to her mailbox by the curb every day. That was all she could do. Her doctor told her it wouldn’t do any good; it wasn’t enough. But over a year, she built up to walking three miles a day. She lost weight and got her blood glucose under better control. The doctor was wrong.

Professionals also damage our self-confidence by labeling patients with terms like “noncompliant,” “nonadherent,” or “obese” (Latin for “overeating,” as if that was the only cause of the problem). Other damaging labels include “in denial”—you’re not serious about your condition—and “chronic progressive”—you can’t get better, you have to get worse, and there’s not much you can do about it. Such labeling and blaming makes self-management much harder.

What experiences have you had with self-management support by your providers? Are they helpful? Are they there for you? Or are you on your own with it?

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Comments
  1. Yes I agree that physicians don’t do enough to help us, but it is up to us to ask for help. They can’t read our minds. You can be refered to Dietitions, eye drs, foot drs and so.

    Posted by Ga Gal |
  2. I am blessed with a physician who takes the position that it is her job to assist ME in taking control of my diabetes. She is a teacher, in other words and believes control and responsibility belongs in the hands of her patients. As a result, I have an a1c of under 5.5% — from a beginning a1c of 9.1% last January. Great lipids, great blood pressure, etc.

    As someone who lived under national health care, I cannot agree that the answer is a national health care system. National health care in Britian and Canada does NOT put the emphasis on management and prevention. They tend towards bureaucratic nightmares, rationing of medical resources, and horrifying stories of ageism (just try being old and getting in a queue for “non essential” care in Great Britian!)

    The US medical system is in a horrible mess, but Michael Moore has not found “The Answer”. Nobody has. But proactive individuals who accept ultimate responsibility for their own care sure do a lot better than those who do not

    Posted by Sarah |
  3. I receive you newsletter & I find it somewhat helpful. I say somewhat because it is still traditional diabetic care. I had a mild heart attack due to uncontrolled diabetes. I have peripheral neuropathy throughout my entire body. Am in a lot of pain. I left the hospital on 2 oral medications & 30u am 20um pm of 70/30 insulin. After 5 months of very little carbs. High fiber, vegies, (very little fruits) swimming laps 30 mins. 3-4 times a week. Many natural supplements. I am off all oral meds. & 1/2 as much insulin.
    It is possible & most doctors DON’T help!

    Posted by Sue |
  4. I found out I was a diabetic 2003, I was 43 homemaker. I complained to my doctor for about 10 years before he figured it. I read one of his posters from a RX ad. I was very angry, but moved on. I told him I wanted to see a Dietitian, I went for about year and lost 50lbs. (Need about 10more to lose)I am now off of RX and A1c is 5.7. I have had a mild heart attack, and two mini strokes since. I am recovering from brain injury and back in college making an A in my last semester. I ride my stationary bike and do 8-16 min. TaeBo (Heart races & sweat) on the off days.
    I went to an Endo. doctor and he was great help and I was released once all my numbers and weight was close to what we aimed for. There are some good doctors and some who are uneducated in that field.
    Good Luck to everyone, and wishing you well!

    Posted by jenstype2 |
  5. What can I do as a brittle diabetic when my doctor says I need the pathway pump with the sensors and my insurance refuses to cover any part of it. The insurance claims that I have met my $10,000 lifetime limit. I have had diabetes for 34 yrs and have hypoglemic unawareness. I don’t feel anything until I am in the 30’s. I’m trying to stay alive and out of the hospital but I can’t find any help. Do you have any suggestions?

    Posted by dangerzone |
  6. Thank you for an excellent blog. I totally agree that self-reliance is the only way to manage diabetes. I am a Type II who is learning how much your own disease can change. Last year I noticed my sugars were beginning to regularly be too high and discussed it with my doctor. He immediately said I need insulin. I disagreed since my only meds were Glipizide 5 mg twice a day and metformin 2000 mg a day. I knew that the Glipizide could be increased and that other meds were out there that I had not tried, including Byetta. Thankfully my doctor must have gone home and completed a crash course in Type 2 medications because I now am using Avandia, 4 mg twice a day, 5 mg Glipizide twice a day, and 2000 mg metformin per day. I haven’t gotten the results of my latest A1c but I’m hoping to have a 7% or less result. I will also be switching my Avandia to Actos once I’ve used my current Avandia supply.
    I think my doctor knows much more now than he did a year ago.

    Posted by Gayle |
  7. I am very lucky in that my family doctor became a Type 1 diabetic in medical school 25 years ago, and can understand any problems I might have. I just went on an insulin pump in February after 21 years of Type 2 diabetes and it has made a tremendous difference in how I feel.

    Some doctors are cognizant of the felings of their patients and some are not. I had a surgical biopsy last November and the doctor’s notes say I am “well-nourished”. My physician daughter told me that is the politically correct version of “overweight”. She also said that many doctors’ computer programs have one key that can be pushed and all “bad” comments will be changed to the PC equivalent!

    Posted by flawed genes |
  8. I have a good diabetes doctor but have so many complications from my cancer surgery I often don’t see him cause I am in the hospital. but I e-mail him re blood sugars and increasing insulin. My life does not allow me a routine despite 10 years of trying and switching jobs–I am an RN. (I am typing left handed due to ‘cat assistance.’) No matter how much exercise, physical therapy, doctor appts, blood sugar checks, writing down what I eat and when I sleep, etc, I cannot ‘control’ my blood sugar or my weight. I am not lazy, altho I am fat. I have endurance but am physically disabled due to a work related back injury and osteoarthritis with an inablity to tolerate NSAIDs for this. Some people over focus and some people deny and everyone goes thru cycles in their life of being somewhere on the scale. Doctors and nurses unfortunately DO make assumptions and refuse to listen to reasons which they hear as excuses. key words are overweight, pain meds, fibromyalgia, arhtritis, tried and failed,

    Posted by zoebear |
  9. After beinging in denial for 20 yrs. I now take insulin every night. I wish I had listened, so, I now have a good doctor and nutritionets (sorry I do not spell very well). But, I have learned a person can have great doctors and get good advise, but once your home it is all up to you, not anyone else. I know and am still learning what my body wants and does not want. Listen,learn,and exceptance is very important. just wish I had done it sooner. I can learn something everyday, and that is a wonderful thing, there is help and there are people we can lsten to, we just have to want to take the next steps for our own lives.

    Mellonie from Oklahoma

    Posted by mellonie |
  10. I am 22yrs old, a type 1 diabetic, and pretty well controlled. My father is also a type 1 diabetic, 56 and on dialsys. He has kindney and liver damage, he also can barely walk. My question is what can he do so that he could streghthen his body and help him so maybe he doesnt have to be on dialsys?

    Posted by Tai |
  11. This is my story. I have been thru 6 doctors already and can’t get any of them to be sympathetic and helpful. Even had one that was posted as one of the best endocrinologist on the East Coast tell me “if you don’t get this under control you are going to be in big trouble.” Same one I told for three months the cholesterol med was wrong and hurting me but she stated “never heard of that” - so I ended up in the hospital because this med was causing injury to my kidneys and atrophy to my muscles which mimic heart attacks. ;-( It is very difficult to find a good doctor for diabetes - at least that has been my experience. Basically, their first response is to place you in several meds - then one takes care of the BG and the other the issues that one causes. So, what is one to do? I don’t know. At this time, I figured that taking Glipizide and Januvia seem to be helping but the Glipizide increases my weight and this causes my cholesterol to increase also. Any ideas out there to help this issue? Thanks a million!!

    Posted by Isabella |

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General Diabetes & Health Issues
How Much Do You Know About Diabetes? Six Facts to Get You Thinking (08/25/14)
Doing Your Own Research (08/06/14)
Ensuring a Successful Hospital Stay (08/15/14)
Summer of Health! (06/19/14)

 

 

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