Diabetes Self-Management Blog

We gave our neighbor Sylvie a ride to her doctor. In the car, the talk turned to medicines. Sylvie said she was on seven or eight drugs. She didn’t remember what they were all for, but said, “I leave that up to my doctor.”

I’m scared for Sylvie. She has high blood pressure, Type 2 diabetes, and asthma. She’s a wonderful person, but she has a tough life, with custody of her young grandchildren and a part-time job. I can see why she might rely on her doctor to make all health decisions, but in my experience, that plan usually runs into trouble.

Her medicines could have side effects or interactions she doesn’t know about. And we have no way of knowing whether her doctor (actually doctors — she has three) know what they are doing, or what the others are doing. Does one even know what the other is prescribing?

I’ve been a nurse for almost 40 years. You kind of see the rough side of medicine when you work in a med/surg unit. I used to not trust doctors at all, but now I take them on a case-by-case basis. Some are wonderful. But still I would never rely on any doctor completely. Would you?

Why I don’t think you should put all your trust in medical professionals: Doctors miss things. They are human. They really don’t have time to know their patients well, so they put us into categories by illness or demographics. Most of them treat diseases, not people. They tend to think drugs are the answer to everything.

Some are too reluctant to share information. Why are you ordering this drug? What does this lab result mean? They don’t always tell you, so you have to trust them.

Also, medicine has become so complicated, with so much new information coming out every year, that no doctor could possibly keep up with it. Only the narrowest specialist can even keep up with developments in his own field. A general practice doctor, or even an endocrinologist, has way too much to think about.

Your doctor might have 2000 patients. You only have to worry about one case, your own. So for me, it’s important to inform yourself and make your own decisions as far as possible. You need to have a care team, and you need to be the captain. Your doctor can be like the star quarterback, but you are still the coach.

Of course, that’s easy for me to say. I’m a lifelong nurse, and now I’m a researcher and writer. I know how to find things out, and I can usually understand the language. If a paper is over my head, I have time to learn it. That’s one of the lovely things about this job: learning new things and sharing them with readers.

Our friend Sylvie has none of those advantages. She doesn’t know how to search the Internet, and she doesn’t read all that well anyway. Plus she’s so busy with child care and housework that there’s no time or energy for informing herself.

So what can she do? I’m guessing most Diabetes Self-Management readers are more informed than the average person, but where do you fall on that scale? How much do you find out for yourself, and how often do you just go along with your doctor? Do you even want to know the science behind the doctor’s orders, or is that not your problem?

The best thing is to have a good relationship with your doctor. If he shares information with you, if he checks in with you about the prescribed therapy, you’ll probably have better results. If you come in with an idea like starting an herb, reducing a medicine, or going low-carb, it would be nice to have a professional to discuss it with. Does your doctor do those things? How do you help him communicate with you?

It’s also good that we have the Internet now to check on things. I wouldn’t take the word of one individual poster on a Web site, but if you see the same advice in different places, it’s at least worth thinking about. Almost anything can be researched on the ’net if you take the time to learn.

But again, that advice applies to people who are somewhat educated, have Internet access, and some time to research. Others might be forced to go along with their doctors’ plan. Even then, you can improve your relationship with your doctors. We gave some strategies for working with doctors here and here.

So how much do you rely on your doctor? Are you comfortable with that? How is it working out?

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Comments
  1. Nearly every pharmacy has software in place that automatically check for potential drug interactions, so it’s important to get all your prescriptions filled at the same pharmacy. My clinic takes the time to review all your meds (prescription and non-prescription) with the MA before the Dr. comes in. They prefer that the patient bring their med bottles with them to make sure nothing is missed. Any new scripts are once again automatically checked against your current meds for problems, so this takes away much of the potential for error, as long as the patient does their part. My primary does a good job of informing me of treatment options and in the end, I decide, so it’s not a case of reliance as mutual understanding and trust. I understand there are those who lack the time, ability, or inclination to be an informed patient, so it is doubly important for them to have a physician who treats them according to their individual needs. I strongly suggest to anyone that feels they can’t rely on their primary, seek another doctor or another clinic. There are smart, engaged, professional doctors out there who know how to use their records, their staff, and the patient’s involvement to give effective, individualized care.

    Posted by Joe |
  2. Great article! I have found that I needed to take control of my diabetes when I found that a vast majority of my doctors only wanted to prescribe drugs and more drugs without much explanation as to “why”. They did not like answering my questions about why they prescribed certain drugs and potential side effects with me and they had no time to discuss diet and exercise options. This way was not for me! I chose to be proactive in my health, so I read and researched everything I could find on my condition. I started to make gradual changes in my eating habits, exercise, supplements, etc. while constantly testing and keeping a log of the results, which I shared with my doctor. Eventually, I was able to taper off all my drugs.

    It takes time to develop a working relationship with a doctor. It would be an ideal world to find a doctor you can work with, one that helps you set and achieve those goals…and one that accepts your insurance coverage. Diabetes is a very expensive, sometimes bewildering, oftentimes scary condition. We make our choice of dealing with this disease from our comfort zone and our pocketbooks. It is up to us whether we let the doctors “do it all” or we take charge where we are able. Sometimes it’s a bit of both.

    Posted by Mary G |
  3. David:

    Excellent ideas, thoughts and real life example.

    I never got my diabetes under control till I jumped in both feet, learned everything I could from Blogs such as yours and this website and learned everything I could be doing from exercise, diets, metering and what drugs did so I could work with my Doctor to provide him extensive reliable data/metering as well as logging food, calories and what I did.

    A doctor’s time is limited but one faces this mess every minute of the day and one needs to monitor issues and seek out additional help.

    One has to become a proactive case manager driving and learning everything one can do to get the mess under control. No exceptions!

    Yes, back in 1980’s I went to Doctor and told take this pill and went home. 26 years later I was really fixing the mess after years of not really fixing issues and now under control.

    Would I do it differently today. Dam rights, diet, nutrition, correct foods to eat, exercise and metering as soon as numbers start wandering up and checking all available research data /articles and experience on this nasty disease.

    Bets wishes and thank you for another illustrative article and lifes experiences backing this up working as a Nurse in the combat end of medicine.

    Posted by jim snell |
  4. Joe is right for so many reasons. I have to deal with two pharmacies because of the VA, but I still provide all doctors and pharmacies with a complete list of medications and supplements. This has only caused one medication to removed because of a conflict and was caught by my local pharmacy. Because I needed the short-term medication, the pharmacist recommended that I stop one of the long term medications until 48 hours after I finished the short-term medication.

    Time after time I see patients go to one pharmacy for one medication and to a second or third pharmacy for other medications. This will eventually end up hurting these people.

    You are right to be concerned about Sylvie. It is a shame that more can’t be done to assist her.

    Posted by Bob Fenton |
  5. Can one rely on his Doctor? I believe one has to have a Doctor one trusts and yes one may relie on but in my mind no substitue for cross checking yourself and ensuring one understands all going on. I believe this is a joint effort.

    Posted by jim snell |
  6. David –

    As always, excellent article. I know we all appreciate your work in the nursing trenches — and your research and writing talents. Thank you.

    I am not wanting to hijack these comments, but I do have other questions. I’m type-2 for 2-years now and want to reverse my diabetes and/or become drug free. I use Metformin twice daily and Glimepiride twice daily. Fasting BG probably runs around 130.

    I seldom eat white bread, but do sometimes eat rye bread. Lots of fruit, nuts, seeds and juicing. Virtually no sugar.

    Recently in an article, http://www.huffingtonpost.com/dr-mark-hyman/5-steps-to-reversing-type_b_263424.html, Dr. Mark Hyman stated — “Some newly discovered compounds have just been found to turn off all of the genes that cause diabetes. You’ll find them on your dinner plate — in rye bread and pasta.”

    That’s all I could find after looking everywhere I can think. No “if, ands or buts” could be found.

    So — would you please look at the information and give us your thoughts? Thanks much —

    Randy Prewitt

    Posted by Randy Prewitt |
  7. Do I put my trust in my Doctor? Well I did for a short period of time and that proved to be one the biggest mistakes I ever made.

    Several years ago with an A1c of over 12 my doctor decided I was a Type 1 diabetic… lets try treating it like Type 2 and see what happens — oh some success so lets keep going and here’s a whole bunch of drugs diabetics need to take. It didn’t take long before a had a big mess on my hands. Going to another doctor wasn’t an option here.

    First thing I noticed when I decided to educate myself was the medical authorities didn’t even agree with each other. Fast forward a few months and my A1c was down to 6 but I was struggling. Turns out I have LADA (T 1.5) so I took a new direction and demanded insulin (had to devise my own treatment with no help) and got rid of most of the drugs. Bingo! Spent a lot of money on test strips :)

    Of course that’s the short story but today almost 10 years later my A1c is just over 5 and I have been able to get rid of most of the nasties associated with diabetes.

    Now for the really sad part. My Doctor did acknowledge my huge accomplishments, but never once asked me how I did it! Professional ego? Do I share some of David’s views of modern medicine — you betcha. When it comes to Diabetes I really feel the treatment standard doesn’t even come close to real help for diabetics — the stats surely bare this out.

    And please don’t believe everything you read… a lot of it will keep you in a bad place. Lucky you if you have a really great Doctor!

    Posted by JohnC |
  8. I take metformin 2 in the morn and 2 in the eve and glipizide 1 in the morn and 1 in the eve.
    The DR. raised my Metformin from 1 in the morn last time I was there because my A1C was 7 or 7.1
    I take thyroid medication in the morn. I take meloxicam for my arthritis in the morn also.
    I do use a website for drug interactions to play it safe. I try to let the Dr. know how I feel and what I don’t like taking,like my Pravastatin because I don’t like how it makes me feel, but I don’t want to die so I take it anyway.
    Anyway I don’t want to go on insulin which I’ve heard is the next step and I hope I have I have the courage to tell my Dr. what I want and don’t want. He never seems to really listen. I realize he’s a busy man but its my life were playing with.
    Sorry for running on thanks for listening.
    Holly Wirth

    Posted by Holly Wirth |
  9. David, Hello. I am a retired social worker living in Minnesota and have had type 2 diabetes for going on 4 years; along with other medical problems, not related. The diabetes is under control with medformin and diet, and I do not use insulin. I read your comments regularly in DM.

    I find it difficult to understand just what you are saying in this report on Sylvie. What comes across to me is ‘to doubt your doctor.’ This troubles me. What about doubt your nurse too and while you are at it, doubt the entire medical profession. That is such a negative. Who needs to be scared into questioning one’s medical care? Children perhaps? I have a good relationship with my doctor and we decide what is best for me at my semi annual visits.

    Perhaps, it might be better in the future, if you ‘really’ care about patients, to ask Sylvie if she would like someone ‘qualified’ to go over her medical care and discuss any irregularities. And you David could go with her to ask the right questions. Please do not ’scare’ her into confusion. Stay positive my good friend. And do not be scared yourself.

    Posted by Robert Hubble |
  10. I found out the hard way. The doctor I had from 1996 to 2010, I relied on him to read my test results and let me know if anything was out of order. I would go to my annual visit and tell him another brother or sister has diabetes. He ordered fasting blood sugars. 2010 I had lost 40+ pounds. I also had two friends who were retired doctors. They were worried about me and they had me ask for a copy of my lab results. The test were done the first week of January. He had told me they would mail me the results. By February 22 I had not received my copy. I called and the nurse got highly upset. My fasting blood sugar was 320. They also wanted me to come in to see the doctor.
    I have a friend who’s father was diabetic and he had been being checked since he was a teen. He told me his doctors name. Who I called and made an appointment for the day after I went back to see my former doctor. While at my former doctor he just happened to print out every test results which he had ordered on me. Eight years prior to these three days, my fasting blood sugars were in the diabetic zone! Every year the results went up higher.
    My doctor which my friend referred me to is great! I have been able to email him with questions and get my answers right a way. He also gives me a copy of my test results. He has also referred me to a few other doctors regarding other things than diabetes. I have also fired two of the doctors which he had referred me to. One of those told me to take a med which I have an allergy to. The other sent blood word out to a lab which he tells me that I have to have the test redone so he could send it to a lab which more reliable results.
    The only one who will really watch out for you is yourself.
    The only one looking out for you is yourself.

    Posted by Jacque |
  11. I once had a former doctor tell me that I didn’t need to go to Diabetes classes or see an endocrinologist, because he knew as much as they did. It wasn’t until I repeated this to another of my doctors that I was sent for diabetes classes some 6 years after becoming diabetic. I changed doctors pretty quick after having that class and went to see an endocrinologist, who had my diabetes under control in less than a month. He taught me so much and encouraged me to take control of my life and my disease. He said I’m not there to watch everything you put in your mouth or to be sure you are taking your medication, all I can do is give you the tools and the rest is up to you. He moved from the area and I miss him, but bless him for understanding that I needed a cheerleader, not a doomsayer. My diabetes is still under control, but even then I’ve developed neuropathy in my feet and stomach. I’ve changed doctors 3 times before I found one that I thought really listened. One was angry because I researched on the internet and subscribed to Diabetes Self Management. That’s where you have to learn to be your own advocate, it you don’t, it’s a really twisted road you find yourself on. I had ovarian cancer when I was 25 and my surgeon gave me a piece of advice I’ve never forgotten. He said when dealing with doctors just use your aggressive self and get the answers to your questions. If they don’t answer, you keep looking until you find a doctor who does.

    Posted by Diana |
  12. I think you are your best advocate when it comes to your personal health care. Doctors are so rushed today, you barely have enough time as the patient, to cover everything with your doctor. Some are issued so much time, to spend with each of their patients. The MEDICAL WORLD is all about money in todays world. The doctors that really went into the business, for the love and interest in helping and treating patients, is gone. It seems so impersonal today, when seeing a doctor. We are just another number. My mother would bring copies of her bloodwork home, when she was done seeing her doctor. I was going through them, and it was ” I “, who found she had diabetes AND Hypothyroidism. Her TSH was not within normal limits, and her blood sugar was at 167, and this was a fast. I alerted her doctor, or rather the NURSE, whoever gets to speak to a doctor via phone anymore. They did start her on diabetic meds and thyroid meds, within the week and you can bet I changed mothers doctor within that month. After that, I always check everything that refers to my mothers or my medical treatment, etc. I go over everything with a fine tooth comb. LOL.

    Posted by Stefanie |
  13. I have type 2 diabetes. I’ve seen 5 different Dr.’s who put me on different drugs. When the drugs did not produce the results the Dr.’s wanted, each time they told me to double my drug intake.
    I was miserable - felt very sick, could not function with my daily tasks, laying in bed hoping I wouldn’t die!
    Each Dr. told me to double my drugs, or see a new Dr.
    Currently, I see a Nutritionist. He has helped me more than any Dr.to eat properly, and exercise, bringing my glucose readings down 70 points!
    For my body - NO MORE DRUGS!
    (Just recently, 7 more diabetes drugs were taken off the market, causing pancreatic cancer)No thank you.
    I’ll run my own life, and not give myself to a stranger (some Dr.)

    Posted by Diane Meyer |

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