Diabetes Self-Management Blog

“What are you going to do with all of that extra space after I leave?” my grandson asked.

I had to think. There were no grandchildren when we moved into this house 23 years ago. Now, they’re 22 and 20 and — finally — leaving “home.” Granddaughter drove off to her college town yesterday morning and Grandson informed us that afternoon he would be moving out September 1. This is after a lifetime of spending weekends, school holidays, and summers with Grandma and Grandpa and, finally, moving in altogether.

Once upon a time, I had a guest room and a room solely devoted to my office. Maybe I can have those again. Maybe I’ll miss having a pile of shoes in the foyer (despite my pleas to put the darned shoes in their rooms). Children and young adults in and out of the house — without knocking — all hours of the day. Empty pizza boxes in the living room. (No, I am NOT hiding the trash cans. It’s possible that children of that age can only find the kitchen when they’re hungry, but not when they need to throw away trash.)

Maybe an empty nest will be good. We’ll see what happens the first time I wake up low and there’s nobody here to bring me a bowl of cereal.

Maybe I should keep their rooms intact for a bit longer. Maybe they’ll be back.

Where, you ask, is my husband when I need to get my blood glucose up? Probably at his office. By the way, we celebrated our 38th anniversary last week. If I want to celebrate many more with him, I need to get him to either change doctors or begin seeing an endocrinologist. I’ll even share mine with him.

Last week, I told you about his doctor deciding to wait another three months before doing anything about his 7.4% HbA1c.

After reading the comments on that post, especially the one from JohnC who suggested the doctor may just be ignorant, I decided to ask Sweet Baboo some questions.

“Does your doctor check your feet?” I asked.

“No.”

“Has he ever?”

“No.”

Note to self: Next time you make an appointment with your podiatrist, make one for hubby, too. It’s important to check those feet before an impending problem becomes problematic. Don’t wait until a problem crops up before getting your first exam, either; the doctor will need a baseline to refer to.

“Has he ever mentioned you need to have a dilated eye exam?”

“No.”

Now, this one I’m not too worried about. He does see an ophthalmologist, and the eye doc knows he has diabetes and will look out for him. In fact, that doc knows about diabetes from a personal perspective.

I do, however, worry about the primary-care physician’s other patients. A lot of the town’s bigwigs go to him and some of them have diabetes. I often wondered why none of them ever went for education, but now I know: He doesn’t refer them to education. At least, he didn’t mention education to my husband.

“How about your kidneys? How are they doing?”

“He’s never mentioned my kidneys. Why should he mention my kidneys?”

Because you’re at risk for kidney disease. Especially with an HbA1c of 7.4% that your doctor is “keeping an eye on.”

Geez.

I feel that I should tell you my husband isn’t stupid. He’s Phi Beta Kappa and has a PhD. But I believe he still thinks doctors know what they’re doing in every instance, and they don’t. They can’t. There’s too much stuff out there to know.

However, I still believe that diabetes is prevalent enough that primary-care docs need to know more about it. They aren’t doing their patients any favors by being unable to properly care for diabetes.

Do you know what your doctor should be doing? I’ll let you in on at least the highlights next week.

And I need to crack down on my husband. If he were to check out, it would be way too much of an empty nest for me.

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Comments
  1. Jan: Oh neat; what an excellent article. You need to bust more butt here.

    Posted by jim snell |
  2. Yes, I can relate. Education takes a back seat again in the busy lives of many PCP’s. With some doctors it’s either too much or too little. My sister-in-law never questions her doctor about her diabetes treatment. Whatever he says, goes…why ask any questions??? The doctor is the expert. If he wants to wait 3 months, then she’ll wait 3 months. It’s the “Damn the torpedoes…full speed ahead!” attitude. Why worry about a 7.4 A1c if the doctor’s not worried… It could be worse!!! But, then again,it could be better…I suppose she figures he’ll know how to take care of her if there’s ever a problem. It worries me how many other diabetics become complacent and lulled into a false sense of security due to their doctor’s treatment.
    You bring out several important points that all people who have diabetes need to be aware of and make sure they insist on getting such as the foot and eye exams and having their kidney function checked. Basic stuff that’s often overlooked, but as you point out, would go a long way in preventing diabetic complications…and that unintended “empty nest” result!

    Posted by Mary G |
  3. Wow, can I ever relate! MY A1C was crazy for quite awhile but since my PCP did not seem overly concerned, I figured this was just par for the course. My PCP, by the way, is a wonderful, accomplished internist who teaches at a major medical school. He would tell me to exercise more, lose weight, and did prescribe a combination of meds. However, the numbers were not cooperating. Finally he told me to see an endocrinologist. I went to this terrific doctor and I now wonder what I was thinking. Should have done this several years ago. This young and very smart doctor added a new med and my numbers are almost normal! Even my triglycerides are better (cholesterol was always very good).

    Posted by Denise C |
  4. I understand exactly what your husband is going through. My Mom went through the same thing. It wasn’t until she started going to an endocrinologist that her diabetes really became managed. I always believe it is better to see a specialist than to let your primary care doctor manage your diabetes. After all, the specialist is the expert in the field. He/she knows much better than a primary care doctor how best to manage the disease. He/she also knows better about the latest advances in diabetes care. I now have diabetes and go to an endocrinologist to manage it too.

    Posted by Carol Gribbin |
  5. I am a diabetic and have been for 15 plus years. I do see an endocrinologist . My HbA1c in March 2013 was 7.3 and I discovered Glucocil off the Internet. Well I read all the stories /testimonials so I decided I would try the 2 Week trial offer and it has lowered my HbA1c to 6.1 in July 2013. My Doctor was extremely happy with my results. I do take lantus insulin and byetta, metformin and glyburide as well and hope to be going off them at my next office visit. My blood sugar readings are always in the low 120 or lower readings daily. I check my blood sugar very often to make sure as sometimes I don’t need my nighttime meds. You take glucocil with two meals daily. Try it - sometimes you have to take action on your own behalf and I say that because in Nov 2012 a temp dr helping out my endocrinologist put me on Novolog (I protested but she insisted) and in 5 months I put on 14+ pounds - something a diabetic does not need. Best of luck to you.

    Posted by Janis |
  6. I can so relate to this. Many years (80’s) ago a Dr. ran a 5 hrs glucose test on me. When he called me with the results he said I had impaired sugar balance, nothing to be concerned about. Jump to 2003 I am at Dr.’s office for lab results on cholesterol test, wondering why I had to come to the office. He says to me “You are diabetic, how do you feel about that?” How do I feel? I think deep down I may have had an expectation. When that particular Dr. left the clinic I asked for a Dr. wise in diabetes. I was in pretty good control, hubby made sure of it. So next Dr. says “Who told you that you were diabetic?”
    That is how it went for a while till counts started increasing again. Asked for another Dr. and she has been good. I wish I could say the same for me. In 2010 I lost my wonderful hubby and I fell off the food wagon. Now I am trying to get control again but last visit Dr. said “You know you have stage 1 kidney disease”. The point is that I may never have been to this point if that first Dr. had known to say “You have pre-diabetes” instead of impaired sugar balance no problem.

    Posted by Linda Albright |
  7. Please don’t feed your husband a bowl of your cereal in the morning…

    Of course this comes from an old guy who doesn’t believe an A1c of over 6 is good! Making up for the high carbs in the morning with extra insulin has never worked very well.

    And get him a meter and tell him what the numbers mean :) Tell him it’s a tool — us guys like tools, whether we have a PhD or not.

    Posted by JohnC |
  8. Great post which has moved me to encourage you and him to get on it early. His PhD and Phi Beta Kappa honors are his history but with an HbA1c of 7.4, his current thinking is likely a bit clouded, a little fuzzy just not as sharp. He was blessed with skills and mental capacity sufficient to pass but in his heart or the back of his mind he has begun to notice. NB a bright man living with a diabetic who doesn’t understand why his kidney function or feet should be checked. As I read your report it struck me as simple albeit serious, symptomatic avoidance or denial. I’ve been there and am amazed at the difference in mental clarity a HbA1c of even < 6.0 makes for me. Good luck to you both!

    Posted by Erik |
  9. Please, please, please for my sake get him to a competent doctor.

    I lost my husband of 38 years, 11 years ago. To this day my son still says the doctor is responsible for his death. My husband had cancer along with diabetes. My husband got to be so anemic that he needed a blood transfusion. He then had low blood sugar which required a trip to the hospital each time. His doctor did diddly squat until I went to the hospital early one morning and demanded he run further tests. When they did, it revealed cancer. Needless to say the chemo did not help the blood sugar. It was terrible.

    Your husband really does need to seek a second opinion. I am now also a diabetic, but I know I am staying on top of things. I recently moved and now see a new bunch of doctors. I make sure I am seeing to all my needs. Medicare also sends you reminders as to what you need to be doing.

    Posted by Carol M |
  10. The primary doctor I had before we moved to another location only checked the A1c every 3 mos and he felt an A1c like her husband’s was ok too. My new PCP did all the things he was supposed to and finally after about 25 years or so of having diabetes regulated my blood sugars for real giving me much needed guidance that I never really got before (and I was so happy!) and now I got a letter saying he was no longer practicing at the clinic I I am going to so I am back to square one again! I hope not!

    PS I once took a whole days worth of Glipizide by mistake and called my primary doctor at the previous city and didn’t hear from him for 3 days I was on my own finally on the third day after the problem was over that I had to deal with by myself I got a message from him to take my meds as directed!

    Posted by Patricia Pursel |
  11. I have had diabetes for the past 9 years, and I have been in control the whole time. Yes, in control of my diabetes and in control of my health care. I realized a long time ago (when I was just “at-risk”) that a person with diabetes is the one who is responsible for how they do.

    The goals for diabetes control are published all over the internet. They are in books. They are everywhere. The doctor prescribes, suggests, supports, and advises.

    However, the diabetic person is the one who is in the driver’s seat. He or she decides to eat properly or not, to test or not, to take medicines or not, to exercise or not, to do proper foot care or not, to keep specialist appointments or not, and so forth.

    You and your husband need to take charge. I promise you that the doctor does not care about your husband’s diabetes as much as you should. He will not lose a foot if your husband does not control his blood sugar. He will not go blind if your husband does not control his blood sugar. He will not have erectile dysfunction if your husband does not control his blood sugar. Nobody has as large a stake in your husband’s diabetes control as he and you do.

    Change doctors, then take charge! Find one that appreciates the importance of staying up to date. The field of diabetology is changing all the time. New drugs are being introduced. New knowledge is coming down the pipeline all the time. You need to stay up to date, too.

    If your husband had appendicitis, of course you would put him in the hands of a competent surgeon, and expect the surgeon to fix it. But diabetes is different, and it requires the patient to be in charge. So be in charge. And don’t forget that education works both ways. Ask for a referral for diabetes education. There is diabetes information from the state and federal governments on the internet. The National Diabetes Information Clearinghouse is on the internet, and it is very helpful.

    Good luck with this.

    Posted by Angel |
  12. Hell Jan - I could be your husband, or somewhat. My MD (more drugs) does get after me about education and is great about prescribing metformin and other such. For years, before my annual physical I would do a 14 day fast which would mask and skew the numbers. This year I turn 60 and decided I needed to something more courageous about managing my T2. In April 1013 my fasting bgs was 258 (at 2p)! This alarmed me and my doctor who had no idea that I had never taken a metformin tablet in eight years, despite the scripts she dutifully provided at each exam…

    I finally accepted that I needed to change my eating and exercise habits and during the first six weeks I was able to drop my fasting numbers to 150 and now, three weeks later, I average 118, with a few 108’s here and there. I have upped my exercise as well. Before, as now, I exercised daily, but it was incidental to my day, now it is with purpose and desire. I have lost eight pounds in the process! Hooray for me.. a great by-product. But, alas, good luck and I know all will turn out well for you both.

    Posted by ShumelS |
  13. I am also disappointed in my doctor visits. The last time I was there for a A1C test the nurse or whatever she was didn’t even take the test and I over heard the doctor joking with her about it. I didn’t think it was funny at all. I am going to a doctor who really isn’t all that interested in my diabetis care. He just goes through the motions but he is close by so I don’t have to drive many miles. So I go to him but I watch out for my own care.I don’t like his staff and he just wants to subscribe meds.

    Posted by Virginia |
  14. I was diagnosed with pancreatic cancer in October 2011. 6-8 months before that, my primary told me I was diabetic. I could not handle metformin at that time. I am a firm believer that if, at the
    time of my diabetic diagnosis, it would have been suspected that my pancreas should be checked, my pancreatic cancer would have been stage 1 or 2 instead of 3. I am not the typical looking person you would suspect that might have diabetes and it does not run in my family. I have expressed this opinion at every opportunity I get. My Oncologist didn’t disagree. He said it is not standard diabetic treatment to start by scanning the pancreas, the producer of insulin, but may be sometime in the future. On a happy note, I have been in remission for 10 months now.

    Posted by Joanne Elkanich |
  15. My nurse practioner drives me up a wall. I read the paperwork that comes with my meds, I don’t think she does. I was on Glyburide. I started having some of the symptoms listed in the paperwork. difficulty breathing, extreme tiredness, uneven heart rate. I told her about it. She said those symptoms were very rare. Well, I had them. I was so pissed I hung up on her. I went off the glyburide and over the course of a month I was no longer tired, my breathing was much better and my heartbeat had improved. I wish she had taken me off the glyburide when she first found the uneven heart beat. Maybe I would not still have it even though it has improved.I also wish I had been quick enough to realize what was going on and gone off the meds. Due to the fact that Ahold will not be supplying our insurance but expecting us to replace it with Obamacare I will no longer be having her as my primary care. I am a veteran so I have decided to switch to the Veteran Clinic.

    Posted by Darlene |
  16. I totally agree with Angel when she says you need to take charge of your own care. Nobody cares about your health as much as you do. And for your hubby, denial never did fix any problems. Attend to your diabetes NOW, and complications later will be less traumatic for you both. Get educated and get smart. Best of health to you both.

    Posted by Valerie |
  17. Reading this has confirmed that I WILL listen to my “inner voice” and call my doctor’s office when I wake up tomorrow, and get a new referral to my local Joslin center (interestingly, it’s even closer than my PCP’s office.)
    I think I sort of gave up a bit, when my previous doctor, just before she retired, changed my test strip ’script to only once or twice a week (down from 1ce-2ce A DAY) citing new guidelines that type 2’s aren’t helped by daily testing — and her replacement didn’t disagree! Well, that morning check was my way to “keep myself honest” and on-track with diabetes care.
    So, getting back in to the endocrinologist should be good for me to remember that I am the head of my personal healthcare team. (I also have missed seeing a podiatrist since I’ve been away from Joslin.)

    Posted by Nicola |
  18. When I was first diagnosed, by the VA, the only “training” I received was a one day ( actually half day) session where they brought various “experts” in at about 15minute intervals. My wife was the only spouse there, and the3 nurse asked her why she was there. She told her that she wanted to learn about my diabetes. Anyhow, we found a Diabetes Support Group at a local hospital that taught us more than we really wanted to know, Fortunataly, I now have a primary care doctor at the VA that cares.

    Posted by John |
  19. I have had diabetes since 1991 and have enough experience and knowledge to make the following statements.

    1- Diabetes is a money maker for either the primary doctor or the specialist. They goal is to keep you alive. You will be prescribed numereous prescriptions that may or may not work. Remember, you are the guinea pig. It is up to you to educated yourself about Diabetes. What you eat; weight management; when & how you exercise; adherance to all of your prescribed medicines; keeping all doctor appointments and above all, check your own body out for foot sores; vision problem; or anything abnormal. And, tell the doctor about each one.

    2-Not all doctors or specialists are created equal. Just because they went to a particular medical school means absolutely nothing at all! Remember that not every student gets and “A”. Doctors are no different in Medical school…..
    They prescribe medicine that they choose for their own personal financial gain. This includes rebates from the Pharmaceutical companies in terms of vacations, cruises, stc. If your doctor does not spend quality time with you in the office and/or you see little to no results, find another doctor.

    3- Every prescribed medicine has a little poison in it. Some of the side effects effect people differently but they are always there. Beware of the new drug on the market. Chances are that you, the patient, are the actual extensive test market. You see many drugs pulled from the market but only after years of documented deaths and/or harm to the patients.

    4- Take control of your own body. Doctors will not do it for you. Remember, you are a meal ticket for the doctor. If your daytime glucose is high, read about it on the internet. If you don’t have a computer or the internet, buy one and suscribe. If your A1c is above 6.0, don’t wait for another three months to pass before you are tested again. If you do nothing to change your lifestyle, the doctor will say “We’ll have to watch that closely and we’ll see if upping your dosage will help” When you see that this is a game being played with your health, you will then take charge of your own body. You are of no use to the doctor when your normal. They are in business to treat sick people. If you remain a full blown diabetic, the door will always be open to the doctor’s office.

    5- Not every diabetic is the same. That is why it is important to monitor your own body. Some diabetics are able to maintain normal blood glucose levels with pills alone. Some diabetics never have foot sores/ulcers; some diabetics do not have eye problems; and the list goes on. This is why you are in charge of “you”. Begin to read and peruse the Internet. You are not alone in the battle with Diabetes. You main objective is to remain healthy and free from complications. Only you can accomplish this!

    Posted by Mr. Gregg |
  20. I too, have been frustrated with my PcP’s lack of concern over my bs numbers (A1C’s in the 6-7 range) and her seemingly lackadaisical methods of managing them, from adding Humalog but not lantus, to suggesting I try several “internet” diets, to cleanses (because her friend’s yoga group did it and they felt great)!!

    Needless to say, I have requested a referral to an endocrinologist and am in the process of switching to a new PCP. Even so, I cannot emphasize enough to EDUCATE YOUSELVES. Read EVERYTHING you can about your disease. Publications like Diabetes Self Management have really been so helpful. Also any information you can get from the ADA, and the Joselin Center for example. NO ONE should assume that a PCP who does not specialize in Diabetes is going to have all the information about the best possible treatment.. and it’s not necessarily their fault. Having said that, we, as patients need to also be CONSUMERS. Doctors provide a service, and we should be educating ourselves in the same way we would learn about a car we were about to buy, or an appliance. It’s our Health, and we just cannot afford to simply sit back and leave it to others.

    Posted by Catherine |
  21. I disagree vehemently with Mr. Gregg. The doctor has no stake in keeping you ill. Poor results translate into malpractice suits. Think of all the great drugs we have, and how they can help you. Not everyone is in it for the money!

    The doctor and the patient are supposed to be a team. But in diabetes, the doctor is just like a coach, not the player. In diabetes, the doctor tells you what you need to do, and then you do it. If it does not work, you work out a different strategy.

    Just as in sports, sometimes you can fire the coach and go with a new one. But you need to work hard, no matter who your “coach” is. I knew Metformin was a good drug, and when it was prescribed for me, I had severe gastrointestinal side effects. But I continued taking it, and now I have “excellent” control, to quote my “coach”.

    You can improve your control. Just get a good coach, and exercise, practice what you know you need to do, and learn more about the game. You can win!

    Posted by Angel |
  22. Whats wrong with you?!?! FIRE THAT IDIOT DOCTOR!

    OMG!!!

    Posted by Tia |
  23. I was diagnosed with diabetes in the hospital after being admitted for an issue with my heart in 2011.(Takosubo)
    I now have a cardiologist, endocrinologist and my primary care. I think the primary care should be wearing egg on his face for ignoring my numbers for so many years. He did raise red flags on numbers over 100-114 on annual physicals, but he never advised me that these were something we could control or look at changing. He would say…’this is creeping up’ or ‘well, you have a family history of it…’ as if just waiting for it to take place. But now he defers to my specialists with the meds they prescribe and seems to be a lot more thorough and spends more time with me….got a team working with me now and he can’t just blow me off. I’ve been with him a long time and he is willing to listen to my requests to defer treatments in the past such as cortosteriods…etc. so, I’m not all that displeased, but I just can’t help but wonder what would have happened if I had not gone to ER in 2011. I have lost 34 pounds and my numbers are great. Last A1c was 5.3 and I hope to get it lower. I take metformin, an aspirin and metropholol daily, and also my BP med. I need to exercise more but I have a very healthy diet. My BP averages 110/60 and I take Edarbychlor. It was prescribed by my endocrinologist. It is the final miracle drug to tame my high BP, but I’m sure when I retire from teaching my BP will stay low, as it does in the summer(!!!). :) I’m a picture of health and I thank my great team at Oklahoma Heart Hospital.

    Posted by Lorna Doone |
  24. P.S. get plenty of sleep. That was something I was NOT doing — maybe averaging 5 hours a night. it can bring on these health problems I had developed. So, beware! Go to bed and get 7-9 hours of rest. Don’t eat after 8:00 p.m. and buy whole foods, not crap.

    Posted by Lorna Doone |

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