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What Does Your Doc Know About Diabetes?
December 12, 2006
Recently, a friend’s daughter who has Type 1 diabetes was admitted to the hospital. By the time they were through with admissions, the child was taken to her room, and her blood glucose was checked, she was hypoglycemic with a blood glucose level of 30 mg/dl.
Now, the kid had glucose tablets—both her own watermelon-flavored ones and the English-toffee-flavored ones she’d snagged from me. But the hospital’s protocol was to treat low blood glucose with orange juice. Which they couldn’t find a drop of. Did they let her treat with glucose tablets? Nope. Not protocol. She was going to drink orange juice. Or else. Whenever, that is, they could find some.
When I heard the story, it reminded me of a book I’ve always wanted to write. I already have the title: What Your Doctor Doesn’t Know About Diabetes Can Kill You.
There are plenty of anecdotes to be cited. Take my husband’s primary care doc (PCP), for example. “Oh, look,” he told my husband one day. “Your fasting blood glucose level is 160. We’re going to have to keep an eye on that.”
His fasting blood glucose was 160 and we’re “going to have to keep an eye on that”? When diabetes is diagnosed with a fasting blood glucose level of 126 mg/dl or higher? Do you reckon that the PCP would have caught the diabetes after the complications began showing up—which is when many people are first diagnosed with Type 2?
Oh, yeah: Make that his former PCP.
In another case, a friend’s brother was diagnosed with Type 2 diabetes with a blood glucose level of more than 300 mg/dl. With treatment, his blood glucose levels went down to normal ranges. At which point, his primary care doc told him he didn’t have diabetes any more. Then he went back up into the 300s. As an aside, his sister, a retired registered nurse and certified diabetes educator, diagnosed him. Both times. And then maneuvered little brother to an endocrinologist.
Endos have their own stories. My own gave a barely contained chuckle when I told him the title of the book. Did he have any examples for me? I asked.
“Seventy-thirty insulin,” he shot back. “Once a day.”
If I recall correctly, a mix of 70% intermediate-acting insulin and 30% rapid-acting insulin would only take somebody through about half a day. If that.
Online e-mail lists are full of cyber-eye-rolling when it comes to doctors’ ignorance of either diabetes or treatment methods.
A few years ago, I was in the middle of arguing with an anesthesiologist who believed that my insulin pump would automatically give me a burst of insulin for the breakfast I hadn’t eaten. Next thing I knew, I was rolling over from the gurney into my bed, postsurgery. (Anesthesiologists know how to shut you up, particularly when you’re trying to tell them something they don’t want to hear.)
The argument was about having glucose dripped into me during surgery. At least I didn’t go as high as one e-mail list poster, whose meter read “HI” (over 600) after she lost the same argument with her anesthesiologist.
At least we got to keep our insulin pumps on. Another poster asked what to do about her surgeon, who wanted her insulin pump taken off eight hours before surgery was scheduled. Think of it as the equivalent of asking somebody without diabetes to remove his or her pancreas before undergoing surgery.
Do you often feel as I do? That you practically have to have a medical degree yourself just so you’ll know if you’re getting the proper care from your doc? Diabetes is a fairly common condition, folks! And we go to the doc more than most people, whether it’s because we’re unwell or in an attempt to remain healthy. I recall reading several years ago that 20% of people who saw a PCP had diabetes. Don’t you think they’d try to learn more about something that one out of five of their patients have?
The answer? Educate yourself about diabetes. If you don’t have the knowledge yourself, you won’t be able to tell if your doctor does, either. I tend to interview potential doctors before I “hire” them. For some sample questions (and the correct answers), you can check out the article I wrote called “Questions for your Doctor,” which is in the Magazine Archives section of this Web site and appeared in the May/June 2006 issue of Diabetes Self-Management magazine.
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