“First, Do No Harm”

My granddaughter is packing up and will be moving out Monday, off to college and to her first apartment, which she’ll share with two other people. Grandma is experiencing a bit of empty-nest syndrome, although my grandson will still be here. He’s talking about moving out, too.


Today, the granddaughter has a doctor’s appointment. Just a checkup, although she does have a suspicious-looking mole.

My husband had his checkup last week, which is kind of what this blog entry is about.

When I was writing last week’s piece, about how doctors in the United Kingdom were real casual about adding medicines for people with Type 2 diabetes, I told myself it was, after all, the UK, which has the publicly funded National Health Service (NHS). Surely that wouldn’t happen here. (Yet.)


So he walks in, hands me a pile of papers and says, “if you want to read them.” It was the visit overview, including lab reports. His HbA1c was 7.4%. His fasting blood glucose was 169 mg/dl.

“Did he add another medicine or increase the dosage?” I asked.


Long story short, they’re going to wait three months and see how things look then. My prediction? It won’t look any better.

I don’t understand. What about that “first, do no harm” thing that’s connected with the physician’s oath?

It’s been proven, via the Diabetes Control and Complications Trial (DCCT) that keeping blood glucose as close to normal as you can lowers the chance of complications involving the eyes, kidneys, and nerves. The DCCT was for people with Type 1 diabetes.

For those with Type 2, there was the 20-year United Kingdom Prospective Diabetes Study (UKPDS), which came up with the same findings. Plus, it’s good for your heart. You can read all about it in the journal Diabetes Care here.

My favorite quote from the article?

It is time for all health professionals to treat diabetes aggressively. It is also time for patients to take their diabetes with utmost seriousness. And it is incumbent upon the health care system to provide the necessary resources for both to be successful. Compromise or acceptance of a disadvantageous and dangerous status quo in people with diabetes should not be tolerated any longer.

Great thought, huh? It should only be put into practice.

I read once that one in five people seen by a doctor has diabetes. If 20% of my caseload shared a pathology, you’d think I’d find out how to take care of it. I certainly don’t like it that my husband’s doctor put off dealing with a 7.4% HbA1c for three more months.

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  • jim snell


    I wish I had the knowledge and experienec I have now 30 years late dealing with this mess called type 2.

    I have the feeling , I could have stopped a stroke and a bunch of nasty complications.

    This is not blaming anybody but goes to the root of the quote you highlight.

    Type 1 by its nature demenad immediate action – diet, exercise, control or die fast. Type 2 by its sneaky nature allows everyone to snooze along just watching it. One eventually gets to the nasty point but only after doing tons of damage.

    My lesson is that one must as soon as there is indications; it is critical to start getting the diet and exercise regimines and metering in place asap and also catching and fixing any medical conditions that are frustrating that and making matters worse – ie leaky livers/metformin et all.

    The just take a pill routine while possibly helpful never made things better for me and simply got worse. Also insulin seems such a better answer as one can diet and not be faced with having to feed the glyburides, glimperides, starlex et all.

    I believe your comments and necessity for proactive steps dealing with type 2 is critically needed and should have been in my plan 30 years ago.

    The good news is that unless you are dead in the box, it is never too late. The bad news might be that your body cannot fix it all but does make amazing strides fixing messes.

  • Deb

    When my husband’s A1c was 10.8, his internist finally sent him to an endocrinologist (and I started sitting in on appointments whenever the DH would let me).
    When my husband was told (by a new endo who is terrific) he should see a kidney specialist because his micro albumin was sky high, he went to his internist instead, told him he didn’t want to see a kidney specialist, and that was that. The internist did nothing to find out if there was a reason for the kidney problem.
    I wasn’t allowed along on that visit, which leads to the fact that it wasn’t till 1 YEAR later, when the endo insisted and referred him herself, that he saw a kidney specialist, who figured out that it was the Celebrex that the internist prescribed that damaged the kidneys, not his diabetes. Another year later, and his kidneys are much better. He’s still going to the same internist. I wouldn’t be.

  • jim snell

    Deb: Yup – ouch!.

    My doctor sent me to kidney specialist and in end damm glad he did. My kidneys were showing protein and my kidney specialist wanted me off the actos.

    That was no small feat as at the time only actos was getting my numbers down. Well, finally got numbers down and got off the actos and my kidneys stabalized and stopped going down hill.

    I was blessed lucky.

    Simply stated it aint easy but always best to check with the correct specialist. Knowledge is so narrow focused and compartementalized, one needs to see the correct specialist!

  • Kathy Mack

    Jan, I agree with you. I think the ‘Do no harm’ part of the hippocratic oath has fallen by the way side. I think doctors do the bare minimum and leave the crucial information out so the patient doesn’t know. I have peripheral neuropathy and an allergy to corn which increases the pain 10-fold.
    I also have gall bladder disease and a hiatal hernia that has decided my stomach should be in my chest in front of my heart. Getting a doctor to listen is one thing. Getting a doctor to do something is another. I think they are all running scared with the new pain and drug laws coming out and I don’t blame them. It is like they are being asked to do their medidal duties with one hand held behind their backs.

  • JohnC

    Jan.. Your husband’s doctor may not have broken his hippocratic oath: he just might be ignorant!

    With those numbers I’d be changing doctors.

  • jim snell

    I believe the result you describe and of course that may be some Doctors.

    The real problem I would offer is the segmenting and compartmentalization of Data is spread over many experts. Hoping your Doctor can cover it all is at best hopeful and if extremely lucky he does but in end one needs to read and research oneself and push to get appropriate experts from body, diet, exercising, cde trainor on the job.

    Smart computerized medical knowlege systems aiding Doctor might prove helpful.

    Best wishes and good luck.

  • vie

    HI, I have been diabetic for 21 years now (I am 71 now). For the most of those years I did OK. As I got older and did not “pay attention” stuff showed up. Kidney scare, really woke me up. I thought I had good Doc in CA. I had to move to Texas and was kind of worried what I would find. What I found was the best Doctors I have ever had in my 71 years. ( I was a sick kid too) Yes I have a bunch of Doctors, ( you name the part I have a Doc for it LOL) But they follow me very carefully and I am very happy about that. One of the the things that help me behave is the fact they will be getting lab work very regularly.AND they share the information to my other Doctors. cool.
    My Ac1 is 6.5, and has been for the last 5 years,all other test are fine, Had 4 heart stints in 05 and they are still working and no sign of any problem. I am not able to do much in the way of exercising so when I watch tv I get up and stand behind the chair and do leg stretches and stand for at least 10 min every hour. I walk in doors as TX is bloody hot. I am on Victoza and have lost 35 pound in a year with out really trying. 20 more I will be under 200 for the first time in 15 years. YAHOO> BEst to all and don’t give up YOU ARE WORTH IT!!