By Jan Chait | February 19, 2008 1:01 pm
Last week I called my family practice physician’s office and asked for a prescription for oseltamivir phosphate (brand name Tamiflu) for myself. My husband had the flu and was taking it for treatment. However, it can also be taken as a preventative measure.
“Doc says he’ll call in a prescription for you but to tell you that the best preventative is a flu shot,” the nurse said when she called back.
“My husband—the one with the flu—had a flu shot,” I responded.
There are no guarantees. You can get your flu shot and still get the flu. Or vice versa: You can skip your flu shot and not get the flu.
It’s kind of like diabetes. How many of us know somebody who goes blissfully through life paying no attention to his or her diabetes and departs with nary a complication? My maternal grandmother, for example, had one toe amputated. That was it. She laid down to take a nap at the age of 98 years and 7 months and didn’t wake up.
Actually, she did pay attention to her diabetes. She very carefully crushed a saccharin tablet over her large bowl of cereal in the morning, drank Tab (a diet soda), and ate ice milk instead of ice cream. Like many others in the days before home blood-glucose monitoring, she did the best she could with the tools and knowledge available in those days.
Dad had a half-brother who was about like my grandmother: He did the best he could. However, he left this world with a long list of complications. He was, I’ll point out, from a different gene pool.
Perhaps that’s what happens with those who do everything “right”—who weigh and measure their food, faithfully count carbs, balance food with medicine or insulin, exercise daily, plot graphs of their blood glucose (in other words, micromanage their diabetes)—and still get about every complication there is. Perhaps they’re just in the wrong gene pool.
Know what I think about sometimes? What if companies begin to penalize people with diabetes who get complications? After all, we have all of those tools to “manage” diabetes. (I put “manage” in quotation marks because it frequently can be unmanageable, despite our best efforts. Not that all health-care professionals recognize that.)
At least one company where I live charges smokers an additional $1,000 per year for their health insurance co-pay. What if it—and other companies—begin to charge extra for people with diabetes who get complications?
Maybe the person’s doctor wasn’t up to snuff on diabetes care. Maybe the person is using everything available but can’t overcome the influence of his genes. Maybe his insurance company fails to cover the necessary tools or doesn’t cover a sufficient amount of, say, test strips. What if diabetes self-management education is either unavailable or not covered?
I can assure you that insurance companies don’t always want to cover the cost of diabetes education, medicines, and supplies. I was one of the people who testified in favor of mandating diabetes coverage in my state and heard firsthand the testimonies from insurance companies and business groups who were against that coverage.
Studies have shown that good blood glucose control can lower the risk of complications, but that isn’t the same as saying it will prevent complications. Do we give up? Nope. We do the best we can. It’s difficult to keep up with diabetes care when the benefits are so far in the distance they can’t be seen. One thing I keep telling myself is that I feel physically better when my glucose is in range as much as possible.
Besides, just like getting a flu shot—and the flu—there are no guarantees.
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