What Does Your Doc Know About Diabetes?

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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  • Audeen

    I have read a few of your blogs and I love the way you write and what you write about… and I have a question for you about dcotors. My PCP ordered an A1c test and mine was 6.1. She diagnosed me with Type 2 diabetes and, shocked, I went to all the diabetes education classes she recommended and from what I learned, I don’t think I have diabetes, just pre-diabetes. The diabetes educators said my PCP is to be applauded for getting me on the right track, but I say if I don’t really have it, I don’t really have it. Do you think I’m in denial? Or am I right?

  • Ephrenia

    To Audeen: My take on pre-diabetes is that it is like the first sneeze of a cold. You are going to get sick, BUT if you start treating yourself right as soon as you know it is coming, you can keep it from getting bad and turning into pneumonia.

    I agree with Jan. Get the education, change your eating habits, exercise. Fight it now BEFORE complications grow.

  • diabetic alone

    touche.doctors and other medical personnel who are not diabetic do not have a clue.they go by standards made up by people who are not diabetic.WAKE UP11111111111111 EVERYTHING i eat makes my sugar go up. should i stop eating? i am also taking 80 units of lantus every night , which makes my sugar too low every morning. i tell my doctor but he does’nt listen.

  • Douglas T. Hawes

    That is real scary. I’m not quite type 2 but seem to be getting closer. Age 71, overweight, I lost 10 plus but ‘3 month residual sugar went over the last year from 5.8 to 5.9 to 6.0. Fasting sugar is 117. My Doctor tells me to lose more weight and watch the diet. I certainly can do both but I’m wondering if it will help. Now I wonder if she knows what she is talking about. Doug

  • Jan Chait

    Well, I can’t give medical advice. But I can tell you that the American Diabetes Association identifies prediabetes as having a fasting blood glucose of between 100 and 125. And I can tell you that it defines prediabetes as “a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of Type 2 diabetes.” And I can tell you that my former CDE has prediabetes and her doctor first prescribed metformin and then Byetta to at least slow down the progression to Type 2 diabetes. Trust me: You don’t want diabetes. It’s good that your doctors are paying attention and it’s good that you’re getting education. I applaud both the close attention to your health paid by your docs and the efforts that you are making.

  • Nina

    I was diagnosed with type 1 by a nephrologist and continued seeing him for the first couple of weeks after my diagnosis. On what was to be my last trip to see him he told me that I didn’t have to test my blood sugar more than once a day and that he was so sorry that this had happened to me because I was only 20 years old and I had a lifetime of complications ahead of me. When I told my new CDE what he said she told me to never to return to his office. If I had he probably would’ve been right.

  • kben

    I couldn’t agree with you more about MDs lack of information about diabetes. You must have a very good health plan that allows you to interview potential doctors. Many people don’t have that option — you pick a name out of a book and hope that the MD you choose is accepting patients. My MD is okay but she’s usually very rushed. Often all my questions don’t get answered and teaching time is short. I got a 5 minute course in how to administer insulin injections. I wish I could get my own personal MD degree that would allow me to treat myself!

  • Gary Williams

    My Doctor has Type 2 Diabetes and when she informed me that I am Type 2 we went over just about everything i needed to know,she even pointed out Web Sites that I could go to so I could learn more by myself. Thank You Dr. Julie

  • shirley jan 8th 2007

    ive never felt so lost as i do now. since i found out i have diabetes. my doctor doesnt know much and i feel like im treating my self blind. not sure whats right about what i read and see on tv any more. its like having cancer and dr tells you just a little and says ok take care of your self now. all my dr told me was watch your sugar intake. that was my lesson in diabetes. even in diabetes books they all answer my questions differently. they only one i found so far is diabetes self management to be helpful. is there a group for diabetics to join for chatting and getting some good advice?

  • Jan Chait

    Hi Shirley, and welcome to the club nobody wants to belong to. It’s normal to feel lost at first, even if you go to a clinic with a lot of support. When you don’t have that support, it’s even worse. I went through nine years of no support and no education. My control was nonexistant because I didn’t understand.

    I have a suggestion for an on-line group for you. The Joslin Diabetes Center has a discussion board that’s monitored by professionals at the Center. You can read the boards and learn from them and you can ask questions and have them answered by a professional. The direct link to the boards is http://www.joslin.harvard.edu/1863.asp. You can also get there through the home page at http://www.joslin.harvard.edu. It’s a very good site to learn about diabetes, too. Just go surf.

    Please let us know how you’re doing.

  • newbie

    I’ve just read your article about Dr’s and their “knowledge” and find it reassuring to know that it isn’t me that is the stupid one. I hate to say it but I trusted my doctor to inform me of the best ways to help myself and found that Barns and Nobles and Borders actually helped me better. I was just recently diagnosed with type 2 diabetes and even though my mom had type 1, realised i didn’t know as much as I thought I did. My next step is an endocrinologist. Thank you for the article.

  • Ginny

    I just read your article and other comments by readers and agree with a lot of them re drs. and Type 2. My doctor (PCP) diagnosed me almost 2 years ago and told me to just not eat white foods, i.e. bread, potatoes, etc. I was so tramatized by learning that I had diabetes 2 that I experienced deep depression and panic attacks. She even told me I was crazy. I had to push to get Diabetic education and the diabetic supplies. And the beat goes on. Since I also have Fibromyalgia, she is more concerned with that than the diabetes and rarely looks at my BS results. I have been entertaining getting a new PCP but since she is very knowledge-able about FM, I haven’t done so.

  • gardnerjr2

    As a regular subscriber I have come to really appreciate your observations and comments about our condition, doctors,and their lack of interest, etc. I too have suffered from inattentive, uninformed and sometimes even seemingly uncaring doctors and other medical personel. It helps knowing that I am not the only one. I also subscribe to your advice to educate yourself. If you don’t you may not survive the battle with diabetes for you certainly can’t rely on the medical profession.

    Bill Gardner Jr

  • Debbie

    I would love to get your news letter hope it has some good iteas about type 2 diabetes and how to loose the weight when everything I eat turns to sugar and my doctor just tells me to play around with my meds since everything he has given me drops my sugar levels down to 30 yep 30 when I told him I went totally blind for at least 20 seconds he didn’t have anything to say to me except LOOSE WEIGHT. I would love to but don’t know how.I wonder how my doctors were allowed to even be doctors since they don’t want to work with the illnesses I have and just do the same blood tests and never do anything about the results.

  • Jan Chait

    According to the American Diabetes Association, diabetes is defined as a fasting level of 126 mg/dL or more. So a fasting level of 151 mg/dL indicates that you do have diabetes. Could it have been a glitch? I suppose. However, an HbA1c of 6.8 equals an average blood glucose level of 165 mg/dL, according to one chart I looked at. The American Association of Clinical Endocrinologists recommends an HbA1c level of less than 6.5.

  • glucose4comfort

    I was diagnosed with type 2 after a fasting glucose of 151 and AC1 of 6.8…my dr said I did not need a follow up to confirm the diagnosis…does that sound right?