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Doctors should learn this...
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Michael Dansinger, MD posted:
Based on your experience as a person with diabetes, what advice do you have for doctors for how to handle that encounter when diabetes is first diagnosed?

I know doctors can generally do a better job than they currently do, so any specific suggestions you have might help doctors and future patients.

Michael Dansinger, MD
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Manoj_in_Bangalore responded:
For type 2 diabetes, doctors must keep in mind that it has been caused by too much insulin being produced and must ensure that the treatment ensures that the amount of insulin produced in response to diet and medication is minimum.

This means no sulphonylureas, insulin injections, statins, and other drugs that increase insulin resistance.

The patient must be asked to eat a high-fat vegan diet. That means plenty of vegetables (preferably raw), low-glycemic fruits, nuts & seeds.

The doctor must brief the patient on exercise which should be a combination of aerobic, interval and resistance. 5 to 7 hours of exercise per week is required.

The patient should be asked to avoid all refined cooking oils and use only cold pressed oils like coconut, sesame or olive oil.

The patient should be advised to sleep by 10 pm for 7 to 8 hours.

The patient should be asked to get plenty of sunshine and UV rays without any glasses or sunscreen (provided the patient is not consuming any processed foods and refined oils).

The biggest mistake doctors make is that they do not think for themselves, but get influenced by the marketing of drug companies. Type 2 diabetes can never be treated successfully with pharmaceutical drugs. The medicine has to be food, exercise, sunlight and sleep.
 
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rebitzman replied to Manoj_in_Bangalore's response:
Manoj - you are entitled to your opinion.

That said - darned EVERY point on it can be and is contradicted by the scientific evidence and it is MY opinion that when you use the words "must" or "never" or when you state as fact that "doctors must keep in mind that it (diabetes) has been caused by too much insulin being produced" your opinions transcends silly - and flows well into the realm of dangerous.

Type 1 diabetes results from the body's failure to produce insulin. Type 2 is a condition in which cells fail to use insulin properly AND can be the result of too little insulin being produced.
 
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rebitzman responded:
what advice do you have for doctors for how to handle that encounter when diabetes is first diagnosed?

Meet with my personal doctor - or one like I perceive you to be, and learn from them.

Talk less - and listen more. Your patient is your partner.
 
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Louise_WebMD_Staff responded:
I think a referral to a CDE is a must. I think useful links for information should be given. I think that people need to know that diabetes doesn't necessarily mean insulin and that oral meds are not "insulin." I think the message needs to be that all carbs count but that with diet, exercise and lifestyle changes-you can have a very wonderful life...at the same time explaining that NOT doing those things-even if taking medications is not going to do the trick.
 
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MrsCora01 responded:
That's a really interesting question. My experience as a person with diabetes has led me to do tons of research on my own, and not just for my own type of diabetes. I think docs should put more effort into doing the same. There are more and more types of diabetes out there. There is, of course, the "traditional" type 1. But T2 seems to be a spectrum of diseases with varying levels of both insulin resistance and low or high levels of insulin production and these two things can appear in a variety of combinations. And there is now T1.5 (aka LADA) as well which is often misdiagnosed as T2 at first. In addition to that there is MODY which can appear in a variety of forms (I believe the most common of which is a genetic disorder found in youth where the pancreas does not produce sufficient insulin, but it does not proceed to total non-insulin production like T1).

There are so many variations now being discovered and I think docs need to be more flexible in both treatments and testing to see what is actually going on.

Cora
 
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phototaker responded:
That's a very good question, because a doctor has to face all kinds of reactions from his patients from denial, shock, disbelief, actual acceptance, and fear.

The first thing to do is reassure the patient that this may be scary at first, that there are all kinds of support available(if that is the case). Direct them to diabetes classes, to talk to a dietician, to research diabetes on the web, to go to the American Association of Diabetes site to learn more, and to understand that each diabetic is different. Talk to them about different approaches that can be used, "if" it is deemed that they could lose the weight and not go onto medicine. If they are to be on medicine or insulin, they need to learn how many carbs they can have for each meal and snack, the types of foods they can eat that would be healthy for them, how to read labels at the store, and about how important exercise is for them. I would recommend making up some sort of booklet to hand out to patients giving this information. It wouldn't take too long for someone to make an informative booklet for those just starting with their diabetes. The patient must understand what works for one diabetic might not work for another. Cora mentioned the different types of diabetics, which shows how many different diabetics are out there. Also, there could be an nurse's aide who could be available to show diabetics how to give themselves shots of insulin or even just learn how to test themselves the first time. Just doing this gives the newly diagnosed diabetic the support they need. There will be some who are angry and in denial who will do what they want. You can't change that, but hopefully they will come around. I tried to set up a support group through Kaiser and that fell through, but I do notice they've gotten "pre-diabetes" classes now on their education classes list, since I've been diagnosed. Now that's more preventative! I wish my doctor had pushed me a little more when I was pre-diabetic. Attending these classes definitely would have helped me, as I wasn't too aware of the dire consequences of diabetes, EVEN WITH a diabetic mother. She kept telling me about eating healthy, but never really explained all the things that could damage the body with having higher blood sugar levels. When I took my first class and they explained the dangers, I took heed, but it was already too late. I had diabetes, but it wasn't too late to get my act together.

I know that doctors often have limited time schedules to talk with each of their patients, but maybe having someone else to help explain more after those first few moments when you're so numb with disbelief or angry at yourself that you didn't do more to keep this disease at bay a little longer would be great. Maybe a 2nd visit with you, the doctor, or someone who can sit and explain things again, when they've calmed down and can take it in more. I know I get overloaded with emotions when hearing things at first, and only hear bits and pieces the first time. After I research things more, I come back to my doctor and ask more questions.
 
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flutetooter responded:
From my personal experience, I wished that my doctor had ordered additional some tests and told me when she first suspected metabolic syndrome. I started reading about it, and my labs seemed high as to weight, fasting sugar, blood pressure, cholesterol, etc., yet I had to ask HER if I had metabolic syndrome, and she answered, "yes" that she had been watching it, and waiting.

I bought a meter and began testing and reading, reading, and more reading. When I took MY numbers in to her, she then ordered a glucose tolerance test and an A1c. All my managing has been because of my reading, and I'm doing fine, no thanks to the doctor.
 
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krhudson responded:
The Dr. has to be positive when discussing this with the patient and make recommendations about food, excersise and meds clearly spelled out and I would agree that resources for the patient to get as much information as possible by seeing a dietitian, learning carb formulas if they are insulin dependant that x carbs = x units of mealtime insulin if they are on fast acting. A physicians assistant can probably be a great resource if the Dr. has one available or a nurse practitioner can instruct on injections. It seems like now with Diabetes being so common a family Dr. really needs to be brushed up on this and explain what process the body is going through. One of my Endocrinologists just preached every time I went in that the goal is to constantly get the sugar off the red blood cells. He probably meant the excess sugar off the red blood cells and constantly enforced how he wanted my sugars at 80 constant and rather than walk 1 mile, walk 5 miles and rather than swim two laps swim for an hour. He was great and much like a coach and if I did not bring a log of my sugars in he would shake his head and not be happy but the A1Cs were 6.8 most of the time with his coaching. I think that is so important. His passion about helping others beat the challenge of Diabetes was nothing short of impressive. His style would rub off and make you want to get involved and help yourself. He was probably 50 at the time and about 5'8' at 175 pounds in perfect shape. He lead by example.

kr
 
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xring replied to flutetooter's response:
Flutetooter, your last sentence speaks volumes & applies to me as well. I'm still surprised that despite having never seen the inside of a medical school, my own research is the only source of my management & my first doctor almost cost me my life, had I trusted him & followed his advice.
 
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arealgijoe responded:
-1- LISTEN......to the patient....Docs expect patients to listen to their advice & instructions, they need to also learn to reciprocate.

-2- TEACH..the simple basics of the bodies need for insulin. The BASAL BOLUS concept is EASY for most people to grasp. BASAL insulin is a body's need for background insulin 24/7, kinda llike the need for an idle car engine to run. BOLUS is a bodies need for insulin to process FOOD, kinda like stepping on the gas to climb a hill; the bigger the hill the more gas needed. With that SIMPLE basic anology or similar most people would understand, form a reasonable foundation of understanding and from there the stage would be set to learn more and more specifics as it pertains to THEIR personal situation.

-3- Do NOT assUme......ANYTHING.
..Personal Examples; When I was first hospitalized for diabetes, the doc came in yelling at me, asking WHY my BS was so high. He assUme'd I KNEW I was diabeteic, assUme'd I KNEW what diabetes was and assUme'd I knew I was out of control. I knew NOTHING!

When I was going thru vocrehab in the mid 80s, they assUme'd my neurological issue were from DIABETES. Everything was assUme'D from the diabetes. No doc BOTHERED to LISTEN or CHECK, ie no real proper testing. Even the VA sent to to their shirnks in the late 80s who described me as being "adamant" something "else" was wrong, that my diabetes was in good control and no problems relating to the cancer, they also noted in my file I was NOT depressed either. Still NOTHING! They still assUme'd my gair and other neuro issues were from being DIABETIC.

I gave up trusting doctors in large part, just idlled along as best I could, even did better with my diabetes based on hard lession learned from experience. I felt the docs seemed to know little about diabetes for a very good reason.

Even in early 07 after falling and tearing my shoulder, they did not bother following up on the brain MRI that showed a massive lesion load, ALL in MS favored deep white matter. The NET simple wrote CNS issue, investigate "if warranted". Finally last summer a new eye doc opened the MS can of worms. He refused to update my prisms, saying my problem was NOT DIABETES related, it was a neuro-muscular problem.

Soon my fam doc (Dr FlipFlop) called me for a MS talk and after a very bumppy road with worsening mobility, rejections beause I was DIABETIC or because I was TOO OLD to come down with MS (Dr Kahn at WSU, " we treat mostly people in their 30s, NOT 60s) , FINALLY more testing was done locally and VA, Dx'd with RRMS (after PROPER testing, such as full spinal MRI, more lesions) EVP LP etc.

FINALLY after decades of living HELL, decades of NOT being LISTENED to, of being victimized by the assUme this, assUme that, and having my mobility gradually get worse adn worse, I am being treated for my MS.

As a diabetic, THEY assUme'd it was NOT diabetes, I was too old for type-1 and far too young for type-2. At first I was assUme'd to be type-2, then when I was in for cancer surgery and badly managed, my then fam doc said, my diabetes was "WORSE".than he thought. He did not BOTHER trying to get my diabetes in good control, the cure (as he called insulin) can be worse than the problem (diabetes), keeping in mind I was not expected to survive even 12 months.

Another doc that had gotten involved while I was hospitalized for the cancer surgery took charge, sent me and my wife to diabetes education (more like scare-fright sesions) and I started insulin.

GOMER, no shortage of adverse experience.
 
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arealgijoe replied to arealgijoe's response:
Continued..........

-4- QUESTIONS..........

-A- Docs do NOT ask enough or the correct questions. Even when they do ask questions, we may NOT realy understand WHAT they are actually asking about.

-B- We do not always, KNOW what questions to ask.

My personal philosophy is the ONLY dub stupid question, is the one NOT ASKED.

-5- LANGUAGE........

We do not speak the language of doctors, and too often doctors do not speak in language WE UNDERSTAND. The same word (or prase) can mean one thing to a doc, and another to us patients, despite speaking English or other common language. In simple terms they might be actually asking one question and we are actually answering a different question.....no JOKE!

GOMER his 5pence 4 2day
 
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rebitzman replied to Louise_WebMD_Staff's response:
I think a referral to a CDE is a must.

Agree

I think that people need to know that diabetes doesn't necessarily mean insulin and that oral meds are not "insulin."

Add to that: Insulin does NOT equal failure, and that even if you do everything right (diet, exercise........) there is a chance that you will remain insulin dependent.
 
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arealgijoe replied to rebitzman's response:
That's 4 sure Reb........

I watched my diet, rode my bike around our subdivision EVERY morning before work, walked on my lunch and was skinny, yet still felt terrable and my BS was still NOT in control. Now my bike is stored and not allowed on anything with 2 wheels, docs orders.

GOMER
 
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auriga1 replied to arealgijoe's response:
For sure, both Gomer and Rebitz. Being underweight at diagnosis, I was shocked when they put me on insulin. I was always active, not a "sweet" eater or carb loader. Goodness gracious, I used to run 5K's and 10K's. Can't figure it out and neither can anyone else.

I don't know how to answer the good doctor's question. My doctor's were experimenting with the diabetic diet and the dosaging of insulin until things were under control. It was as maddening for me as it was for them. A learning process for all involved. My sugars were too high to safely do any exercise when first diagnosed. Once my sugars were under control, I started exercising in conjunction with the diet and insulin.

If a diabetic is overweight, the first prescription would be to lose weight by eating properly and get active, if possible. For many, it can be a lot of weight to lose and the diabetic should be patient. To accomplish this, I agree with Louise on this one; a dietician and/or CDE. My CDE is a diabetic and knows first-hand what should be done and what can be accomplished.


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