My sister came to visit last weekend. She's 63, diagnosed with Diabetes Type 2 over 15 yrs ago.

She takes 2 meds....Metformin and another (dang I can't remember the name!)....and she takes 2 pills for each, one 2 in the AM, the other 1 in AM and 1 just before dinner. Basically one is to increase sensitivity to insulin, the other stimulates the pancrease to produce insulin. She's also on Lipitor, high BP meds (2), arthritis meds.

She is NOT following LC, even tho her husband is....and adds potato, fruit, etc to her portion of meals because she's not on LC and "has to get her carbs". She's been to a dietician and was warned NOT to go LC because "it could damage my kidneys"

OK....first off, her doc told her to only check her BS "a few times a week" so she "won't get hung up on it". She goes to the MD twice a year and has lipids, BS, etc checked by the lab. The doc has checked her meter against her lab work and it's exact.

Her fasting BS has been running 140-160's. Pre-meal BS (later in the day) are running high 150's to low 180's! Her A1C was 6.8 on her last check.

I am very upset about these numbers. I'm a nurse and have worked with her doc and always held him in high regard.....I chose him for my dad when we had to replace his doc.

Her average day:
Breakfast:
Cereal....usually Cheerios with blueberries in season, a banana when blueberries aren't available. She uses 1% milk on her cereal. "once or twice a week" she will have oatmeal instead of the cheerios.....the "instant" oatmeal, but plain.

Lunch: Meat and cheese sandwich. Occasionally has a salad with meat. LF dsg on salad. (she sticks with LF everything)

Dinner: Meat or fish (hubby's a fisherman, they eat a lot of fish).
Salad plus one other veggie (according to hubby's LC plan). For herself she also adds a small potato, small amount of pasta or bread.

She rarely eats after dinner....but when she does it's usually a banana, sm am't of ice cream, maybe some crackers with cheese or peanut butter.

She does NOT have a big appetite. Seemed to me to have trouble finishing every meal. She's very active but doesn't have any "regular" exercise routine. She's overweight by at least 30#....and has been for many years. Weight doesn't seem to have changed much over the years, before or after diabetes diagnosis. She carries ALL her weight in her abdomen and bust. (she has the skinniest arms and legs! Always has)

I feel her numbers are too high and she should be checking her bs more frequently. Oh yea....her BP is also too high, running around 140+/80+.

What would your docs say about these numbers? Are they in fact "acceptable" for diabetics?

Unfortunately, many doctors are just like your sister's. I think many (most?) doctors have given up on their diabetic patients because so many patients are non-complient and because so many doctors don't know how to treat diabetes. The American Diabetes Association even recommends a high carb diet. That is why there are so many diabetics with so many serious health problems. As to the low carb ruining kidneys - there is nothing like high blood sugar to ruin kidneys, or make you blind, or cause heart disease, or cause amputation. Why do they prescribe high carb and accept high blood sugar when they know it is killing the patient?
Like your sister, many people don't want to know anything about their disease and are happy to have the doctor take care of it for them - which in this case and others, means a pat on the back and no testing. For many folks, ignorance is bliss.

Nopie....I agree with everything you say. But are these the numbers they're accepting?

I'm a RN...graduated over 25 yrs ago. I was taught to "treat" patients with diabetes....now they "manage" them....and there's a BIG difference in the two.

I tried to explain this to my sister.....If you're lactose intolerant, you dont' eat lactose.....if you're allergic to peanuts you dont' eat them....if you can't tolerate gluten you can't eat regular bread (do they even MAKE gluten-free bread anymore?)....BUT when you're glusoce intolerant, you keep eating gluocse? Makes NO SENSE to me at all!

She has no signs of kiney damage, or eye damage. No problems with circulation, CAD, etc. She's also survivied 2 bouts of cancer.

I know the major difference between treating patients in the past and managing them today is that they dont' try to get "normal" blood sugars.....but aren't they even trying to get close to normal? If she WASN'T on meds, she'd be put on them with numbers that high, so why are those numbers considered acceptable?

She is NOT a non-compliant patient.....not by any means....she's actually one of those people that think they're docs are always right and follows instructions to the letter.

I just don't get it!

The sad truth is that many doctors would be satisfied with those numbers. This is changing, the guideline numbers were recently down sized and doctors are starting to revise some previously held positions regard treatment of the dx. The fact is that if your sister is living at that level of blood sugar control she is being damaged, head to toe.

The new A1c thresh hold for diagnosis is 6.0.

Cindy,
I agree with Nopie here. Whether or not your sister is non-compliant, her doctor is sick and tired of banging his head against the wall, trying to convince his patients to take proper care of themselves. How frustrating to spend your days lecturing people for not eating properly. I'm not entirely sure that you could ever have great sugars if you followed the prescribed diet, so they are literally chasing their tails. Even if they convince someone to be compliant, they are eating too many carbs. And those carbs, just feed the addiction, and boom! where's those Krispy Kremes?
I had A1C's much worse than hers for years. My usual semi annual A1C was between 7-8 (126 to 144) and the doctor never really seemed to be alarmed by it. He would say "It's a little high... but we aren't going to put you on anything else" (I've been on metformin since diagnosis in Dec '96) until I finally had an A1C result over 180 which made him want to put me on Avandia as well as the metformin. I decided not to start the med and found Atkins instead.
BTW, my last appointment, when I told the endo that I was doing Atkins, he was very happy. Happy with my results too, A1C went down to 7 (I had whooping cough those three months, so I'm really hoping to get a better result when I go back in June, just had the blood drawn yesterday) and my chol was lowered, the ratio improved. The doctor himself was more vivid and lively than I'd ever seen him before, because he saw that I was now committed to my health.
Your sister won't get anything more than what she puts in to her health. The doctor isn't going to put himself out there to support and help her, if he senses her disinterest, because there's just no way that he can tell her exactly what to do every step of the way. If a diabetic isn't interested in managing their diabetes properly, there isn't a thing in this world that you or her doctor can do to change it... I'm speaking from experience of being the diabetic who wasn't interested....

Jenn

I can only speak for my doctor, CindySue, but no he would not be happy with those numbers.
When my blood sugars got out of control and I was put on meds, he wanted me checking (and keeping a log of) my blood sugars fasting and after every meal. Bedtime was optional since I wasn't on insulin, but I did it anyway. Now that things are consistently controlled, he has said that I can back off to testing a few times a week, but I still test daily at least; more often if I'm experimenting with new foods or recipes.
I know that some doctors recommend testing less often because of concern about their patients becoming obsessed about their meeter readings, and for some patients that might just be true, but my thoughts on the matter are you can't control what you don't know about. Besides...if you're going to become obsessed about something, that might be a good thing to be obsessed about since it has such a great impact on your current and future health status. How does it make sense to let your blood sugars stay elevated for 2-3 days at a time before you check and realize that they are too high? How can you adjust what you are eating if you have no idea what impact those foods have on your blood sugar?
I also have to agree with Jade. I think a lot of doctors have become willing to settle for "good enough" simply because they are tired and frustrated of patients that are non-compliant or just don't care (or want the doctor to do everything for them instead of taking some responsibility themselves). You can only beat your head against a brick wall so long before you decide that the aggrivation just isn't worth it. When it comes down to it, the doctor can set the standards but it's up to the patient to achieve them through self-education and compliance and too many simply aren't willing to put out that effort even when their lives are on the line. It's also nearly impossible to achieve good/normal readings with the standard ADA diet as well, so the patients are handicapped right off the bat even if they are compliant.



It never made any sense to me, either, but I still followed the ADA diet for several years until finally my blood sugars wound up completely out of control before I wised up and switched to low carb. I think a lot of diabetics never reach the conclusion of "If what I'm doing is making me worse instead of better, maybe I should try something else." Perhaps because their doctors (as mine did) shrug it off as "the natural progression of the disease".

Well, as a nurse for over 25 years.....many of them working in Case Management, I know first hand about non-compliant patients, and the frustration of beating your head against a wall....but that is NOT an excuse for not giving your patient the best care you can provide for them!

My niece was "dismissed" from one doc because of non-compliance. It can and is done. But most docs don't do it, they just keep urging their patients to do what they have to do. Having the patient ignore them....or even worse having a history of patients that ignore them....is part of the job, not a reason to stop giving advice or expecting poorer results.

As for patients not being obsessed with their disease? Well for many years that is exactly how diabetes was treated. People were told to question everything they put in their mouths. They also checked their urine and/or blood several times a day, on insulin or not. I cannot understand the rationale on how patients are treated now! Studies prove that better control means less complications. So why the heck are they not looking for tighter control!?!?!?!?

Frustration! When first diagnosed, you might have called my sister non-compliant....but now, since she's read up on it and knows the potential complications, she follows her MD's orders as carefully as possible. AND even if she was, telling her that her numbers are acceptable, when they're in fact too high is WRONG!

She understands what I was telling her about insulin resistance, diabetes, LC diets, etc.....but she also trusts her doc over me.....I may be her sister, but I'm also "just a nurse"! AAAARRRRGGGGGHHHHH!!!!!!!!!!!

CindySue, I understand your frustration with that. Here you have the knowledge to help her achieve much better control and minimize the potential for long-term complications, but she's choosing to listen to "an expert" that you believe (and I agree with you) is dead wrong. She's your sister and you love her and you don't want to see her heading down the path that you know she's on, but she's still free to choose that path whether you like it or not.
Perhaps if she won't listen to you because you're "just a nurse" , perhaps she will listen to a few doctors on the matter...like Drs. Bernstein and Schwarzbein. Any chance you can get her to read a few books written by doctors who are specialists in treating diabetics?

Schwarzbein! I knew there was another guy.

After I posted I sent her an email. I told her that I was very concerned about her numbers and gave her a bunch of references. I included Bernstein, but couldn't remember the name of the other guy.

This is my big sister....she's 13 yrs older than me and she's pretty much all I have for immediate family. I am so concerned about her. Her hubby is following LC for his weight, so maybe she'll give it a try.

Also, with the doses of her meds, I wonder if she might need insulin. At what point do docs start insulin with Type 2? In my working days we'd probably already have her on insulin....at least to cover testing.

Thanks for letting me rant!

Dr. Schwarzbein is a lady, but IIRC she has worked specifically with female diabetics, so she might "click" with your sister a bit better. Women diabetics often have a lot of hormone issues going on that can complicate diabetes (thyroid, PCOS, etc...) so it's almost a subspecialty. Her plan tends to be a bit higher in carbs than Dr. Bernstein's, but it's still a lot lower than what your sister is typically eating right now. I believe that Dr. Schwarzbein allows 15 grams of carbs at meal time and 7.5 for a snack. That's more than I can handle right now and still maintain the type of control I want, but perhaps when I get to a lower weight or reach maintainence, it may work better then.

Thanks Lisa....I'll recomend the good doctor to her.