Make America sick again: diabetes

The trend in diabetes treatment is clear: keep Americans sick.

The guidelines say that as soon as we diagnose type II diabetes, we should start a medicine. Usually metformin.

A recent study says that teaching patients to use a glucometer and to check home blood sugars is useless. The key word here is teach, because when I get a diabetic transferring into my clinic, the vast majority have not been taught much of anything.

What is the goal for your blood sugar? They don’t know.

What is normal fasting? What is normal after you eat? What is the difference between checking in the morning and when should you check it after a meal? What is a carbohydrate? What is basic carbohydrate counting?

I think that the real problem is that the US medical system assumes that patients are stupid and doesn’t even attempt to teach them. And patients just give up.

New patient recently, diabetes diagnosed four years ago, on metformin for two years, and has no idea what the normal ranges of fasting and postprandial (after eating) are. Has never had a glucometer.

When I have a new type II diabetic, I call them. I schedule a visit.

At the visit I draw a diagram. Normal fasting glucose is 70-100. Borderline 110 to 125. Two measurements fasting over 125 means diabetes.

After eating: normal is 70-140. Borderline 140-200. Over 200 means diabetes.

Some researchers are calling Alzheimer’s “Type IV diabetes”. The evidence is saying that a glucose over 155 causes damage: to eyes, brain, kidneys, small vessels and peripheral nerves.

Ok, so: what is the goal? To have blood sugars mostly under 155. That isn’t rocket science. People understand that.

Next I talk about carbohydrates. Carbohydrates are any food that isn’t fat or protein. Carbohydrates range from simple sugars: glucose and fructose, to long chain complicated sugars. Whole fruits and vegetables have longer chain carbohydrates, are absorbed slowly, the body breaks them down slowly and the blood sugar rises more slowly. Eat green, yellow, orange vegetables. A big apple is 30 grams of carbohydrate, a small one is 15, more or less. A tablespoon of sugar is 15 grams too. A coke has 30 grams and a Starbuck’s 12 ounce mocha has 62. DO NOT DRINK SWEETENED DRINKS THEY ARE EVIL AND TOOLS OF THE DEVIL. The evidence is saying that the fake sugars cause diabetes too.

Meals: half the small plate should be green, yellow or orange vegetables. A deck of card size “white” food: grains, potatoes, pasta, whole wheat bread, a roll, whatever. A deck of card size protein. Beans and rice, yes, but not too much rice.

For most diabetics, they get 3 meals and 3 snacks a day. A meal can have up to 30 grams of carbohydrate and the snacks, 15 grams.

Next I tell them to get a glucometer. Check with their pharmacy first. The expensive part is the testing strips, so find the cheapest brand. We have a pharmacy that will give the person a glucometer and the strips for it are around 4 for a dollar. Many machines have strips that cost over a dollar each.

I set the patient up with the diabetic educator. The insurance will usually cover classes with the educator and the nutritionist but only in the first year after diagnosis. So don’t put it off.

For type II diabetes, the insurance will usually only cover once a day glucose testing. So alternate. Test 3 days fasting. Test 1-2 hours after a meal on the other days. Test after a meal that you think is “good”. Also after a meal that you think is “bad”. I have had long term diabetics come in and say gleefully “I found a dessert that I can eat!” The numbers are not always what people expect. And there are sneaky sources of carbohydrate. Coffeemate and the coffee flavorings, oooo, those are REALLY BAD.

For most of my patients, the motivated ones, they have played with the glucometer for at least a week by the time they see the diabetic educator. I have had a person whose glucose was at 350 in the glucose testing. The diabetic educator called and scolded me for not starting metformin yet. The diabetic educator called me again a week later. “The patient brought their blood sugars down!” she said. “She’s under 200 after eating now! Maybe she doesn’t need the metformin, not yet!” Ah, that is my thought. If we don’t give people information and a tool to track themselves, then why would they bother? They eat the dessert and figure that the medicine will fix it or they can always get more medicine.

Type I diabetes has to have insulin. If a type II diabetic is out of control, high sugars, for long enough, they too will need insulin. The cells in the pancreas that make insulin are killed by prolonged high blood sugars.

I went to a lunch conference, paid for by a pharmaceutical company, at the AAFP conference in September. The drug company said start people on metformin at diagnosis and if they are not in control in 3 months, start a second medicine, the drug company’s new and improved and better and beastly expensive medicine!!!

Yeah, I don’t think so. All of my patients are smart and they all can figure it out. Some get discouraged and some are already on insulin, but they are still all smart.

Fight back against the moronization of US citizens. Keep America healthy, wealthy and wise.

All of my patients are smart

I am a rural family practice doctor for over twenty five years and all of my patients are smart.

All of my patients are complicated.

I don’t mean that they all have degrees or PhDs or are intellectuals. I mean that they are smart in all sorts of ways.

I was talking to the UW Pain and Addiction Telemedicine Team four years ago. I said that when I had a new chronic pain patient who is angry about the law in Washington, I would give them the link to the law: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement.

“You give them the link?” said one of the faculty. “But they can’t understand that.”

“Why not?” I replied. “I did.”

This was met with silence. My attitude is, well, I am a physician. I am not a lawyer. Yet I have to follow the pain law. Actually we all have to follow all the laws in our country. We say ignorance of the law is no excuse. Yet then the attitude of the pain specialists at UW was that the law is too confusing for my rural patients.

I think UW is wrong and I think that it is disrespectful to patients. Treat them as adults. Treat them as smart. Treat them as if they can understand and you will get respect back. And if they trust you they will then tell you when they do not understand or need something translated from medicalese to english.

I worked with a patient who works every day. She is in a wheelchair, a motorized one. She has cerebral palsy and can’t talk much. And she is smart too.

This election is about the United States population being smart. They know something is very wrong and they want it fixed. I think that Citizens United needs to be taken down. Corporations are not people, unless the CEO can be the physical representation of the corporation and go to jail when the corporation lies and steals. Wells Fargo, I am talking to you. I am taking my money to another bank. Pay reparations. The United States population is sick and tired of the rich getting richer and corporations stealing from people for profit. Democrats and republicans are sick and tired of it. We are not going to take it any more. If you have gotten rich from corporate underhand theft, lies and confusing regular people, give the money back. Because you can buy an island, but if the United States population rises up to hunt for you, there is no where in the world you can hide.

It is time for corporations to give the United States population the government back. Or we will take it. Because every patient I have ever taken care of in over twenty five years is smart. That is not to say we don’t all do stupid things. And some people won’t change. But in the end, everyone can learn and everyone can change.

I took the photograph in Larrabee State Park in September. This tree is down: but it is not a nurse log yet. It is not dead. The roots are still providing nourishment and it is sprouting branches all along the downed trunk.