Beauty Health for Life

My fasting glucose at diagnosis, versus currently.

All around us there are people who are struggling or living with challenging health conditions or diseases. Some are very visual, and apparent, and some are not. For those with apparent health conditions or diseases, we feel an immediate sense of empathy. However, it is not so easy for us to empathize with those whose needs we cannot openly see. We may assume a person is exaggerating (they really dont have it that bad), is being wimpy (they should just shut up and deal with it), or is simply lying.

Type 2 diabetes is one of these misunderstood diseases; it is a hidden illness and people with hidden illnesses often end up being judged as if they had no needs, or should be restricted in needs. These attitudes often end up in discrimination, particularly from employers, health insurance companies, and some health care providers and agencies. The problem becomes compounded because type 2 diabetes is also a silent disease. It is a disease which can remain silent (not showing very many outward signs of its presence) for many years, even decades. Hence, many people will often ignore their condition because they feel fine and healthy, and the condition does not seem real to them. Because there is NOTHING telling them they are sick, they feel a certain sense of invincibility... until they get their blood glucose level tested with a finger prick.  Persons with type 2 diabetes must check their blood glucose levels regularly if they are to be kept constantly aware that they a.) have a serious medical condition, and b.) that they need to adjust their food intake according to what their glucose levels are. A person with type 2 diabetes needs to be able to eat to their meter in order to be able to manage their disease.

If the medical establishment (who are constantly preaching on the diabetes pandemic, and how serious this matter is, and how the condition is costing our governments, worldwide, billions of dollars) had any inkling of the issue at hand, or indeed, if they believed their own warnings, they would realize that in order to reduce the risk of type 2 diabetes, and to control the health of those with current type 2 diabetes diagnoses, we need...

• Educated clinicians: Clinicians who are not trivializing the condition to their patients, but which strive to understand the condition, its potential risks and dangers, and who are committed to empowering their patients and properly educating them as to what the condition is; and
• Access to Proper Tools and Medicines: Sufficient glucose testing strips to make appropriate nutritional decisions, from day to day, to help control glucose levels, as well as access to necessary medications -- including insulin. 

Currently, the OHP provides 100 test strips every 90 days, but a new plan would severely restrict access to strips for type 2 patients unless they are newly diagnosed, take insulin, or meet a few other special requirements. For people not taking insulin – which covers the vast majority, about 70% of all type 2 patients – those with an A1c above 8.0% would be entitled to one test strip per week, while those with an A1c below 8.0% would not be provided with any test strips at all.

This is obscene!! One test strip a week tells NOTHING to a patient with type 2 diabetes! Tests need to be done in pairs so that we can see the cause and effect of things like meals, exercise, illness or periods, or even overnight sleep. Patients with type 2 diabetes are practically being PUNISHED for having good control, and being told that their health is not important enough to merit an educated management of their disease. Besides that, patients are supposed to work hard to keep an A1C which is at or below 6.5%. Telling a person that they will only get strips if they have higher A1C levels is not only not a good recommendation, but it is also unconscionable. It is the testing that keeps me at a lower A1C! Im not psychic, for crying out loud. As of yet, there is no magical Glucose Level 8-Ball.

We need to stand together as a type 2 community against these kinds of things, or we will continue to be bullied by the medical establishment. If we are to stem the tide of unfortunate complications, and type 2 diabetes diagnoses, then we need to stand up for our rights as patients. We DESERVE education, quality treatment, tools, and medications, to manage our condition and lead healthy lives.

Really... whatever happened to the Hippocratic Oath?

DO NO HARM. 

We have very little time... Please sign the petition, here: Dont Restrict Test Strips for People with Diabetes.  

Suspecting that the poorly controlled [insert name of chronic condition here] is the result of not taking the medication as prescribed, the doctor says: "Remember to take the [insert name of pharmaceutical here]!"

After silently concluding that the benefit of the medicine is less than the cost, hassles, side effects and long-term risks, the patient thinks "Like hell!"

That scenario has probably been played out thousands of times today in clinics across the United States.  According to Zachary Marcum and colleagues writing in the May 22 JAMA, thats costing $100 billion a year. 

Doctors like the Disease Management Care Blog have responded to "medication nonadherence" with entreaties to take the pills as prescribed. When docs take the time to address the issue with patients, research shows it can make a positive difference.

Marcum et al believe physicians can do better if they understand the six types of behaviors that lead to medicines going unused:

1. Insufficient understanding of the link to health and well-being

2. A decision that the benefit is exceeded by the costs.

3. Complexity of the medication management overwhelms the patient

4. Inattention (or what the authors describe as low vigilance)

5. Irrational or conflicting beliefs about medicine

6. Perceived lack of efficacy

What does the population health management service provider community need to know about this?

1. There are a variety of screening surveys that can be used to identify each of the patterns above; unfortunately for DMCB readers, however, there is no single survey that can do it all. 

2. There is also no single intervention that has been shown to consistently increase medication compliance.  Instead, multiple concurrent supports are needed, including education and behavioral support.  This paper by Ho et al echoes that assessment, pointing out that there is ample evidence that other valuable supports include reducing the number of pills, use of special containers, telemonitoring with interactive voice response, non-physician (nurse or pharmacist) one-on-one involvement and regular clinical follow-up with reminders.  Last but not least this paper in the Annals points out that reducing out of pocket patient costs can also make a difference.

Image from Wikipedia