By: Scott M. King
A survey involving over 1400 family-practice and general-practice physicians, internists, and pediatricians suggests that less than one third of the non-specializing physicians who treat people with diabetes agree with the “acceptable ranges” for blood glucose and HbA1c levels recommended by the American Diabetes Association (ADA). The three designated “acceptable ranges” are: fasting blood glucose levels between 70-120 mg/dl; two hour post-meal blood glucose levels less than 180 mg/dl, and HbA1c levels less than or equal to 8%.
The survey indicates that even among those physicians who agree with the ADA recommendations, surprisingly few instruct patients about current techniques that help keep tight control-such as multiple daily injections of insulin, the use of diabetes educators and dieticians, and frequent daily blood glucose monitoring.
In addition, more than one third of those surveyed agreed with one or none of the ADA’s recommended ranges, including almost half the pediatricians. The pediatricians, however, were on average less reluctant to have their patients adjust their own insulin and monitor their blood glucose levels.
The survey appears to indicate that most of these primary-care physicians are in need of additional education about diabetes. The researchers who compiled this survey cautioned, however, that there was no way to insure the validity of the responses, and that the actual beliefs and actions of the doctors involved could be different than those they reported. They also noted that there are often factors involved in the treatment of diabetes, such as a patient’s financial situation or geographical status (such as a rural setting) that may contribute to the disOn many occasions I have tested my blood sugar and found an unexpected reading of 250 mg/dl or higher! I get frustrated and mad, and I try to understand where I went wrong? This usually amounts to beating myself up for the past and doesn’t serve to make me feel any better. Fortunately I have an ally.
I’m lucky enough to have the best wife in the world-she knows exactly what to say to me. When I lament my awful reading to her she says in her sweetest voice:
“Don’t worry honey, you’ll get it back down.”
It’s true. I know how to get it down when it does go high. How I do this could be the topic for another article. The upshot is that I have a solution and I try harder to avoid what ever made the blood sugar shoot up.
Numbers are so important to us. Our life is run by numbers. We look at the readings on our blood glucose meters, check our A1C tests, our cholesterol, and our urine micro-albumin. There are also quality of life questions here, and whether we should let our meter and its readings rule our life. Recently, I was talking to another person with diabetes who had this all solved. She used to wake up each morning with high blood sugars which upset her very much.
She sought out professional help to get these blood sugar readings down, but no one could help her. She decided to just NOT test in the morning and then she felt much better! She felt her quality of life improve because she didn’t have to face those depressing numbers each morning. I said “I understood your line of thinking, and I support you in not letting diabetes rule your life, but…. But I see the solution a bit differently.”
I explained that there must be something that she hadn’t yet tried that would work. I told her of several of the options we have written about in this paper on this very topic. One recent study extolled the success of using Ultra-Lente insulin to solve the problem of high morning blood sugar. I told her about the article on adjusting insulin written by Barry Ginsberg. No one had ever offered her these suggestions. I also recommended some good reading material which would go over the problem of high morning blood sugars in detail. she was receptive and took the material to read.
We talked two weeks later and she had found something that worked for her. She also told me that waking up with a “normal” (80-120 mg/dl) blood sugar reading made a huge difference in how she felt physically in the morning. She felt much better-more energy, lighter and happier.
A landmark study may soon release its results. It has to do with proving that tight blood sugar control prevents diabetes complications. Of course many in the field including myself already believe this. This study is called the Diabetes Control and Complications Trial (DCCT) and we will be reporting on the significance of the outcomes in future issues.