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This month we devote our entire "letters to the editor" column to one letter. Also presented is an answer from a member of our medical advisory board.
Dear DIABETES HEALTH:
I have just received a copy of your November 1992 DIABETES HEALTH. It seems to be a very sensible, straight-forward newspaper. I'm hoping you can provide me with some direction. As the wife of a recently diagnosed diabetic, managed (unsatisfactorily to my mind) on 5 mg per day of Micronase, with a fasting blood glucose of 140-170, and with numbness and tingling of the toes, I'm feeling very frustrated and confused. My husband keeps getting pats on the head from his practitioners and told how well he's doing, yet I don't feel he's doing well at all. He's a youthful, otherwise healthy and very active 52. Should we expect more aggressive management or am I being unrealistic?
As an RN, I'm realizing how very little I and other nurses actually know about diabetes, and I can't help but wonder if that doesn't carry through to internists and generic dietitians, as well. And as a Kaiser employee and user of the system, I understand the realities of "Managed Medical Care." Cost Containment is a major buzzword and was certainly the guiding rationale behind the tirade in the pharmacy in which you interceded ("My Own Injection" 11/92). The lady who was on pills and was being told by the pharmacist that she didn't need to do home blood checks and that buying Test Strips was a waste of money was, quite likely, NOT spending her own money but was getting her strips through a group plan.
Kaiser "Dings" Practitioners
While the pharmacist may have been acting as a misguided patient advocate, it's far more likely that some official dictum came down the pike saying "it's not cost effective to monitor blood sugars aggressively while on oral hypoglycemics." Kaiser "dings" practitioners for ordering too many tests and we advice nurses get dinged for giving out too many appointments for unnecessary problems-our function is to triage, deny, and advise. (Of course, if someone is truly ill, cost is not a factor in care; neither tests nor costly treatments or medicines are withheld.) But for the gray-area patients, those with problems that don't seem to be affecting their ability to function and aren't immediately life-threatening, they don't rush to aggressively treat these people. (I had to snort derisively when I read Dr. Nancy Bohannon's very interesting article on preventing diabetes with testing, regular prophylactic insulin injections and a week in the hospital annually or more often on the Bio-Stator artificial pancreas. Yeah, right! HMOs will sure go for that!)
Reversing Diabetes by Julian Whitaker, MD?
Another continuing frustration to me is how much conflicting information there is and how little anyone REALLY seems to know about diabetes. We may be ahead of raw quince and gruel, but not far. I got a book that made a lot of sense to me and was strict, but didn't seem particularly radical. It's Reversing Diabetes by Julian Whitaker, MD. He makes some thought-provoking comments about cutting out meat now, while your kidneys are in good shape, rather than waiting for your kidneys to fail before starting to take care of them. That makes a lot of sense to me and it doesn't seem a bit radical. I've quit eating meat entirely, and in doing so, my husband has lost most of his meat dinners. And he's voluntarily begun taking a bag lunch of whole grain bread and several raw fruits and veggies for lunch. His meat intake has dropped about 75%. And I've been trying to limit his fat intake. Whitaker feels that often times the insulin is there but it's somehow blocked from bonding with the glucose and that fat is the key. And by knocking out meat and fat (and sucrose, of course), I was able to get him OFF Micronase. And his fasting blood sugars were in the 90 to 120 range. But I got no support in doing this from the medical profession, and a diabetic educator I work with treated me like I was cuckoo and thought he was eating too much fruit and disapproved of using fruit juice for sweetening desserts, saying scoldingly, "It's all sugar." (Read that as "You should know better!") Never mind that his sugars were improved and he was OFF Micronase.
And the real kicker is that he's back on Micronase and his fasting sugars are back up to 150-170. Why? Well, I didn't get any support from his doctor or nutritionist and he trusted them more than me and the Whitaker book (because it came from a health food store which is not mainstream, and was therefore suspect). Since he's on pills again, he's not as strict with his diet as he was when he was diet-controlled. We're just patted on the head and told, patronizingly, that we're doing fine and I shouldn't worry so much. (Naturally, as a nurse, I've seen the awful side of diabetic complications, so I do worry.)
Quack? Opportunist? Renegade Pioneer?
Sorry this is such a long letter, but I'm so frustrated-and angry, as I'm sure you can hear in the tone of my letter. I'm hoping that you have some knowledge of Dr. Whitaker, his ideas, his book (and his Wellness Institute). Quack? Opportunist? Renegade Pioneer? I'd love to have some sort of support, positive or negative information, or a place to turn.
Signed-Frustrated and Confused
Name & Address withheld on request
Dear "Frustrated and Confused"
We received your letter and will try to respond to it as best we can. You are right, there is still a lot we have to learn about diabetes, etiology, and the methods of preventing its complications once it has already developed.
In your husband's case, his recently diagnosed diabetes had come under good control possibly related to the Whitaker diet that he had been on. Although this may be an indication that the Whitaker diet was solely responsible, it has been the experience of many diabetes specialists, my self included, that a cut back in calories, no matter what the actual caloric ingredients or distribution, will frequently ameliorate the diabetes, and along with an exercise program, weight loss and possibly some vitamins, will help to normalize blood sugars. I've seen patients with blood sugars over 1000 mg/dl who, after initiation of some of the above measures, normalize their blood sugars and are able to go off insulin for very long periods of time, and in fact, not need insulin at all.
I am familiar with Dr. Whitaker's book and institute. He frequently scorns the medical profession as "narrow minded" and depicts doctors as doing procedures for profit, to strike it rich on illness and disease. I have objected to his labelling and description of medical doctors in this way. It has been my experience in working with my medical colleagues that they are sincerely interested in helping their patients in the fight against disease. There are many doctors, of whom he is one, who are looking for better ways of treating disease. His holistic approach, which includes vitamins and complex carbohydrates, a diet similar to Pritikin's, is just one of the approaches which may in fact prove beneficial in helping many people with diabetes. In this way, Dr. Whitaker may in fact be a "renegade pioneer." Whether his approaches will prove effective needs to stand up to scientific scrutiny, which the medical profession likes to see before jumping on the bandwagon. In the meantime, the medical profession must have its treatment, much of which is effective, based on the information we have a hand, on what is best for the patient. And it has been my experience that there are no universal remedies such that you can treat all patients alike. Each treatment has to be modified to take into account the individuality of the patient-and there are no two patients alike.
Finally, if you and your husband were happy with the Whitaker approach, so be it. The more you know and learn, the better you will know what's best for you.
Peter Lodewick MD
[Editor: We are proud to have Peter Lodewick, MD, on our medical advisory board. Besides having Type I diabetes, Peter is a diabetologist and has been seeing patients for 22 years. Peter is the author of a terrific book called "The Diabetic Man," which is available through mail order by calling Prana Publication at 1-800-735-7726. Ask for their free Diabetic Reader Newsletter.]
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.