Letters to the Editor
Doctors Say "Noncompliant" is an Irrelevant Term
I appreciate your exploring the area of compliance. The concept that we use is that of an athlete-coach model. The athlete is a person on the field making the moment-to-moment decisions, and is ultimately responsible for the outcome. The coach and the coach's assistants are there to observe and provide objective feedback to the athlete, and to share their knowledge of the sport. Together they win or lose based upon their coordinated efforts.
Daniel Einhorn, MD, FACP, FACE
Diabetes and Endocrine Associates
I read with much interest your article on compliance. As a physician who happens to have type 1 diabetes, I am very aware of the complexities of the term. "Noncompliant" is such a negative and emotive term that I feel it is of little use in a physician's assessment of anyone with a chronic disease.
The real issue, as Taylor notes, is the relationship between the health care provider and the patient. Unfortunately, a great many physicians have little or no insight into the many challenges faced by people who live with diabetes. Rather than noncompliant patients, I am far more concerned with complacent, condescending, didactic and judgmental MDs.
In addition to a poor attitude, an alarming number of physicians in the United States, Canada and the United Kingdom fail to come close to recommended clinical practice guidelines. Care is often arbitrary, variable and based on poor information. Most (95 percent) of diabetes care is patient driven (or should be). The Hertz model applies, with the patient in the driver's seat, in contrast to the Greyhound model, where the individual sits still and shuts up. At the very core of modern intensive diabetes management is patient empowerment and taking responsibility for self-care.
When I speak to colleagues, I emphasize the 4 Es of diabetes management:
- Education - in the rationale and mechanics of intensive, flexible insulin therapy
- Encouragement - to be proactive and make informed decisions based on frequent blood glucose monitoring
- Empowerment - to take charge of their own diabetes management and become experts in their own self-care
- Empathy - understand the uncertainty experienced by all people living with diabetes
Finally, I must comment on Stephen Freed's remark that "in this day and age, with all the new medications, insulin and information, there is no reason why anyone with diabetes cannot control his or her blood sugars and prevent the complications." He clearly does not have diabetes. From a physiological point of view, insulin is still given at the wrong time, in the wrong amount and in the wrong place. Little wonder it is so extraordinarily difficult for even the most highly motivated patients to attain a normal A1c. Are they all noncompliant? Of course not. It is simply that we do not yet have adequate tools to do what is an incredibly difficult and complex task.
Andrew Farquhar, MD
Kelowna, British Columbia
Clipping Syringe Needles is Dangerous
I would like to advise people with diabetes to not clip their syringe needles. I just started caring for an elderly type 2 with poor vision who ended up losing track of a clipped needle and imbedding it into her tongue when she ate a banana. It rapidly worked its way deeper into her tongue, and the very painful surgery to remove it was unsuccessful. No one should be clipping needles.
Karen LaVine, RN, CDE
Presbyterian Homehealth Care
Albuquerque, New Mexico
My HMO Made a Deal, So I Offered Them a Deal
The article about HMOs' providing only one brand of blood glucose meter hit home. After several years of using a LifeScan Profile and developing a system to track averages, I needed a new meter. Even with a doctor's letter, Cigna turned down my request for the meter I had been using.
A few weeks later, I received a letter from Cigna offering me a free Accu-Chek blood glucose monitoring system, and touting its advantages. It seems they are making medical decisions without input from patients or the recommendations of patients' doctors.
I wrote to them and am now awaiting a response. My offer to them was that I would try their system for one month, but if I still preferred staying with my current system, they would cover a new one. That seems to me to be a fair offer, which would balance their efforts to keep costs down with my desire not be moved to a new system without my consent.
It is important to continue to publicize these actions of HMOs, and to encourage people to fight for their rights and needs.
The article on California HMO Health Net was a great article. It brought back memories of Independent Health in western New York, which took a similar action. I was so upset that I called the state attorney general's office and they were upset too. I was told to contact people with diabetes involved with Independent Health, so I called the local television station's health anchor and told her what was happening. She investigated, and the final outcome was that we could all continue to use the machine we were used to-one of the minor triumphs in my life.
Carol B. Wojtaszek
Lancaster, New York
I read with interest the article on an insurance company's paying for only one type of meter. I live on the East Coast, and my insurance company is doing just that. I have a couple of friends who have the same insurance company, and they were sent a letter saying that if they use a One Touch, they must pay the current copay. If, however, they choose to use another brand, the patients will be charged higher copays. The company felt this was the best product to help people with diabetes to stay in control of their blood sugar.
I have not received this letter, but if I do, I plan to complain. I have used my current meter for a few years, and feel very comfortable with this product and my results. My diabetes is in better control than ever.
How dare an insurance company put all people with diabetes in one basket and think that one treatment will work for everyone. Until there is a cure, we will always fight for our health coverage and what we need, as people with diabetes, to stay in control.
Diet and Exercise Do Work
I read a letter to the editor by Rima Kittener of Berkeley, California [saying that type 2 diabetes can be controlled through diet and exercise], and wish to write in support of her comments. I was diagnosed a couple of years ago, and at that time, my weight was approximately 210 pounds. My Hb1Ac was 7%, and my blood glucose levels ranged from 140 to 180, with occasional jumps into the low 200s. Through a diet of very limited carbohydrates and exercise (primarily walking three miles, five to six times per week), my weight decreased to 175 pounds. My Hb1Ac is below 6%, and my blood glucose levels range from the low 90s to 120.
I hope your news magazine will focus more attention on diet and exercise as a means of diabetes control. A downside to doing it this way is that one is limited or controlled by the body's ability to process blood sugar. One advantage for those on insulin or medication is that they can compensate for the type and amount of food by adjusting insulin or medication amounts. This advantage is not available to those using just diet and exercise. Thanks.
Say It Ain't So, Novo
I have read with interest your many letters and stories on the quickly disappearing choices for people with diabetes as far as animal insulins go. A type 1 for 50 years, I am well controlled using Novo Nordisk's pork insulins, NPH and Regular. After doing thorough research on switching from animal to human insulin, I've decided to stay on the pork.
I had not heard or read anything about Novo Nordisk's discontinuing their production of pork insulin, until I recently sent an email inquiry to an Internet pharmacy service. They told me they were not able to obtain pork insulin because Novo Nordisk was soon going to stop manufacturing it.
We asked Novo Nordisk for guidance.
Novo Nordisk has no plans to discontinue animal insulin in the United States. If patients have problems attaining Novo animal insulins, we suggest trying another pharmacy. If no pharmacy can help, please contact us at (800) 727-6500.
Director of Corporate Communications
New York City
Love the Facelift
I really like the new look. The cover on your news magazine really looks good, although it doesn't make any difference to me. If you print it on toilet tissue, you still have the best publication in this industry. Thanks again. It's a super nice look.
Airline Pilot Loses Job Because of Diabetes
I enjoyed the information in the June issue about discrimination against kids with diabetes. I was diagnosed with diabetes about two years ago. I was an airline pilot and military reserve pilot at the time, and subsequently lost both jobs. I'm trying to fight it but it's an uphill battle. I feel I am being discriminated against in the work place.
Name withheld upon request
Vitamins Give Me Energy and Good BGs
I appreciate the continuing information your news magazine provides. Congratulations on the glossy color cover. It is terrific.
After reading the guidelines of your article on vitamin supplements ["School Yourself on How Vitamins Benefit Diabetes Care"], I have been able to cease two prescription medications, and I continue to have energy and maintain good BG control! Supplements make sense and I'm sure others will reap the rewards of better health if they adhere to the supplements recommended, exercise regularly, follow a reasonable menu plan, get adequate rest and test, test, test.
Thanks for your help.
A Clearer Picture of Celiac Disease
Thank you so much for writing the article on the connection between celiac disease and type 1 diabetes. It is a very common duo that is often overlooked.
In the article, however, celiac disease was reported to be an inherited disease "where the body improperly absorbs fat." This information is not 100 percent accurate. The disease is actually an intolerance to gluten, a protein found in grains including wheat, buckwheat, barley, rye, oats and millet. Gluten-containing foods cause a toxic reaction in the gastrointestinal tract, resulting in the malabsorption of many essential nutrients, one of which is fat.
The good news is that this toxic reaction can be reversed with the adoption of a life-long gluten-free diet. Unfortunately, people with celiac disease are oftentimes left undiagnosed or misdiagnosed. Celiac disease is frequently mistaken for lactose intolerance, irritable bowel syndrome, depression, chronic fatigue, Chrohn's disease and gastroparesis. Because it occurs so often in people with type 1 diabetes, it is recommended that everyone with this condition be screened for celiac disease.
Cleveland Heights, Ohio
June Issue Inspired My Young Patients
Last month's issue on kids was great. I ordered 50 copies for our clinic (pediatric and young adults). Thanks for this opportunity to offer good role models and inspiration for these kids.
Karyl Hare, RN, CDE