Monday, November 23, 2009

Rethinking the System

Last night I was getting caught up on my blog-reading, and came across this article. Read it, it will make you mad.(or it should)

Screaming Headline: Is Uncontrolled Diabetes a Reason for Divorce?

There are many,many blogs(some even in the OC, you know what I'm talking about) out there complaining about their spouses, significant others not taking care of their diabetes. About how they can't take it anymore,and are just so fed up they could leave tomorrow, etc. I'm not here to minimalize the fact that their spouses(as well as the blog writers) are acting like irresponsible jerks. That they should be more considerate.(we all can)

But it is not a diabetes issue. And pinning all this on the diabetes, because you can't believe that the person you married would EVER act like that,if they didn't have diabetes,is just plain stupid. People are complex creatures, & what governs their actions is not just one's many. If you're yelling at your spouse/mistreating the kids/etc. you have issues that go way,way,way beyond your chronic disease. And if you're not "taking care of it", the following speech will not improve your compliance. (quote)
"Diabetes is not a disease or blood sugar. It is a disease of blood vessels. If you can imagine everywhere blood vessels go (which is everywhere), diabetes will destroy that part of your body. It will lead to a horribly disabled and miserable existence. I described all aspects that she had to look forward to from uncontrolled diabetes

* Memory loss
* Stroke
* Blindness
* Heart attacks
* Arrhythmias
* Heart failure
* Gastroparesis
* Ischemic bowl
* Painful neuropathy
* Diabetic myopathy
* Claudication
* Amputations
* Frequent infections
* Life threatening illness with septic shock

The list can go on and on and on. I told her that 1halfof my hospitalized patients are likely there as a direct result of uncontrolled diabetes in one way or another. I told her about the life changing disability she was in for. I told her she presented with a high risk of death due to an acute illness within the next two years. Her admission now should be a wake up call for change." (unquote)

Telling people horror stories makes the exact opposite closes off their willingness to listen. I have been told horror stories,and I'm one of the ones who actually attempts management of this disease. I just wonder why, after 80+ years of T1 diabetes history and the hundreds of thousands of diabetics who have been preached at by their physicians(more so in the later part of this century) why the physicians haven't gotten a clue yet that said scare tactics don't work, 99.9% of the time. Despite that,it's a scene that repeats itself hourly, daily,all across America.(and the world)

I will tell you what a goes through the mind of someone with diabetes, when they hear something like that.

1."It won't happen to me." (It likely will-but they know that anyway,and you telling it to them won't do any good. They're in protection-denial mode)
2. "Might as well go out with a bang."(eat, drink, for tomorrow I might die)
3. "You have no clue what diabetics go through everyday. You don't HAVE diabetes,or you wouldn't be lecturing me like this. You don't know what its like to
swing madly, no matter what you do."
4. "Is it lunchtime yet?"

For a type 2 diabetic,it's likely to be so much harder to come to terms with diabetes. You feel fine(most of the time), and you'd rather not think of yourself as sick/needy in any way. I don't know what the solution is,but a positive outlook/support system is the first step. High blood sugars breed depression, both mentally and physically(they may say they aren't depressed but it's impossible not to be)

One thing I do know..for the millions of "non-compliant" PWD out there, there has to be a better way of reaching them then scaring them into an early grave.My heart bleeds for my 'betic brothers and sisters. I don't think anyone is unreachable, and I don't think anyone deserves the complications of diabetes.(compliant, or not)


George said...

Well said and thank you SOOOOO much for this post.

some people are jerks, with our without sugar.

tmana said...

There are a couple of separate issues here, of which you've only addressed one. Sometimes divorce can be a useful method of preserving the couple's resources. (This is one reason many widowed senior citizens choose not to marry the loves of their twilight years, or divorce them when medical care costs threaten to wipe out both parties' incomes.) It's painful even when done for purely economic reasons... but sometimes necessary.

The other issue is one of how T2 is represented and treated. Too many clinicians forget to mention that proper self-care can mitigate the destructive tendencies of T2DM. Also, most T2s are NOT referred to endos, may not be referred to CDEs, and are treated exclusively by PCPs who may have not had any updated education re: diabetes care (or bedside manner) since residency.

Add to that the socioeconomic issues that accompany T2DM -- i.e., poor and lower-middle-class groups. Do I buy food or test strips? Do I pay the rent or buy Januvia and Caduet? Do I buy a pound of green beans or ten pounds of potatoes? Do I work two jobs to keep a roof over our heads, even if that means McDonald's for dinner, or do I worry even further about the rent and spend half the day home cooking food I can't even afford now?

These are the questions many T2s have to ask themselves every day.

And since unlike T1s, T2s won't be dead in a week if we stop eating right, testing, or taking oral meds... it's easier to ignore. Until the damage has been made permanent.