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Monday, June 22, 2009

Choices, Consequences and Responsibility

Life is full of choices. Diabetes is one of those conditions where we are presented with many choices. From the start we have to choose who to listen to, who to ignore, what foods to eat, what exercise to do, what medications to take; the list goes on and on.

Naturally we seek qualified professional advice to help us make those choices. Some of us place our lives in the hands of those advisors, some of us use them as just one source of information and seek input from others such as other diabetics, support groups, forums, the internet, blogs, books and similar to assist us.

But that has dangers. There is an awful lot of dangerous nonsense on the web. That is particularly true concerning diabetes, diet and medications. So we must filter those sources using common sense, research and our medical advisors to pick the good information from the rubbish.

There is no doubt that our medical advisors should be our first port of call and the source of the best information. We should value that source above all others. But sometimes that is not always true. Our medical advisors can only offer advice based on their training and professional experience; however, that training syllabus may not always be up to date. If it is current, the research leading to that training may still be continuing, making new discoveries that change the basic premises that advice is based on.

For example, the diagnostic blood glucose levels for diabetes have been steadily reducing over the past few decades. I was not diagnosed for several years when my fasting blood glucose levels were around 7.9mmol/l(140) but a diagnostic fasting blood glucose of 8 applied in Australia. Of course, when I was finally diagnosed the official level had come down to 7(126).

Similarly the guidelines for good blood glucose levels are slowly being reduced. Despite that I see many people reporting their doctors quoting the old ADA guidelines of 2hr post-meal BGs of less than 180 as "tight control" or that it does not matter how high the peak BG spike is, provided that your 2hr BGs have returned to an acceptable level. I mentioned earlier the nonsense we hear from many official sources about our vital need for lots of "good, healthy" carbohydrates.

If those examples are representative of the quality of advice you are receiving from professional sources, try this small test. A multi-choice question for you.

Choose one answer.

Who or which of the following may go blind, lose a limb, suffer kidney failure or have a heart attack if the advice from your Doctor, your Dietician, your Diabetes Educator or the ADA/NHS/DA (Diabetes Australia) is discovered to be incorrect in ten years time?

A. Your Doctor

B. Your Diabetes Educator.

C. Your Dietician


C. You.

D. Me.

D. None of the above.

You may use the following links as reference materials while considering your answer:

Research Connecting Organ Damage with Blood Sugar Level

Blood Glucose Targets

Cheers, Alan

Everything in Moderation - Except Laughter.


Trinkwasser said...

To an extent this ties in with your previous post. Here in the UK it's not uncommon for doctors, nurses and even dieticians to say things like

"Of course a low carb diet is an excellent idea but I'm not allowed to tell you that"

Nicky said...

I also had the classic comment from my GP last week - "Oh, your A1c is amazing, I haven't got the time today to argue with you about your prescription for test strips" :D

Jim the Guacamole Diet guy said...

"From the start we have to choose who to listen to, who to ignore, what foods to eat, what exercise to do, what medications to take; the list goes on and on."

I think it's odd when people tell me that I should always follow my doctor's advice. On the contrary, if a doctor's advice doesn't make sense to me, I just find another doctor.