[Diabetes India]

I think, I am missing this vital part before posting anything in a forum. Never was a part of forum before.

Myself - Abhijeet Nakave currently a resident physician in internal medicine in the state of Virginia and finished a year of endocrinology research fellowship.

About reasons to why am I here: With my posts/poll, I made it clear. My understanding about physician's online approach is still in novice stages. And I believe, any changes in usual things is not easily acceptable by anyone. I do not know if anybody has tried this before, but I believe that being a professional, I really want to know about diabetic population and their lifestyle in order to be a part of the effective treatment team and share my opinions with them (not as a direct medical advice unless I see them personally in clinic) and also share their opinions with me.

I do not want to be a focus of skepticism for spam or advertisement. I think, I want to be a part of diabetesforums not for teaching anyone but to understand the opinions of all of you and share my opinion with all of you. If my presence or my posts create a confusion or dispute, please do let me know, and I would be happy to take a step back.

Thanks.

[fgummett]

Hello Abhijeet Nakave and Welcome to DF!

I think it is highly commendable whenever a Physician seeks to improve their effectiveness as part of the Health Care team.

Please do not take it too personally if you get some pretty forthright responses here on DF... there are some strong opinions about the current state of the Diabetes management establishment

[alicat61]

Hi Abhijeet,
Welcome to our family. I think it is great that you taking the time to see how we the people who live with Diabetes feel and think about things.
The problem with forums is that scammers do get in and it makes people scepticle (sp) at times.
Good that you have explained your self.

[jenb]

Originally Posted by Diabetes India

I really want to know about diabetic population and their lifestyle in order to be a part of the effective treatment team and share my opinions with them (not as a direct medical advice unless I see them personally in clinic) and also share their opinions with me.

Hi and welcome. If you can accomplish this you will be a special physician indeed. The concept of a "team" comprised of the patient, a doctor (or doctors) and educators is a laudable goal, but in my experience, as a practical matter it is almost non-existent. By the time a diabetic has successfully managed their condition for a year or two, that person may in fact be more knowledgeable than some members of the supposed team.

I would encourage you to think outside the box, treat your diabetic patients like the intelligent people they are, and when you find someone who is willing to learn, experiment, and push the envelope, encourage them. You may have the medical jargon, but your diabetic patients live with their condition every day...recognize that they will have practical experience that you will never have (unless, of course, you're one of the annointed!). Never assume that your patient is not as sophisticated as you, nor that they unable to garner much of the knowledge that you have. The free flow of information is changing the knowledge gap and putting patient and physician on much more even footing.

I look forward to observing your contributions here and hope we can in turn give you some insight.

Jen

[jps]

I echo the sentiment. I think any physician that takes the time to truly learn about all aspects of such an epidemic is commendable.

I've seen so many complains here about physicians. That they aren't up to date, that they are quick to treat with meds/wrong meds, that their information is wrong (by subscribing to ADA standards), etc.

I think that T2 diabetes is a disease in which there is alot of misinformation and that physicians need to think outside the box of what's been learned.

One of the true strengths of this forum is that people have learned to question what has been widely accepted as factual.

The earth is not flat...

[Diabetes India]

Appreciate your comments. I think, what I have learned in medical school in India is a bedside medicine which had more interaction with patients and their family but lack of advanced imaging/lab techniques. What I am learning is an advanced evidence based medicine, where I found minimal patient interaction as compared to my medical school and more of a electronic medical record review. Thats why I started my own website and blog to get connected with people but now found that diabetes forum actually exist. This forum makes me feel as if I am understanding the basics of diabetes life from the patient perspective and listening to their problems and concerns.

Will continue to contribute my opinions and views. Constructive criticism is most welcome on my posts/ opinions/ views.

Thanks.

[jps]

Doc, just some things off the top of my head....

1) Insulin should be an option, not a last resort. It was my only med and worked wonders, has worked for others.

2) Especially if a patient is proactive, if he/she requests a script that enables testing 10 times per day, even if you think it's excessive, prescribe it. Especially early on in the disease. Many of us have found that testing before and two hours after every time we eat helps us effectively modify our diet and bring our sugars down in a more natural way. When we ask for these strips, it is us doing our very best to get healthy.

3) Open your mind to the "fat is evil" mantra. Many of us have found that not only do they not harm our lipid panel, they can help it - as long as we maintain good glucose control.

4) Don't be afraid to support stricter guidelines than that of the AACE and ADA. A person may able to achieve better numbers and if so, that should be the goal.

5) Being aggressive EARLY ON with this metabolic dysfunction is the most effective way of combating it.

Good luck to you. I know it will be disheartening with the many non-compliant patients you are sure to see. But there are many of us that want to get better and do whatever it takes.

[foxl]

Hi, Abhijeet. I have a daughter born in India and she received lifesaving and excellent (per her Rehab Ped here) care there, it have given me a great deal of respect for the medical professionals from there!

I am glad you are seeking information here -- I tend to be skeptical of posters as well, including medical professionals since some of mine tend to follow the letter of the AACE and/or ADA recommendations ... and I think we have learned that is not always the best thing, here.

[Diabetes India]

Originally Posted by foxl

I tend to be skeptical of posters as well, including medical professionals since some of mine tend to follow the letter of the AACE and/or ADA recommendations ... and I think we have learned that is not always the best thing, here.

I really was surprised to see skepticism about guidelines/recommendations. They are not "THE" final decisions but guide physicians and patients with a baseline reference.

[foxl]

Originally Posted by Diabetes India

I really was surprised to see skepticism about guidelines/recommendations. They are not "THE" final decisions but guide physicians and patients with a baseline reference.

Yes, that is how they are supposed to be used ...

[jps]

I understand the need for guidelines, but some of us feel they are way too high and we can do better. To me, if a person can maintain control within those guidelines most of the time, they are still a candidate for complications. So why not aim for better numbers? Even with better numbers, we are all still candidates for complications, but common sense says the odds are decreased.

I used the AACE's guidelines when I started, but I saw that I could do better so I modified my own personal goals. It's a matter of personal choice though. My own guidelines are to maintain the sugar levels of a non-diabetic at all times. It takes a stricter, low-carb diet to attain that, but I figure if I can maintain "normal" numbers, that gives me the best chance to avoid complications.

[jenb]

Unfortunately, guidlines set by the ADA are being used both by insurance companies and by physicians to deny coverage of basic tools such as strips for T2's.

Such guidlines are also used to encourage very unhealthy eating habits in all diabetics. Had I followed my original Endo's dietary advice ("use the ADA 1800 calorie a day regmen"), I would now be seriously overweight and using significantly more insulin than I am. Ridiculous for a 5' tall 50-something woman! I am not alone in this.

When doctors, educators and insurers recognize that the term "guideline" does not mean "rule", then some of this skepticism will be ameliorated. Until then, I think it's very healthy to question these authorities.

Jen

[foxl]

Originally Posted by jenb

Unfortunately, guidlines set by the ADA are being used both by insurance companies and by physicians to deny coverage of basic tools such as strips for T2's.

Such guidlines are also used to encourage very unhealthy eating habits in all diabetics. Had I followed my original Endo's dietary advice ("use the ADA 1800 calorie a day regmen"), I would now be seriously overweight and using significantly more insulin than I am. Ridiculous for a 5' tall 50-something woman! I am not alone in this.

When doctors, educators and insurers recognize that the term "guideline" does not mean "rule", then some of this skepticism will be ameliorated. Until then, I think it's very healthy to question these authorities.

Jen

Yes, thanks for this, Jen! I too got the 1800 kcal/ 800 bazillion carb grams diet.

And nevermind that anyone trying anything different, ie, not in the guidelines or recommendations, has the risk of it being held against them.

[fgummett]

I also find that licensed professionals are somewhat constrained by the guidelines no matter what they may personally feel... I have a constant struggle with my family Doctor over my supposed "high" LDL volume* and she insisting that by the guidelines I should be on a statin so we have this game where she promotes it and I refuse to take it.


*My HDL is high and my Trigs are low

[Diabetes India]

Well... good thoughts and discussion.

So guidelines are not favoured by most people.

And anything trying out of guidelines is worth risky.

What is this approach.. I am really not understanding.

e.g. lets say "X" patient is not happy since his family doc is asking him to take statins "due to the guidelines" even though his LDL is normal.

Now my question is who set the limits for normal values? and How did they set normal values?

It takes many years of research, observation, clinical trials to set these guidelines. Obviously they are not "THE" rules. But they did not come out of no where. They have a meaning and an agenda. That meaning and agenda needs to be understood properly and it is a physician's job not even NPs to explain that meaning or agenda to the patient and offer different set of options so that patient choose the right option that suites him.

Thanks.