If we don't help ourselves, should others?

[sand-not-oil]

In Great Britain there are a few debates that keep popping up about the NHS (National Health Service), and how to improve it. The interesting bit I heard was the idea that we should have our FREE treatment only if we help ourselves. In other words if I am diabetic and don't take my drugs, or if I am overweight and don't try to lose some, if I smoke and won't quit, even after advice, then free health care would be withheld, and any complication due to this lack of self help would incur charges (ie: pay for your treatments).

We are given the information when diagnosed about changing our lifestyles and eating habits to help our situation, if we don't choose to use this wisely, then I DO think that there should be some kind of penalty imposed, ......BUT I don't think that creating more stress on someone by charging them for an operation etc. is the way to do it. Maybe these people should have an extra charge on their income tax, that will help pay for their extra drugs/operations that they will probably need.

I know someone who is type 2, over TWICE her ideal weight, takes various pills for other complications, does takes metformin, but then eats sugar laden things at EVERY opportunity (eg: chocolate milk, sweets). She then complains that she can't seem to get her BS levels stable, and BLAMES it on the pills not working, or the doctors.

To me she doesn't help herself, and she goes to the doctors at least thrice as much as me. Now I know I'm not perfect, I don't exercise like I should, and I do eat some things that are no nos, but overall I do try to help myself by keeping my weight within BMI guidelines, and always taking my shots, so should I and others who spend time and effort trying not to end up in the doctors be paying for others unwillingness to change. If we don't help ourselves, should others?
Lets put it like this, our NHS is strapped for cash, so what's the solution?
:confused:

[DeusXM]

The best solution is to construct a time machine, travel back to 1930s Grantham, devise some elaborate way of removing life from a young Margaret Thatcher, and then putting it into action.

That way the 80s might therefore actually see some investment in the health service so it wouldn't be quite strapped for cash right now.

On a more serious note: The problem with such a noble idea as the NHS is inevitable people will try to take advantage of it, such as the case you've documented there. Whilst it would be great if there was a way of punishing such people, there's always the problem of what you define as abuse. Whilst obviously the case you outlined is one of abusing the system, who's to say that me eating the odd chocolate bar or going out drinking isn't abuse either? There's another thread in chit-chat which proves how little people without diabetes understand our condition, and I can't help but think that someone like that would be in the chain of command, and therefore might judge me or you as an abuser of the system, which then gets us screwed.

It's a thorny problem, but as some specific suggestions, the person you know with T2 obviously doesn't understand her condition and needs some serious re-educating, which should be provided free by the NHS. In a sense she may be right to blame the doctors, in that clearly they haven't highlighted the consequences of her actions to her. On the other hand, I've already made my feelings known about people who've developed T2 as a result of their weight.

On a REALLY sour note, if she carries on like she does anyway she'll be dead in a few years and a bit less of a drain on the NHS.

[Belinda]

My thoughts on insurance........thankful that i have it and irritated with them for changing co pays, rates, allowable doctors all the time....What can I do? Find ways to make sure I get all meds on a 90 day supply (if Possible) and call and question them ALL the time....(think my name is flagged!!!! b/c I usually get the answer I want!) I pay for part of my insurance so it is different from you in the UK so I think that those that abuse their health continuously will either continue to do so or wise up but I am with Deus...the blame can always be placed back on the health sytem and doctors for not doing their parts correctly.

[kcwinter]

If you so something about the diabetic person. What about the smoker, the drug user, the over eater and anyone else that doesn't take care of there body.

Then you would have to decided if this person is really trying to change there way of life. I think it would just be to confussing.

[Lorna]

Originally posted by Belinda
the blame can always be placed back on the health sytem and doctors for not doing their parts correctly. [/B]

In with this, also does anyone have this problem? I am actively being encouraged by my GP not to control my BGs as he will not prescribe enough strips for more than two tests a day

[Ella1]

We went to the doc with the recent high BG problems. The "emergency" appointment through NHS would be in August... hmmm... So, I had to cash on my work insurance so my boyfriend could see someone privately. He saw the same NHS doctor, who was doing private appointments during the week. It wasn't normal 10 minutes, but a proper 1 hour... I'm sorry, but the result was zilch! He said that the rise in HbA1c from 7 to 8 in the last two months is nothing to worry about. He blamed the insulins, and said that there isn't a perfect insulin which could make your BS predictable!!! He was against carb count, against DAFNE, against the program that we use to calculate the insulin doses. Ok, what could you advise us then? Any alternatives? NO! All he did just gave us the psychological reassurance and no practical answers.

I come from the so-called 3rd world country, which is in the Western eyes is poor and way backward, the place which used to be the Soviet Union. I must say, that only because I used to receive a proper medical service there I really can compare. Every clinic over there has its own lab, and you don't have to wait for months to get your test results, you get them in an hour, or in the worst case scenario - next day. Doctors explain you the mechanics of your disease, they don't think that you are too ignorant to understand it. I don't get it here though. I'm lucky as I got the BUPA scheme (private insurance) through my office.. But the difference is - you get seen quicker, they charge your insurance pot, the receptionist smiles at you more than necessary, but in the end you leave with no answers. The funny thing is, all my friends who come from the same part of the world and who live in London and work in the City of London and wealthy enough to see someone privately, still choose to go to Moscow for their doctor appointments. Seriously, the ticket would cost just as much as the appointment here, but they do get what they expect. I guess the problem here is not only financial, but also in the approach. They tend to treat symptoms, without digging into the actual cause of the problem. I also think that if doctors talked more to their patients about working of their illnesses, the patients would have a good educated guess and wouldn't be puzzled next time when the same problem strikes. That's exactly what Russian doctors do.

Sorry, I must be still under the effect of our last visit to the doctor.

[DeusXM]

Whilst I obviously sympathise with your story Ella, I am rather intrigued. Does your boyfriend not have a regular diabetes clinic? Or does he not have a specialist diabetes nurse?

I only ask because whenever I have a problem, I can just pick up the phone, ring my clinic and make an appointment for the same month, no hassle. I don't ever go to see my GP about strictly diabetes related issues purely because I think that my nurse and care team must be by definition be far more qualified to deal with my problems than someone who must be very generalised.

It's a shame that your doctor seems to be rather useless, though it's often been noticed that a lot of GPs (private or NHS) are hopelessly underinformed when it comes to diabetes, and it sounds to me like you've managed to land just such a doctor. Change your GP - it's much better than coming home with no practical help.

[Ella1]

DeusXM,

It was a specialist in the private diabetic clinic, quite a reputable one as well (with the swanky WC something in the postcode)... The GP is out of the question, he once gave a hand-written prescription for "Lantus cartridge in vials", the Boots pharmacist chuckled on that one. Nice bloke though.

It's not that easy to get appointments with a specialist in London through NHS, they are simply overbooked. When I called and explain the problem, all I got is: the next available appointment with the specialist in August. In the end he called his nurse, who after a few minutes on the phone, told him to increase his Lantus by 2 units, without even looking into his readings. I did notice the tendency of increasing doses when something goes wrong. Oh, yeah, the specialist said that we are pretty clued in, and none of his patients know as much as we do (whatever). He said that we are looking for answers, while there are no answers, and every day is different...

The thing is that I am a member on the other diabetic forum. It's in Russian, I had to resort to something when my boyfriend kept having this post-honeymoon rollercoaster with normal HbA1c... yes it does happen. So the docs didn't take him seriously, good HbA1c, so no probs - see you in 4 months, i.e. deal with it yourself (I couldn't watch it and do nothing about it!). We saw when it was swinging from 3 to 22mmol/l all the time. Then I started reading and searching for some information, and luckily found these guys on the Russian forum who manage their BS to the perfection. They explained why when injecting 5-6units trying to bring BS down from 20-something mmol/l, BS doesn't go down, and sometimes goes even up, and then just 1 unit and you hit the hypo end. With the help of the special program, which was created by the computer engineer, and a diabetic himself, Without any special diet, but with precise doses, my boyfriend managed to get out of this unpredictable BS situation. That's when we learned that there is a need for precision to a decimal in doses. There are young people and old people on the forum. There are parents who control diabetes of their children. And they do have answers. So I got "a bit" annoyed with this diabetologist who was telling that there are no answers, and every day is different and there are so many factors that affect BS - like a position of the moon etc. He was wrong, because he is not a diabetic himself, of course he wouldn't have answers, cause he doesn't live with this for 24 hours 7 days a week. How would he know? It's only a diabetic himself can account for all these external and internal factors, when they get necessary knowledge which is guarded by the doctors. It's like in math, when we get an equation with too many unknown values. So the doctors have the formula, and the patients have the values. It's a matter of the two meeting each other half way. So I think that spending more time with patients explaining how it works woulnd't do any harm to NHS. They are doing it successfully in Germany (they realised that in the end dealing with all the complications would cost much more).

sorry, one month since the appointment, and it's still sore...

[DeusXM]

Hmmm, I think it's very dangerous to assume that diabetes is basically like a maths equation. The sad thing is the diabetologist you went to see is right - there is no definite way to know EXACTLY how much to inject etc. The body's an organic system and as such doesn't really deal in binary.

Whilst it's true that you can pretty much predict how much to take etc. it's still a very rough guess, and you've got to remember that bg fluctuates for a whole variety of reasons that probably make a lot of sense to your body. but since they don't have any obvious external cause, won't make a lot of sense to who it's happening.

The best thing we really have to help deal with properly controlling BG is the DAFNE course, which has been time and time again recognised by Diabetes UK (and other organisation) as a course that really works. What you say they are doing successfully in Germany isn't a case of patients with the values meeting with the doctors with the formula (because there isn't one). What's going on is that DAFNE (or at least the German version of it) is a mandatory part of a diabetics treatment, considered as just as important as that prescription for insulin. DAFNE is currently available on the NHS (I'm going on a course this summer once I've got my exams out the way), but it is not designated as mandatory - instead it's an optional course, that to some extent gives you an idea of what 'the formula' might be. The closest thing there is to a formula here is the ol' carb ratios, something which admittedly seems to be drummed into the heads of the Americans on this site, but most of us in Britain don't seem to be particularly aware (or bothered) by it. My specialist did used to moan at me to try and find out what my ratios are, but she saw I was getting good readings anyway so it's not a pressing need.

As for some further tips about dealing with your specialist that isn't taking your bf seriously...don't go in expecting the HbA1c to be your only evidence if you want to actually get anything done. Any doctor with half a brain knows it's only a 3-month average and as such can only make vague recommendations based on it, which is why it surprises me that your private specialist has done something so ridiculous. That's why my care team insist that I also provide a diary of BG results ie. all the tests I've done since the last time I went to clinic, so they can see exactly what's going on. If it's any help I've got an Excel spreadsheet I could send you that you can type results into, and it provides time of day, daily and monthly averages, as well as providing graphs for a more immediate graphical analysis.

[Ella1]

DeusXM

I work with graphs and anaylsis a lot, so I created a dozens of different versions of graphs. My bf has got a palm wit Excel spreadsheets where he recordds his BS (8 per day), carbs, coefficients, activities, doses. Every time we go to the appointment the docs just get swamped with spreadsheets (call me obsessed :rolleyes: ) The doc was right we are pretty clued in.

About DAFNE, I think it should be compulsory, though it's not largely supported by the medical establishment. We are lucky with the postcode, so he can go to Kings College hospital for a week course this summer. However all the specialists we saw privately are against DAFNE, callying it "an expensive way to teach people some common sense". They support a more intuition-guided management.

I translated a program called Diabet2000. It's an insulin dose calculator for bolus injections. It's based on your individual coefficients for high GI foods (K1) and for low/0 GI foods (K2). It takes into account carb count, GI concept, protein, fat. The coefficients should be adjusted according to the factors. It's obviously just a tool and not a solution to all the problems. But if you know physiology of the insulins used and if you are familiar with intensive insuline therapy you can use it every day. It uses the algorithm and it does work. Jamies' problem was that when his insulin requirements started going down, it affected his Lantus dose. Decreasing Lantus we noticed that it stopped working for 24 hours, and that's what caused the havoc recently. Now we know this.

[DeusXM]

However all the specialists we saw privately are against DAFNE, callying it "an expensive way to teach people some common sense". They support a more intuition-guided management.

Hehe, and there's the rub with private healthcare.

People who go on DAFNE tend to need to see their doctors a lot less. Which, of course, means Dr. Moneygrabber might not be able to afford that TVR this year!

Good luck to your boyfriend, he's very lucky to have someone as supportive as you behind him :thumbsup:

[Ella1]

The sad truth is that most of the private specialists work for NHS hospitals. I 've read that in England there are only 4 hospitals which accepted DAFNE. One of them is in King's College in London.

I think that DAFNE needs more support, and it should be coming from the patients. After all we pay taxes and we should decide wheter we want to be taught some "common sense" or not

[lgvincent]

I have seen a lot of people with diabetes who think that they can do anything they want, as long as they take insulin or whatever other drug is required. Most people who don't have diabetes think the same thing. They think all you have to do is take a shot and everything else is fine.

[Harold]

Ella, you may have seen this, but if not have fun with it.

Dan Evans (http://www.danevans.co.uk/insulin/)

[kitty]

Originally posted by lgvincent
They think all you have to do is take a shot and everything else is fine.

Indeed a lot of people I have met do not understand anything, even if I spend the time explaining it to them(and they are the ones who say they want to understand) they still think a shot of insulin fixes everything...even some mild hypos...:rolleyes: !

There is a girl, a distant cousin of mine, I don't really know her, but aparantly she doesn't take her insulin, and so runs very high ketones, and expells a lot of water, resulting in what she thinks is the perfect solution to weight loss!

In reply to DAFNE, I'm very glad that my clinic is actually all for the DAFNE course(in fact they're obessed with getting everyone onto Lantus and then onto the DAFNE course!-they even have lantus pens and mugs!!!lol), I'm going there in July, so maybe finally my sugars will be better controlled:D .

[DeusXM]

I have seen a lot of people with diabetes who think that they can do anything they want, as long as they take insulin or whatever other drug is required.

Ummm...whilst obviously it's not as simple as that, I'm firmly of the opinion that as long as I'm carrying some insulin and glucose tablets with me, I can do whatever the **** I like - and I frequently do.

[Ella1]

I think that it is illegal to give insulin to anyone without proper education on carbs/exercise/stress/illness/injury/weather vs insulin. When my bf had been diagnosed he spent few hours in the hospital, where they gave him his very first turbo dose of insulin without any food (oops! just slipped their mind! or perhaps it was a hypo-training...hmmmm....).

His injections for 2 years were purely intuition-based. And they were good years with good HbA1c, because of the honeymoon. Around that time I got interested in Atkins and Shwarzbein principle. And that's when I nearly killed him with my carb-free English fry-up breaky, after which we went for a walk in the docks. I had to do the cross-country run to find a newsagent to get some sweets. The dose was based on: "Ooo, very heavy breakfast, lots of calories.. ehm... 10 units I guess.." And I don't blame him for that.. His dietician, instead of waffling on about the food pyramid during his bi-annual visits, should have explained to him the simple carbs=BG concept.

Even though I haven't got diabetes myself, after a good year of analysing, reading and talking to other people, I'm inclined to think that there are so many questions and dilemmas you have to deal with every day, that it's becoming impossible to communicate all this to your doctor. A person needs to know how to correct his/her doses analysing situation and applying his/her knowledge. At the moment, our doc is good for letting us know about some new insulins on the market, doing test and writing prescriptions... The rest is in our hands.

[KLD]

I've been reading these posts, but I'm at a disadvantage because I don't know what DAFNE is. Could someone please explain it to me.

Karen D.

[Harold]

Take it your not from the UK.

DAFNE, not sure myself, but in how it is used my take is it is some kind of social medical program.

[IceMan]

My doc is pretty laconic when it comes to what he's willing to invest in my treatment regimen..but I keep him on the payroll because he is very good at writing prescriptions and ordering lab tests. I took responsiblity for my own treatment regimen months ago. I think he just treats the dx to the point of affordability and sees diminishing returns after that.

Link To DAFNE (http://www.diabetes.org.uk/home.htm)

Discrimination for lifestyle shortcomings wouldn't get past first base in the USA...the ACLU would be all over it. I think that if some radical changes are not forthcoming that this dx has the potential to break the medicare/medicaid program and seriously depress profits at the major health insurance providers....and, oh yeah..there are those 41 million undiagnosed cases of pre-diebetes waiting in the wings.

There are no simple answers, either..the magnitude of the problem is enormous...the gross income for test strip sales world wide is in the billions...very interesting topic.

[Harold]

Knew I should have invested in those test strip companies. Now if I could just figure out which one will come out with a decent non-invasive monitor first I could really help myself!

[IceMan]

The leading edge candidate is Sanyo and the GlucoWatch (http://www.glucowatch.com/us/default.html)

or this from Hitachi (http://www.hitachi.com/New/cnews/040223.html)

More On The Subject (http://www.ieee.org/organizations/pubs/newsletters/leos/apr98/overview.htm)

[statdeac]

Warning for T1s on the Glucowatch...Continuous Glucose Monitors Not Effective In Preventing Hypoglycemia (http://www.diabetesincontrol.com/issue202/item5.shtml)

[Harold]

Hey Stat I posted a link in the I believe Parents forum on the study on the Glucowatch and CGMI to detect hypos in children.

Professor Ice, Yes I am aware of the glucowatch and it's limitations. Had not read the Hatachi link, but there are others trying to use infrared sensors and electro magnetic induction to determine bg's. The real challenge is coming up with something that will give either an analog reading or a frequent digital readout that is updated in less than a minute. Something that will say store the data and can be uploaded to a PC every other day or so at the least. The pumpers will have the continous monitoring first and I expect we will learn a lot from them. However the sensor they use will be intrusive and I expect the first truly continously monitoring the rest of us can expect will be an implantable chip that will communicates to a carried monitor.

[mg_2204]

... for those in the UK, ever seen that advert on tv, where a woman is sitting, having great difficulty breathing, and she's hooked up to an oxygen tank? --- It's to 'help' people stop smoking. Pretty shocking isn't it?

The truth is, many still smoke. And will do so until well...it's too late. Human nature I suppose?

Same with diabetes perhaps? I for one was in denial for years. And because you can't see it... you think you can beat this thing? Get over it like an infection for example? I sure thought so! Lack of education on the matter plays an important role too. Some people will read everything they can on a particular illness, others will simply rely on what the doc says (and let's be honest, some docs are just pill dispensers). And some people whine all the time but do nothing about any given situation, it's the way they are, full stop. Some don't have the capacity to understand. Others deliberately choose not to acknowledge the seriousness of their illness. the But still... it makes me shudder to even think the best of care could be taken away from them... or they'd be charged for it.

I may be wrong thinking this but for me, additional fees for those who don't take care of themselves is just a short term solution. I will forever believe in education. And it has to start very young. When I see children 9, 10, 11 and young teens smoking... and eating tons of sweets and packs of crisps... well it makes me wince. I know kids who are growing up on Burger King and Tesco's chicken nuggets & chips. Do you see many kids playing outside? Nah. They're all in front of a computer, tv or a PS2. They teach interesting subjects in school; none however on how to take care of yourself better. In many ways, we're failing our children.

Marie
:)

[sand-not-oil]

Dear Marie,
I couldn't agree more about the education of the young, I too wince at the sight of Coke guzzling, sweety chomping kids.

I say this knowing what I have learnt about my diabetes and my health since being diagnosed, but up till then I was one of those uneducated people who thought that the only harm that I was doing to myself was the potential to put on weight.

Why can't nursery/primary schools (get them young) have nutrition classes that explain how our bodies use foods, or even better have anyone who intends to be parents taught how to feed their kids good food.

My husband is a youth worker, and the youths he deals with think that going to McDonalds is going out for a 'good meal'.

Education is needed, and SOON!!

[IceMan]

To me dx is best and most easlily managed on a personal level and I am proactive in my efforts to share what I've been forced to learn. I go around the village patting protuding bellies and asking peeps if they had a diabtetes test lately. I've got an uncle here in town that is T2 and in denial...every time I ask him how he's doin' he just sez fine...but when I walk in his house the first thing you notice is the discarded Snicker's wrappers layin' around the couch....I don't believe a diabetic eating Snicker's bars can be fine.

Who knows...maybe if Uncle Joe had been taught the dangers of obesity and that he was more at risk as a Native Amercan he could have avoided the dx...but then again, maybe not....and we'll never know now.

I've been invited down to Kotzebue for a radio appearance (is that an oxymoron..??) with the Diabetes Manager for Maniliq Medical Center...a PHS facility. I'm reluctant to do it because so much of what I believe and practice flys straight in the face of ADA dogma that he may be sorry he ever asked me...but on the othere hand I feel an obligation to my fellow diabetics..to share my success at gaining rigid control of this dx while continueing to live a happy, active and productive life. I have more energy today than at any time in the last 15 years and every one in my life has benefitted from my recovery.

I don't know a whole lot but I do know that there are no easy answers...none at all.

[Ella1]

Karen, here are some links to DAFNE (Dose Adjustment for Normal Eating)

Diabetes UK (http://www.diabetes.org.uk/dafne/whatis.html)
Aventis (http://www.aventis.com/future/downloads/PDF/fut0203/En_03_2002_dafne.pdf)

It's a new thing in the UK where people are taught carb count concept, as this is not widely practiced in UK.

I think the junk-food and children issue won't stop till they don't put some limits on the marketing of thes products. UK and US are the only developed countries which continue to ignore this issue. I had friends visiting from Sweden, they were shocked when they saw numerous adverts for sweets and other "empty" foods on children TV. It's hard enough for parent to control kids' diet, commercials surely don't help.

I don't know how it works in the US, but in UK, when you get diagnosed with diabetes you spent no more than one day in the hospital and get your initial therapy regimen. I just don't understand how it's possible. One has to take on board so much information, doubt it could be done in one day. I think there should be an equivalent of a "diabetes school" which would last for at least a week. It's an investment which would reap the benefits later. That's what they are trying to achieve introducing DAFNE in the UK. The conventional medical establishment is vastly against it, saying it's too expensive... :mad:

[KLD]

I live in Canada, Ella, and when we're diagnosed we are sent to a diabetes clinic at a local hospital, where we're "educated" by both a diabetes educator nurse and a nutritionist. The only problem is that they just spout the standard diabetes association nonsense about a 50% carbohydrate diet and send people on their way with all the wrong information. My husband first lost his sight and finally died of kidney failure last year by following that advice for all but the last year of his life. He switched to Dr. Bernstein's methods then, but it was too late for him; the damage had already been done.

Thank you very much for the information about DAFNE. I'll have a look at it.

Karen D.

[Ella1]

Karen, I'm very sorry to hear about it... I can't find the right words to ... I'm sure you heard a lot. I truly believe that we should remain strong and positive for their sake. It's hard but that's what they would want us to do, and we should honour that wish.

I get a bit rigid when I hear about the food pyramids and all that... Why pyramids? why not circles or some other shapes... Why not just tell people stop eating highly-processed junk and keep the balance. Oh well, I guess it's a subject for another thread

[KLD]

Thank you for your kind words, Ella. I'm getting on with my life very successfully, and the people on the other forum I was telling you about have been a huge help to me in doing that. I have been telling them some very complimentary things about you, and I do hope you will introduce yourself as a new member when you have a chance.

Karen D.

[Ella1]

Karen, thank you! Ooo, I'm always up for compliments :) I will definitely introduce myself. In fact people on the Russian forum raised few question about the Bernstein's book. So, I'll bring them all up on the forum ;)

[mg_2204]

Hello Ella!

I agree with you : tv commercials and such don't help the younger generation to make good healthy choices. Junk food, sweets, and even breakfast cereal (tons of sugar & a bit of fibre) are made appealing and fun and tempting. They don't spend that much on advertising... apples or celery.

Perhaps a solution would be to put a new -t-a-x- on junk food? I'm still amazed it costs less to buy penguin cakes or a bag of crisps rather than buy a few fruits. Unfortunately, and it has been proven too, eating healthy costs a lot more. And is time consuming if you consider cooking, etc.

Something I just don't understand : I hear my children's friends say 'OH!!! Look how fat he/she is!!!' - 'I never eat breakfast because I don't want to be fat!' - and you offer them a little (healthy) snack after school and they loot at you in disgust, saying 'No thank you I don't want to be fat' ... and yet, they STUFF their face with sweets and crisps and fizzy drinks all the time. Duh!

Peer pressure could be far worse than tv commercials...

Marie
:)