[Subby]

I got orange-juice-on-sunday'd yesterday at my endo's.

That's the term that comes to my mind when I think about how many endo's have dealt with me over the years when it comes to diagnosing blood sugar problems. Here's a semi fictional example:

ME: I've had such a lot of variation lately. I know there are lots of factors but I think something is really out and I get semi-patterns. Here's the tests and data from the past few weeks, can you help with any observations or ideas?

DR: <staring blankly at me> Yes lets look, but remember your A1c is good, all things considered.

ME: Ok I agree that's good, but these fluctuations make me sick and knock me around all the time. What about for example, Friday there?

DR: <staring blankly at the data> On Friday there, that could have been a bad injection site.

ME: OK I don't think so, I avoid all those lately.

DR: But we can't rule it out, that could be it.

ME: OK then, I can't argue with that statement. But wait, What about the rest (ie, fluctuations all over the place)?

DR: <staring blankly at the data> Hmm, you had an orange juice on Sunday. That stuff often has so much sugar. Gees you take a lot of tests. Stop worrying so much about it all. That was a great BG that afternoon there. Now how are your feet feeling?

ME: Hmmm. <wow, another few weeks/months/whatever trying to record as many factors as possible, flushed away with "stop worrying" and "sorry it's all too slippery for us doctors to engage with properly, I'm just going to be obtuse instead">

Now, I am not talking about honest, useful advice (which can be short and to the point too). But the OJ syndrome involves quick superficial assumptions, (it's the OJ causing instability, or suggesting lack of care in diet) not verifying anything properly with the patient (does this amount of OJ USUALLY spike you at all?), and moving on with it established that either a) it's too hard and annoying to get into the issues properly or b) it's unreasonable to want some avenues of progress (or movement towards such) via quality scientific deduction.

An unwillingness to say "hmm, I'm not sure. It is tricky with the 1 minute window I have with your data... lets try looking at this or that issue properly over the next few months. here's how... "

And often, it involves - leave me alone I have another 400 patients to see today.

I am beyond fed up with this attitude, even my wonderful latest endo (and she is, compared) is not immune from it. Not much in the world gives me bigger stress spikes than this kind of interview these days.

I am going to work towards a more practical diagnostic framework that I take to these situations to minimise this endocrinological squirm... and try and see insulin therapy as something where there is hope of some kind of useful, if not necessarily clear, diagnostic discussions to be had, with better directions coming out of it rather than a sore head.

[Jan B]

One of the books I'm reading now talks about what many diabetics are going through. Doctors are not compensated well at all for their time spent with us chronic sufferers reviewing our blood glucose (example reimbursement to docs about $15 for our visit). They are, however, compensated much more for amputating a leg ($1500 wild a. guess.). This sounds brutal, but it's true many governments & insurance companies pay like this. Until the health care system focuses much more on prevention and realizes what a serious epidemic diabetes has become . . . our experiences won't improve much. Only the wealthier doctors can afford to give us what we need -- time and attention and training and support.

[Subby]

Interesting Jan. I don't know how that translates in australia, but I do know that the good (and not so good) endos seem unbearably snowed under with work and seem to (have to?) cram the entire visit into standard 15 or 20 min sessions. Which, once you've chatted about things a bit, checked physical condition, etc, leaves about 5 minutes (usually less) to make sense of data. Really, this disease needs more. I know that diabetic educators and teams seem to have been offered more in recent years to pick up the slack. My experience is limited with them, but they don't seem willing to do advanced analysis or come up with advanced or complex testing procedures (such as basal fasting protocols), which is exactly what diabetics like me, with frustratingly brittle diabetes, need help with.

I'm not blamning one party or area, I don't know enough to do that. I do know most endos I have seen have a shocking way of dealing with this lack of time to consider things properly. (see above post). Just saying, "I don't know" would be far preferable to quickly and blindly blaming factors or the patient, without being prepared to interact with the ideas positively.

Now, lets just say this is a limitation that is here to stay. That getting funding/time to do some decent analysis is just not possible. OK. Let's be honest about that and let's spend the time helping the diabetic (when they are ready and able to) learn how to better interpret the results, understand blood sugar processes, and eliminate and isolate factors, instead of give half baked medical diagnosis and advice and an attitude it's all pretty hopeless, but hey you're not going to die next year at this rate.

Well, anyway. That's life hey? It's good to find this forum with some great knowledge and experience floating around here. I feel more confident of getting somewhere since finding it.