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Re: [IPu] Fw: [IP] endocrinologists

 What an insightful article I love it, my endo I had for many years was a Type 1
diabetic himself and while a wonderful doctor failed to insight me to new and
wonderful things that would of been a great help to me eg insulin pump as he
managed his diabetes quiet alright without one so it appears so could everyone
else he often related your life experiences of diabetes with his and thought
that all cases should have the same outcome as him as he was also a diabetic and
don't get me wrong while I think he is still the greatest thing since sliced
bread because he did save my life on several occassions I also think some things
could have been handled better, my diabetic specialist I have now is not
diabetic but has devoted a good part of his life caring for both type 1 and 2
diabetics and seems to be way more in tune with new items being supplied to
diabetics to make their control more adequate and endurable and understands that
you have to live at the same time as controlling this disease and taken the
below mentioned into consideration such as life style and certain situations. So
while he doesn't have diabetes I like his form of advice much better and think
sometimes it is handy to have someone on the outside looking in to really
understand instead of comparing every situation to your own.

--- email @ redacted wrote:

From: "Janette Dunn" <email @ redacted>
To: <email @ redacted>
Subject: [IPu] Fw: [IP] endocrinologists
Date: Sun, 18 Jun 2006 08:44:51 +1000

From: <email @ redacted>
To: <email @ redacted>
Sent: Saturday, June 17, 2006 9:26 AM
Subject: [IP] endocrinologists

 This posting was made by, Klausen a person with IDDM, and I thought it was

I visit a specialist, the doctor always wants to know whatendocrinologist is
 managing (or, more politely, 'following') my blood sugar,to which I reply,
which always evokes exclamations of surprise andconcern that I am not being
better supervised. But what good is a doctor inmanaging a diabetic's blood
sugar?First, the actual techniques of dosing the various types of insulin can
belearned by a fifth grader in about a week, so the doctor's 'expertise'
iswasted there for the experienced patient. But even in this area, the
doctor,unless he or she has type 1 diabetes, is more of a hindrance than a
help,because it is impossible to understand how difficult blood sugar control
isunless you have the disease. Since doctors are trained to think they knowbest
and yet in fact have no understanding or appreciation of the complexityof blood
sugar management in the real world, their contribution to t!
  hiseffort can be positively dangerous.Second, blood sugar management depends
on the particular patient'slifestyle, and that is something the patient
understands infinitely betterthan any doctor. If I am living at home writing a
novel while in theconstant presence of other people to guard against my having
severehypoglycemia, I can control the blood sugar level quite well, since it is
nogreat inconvenience to be constantly testing blood sugar, injecting
insulin,and counting calories, and no great danger to be skirting the edge
ofhypoglycemia. But if I am working in the outside world under intensepressure
in a job requiring a lot of travel, involving unexpectedchallenges, as well as
 great time constraints, such that the boss mightrequire me to work through
or such that I cannot afford to lose a halfan hour dealing with hypoglycemia,
 then blood sugar control will be verydifferent. Given these variations
to how I am living, themanagement of the disease can only !
 be done by me, since only I know howinsulin treatment interacts with t
  he particular kind of work and schedule Ihave.Third, only I can know how I
with different styles of blood sugarmanagement, and my doctor can only have a
dim, second-hand awaremess of thisreality. If approaching, experiencing, and
coming out of hypoglycemia takesup three hours of my time with exhaustion,
confusion, and recouperation,then I can't afford to keep the blood sugar low in
the way that a person whocan go in and out of that process in 20 minutes could.
If I feel shakey,confused, and tired with a near-normal blood sugar, then that
is not normalfor me. If I have diminished awareness of the onset of low blood
sugar, thatis another factor to consider. Recently I find that I become
intolerablysleeply if my blood sugar sinks from high to normal too quickly, so
this isa new idiosyncratic factor in my physiology, which I understand better
thanany doctor treating me, so I have to be the one to manage the blood
sugararound this phenomenon.Fourth, there is the psychologica!
  l dimension. Different people handle stressin different ways, and while some
people can stand the stress of livingevery minute of their lives on the edge of
a hypoglycemic coma, otherscannot. Some people are depressed and frightened
about severe hypoglycemicepisodes; others are not. Depending on how the patient
subjectively reactsto low or normal blood sugar will determine how control has
to be managed,and this the patient alone understands, not the doctor.Fifth,
there is the philosophical dimension. How I want to balance my desireto enjoy a
normal, productive lifestyle now, against my interest in avoidingcomplications
 in the future by keeping blood sugar perpetually on the brinkof hypoglycemia,
a profoundly personal, existential choice. Some peoplewould rather live twenty
enjoyable, productive, free and spontaneous yearswith high blood sugar even if
that meant dying at the end of that periodfrom complications, while others are
content to live in diabetic misery,testing,!
  injecting, calculating, fainting all day and half the night, sothat t
 hey can die of complications after thirty rather than after justtwenty years.
How to deal with the possibility that the patient may begenetically protected
against complications and so may be just ruining hislife unnecessarily by
intensive blood sugar management, or how to respond tothe chance that the
disease may be cured or treatment may be improved in thefuture so that
complications will not arise no matter what the blood sugarcontrol has been up
to that point, are also purely subjective decisionswhich the patient alone can
 make, not his or her doctor.So for all these reasons, the legitimate role of
endocrinologist in'managing' the patient's blood sugar is much smaller than the
medicalprofession likes to think. .
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