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Re: [IPk] was Sliding scale vs. pumps, now medical ignorance!

Date: Sat, 27 Oct 2001 22:41:15 +0100
From: "Tony O'Sullivan" <email @ redacted>
Subject: Re: [IPk] Sliding scale vs. pumps

>It is frightening how little many hospital staff know about diabetes, 
>say on surgical units and the like.

I second that.  It has been my experience too when talking with almost
all physicians other than those who really are specialists in diabetes.
 Watching the proliferation of medical literature (for which the 
pressure to 'publish or perish' in the scientific/medical community is
responsible) it is really not suprising that drs cannot keep up with
the literature outside their specialty.  What is suprising and
upsetting is the arrogance of those physicians who will not admit that
their knowledge of diabetes was acquired n years ago in medical school
and since they are human, this knowledge is a) only hazily remembered
unless they use it regularly, and b) out of date.

I have worked in hospitals for many years (as a Medical Physicist in
Nuclear Medicine), and it was only when I started reading all about
diabetes when I developed type 1 nearly 4 years ago, that I realized
first how dangerous was the little list of blanket recommendations in a
recent highly reputable textbook on cardiac imaging about giving
glucose and insulin to diabetic patients who come for certain cardiac
scans for which they should be 'glucose loaded'.  It amazed me that
none of my medical colleagues had ever questioned it - I shocked them
by telling them that if anyone treated me according to those
guidelines, I would for sure be out cold - I have been educating them
ever since on this and other issues relating to diabetes and relevant
to ensuring that diabetic patients are in an optimal state for various

Some of them still thought they knew it all, but after an unpleasant
incident where they had 'guessed' how much insulin to give a patient
and sent him badly hypo (though since they were monitoring him closely
and had an iv line in place to give glucose just in case, the incident
was quickly dealt with), they decided to listen to me.

I then found that I was being asked to take a major role in patient
management decisions every time a patient showed up for a scan with
high blood glucose, and aware that I am not a dr, and feeling the
responsibility was too much and inappropriate, I arranged, with their
enthusiastic agreement, for an endocrinologist to come and talk to the
department, and he discussed with us the issues involved in determining
the optimal physiological state for scanning, and gave us some simple
guidelines (way more intelligent and flexible than the textbook) and
agreed to act as a consultant any time we cannot easily decide together
with the patient what to do (a lot of diabetics have very little real
understanding of their condition and their treatment, regretfully -
presumably due to a combination of doctors not educating them and
patients themselves who do not really want to know, just want to be
told what to do and not to have to think about it - I used to think
this was a myth, that it was all the doctors' fault, but now believe

>From the relatively few papers published on this subject (several by a
very serious group in Finland where rate of type 1 diabetes is I think
highest in the world), I guess that in most Nuclear Medicine
departments, this issue is not taken seriously, and that as a result
diabetic patients (assuming they escape the worse scenario of
well-meaning but ignorant physicians sending them hypo) may get less
than optimal images when they come for FDG scans (FDG is a radioactive
tracer which is a glucose analogue - you see why it could be a problem
area? - and is very useful for scans in cardiology and oncology).  We
are trying to put something together for a paper on this subject, with
the noble aim of educating the wider nuclear medicine community, but
there is a lot of careful work required to do that, and it won't happen
any time soon - maybe someone else will get there first, and in spite
of my need too to 'publish or perish', I would be delighted in this
case if they do.

This is of course only one example, relating to my specialty, but I'm
sure one can point to numerous other examples.


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