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[IPk] Rant: Lack of basic diabetes knowledge

Aside from pitiful ignorance among 'experts' re pumps, Heather's e-mail 
reported, "The dietician was quick to denounce carbohydrate counting saying 
'it doesn't work'." The glycaemic index still works better for some people 
than for others, but if I _ever_ meet a dietician who tells me that carb 
counting is useless, I will scream and shout until he/she believes that it 
is the only way forward. (No kidding.)

Rant item 1) It seems to me that the NHS has a REAL problem with the concept 
of self-management. Diabetes would cost the NHS a lot less (in time and 
money) if people with diabetes got enough education and support to _take 
care of themselves_ properly. I would seek help if I didn't know why my 
HbA1c came back high. However, I don't regularly need a lot of advice (I 
lowered my HbA1c by a point earlier this year by myself). My independence 
saves the NHS an appointment or two, or even a hospital stay, no?

Rant item 2) I have been surprised and dismayed to see on this listserv 
questions about physiology and basic diabetes facts which I would have been 
able to answer within 6 months of my diagnosis, especially from people 
who've had diabetes much longer than I. How people can stay alive, much less 
avoid complications, without knowing the answers to some of them (for 
example: what causes diabetes, what factors other than 'sugar' can affect 
blood sugar, the long-term downsides of injections) astounds me.

Rant item 3) After doing it for about 7 years--less time than many people on 
the listserv--I think carbohydrate counting beats the American Diabetes 
Association's 'exchange plan' hands-down. The exchange system is too 
simplistic and not flexible enough for most people who eat (i.e., everyone). 
Figuring out the 'exchange value' for a cup of homemade lentil soup, for 
example, used to be a real exercise: "Lentils have protein...do I count a 
meat exchange? Then how many carbs? Lentils have fibre too, so that means 
subtracting something from the carb count [<--Aha!! Carb counting in the 
exchange system! How I noticed that at age 13 and the dietician Heather met 
doesn't see it _amazes_ me.]. Ah, and there's some ham...might be some real 
meat, or maybe fat, in there too...." The 'simplicity' of exchanges becomes 
pretty complex rather fast. I think any dietician who recommends 
exchanges--whether diabetic or not--should have to live by the exchange 
system for a month and see how it goes. Nyah!!!

Rant item 4) I think Julian might have hit on something about why the NHS 
won't go for pumps. Rather than rely on the bloody *research* that has led 
many major private insurers in the US to approve coverage for pumps--the 
research that shows that complications are more expensive than pumps, for 
example ('an ounce of prevention...'), the NHS is happy to look at the 
sticker price and say, 'Too expensive', and then look for (/spend money 
inventing?) reasons why something that has been shown to work around the 
world just won't work in Britain. I could start on the chicken pox vaccine 
and autism thing, but I won't.

Rant item 5)  Would a medic please comment on why GPs and specialists seem 
to leave so many rather capable people with diabetes in the dark about what 
is going on inside their bodies? Does the British medical establishment have 
'what they don't know won't hurt them' as an unofficial motto? Do medics 
fear that the NHS will punish them for educating patients so that they 
demand adequate care? Does the potential power of better informed patients 
threaten to undermine the NHS's monolopoly-in-all-but-name? (I know there 
are some private insurance companies, but from what I hear they are not 
taking a lot of business from the NHS.)

Now to do the Latin I woke up at 5 a.m.(!) to do. Ha!

Ranting and raving at 6:36 a.m.,

IDDM 8+ years; MiniMed pumper 6+ years; American 21 years and resident in 
Britain 18 months cumulatively.

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