/define rant On

Ok, so I know that not all doctors are stupid, nor should they be called blankety-blanks. However, there are some who truly deserve this and at the moment, my mother's doctor is one who has earned this title.

My mom had gestational diabetes when she was pregnant with me all those years ago and then again when she was pregnant with my brother. About 15 years ago, she developed type 2 diabetes. Metformin was the hot "new" drug back then and it caused her loads of problems, such as gastrointestinal upset and diarrhea and she stopped taking it. She took control of her diet, lost weight, and for a number of years, she was able to manage with diet and exercise alone. Then, her numbers started to creep up and she restarted Met, only this time in the long-acting form and at night, so the worst of the stomach issues were while she was sleeping. That worked for a short period then she added Glipizide XL, went on and off of Actos (after it caused her to gain a significant amount of weight that she has yet to lose), and then when Januvia came out, she was put on that. She's been on this "triple therapy" since around 2007. Depsite this, her A1cs haven't been below 6.8 since 2008. Maybe longer.

My mom's cardiologists who have been performing stenting procedures on her since 2010 haven't been happy with her A1cs since she started seeing them. They want her in the 5s. I personally want to see her in the 6s. Hasn't happened. Her most recent appointment with her GP was last week and her A1c was 7.8!! 7.8!

The last few times she's gotten her A1c from this guy, the office girls ask, "Are you watching your diet?" (GOD how I hate that question! How the blank can I "watch" my diet?? ALSO, ISN'T YOUR DIET SOMETHING YOU ACTUALLY DO??) Then they ask her if she wants to see a dietitian, to which she always responds "NO." It's not that she doesn't want some direction, but the last time she went to a dietitian, with my stepfather, they came home extremely disappointed. Not only did the dietitian FAIL to look at the food journal we had kept for him (just for a couple of days), not only did she FAIL to ask him about his eating habits (remember, this is the guy who considers breakfast coffee and cigarettes), she FAILED to offer them a diet plan to follow! This is likely to be the SAME dietitian this doctor will send my mom to. Hmm, think she has a reason to reject this woman?? She's afraid this person will do less than nothing to actually help her! I wouldn't go either.

So, when the doctor called last week to tell her that her A1c was 7.8, they asked her the question yet again if she was watching her diet and if she wanted to go see a dietitian. She admitted she wasn't doing well on her diet but that she didn't want to go see a dietitian. A few days later, the girls called back to ask if she would be willing to start insulin therapy. I've been talking to her about this for a while and she has finally started seeing this might be a good idea. So, she agreed, thinking that the doctor would have her come in for some instruction, discuss the different types of insulin treatments and prescribe a regimen that best fits her lifestyle. Yeah, DREAM ON.

Today, they called to see if she'd call her insurance company to see which long-acting insulin pen, Lantus or Levemir, would be covered and which would be cheapest for her. Not a problem; she made the call, found out which were covered (both), which was cheaper (Lantus), and the cost at both retail pharmacies and through mail order. Called the doctor's office back to let them know what she had found out and asked when her appointment with the doctor was going to be so he could talk to her about the options and show her how to inject herself. The girl on the line, though was a bit flabberghasted. Her attitude was "Why would you want that? YOU REFUSED to go see a dietitian. So, now you MUST go on insulin!"

Essentially, the doctor and his "girls" are making insulin out to be a punishment for failing to achieve the goals they set out for her and for not wanting to go see an incompetent dietitian. She hasn't been offered an individualized appointment with a CDE, she's only had stupid old Lily diet sheets from back in the 90s thrown at her, and she hasn't ever had anyone sit down with her to put all the parts together (hey, I am the daughter here, and she does not exactly listen to me) -- IOW, she's never been to a CDE, never had anyone talk to her on a personal level and design a plan that works for her, nor has she seen an endo or had the blood work done to help make some decisions as to what therapy/therapies would be best for her. NEVER.

Can you tell I'm frustrated? Can you tell I'm angry? This doctor is, IMO, doing everything wrong. He's treating insulin like a punishment for not doing as he says, he's not looking at her as an individual and sending her to see professionals to help personalize her plan, though the one professional he wants to send her to is little better than he is. If her behavior with my stepfather is anything to go by, she would do next to nothing for my mom. This is inexcusable. Hey, doc: INSULIN IS NOT A PUNISHMENT!! INSULIN IS A TREATMENT, ONE WHICH IS EXTRAORDINARILY EFFECTIVE! Dietitians: The whole goal of going to see you is to not only gain information about food composition and serving size (which, hell, I can find at, but to help create a meal plan specifically designed for the person sitting across from you. PUT AWAY YOUR STUPID PLASTIC/RUBBER PIECES OF CRAP AND ACTUALLY SPEND TIME TALKING TO THE PERSON IN FRONT OF YOU!!

Anyhow, I could continue to rant like crazy. I'm extremely upset at this turn of events. I know I didn't get this sort of treatment (in its own way, my treatment has been worse, though in other ways, it's been better) by my doctors. I'm angry and I'm very upset at this behavior. I know it goes on everywhere and frankly, it's GOT TO STOP. If doctors are serious about improving outcomes for diabetics, then they need to stop playing these blame games and start thinking about the individuals in front of them!

/define rant off

I think that the characterization of insulin as "punishment" or "failure" contributes to a lot of misunderstanding of T2 which very likely contributes to doctors and their flying monkeys failing to treat the disease properly and providing very poor information to their patients, when they are most in need of it. Your mom is very lucky to have a resource like you to help her!

The general societal hype about diabetes these days as "cureable" and "preventable" is an appalling load of stupid crap. "Treatable" yes but the underlying genetic problems will be there.