Can we take a stab at a concrete definition for ‘controlled’ vs ‘uncontrolled?’
These are such powerful words and people throw them around so willy nilly.
There has to be some more numeric, hard and fast definition.
Give me something that would hold up in court.
If words have no meaning than we shouldn’t even use them.
Control is an opinion. I suggest only your doctor can define control vs uncontrolled. In addition if you have two doctors, you could have two different definitions. Since it is not a scientific term I it is a relational term.
I think everyone works out a treatment plan with their care team that is right for them, and they continually adapt that plan for their situation.
“Control” is when individual is achieving goals that are designed for their situation. Not everyone has access to treatment, food choices, equipment, or medical resources, or the desire to even set goals.
The only possible answer there might be that the person is following/compliant (I hate that word), with doctors orders. That may hold up in court, unless proven that doctor is incompetent!
So, a Doc can define this however he wants, it can change at any time, and there is not any formal definition that I can ever meet to become a ‘controlled’ diabetic? Thats a tough standard to meet. That creates a lot of uncertainty for an individual.
I don’t think that plays to our benefit. We are all guilty until proven innocent. We are all, automatically, by default, defined as ‘uncontrolled,’ and incapable of anything. Beyond that, there is no standard we can meet before we are defined as ‘capable.’
No, I stated (implied) that patient and doctor agree on plan/goals together, based on patient input and ADA guidelines.
No agreement can be reached. War!
Therefore we should eliminate the concept of controlled vs uncontrolled, from a user discussion platform.
so, what - I pay another $350 and go to another Doc with no definition of what standard they would like me to meet? And, then another? Maybe I should just pay out of pocket and see a Doc who’s standard I am already familiar with. (I think that’s the best recommendation I’ve gotten so far.)
It all just seems pretty expensive to not have a formal standard. It also seems like they are asking quite a lot from me, to meet a standard that they can’t even define. If your not gonna adhere to the 2019 ADA standard, then you have to produce something else. Thats only reasonable. These types of hoops make people’s ability to live their lives prohibitively difficult. That’s not right.
War!
But it’s a subjective word, just like saying someone is pretty or handsome. So if a doctor writes controlled then in his opinion it is controlled. When you write you are controlled it is in your opinion controlled.
So example say you go into court and go I am a controlled diabetic, they might want proof or not. So you present copies of say clarity reports that say you are 70% in the generally accepted target range of 70-180, and less than 4% under 70. I believe that is the latest bandied about numbers.
And you take a copy of this page with you to show
Or you say I have an A1C of 6.9% and the aim is to be under 7% so I am considered controlled and you bring in something like this.
In both these cases it would benefit you to have several documents from well known sources like ADA, something widely known and accepted. I don’t think wedmd would cut it, but it was easy to find.
But if you need something from a doctor that says you are controlled it would still end up being from his viewpoint that he is signing too. Then you would need to talk him into believing you are controlled for him to be able to write it.
And if you are talking about not getting along with your doctor, yea switch doctors. But you won’t know until you see the doctor if whether you will get along with him or if he is even nice. You can try the internet to see if people have written anything about them. I know the endo I hated had several people not like him and even my GP said he had a lot of people not like him. They won’t always tell you but maybe counter people might etc.
Unfortunately seeing a doctor is trial and error.
Is this the ADA standard you refer too ?
Are you asking what doctors follow or other entities?
You make some good points.
I guess I claim that trial and error isn’t good enough. Its too expensive.
I live in a major metropolitan area and I had to drive 2 1/2 hours (in a blizzard) to get there. I was too afraid to drive, but I had someone else drive me (I closed my eyes much of the way). It was really, really dangerous. But, there’s not an option to simply reschedule because it takes 3 months to get an appointment and people in my state are under time restraints imposed by the state. There are deadlines. If I miss an appointment, I loose my ability to support myself.
I’ll bring more paperwork next time. Ill bring the standards, but they know what those are. This guys just has bad judgement. The good Docs keep retiring, or ending up in better jobs. They leave and then there’s a scramble to find someone new. There is, frankly, no one left.
I’m gonna request the medical record.
No, @MM1. Sorry, I can never find it when I need it. This kinda summarizes it: ADA Time in Range Guidelines: What They Are, Their Importance and How This Affects Diabetes Educators
And, just to be clear, I am off in some categories 1-2%. But, these are difficult standards to meet and I’mm calling that a passing score.
Do you have to have an endo? The very first endo I had after 2 visits I refused to go back to him. I was going to transfer groups but instead of driving farther I looked up internists and picked one that said they specialized in diabetes. They don’t know a lot, especially anything tech, but she could prescribe for me. When I told her I transferred to her hoping an internist could help because I didn’t like the endo, she said a lot didn’t like him. As soon as a new endo was hired in my group she sent me to her and I ended up being diagnosed right. Although an internist might get nervous if you aren’t “well controlled”. But you have the excuse of the endo being to far away and the snowstorms making it difficult.
Do request your medical records, it is eye opening sometimes. The GP I had had wrote I was non compliant about taking medications , I was non compliant because they made me sick, she didn’t write that part. I hadn’t really liked that GP either, she kept trying to put me on meds that were making me sick, along with the first endo, they are the ones I asked if ai could be a type 1 because my uncle had been and her reply was the medications wouldn’t work at all if I was a type 1. Her and that endo never bothered testing me. Switching doctors who in turn sent me to the new endo saved me from ending up really sick.
There was a 4 month waiting time in Calif for endo appointments. And an 8 month wait for new patients here. We just have a visiting one here. Although being type 1 on a pump my doctor got me in in weeks. The DE was also a 8 month wait.
Marie!!! 8 months!!!
That doesn’t work. You guys have the drivers license form, just like we do.
That means that the first time they meet you, they have to sign the form.
They have 15 min to talk to you before signing the form.
Thats the kinda stuff that gets them all worked up about their insurance/liability.
I think its unkind to ask them to sign that form after 15 min, the first time they met you.
This stupid form does disservice to them and disservice to us. Its diabetes bureaucratic insanity. It doesn’t make practical sense. This is why people hate treating diabetics and no one wants to do it.
@mohe0001. That is a really good article from an endos point of view. Gave me new insight as to why some might not like diabetic patients. Hopefully though most don’t feel this way, sounds like major burn out.
We need a lot more endos graduating with all the diabetics around, I know they are major overloaded.
Two years ago I developed a stomach virus which brought on severe diarrhea and vomiting which, in turn, brought on dehydration and high BGs (over 1,000.) In the emergency room, it was determined I had also suffered a heart attack, Keto acidosis And kidney failure. A subsequent cardiac cathertezation showed no blockage and it was believed that the thickened blood brought on the complications.
Though I recovered completely, It was recommended that I make follow up visits to a cardiologist and a nephrologist. When reviewing my records with each of these specialists, I noticed that each has classified me as a non-controlled diabetic.
However, If I check the history on my Medtronic 670G/CGM, it tells me that I have been in the target range 77% of the time and my SG (blood sugar average) was 144 for the past 30 days. To me, this indicates that I have my diabetes under control. Definitely better than when my A1c was above 10 prior to going on the pump seven years ago.
Over 1,000 !!! That’s amazing. I’ve never spoken to anybody who has broken 1,000. I hear about them, but never speak to them in person. Incredible. You are incredible.
What do you make of that much variability between sensor and lab? Which one is correct? This is the argument between me and my Doc. I see this argument popping up a lot lately. It gets to the fundamental point of the post, I think. Its pretty important.
This is an interesting (and complex) question. Thank you @mohe0001 for raising this issue.
Here is a link to Chapter 6 of the ADA 2020 Guidelines for Glycemic Control:
https://care.diabetesjournals.org/content/43/Supplement_1/S66
First, those ADA folks must really be on top of their game to have their 2020 report and guidelines available on Jan 5, 2020 …
I expect that a number of you will find this an interesting read. In my view (and I have no medical/pharmacological/endocrinological training) it is a detailed and nuanced discussion that brings in elements of A1C (with caveats about knowing whether an individual’s A1C runs higher or lower than that predicted by the eAG to A1C “magic equation”), variability in glycemic control for folks that have the same A1C, time-in-range, avoidance of Level 3 hypoglycemic events, age, ethnicity, etc.
Certainly this complex issue would be hard to easily translate into a yea-or-nay checkbox on some form that says “Is this person with diabetes well-controlled?”
But, as I understand it, at least here in the USA, this ADA document would likely represent the most authoritative definition of what constitutes good glycemic control.
Happy New Year all.
John
@John_S2 Very interesting read. Thank You!
My definition of controlled diabetes: having T1 for at least 30-50 years and not having any awful diabetic-related complications such as peripheral neuropathy, kidney disease, retinopathy…just to name a few.