Hi everyone,
I am starting my senior year of nursing school and have to write a research paper dealing with something that I would like to change within healthcare. I would like to write about something diabetes related.
What are somethings you would like to see changed related to diabetes?
Having the retail cost of insulin reflect all discounts received by the Pharmacy benefit Manager (PBM) from the manufacture.
So I hope this doesn’t offend, but this is a subject than many of us experience.
Treating diabetics as a person with unique needs, and not as a stereotyped Type
This would mean that a T2 who needs pump /cgm would be treated equally in the decision making process to a T1 and not get the automatic pushback denial from physicians & insurers.
Eliminate/Outlaw For-Profit Health Plans
In the interest of making a yearly profit, insurance companies are gambling with our longevity and quality of healthcare. I have been typed on both sides of the spectrum, as a T2 and a T1. T2’s are treated like criminals and dismissed by healthcare since it is obviously all our fault we now have diabetes, while T1s rarely have to fight for benefits that are paid for by the healthplan. People don’t always fit in those neat little shoebox stereotypes. Utilization Management reviews are in place to deny benefits to people who are not willing to fight for every benefit. It’s the first line of defense for an insurance company to say no, we won’t pay for it even though you might benefit therapeutically by it, because then we would have to cover others and potentially diminish our profit margins.
The biggest change I would make health -related would be to outlaw For-Profit health plans and eliminate diabetes types. You are either insulin dependent or not. Simple.
I would like to see the price of insulin drop back down to what it was 10 years ago. It has more than quadrupled since 2008 and there are very few other medications that I know of that have done this, especially since the most used insulins on the market (like Humalog) are more than 20 years old.
As far as actual care by healthcare professionals goes I would like to see a change in how diabetics are treated by their Dr.s and nurses. So often we are treated like bad children who don’t know what’s best for ourselves and often if we feel there is something wrong but our A1C’s are okay then our concerns are brushed aside.
What’s worse is if we actually are doing badly, then we get all kinds of reprimands and lectures when most of us are doing everything we possibly can to take good care of ourselves and are stumped on what we could do to get better control. And one last thing is that most Dr.s are completely in the dark (in my experience) about just how much these life saving medications and devices cost so they act like refusing to go on a pump or buy a Dexcom is ridiculous when it’s really a matter of whether or not you want to have food on the table.
My brothers girlfriend is in nursing school and she did one of her papers on CGM’s so it’s nice to see this newest generation of nurses is getting some extended knowledge about diabetes.
Personally, I would like to see more correlation between diabetes and genetically altered wheat (done in 1985 and known as dwarf wheat). When wheat is eliminated from one’s diet, one can lose the weight and reverse diabetes. See “Wheat Belly” by William Davis, MD for source material and references.
I’m gonna start a citation list for you with some of the ideas mentioned above:
Price of Insulin
http://harvardpolitics.com/united-states/how-insulin-became-unaffordable/
Discrimination
http://main.diabetes.org/dorg/PDFs/Advocacy/forecast-stories/2009-05-defeating-discrimination.pdf
Quality of tools for managing the illness
Note: The following article is one of the most interesting I’ve read lately, but needs further investigation. People are scrambling to investigate insulin quality after it was published. It was posted by a member here: Insulin Concentration in Vials Randomly Purchased in Pharmacies in the United States: Considerable Loss in the Cold Supply Chain authors: Alan W. Carter, and Lutz Heinemann (you’ll have to get this from your library. It took me a while to get, but its not published online)
https://www.diabetestechnology.org/surveillance.shtml
Healthcare Data and Device Cybersecurity
If you need anything on healthcare device and data security, here’s my paper from last year. Its got a bunch of stuff in the bibliography you can use. It talks about how vulnerable our medical information is once it gets into the computer system at the hospital and how frequently hospitals are breached. Its a hot topic, but difficult problem to fix.
@mohe0001 your “Paper on Healthcare Data Cybersecurity” definitely speaks towards the recent discoveries with the MEDantex fiasco.
Those of us who live with diabetes all day, every day, swim in a sea a diabetes cultural ignorance and disinformation. Unfortunately, medical professionals are not immune to that circumstance. Culturally we look up to doctors and nurses as the experts in health. When we first encounter ignorance of diabetes facts and science, it is unnerving. Often, when we try to fill a diabetes information gap, we are discounted and dismissed.
What I would like to see changed in the current health environment is for medical professionals to increase their command of current diabetes knowledge. I’m not looking for mastery of diabetes; I realize that information in the medical discipline is exploding exponentially. No professional can keep up with all the developments in the field of diabetes.
I’m thinking that a program that could inform nurses and doctors of the basic facts about diabetes. Here’s a partial list of subjects that I think could help practitioners and patients:
The key and crucial differences between type 1 and type 2 diabetes.
The fact that 10% of people diagnosed with type 2 diabetes are actually type 1.
In the hospital, the importance of synchronizing food with the insulin dose. This is a simple yet demanding aspect of patient care that is not appreciated by health care professionals. Insulin mistiming alone drives much hyper- and hypo-glycemia.
Patient obesity does not cause type 2 diabetes.
No patient causes their diabetes. Shame and blame poison the relationship with the patient.
Insulin should never be used as a threat! It is a life-saving and potent tool. It’s prescription and use is never evidence of failure.
No diabetic can reverse their diabetes. Some type 2 patients, especially early in the course of their diabetes, may be able to reverse their symptoms but their diabetes is permanent.
Controlling blood glucose, even given important technical advances, is way harder than it looks.
Nutrition knowledge is critical for doctors and nurses to know, especially when treating diabetes.
When taking insulin, carbohydrate consumption is a big deal. Limiting carbs is one of the most potent tactics for controlling blood glucose for many diabetics.
Patients live with diabetes for 8,760 hours every year. Why doesn’t clinical medicine consider us partners in their effort to help us? Many of us resent being looked at merely as subjects, instead of partners. Nothing about us, without us!
@El_Ver, Haven’t heard about that oe. I’ll look it up!
Thanks everyone! I definitely hadn’t thought about some of these suggestions.
I totally agree with this. That is how I feel almost every time I go in to see my NP for my A1C and such.
That is part of the reason I want to go into Diabetic Education after nursing school. As a diabetic, I feel like I’ll be able to level with and provide non-judgmental care for my patients.
Price of insulin. It’s ridiculous how it’s gone up in price and you can’t help but think it’s because it has to be used, not a choice by a group of people.
More awareness in the medical community about LADA Diabetes. I had an uncle that died from type 1 in his 30’s so I knew it might run in our family. So when my sugar started being higher I caught it immediately, but at first I was told it was just a fluctuation and then when it kept going up and I asked if it was type 1, I was told by my medical doctor that the medications wouldn’t work at all if I was type 1. Then I’m sent to an endo as I was swimming 75 laps a day, keeping tight control of my diet, although still overweight. When I asked the endo if I could be type 1, I again was told I wasn’t type 1 and he wanted to try me on some medications again that had made me so sick before. (I was now on long acting insulin only) I refused to go to him and switched Doctors. I was sent to a new endo and the first thing she did was test me for type 1 and I hadn’t even asked at this point because I had given up on the idea that I was type 1. And guess what, I was type 1, LADA.
What gets me is besides the first Doctor, the first endo not even testing or acknowledging I could be type 1, I believe because I was overweight. I had no other issues at all, but have always been overweight and my sugars kept climbing. But with an uncle that had type 1, and it not being controlled with medications, besides the fact that the medications made me sick you would have thought they would have considered the fact I could have been type 1.
The new Doctor that put me on fast acting insulin along with long lasting insulin and then the endo that diagnosed me saved my life. My refusal to see the original endo and switching Doctors saved my life.
And I’m still running into people in the medical field that think you can’t have type 1 diabetes if you didn’t get it as a kid. That have never heard of LADA.
We all know there is probably more LADA’s out there not diagnosed and getting sicker because so many medical professionals still don’t seem to know anything or much about it.
I would like to see more education out there in the medical field. About the slower progression of type 1 in an older adult and that it’s a possibility.
The medical practitioners should better educate their patients to avoid carbs as the first line defense against high blood sugar and its resulting complications. This includes doctors and dieticians.
i would like to see routine testing of glucose and hba1c for all patients presenting at ER with any illness, particularly abdominal and flu-like complaints. So many stories of diabetes being missed, sometimes with fatal consequence, for adults and kids… the level of suspicion needs to be far higher.
I agree, Negg. The problem is that the medical practitioners are very often ignorant of this fact themselves—really!
Diet nutrition, nutrition diet.
Though many responding on this board may be type 1, the overwhelming majority of people in the US have, are getting, and get type 2, and it can be prevented. Let’s have the medical industry stop playing whack a mole, and prevent this thing before it can get out of the box. Start with ways to reduce sugar. First comes education, then legislation. As a nurse, one of your patients really is the community.
I agree with your premise, but please, let’s not perpetuate the sugar myths. It is an over simplification that will make it harder to get more accurate info taken seriously…
Nutrition, over all–of course—and exercise. But there is also a genetic element for T2, for example…
Judith in Portland…T2 for 11 years, very low carb eating and exercise only so far, anyway…but given the diabolic whimsy of this scourge, who knows for how long…I was a dancer for 40 years, but my dad was T2…I drew the short straw—my Big Bro and little sister were not so damned!..
What does this mean? Your entire message seems cryptic to me.
What does the T1D/T2D relative demographics at TuD have to do with your response to the original poster’s plea for comments from TuD to help inform structuring a nursing school diabetes research project?
Does your comment have anything to do with the shameful misdiagnosis rate of T1Ds as T2Ds?
You do realize that the molecular structure of simple carbohydrates like bread, rice, and noodles are simply long chains of glucose molecules bonded together and amylase, an enzyme found in our mouths, immediately cuts these bonds as soon as the food hits our mouths?
I’m sorry if I’m misinterpreting your words.
OK. Maybe I’m a little slow today. So you are addressing the original poster and telling her that the “patient community” is almost like another individual patient. Fair enough.
Do you agree that carbohydrates, especially simple ones, are really just another name for sugar?
Hello. Welcome to nursing! I went to nursing school at the young age of 53. When I graduated was diagnosed with DM2. This did not seem correct based on my diet which was vegetarian weight was 110 lbs on 5’7”. Took me 2 years to discover adult onset type 1. LADA. But even as a student nurse before diagnosis I could not understand why they were alway dosing insulin behind the curve. Test before meals and dose for that but no carbs consumed at meals. Not evidenced based practice in my book. Could go on about the meals themselves but will refrain.
I have excellent insurance which pays for pump, insulin etc but there are so many diabetics who cannot afford enough supplies and medication to keep diabetes under control. This is just so wrong on many levels. Would like the see more affordable. Thanks for listening and best of luck.