Thinking About Diabetes and Cardiovascular Disease

I do not know if I ever mentioned this here before, but my mother has Type 2 diabetes, for more than 12 years. She manages with metformin, glipizide, and Januvia. She also has hypertension that she’s had since 1991. Over the years, she’s never been to see an endo, a diabetes educator, or even a dietitian. She was simply thrown a pre-printed Lily diet sheet and told to “follow it”, to take her medications as prescribed, and to test every so often. Her doctor doesn’t even ask for her bg readings. IOW, he takes a typical lackadaisical approach to type 2 management. She also smokes, anywhere between 8-12 cigarettes/day.

About 7 years ago, while she was working on paperwork for her business, she noticed one of her legs had turned dusky – very dark. It scared her enough that she went to her doctor, who dismissed it as little more than aging, told her to keep her legs up and to drink quinine (in tonic water). Over the years, that “funky” color has come back more and more frequently, along with increasing pain, and decreasing ablity to walk for more than 10 minutes at a time. On top of that, the pain in her leg has been disrupting her sleep for several years now.

Her doctor has attributed most of what was going on to the degenerative disks in her lower spine. That is, when he thinks about her pain and numbness at all. At her last regularly scheduled appointment, my mom finally pushed the doctor into referring her to specialists for this problem. She had two glucocorticosteroid injections, but the pain management specialist did not think that the injections were working like they should and that her left leg (bad leg) was cooler to the touch than her right leg. To him, that pointed to a possible vascular problem and he sent a recommendation to her PCP that she have a doppler study done on her legs. Though the PCP didn’t think it was necessary, he sent her for it, saying that “Nothing will turn up. Waste of time.”

He received the results on Monday and quickly referred her to a cardiologist. That appointment was today, and much to my mom’s surprise, she has a 100% blockage in her left leg – IOW, Peripheral Artery Disease. Turns out that almost all of her problems can be explained by PAD. He was able to describe her experiences over the past several years to a “T” because he has seen it in virtually each and every one of his cases. He’s recommended the placement of a stent in that leg to get the blood flowing once again, and she’s going to go in for the procedure next Tuesday.

While her problem could be attributed to age, hypertension, high cholesterol, or smoking or any and all of the above, I have to wonder how much of this problem can be attributed to her PCP’s mediocre treatment of her and her diabetes. He was quite lax and at times (at least to me) didn’t take her diabetes or her complaints seriously and let this go on for far too long. Now she’s facing at least this upcoming procedure, if not others (more than likely).

I know this situation scares me. It scares me not just because it’s my mom and this is an indication of CVD, which is SO common with diabetes, but because I can also see myself in this situation. I’ve had those same lax doctors who were all too willing to accept mediocre A1cs, who thought I was being too controlling when I achieved A1cs in the 5.x range, who ignored post meal bgs over 200. It makes me angry because I know this is not an isolated incident, I know it’s not just me. Or my mom.

hope your mom is feeling better and has stopped smoking. patients and doctors both gotta take this seriously. can’t believe he didn’t harp on her for smokiing at least

Is that the laziest doctor in the world? Have you fired him yet?

Good on you for being proactive in taking on diabetes.