The first thing that happened that let me start getting the beast of diabetes under control was a switch from oral medications to insulin.
Let me back up a bit. When I was pregnant with my son 16 years ago, I had gestational diabetes. Back in those days (and possibly still today, I don't know), you couldn't use oral medication for treating gestational diabetes, so I had to use insulin. The needles then were quite large and the process was painful. (You also had to use a HUGE drop of blood on the test strips and let it sit on the strip for about 15 seconds before inserting it in the meter, if I recall correctly.) Anyway, I remember sitting there every morning with the filled syringe in one hand, trying to work up the courage to actually push the thing into my skin. I used insulin for four or five months, and it never got any easier, but it did help me keep my diabetes under very tight control.
Fast forward to about five years ago. Metformin was killing my stomach and it was time to switch to something else. I asked my PCP about using insulin, but she shot (no pun intended) the idea down immediately. "Let's try this first," she said, writing out a scrip for glimepiride. Yes, by all means, let's try the product that will help destroy my remaining functioning beta cells without giving me true control over my disease instead of the one that will actually WORK. But because I didn't know any better, I agreed.
Three years ago, when glimepiride alone wasn't doing the job for me anymore, I again asked about insulin. "Let's try this in combination with the glimepiride first," the doctor said, writing out a scrip for metformin XR.
Two years ago, the combination stopped cutting it for me, as well. At this point, all she could do was increase the dosages of both drugs, because my horrible insurance coverage (up yours, Independence Blue Cross, seriously) made it impossible for me to afford anything other than generics.
I finally decided I needed to see an endocrinologist. The first doctor I called actually answered the phone herself. This should have been the first red flag. She had no support staff. When I went into the office, she was sitting at the reception desk (though I didn't know it was her) and handed me the clipboard with the new patient forms attached, then took my insurance card to make a copy of it. Then she disappeared for about 20 minutes. I was sitting there waiting and all I could think was, "Isn't the doctor going to be pissed that the nurse isn't sitting here at the desk?" Then she came back and told me to come into the exam room, and it slowly dawned on me that this was the doctor.
To her credit, she did spend quite a lot of time with me, talking over my situation. I told her my insurance coverage was very poor and said I had to keep things inexpensive, to which she responded, "Don't worry, I'm an expert at that." Then she proceeded to order about $500,000 worth of lab work. (Okay, I exaggerate, but it was a lot.)
Then we started talking about medications. She first suggested increasing my metformin dose, and that was fine with me. Then she said "Actos," and I said no. Then she said "Avandia." I asked her about the cardiovascular issues associated with that drug, and she actually glared at me. "There are no cardiovascular issues with that drug," she snapped. "The endocrinology community is absolutely furious about the way that drug is being looked at now, because the charges against it are ridiculous."
At that point I decided this wasn't the right doctor for me. I just smiled and nodded and let her write the scrip, telling myself I would toss it when I left the office.
And then she started talking about statins, which I flatly refused. I no longer buy into the lipid hypothesis, and in any case I had been taking simvastatin for a while previously and it did horrible things to my short-term memory.
"Oh, I hope you'll change your mind," the doctor said. "This is a matter of life or death."
I couldn't get out of her office fast enough.
This put me off seeing another endo for a long time. Finally, I realized I was probably looking at the last decade or so of my life if I didn't do something about it. By this time, I had finally begun to educate myself and had decided I wasn't going to accept anything other than insulin. And thankfully, after taking one look at the kind of blood sugar numbers I mentioned in my last post, this endo decided to go straight to insulin.
This was the first step I took that let me finally starting getting my hands around this thing, and it took me 7 years to get here. What a ridiculous waste of time and money, and God only knows what it's done to my health in the interim. I will never understand why insulin wasn't offered to me earlier. I get that a lot of patients are very resistant to the idea of starting on insulin, but I was actually ASKING for it and my request was refused. Multiple times. What sense does this make?
None. At. All.
I cringe when I think how many uncontrolled diabetics there are out there who could be benefitting from the use of insulin, and it's not being offered to them. Maybe they don't realize that with today's insulin syringes, the injection hurts far, far less than the lancets you use to get a drop of blood to put on a test strip. (Many times I don't feel the injection at all.) Maybe they're worried about cost. (A vial of insulin costs me $25 at Walmart, far less than I was paying for Actos back when I used to take it.) Maybe they're worried about blowback from their insurance companies. (When I was shopping for better insurance -- a formidable enough task for someone with a pre-existing condition like diabetes -- every company I talked to asked if I was taking insulin. I suppose somehow this disqualified me from coverage, even though I have achieved far, far better control of the condition on insulin than I could have ever hoped for with the oral meds.) Or maybe they just don't know what insulin can do for them. I can't say.
In any case, my issue is not so much with the patients who for whatever reason don't want or can't use insulin. My issue is with the medical community, who insists on trying oral medications for such a long period of time, even in patients who want to be on insulin, and even when it's clear that the oral medications just aren't working anymore. How dare they fool around with the health of their diabetic patients this way?
How dare they?
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