I am insulin dependent diabetic and have a vested interest in this topic but I am interested in hearing the experiences and opinions of my peers on this topic. For the past three days, the New York Times has run a series of articles regarding the cost of diabetic care, the impact on the city and the diabetics themselves, programs tried and one that is currently being funded by a grant. For those interested, go to their website to read the complete articles.
We all know that there has been an increase in weight, in most adults and children. And we are aware of the fact that there has been a corresponding increase in the number of Type II diabetics. We are also seeing an increase in the hospitalization of those suffering from complications of their poorly controlled diabetes. What most of us fail to realize is the following:
1. Approximately 90% of diabetics are managed by their PCP.
2. Most PCP average eight to ten minutes a visit with their diabetic patients.
3. Medicare, Medicaid and private insurance re-reimburse less for the education and preventive care, then they do for the acute care such as amputations.
4. Most diabetics receive hit and miss education about their disease.
5. Many diabetic do not look at the long term complications, not being able to focus 10 or 20 years down the road.
6. Most diabetic are unaware of the importance of theirA1c test and its importance.
Several hospitals have opened diabetic centers where their outpatients meet in groups with diabetic educators and nutritionists. And they have access to endocrinologist, ophthalmologists and podiatrist. Studies have shown in improvement in the health of those attending such programs, weight loss, reduction in A1c percentage, improved nutrition and lessening of the number of complications. All three types of patients, Medicare, Medicaid and private insurance attend these programs. Now, one would think that with such proof, everyone would be willing to fund such programs. Guess what? No, no no. All but one, at Columbia has been forced to close its doors because of the loss of dollars. Apparently all three forms of coverage would rather spend its money on complications.
What does everyone think? Do you think that one or two education sessions are enough? Do you think it is a matter entirely of personal responsibility? That the people are responsible for the management of their own disease? Do some blame the diabetic for any complication he/she develops because if they managed their disease better they wouldn't suffer complications? How do you feel about the poor funding for the management of a chronic disease like diabetes?
Like I said, I am an insulin dependent diabetes, who also suffers from hypertension and asthma. I suffered a TIA in 1998 and it scared me. I became an insulin dependent diabetic in 2001. I have a problem with controlling my blood sugar because, one I love a drink of regular soda once a day and two I have to take prednisone, which effects my blood sugar. I fortunately have not suffered any complications although I have been a diabetic for fifteen years. Am I responsible for my high blood sugar by drinking that regular soda. Or can I lay the blame on my prednisone. Actually I think it is both. And I am dependent on my SIL for one meal a day, which tends to be high in carbs. What do you all think? Do you think, as a nurse I should be able to do what I have taught other diabetics?
