August 30, 2001
Daily Care, Type 2
Question from Texas, USA:
My three year old has type 1 diabetes, we recently visited his great-grandmother who has had type 2 for about 10 years, and after the visit, I am very concerned with the type of care that she is getting. I first tried to pass on some of the diabetes magazines when we were finished, but I don’t think that she really got much out of them.
In the ten years, she has never seen an endocrinologist. She only checks her blood sugar a couple of times a week before breakfast, and takes a pill. During her last visit to her primary care physician, he did a glucose tolerance test and was happy to see that she had an 80 mg/dl [4.4 mmol/L], which made no sense to me since she was already diagnosed.
Shouldn’t she be checking her blood sugar twice a day and alternating times? (i.e. pre-breakfast and pre-dinner one day and pre-lunch and pre-bed the next)? Shouldn’t she at least have an hemoglobin A1c reading a minimum of once a year? Shouldn’t they be running tests for kidney function (due to the diabetes) and liver function (due to the diabetes pills)?
About a month ago, she developed or sore between two toes that would not heal and became a very large ulcer that is just now starting to heal. Would that point to sugars running higher than she and the doctor think they are?
She has not really listened to anyone before when they have discussed what she really should be doing. She lives in rural Mississippi and seems to be very happy with the care from her current physician. I need to know what I should realistically suggest be included as standard type 2 diabetes care.
Answer:
You have brought up some very big points of concern for your son’s great grandmother. Even though type�1 and type�2 diabetes have different causes and treatment options, the standards of care and goals of therapy are the same. It sounds like you have reason for concern. If she is happy with her current physician and the care provided, it will be challenging to make changes until she is aware of all that is new in diabetes care.
If she currently does not have a diabetes educator on her team, you can find one in her area by calling 1-800-team up 4. This might be a good resource for diabetes support groups in her area to get new, up to date information about diabetes care. How about a subscription to Diabetes Forecast on her next birthday or holiday?
KS
[Editor’s comment: See Advice to new patients with Type 2 Diabetes, at the Diabetes Monitor, for some additional thoughts.
WWQ]
