Recently, I attended a round table discussion with some Family Physicians on Early Management for Diabetes. What the speaker said really got me to thinking. He said that at blood sugar levels greater than 90mg/dL (approx 2.5 IU), we should start giving hypoglycemic agents to patients. Most of the doctors in the group were amused because they all have fasting blood glucose levels of more than 100. What a relief that mine is just 87.
However, this is really a tough mandate. It is not frequent to see patients with sugar levels less than 90. Most come in at 100 and above, and for as long as it's not 126 and above, I just advise them to be careful with their diet. If their levels are 90, I just tell them to maintain their healthy lifestyle. The rationale for lowering the normal sugar level, the speaker said, was because of the fact that at 90, studies have shown that pancreatic insufficiency starts to surface, and that there is already insulin incapacity and he challenged us to be very aggressive in our treatment. Why should I believe him? He was the first diabetologist in the Philippines who did his research in the time of Marcos.
Yet, until now, I cannot seem to follow his advice when I see patients with levels greater than 90. I was always a conservative doctor. I believe that physiologic changes happen because at one point or another the patient abused himself or have taken in a lot of calories unknowingly. Besides, treating them at 90 means prescribing drugs which will add up to their daily expenses as if the consultation is not enough to worry them considering the decline in global economy. The American Diabetes Association still sticks to its less than 100 normal level for known diabetics and 126 and above for new patients. 100-126 is still Impaired Glucose Function.
Yesterday, I had a 42 year old female patient, (very pretty and tall, with a face that could pass as an actress), who saw her husband died in a badminton court while playing. This happened in February. She said he never had problems and always looked healthy, however, no screening consultation was ever done because he never felt anything troublesome. She came in with a blood sugar of 99. Previously she has 110. She was crying a lot and I knew her sugar level may be influenced by the stress she's having. I had the dilemma of putting her into drugs or not. Family history is positive for Diabetes and Hypertension. She owns several food cart franchise in different malls all over Manila.
More than her blood chemistry, I knew she just needed someone to listen. Her concern is the left lower quadrant pain she's been experiencing for the past 2 days. After her husband's death she became paranoid at anything that she feels in her body and as a doctor I fully understand. I know she's still within physiologic grieving and all I need is to listen and be a helping hand. I know she can afford hypoglycemic agents but is it of utmost importance at this time?
She cried after several minutes and I listened. I even shared with her my own experiences of 'depression' and how I was able to cope with it. I gave her medications to relieve her LLQ pain and requested for ancillary procedures. I advised her on proper nutrition. I asked her to come back with results of her new blood exams. I couldn't detain her long, the line of patients outside was long enough for me not to have lunch that day. Most of them were follow up patients. After 2 patients, she was back again, now consulting on what to do with her kids. I ended up giving her my calling card and advising her to 'call me' instead.
To treat or not to treat the 90? That is the question. Perhaps, I'll weigh the issues when she comea back 6 months after the death of her husband. When physiologic time allowed for grieving is over and she still cries in front of me--I'd probably consider addressing all the laboratory problems I'd see.
No comments:
Post a Comment