Wednesday, March 11, 2020

Retrospective #389: Don’t go to THIS* hospital…

As Hippocrates, the father of Western medicine said, “First, do no harm.” The warning is as true today as it was almost 2,500 years ago. If you go to THIS* hospital for outpatient Type 2 diabetes care, IT WILL CAUSE YOU HARM.
I discovered this while visiting my wife in 2017 as she was recovering from successful back surgery (yeah!). I decided to check out the cafeteria and along the way saw signs for the Diabetes Care Center and decided to visit. The waiting room and reception station were empty, so I just gathered up all the free literature I could find.
There were four types of literature available: 1) two 3-fold 8½ x 11 glossy sheets promoting the hospital’s Diabetes Care Center, 2) two 8½ by 11, 3-page, 2-sided color pages about “Healthy Eating” and food “Tips for People with Diabetes,” “brought to you by the AADE (American Association of Diabetes Educators), and “supported by an educational grant from Eli Lilly and Company,” a big pharma company that makes insulin, 3) two different 5 x 7 glossy magazines filled with diabetes drug advertisements, and 4) an educational flyer about injecting insulin.
As you can see, the theme that dominated this “individualized” diabetes education program was 1) drugs and 2) medical devices, to wit: “initiation of insulin, instruction on blood sugar monitoring, insulin pump therapy, continuous glucose monitoring sensors, medical nutrition therapy and follow-up education,” all the domain of doctors and RNs.
One of the hospital brochures specifically addressed advice for Pre-diabetics. For them, it said, “Dieticians who are Certified Diabetes Educators serve as resources,” both for “medical providers” [doctors and RNs] and “participants” [diabetes patients]. For the Diabetes Educators’ advice, I turned to the 3-page handouts on “Healthy Eating” and “Summer Fun and Food Tips for People with Diabetes.” And this is what I am warning you to avoid, like the plague.
Essentially, the American Association of Diabetes Educators (AADE), the organization of CDEs (Certified Diabetes Educators), espouses the same one-size-fits-all diet for Pre-diabetics and Type 2 diabetics that the Dietary Guidelines for Americans (2015) prescribe for everyone else in the U. S. over 2 years old: that is, “the plate method,” except  in the “Summer Fun” version, they call it “the paper plate plan”:
·         Fill ½ the plate with non-starchy vegetables (such as greens, green beans, broccoli, cabbage)
·         ¼ should contain meat or other protein (fish, eggs, low-fat cheese, cottage cheese, beans or legumes)
·         ¼ contains starch (such as a potato or whole grain bread)
·         On the side, include an 8-ounce glass of low-fat milk or a small piece of fruit
Also, you are reminded that a “healthy meal plan” should include “a limited amount of “heart-healthy fats.” Examples given are oils and nuts, all high in unsaturated fats. Meats should be “lean” and cheeses “low-fat,” in other words, as low as possible in saturated fats and dietary cholesterol. Straight from the USDA/HHS’s “Dietary Guidelines.”
Your plate in this “healthy meal plan” is thus ¾’s carbohydrates. But TYPE 2 DIABETES IS A DIETARY DISEASE!!! Of eating too many carbohydrates?!!! Doesn’t the AADE and their CDEs know that?!!! Apparently, they do because elsewhere they want you to “count carbohydrates,” lose weight and exercise. But how are you going to do that on THIS meal plan, especially, as they advise, if you eat “small snacks between meals…to help keep your body going”?
Answer: the hospital outpatient department will help you with 1) “emotional support,” 2) “empowerment,” and 3) “tools for self-care” (“education” and a meter). They will also supply you with oral medications (as needed, up to max dose of 3 different classes), then “initiation of insulin” injections, insulin pump therapy, continuous glucose monitoring sensors, and eventually – and here’s where THIS hospital excels – they’ll help you with bariatric (weight loss) surgery.
Want proof? THIS* nameless hospital proudly proclaims on a plaque in the corridor that it is ranked among best in the country for “Bariatric Surgery…” So, rest assured, once they get you in their outpatient diabetes department – as a Pre-diabetic or Type 2 – your diabetes will “progress” on their very high carb “healthy eating plan,” your glucose regulation will continue to deteriorate, and you will begin injecting insulin or using a pump and a Continuous Glucose Monitor, or become a candidate for surgery.  Solution: Don’t go to this hospital’s outpatient diabetes department. 

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