Mashkikiwinini: “I don’t have diabetes.”

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By Arne Vainio, M.D
News From Indian Country 6-08

“I don’t have diabetes, I just have high blood sugars. My brother has diabetes, he’s on insulin.”

I was told this by someone I saw recently. He has not been in for a clinic visit in over 3 years. He was diagnosed with diabetes 4 years ago, came in for a couple of visits after that, saw the dietician once and hasn’t been back since.

He questioned his diagnosis of diabetes 4 years ago, even though his sugars were over 300 initially. His sugar on his recent visit was 386, but he has not checked any blood sugars at home for the last 3 years. Any sugar over 200 with symptoms (unexplained weight loss, excessive urination, excessive thirst) is diagnostic for diabetes. Any fasting sugar over 126 is diagnostic for diabetes.

He hit both of those criteria easily, but even after our recent visit refuses to believe he has diabetes. He refused a blood draw. “I ate before I came in, that’s going to make my labs high.” He refused to consider medicines as he was concerned about possible side effects. I ordered him a new glucometer, he promises to come back and see me in a month with his blood sugars. Will he come back? I sure hope so.

What other misunderstandings are out there?

“I don’t need to see the diabetes educator. I know all about diabetes because other people in my family have diabetes and I watched my grandmother give herself shots.”

Diabetes is more than giving insulin injections and much can be done to prevent complications from diabetes. We have much more to offer people than we did just a few years ago. There are new medicines, we can have an exercise trainer work individually with someone, we have a counselor to help with the stresses of diabetes, we have a Weight Watchers program and we have diabetes support groups so people can give each other reasons to take care of their diabetes.

At our clinic our diabetes support groups meet once monthly, but attendance is typically 0-2 people. This is out of about 600 people with diabetes in our clinic population. This is NOT because our diabetes program providers are not trying. They are very proactive in getting the word out and they stand behind their words.

“I knew I was going to get diabetes because my parents and siblings have it.”

We have a Diabetes Prevention Program at our clinic, and most clinics offer something similar. Let me repeat that: Diabetes Prevention Program. That almost makes it sound like diabetes can be prevented. Want to know a secret? Diabetes CAN be prevented, or at least delayed. Lots of us have risks for getting diabetes, and having multiple family members with diabetes is certainly one of those risks. For those with pre-diabetes (elevated sugars, but not high enough to diagnose diabetes), modest weight loss (5-7 percent) through regular physical activity and a low fat, low calorie diet is crucial. This is where our Diabetes Prevention Program is targeted. I went through our Diabetes Prevention Program, and am still in the program for a total 3 year commitment. This is a commitment, but it’s one worth making.

“I’m going to get the same problems others in my family with diabetes have had. It doesn’t matter what I do, I have no control over this.”

This is just not true. Personally, I am betting the farm on this one with my own family history. Just because my mother was on dialysis and needed a kidney transplant doesn’t mean that it’s in my future. When my YOUNGER brother had his stroke at age 46, this was a major wake up call for me. His diabetes was out of control when this happened to him. My favorite uncle had uncontrolled diabetes. I watched him go from being a strong mechanic, fisherman and hunter to a frail old blind man with a walker. He is the reason I still work on cars today and is responsible for much of how I look at life. Fortunately, I was able to tell him that before he died. Does it matter what I do? You bet it does.

“Once my blood sugars normalize, I can eat whatever I want.”

Diet is a very important part of taking care of your diabetes. Our job is not to deprive you of everything that makes life worth living, but cutting back on sweets, carbohydrates and high fat foods is essential. How many doughnuts does it take to make life worth living anyway? It just might be less than you think.

“Indian people need a higher blood sugar to feel better.”

I have only heard this from one person, and I don’t think I convinced him otherwise. In lots of ways we’re different than the rest of the population, but this isn’t one of them. Your hemoglobin A1c is a measure of your average blood sugar over the last 6 weeks to 3 months. This is a simple blood test and the number should be less than 7.0 percent (we use 6.5 percent). Any number of 8 percent or higher needs changes, anything over 10 percent is totally out of control. Controlling blood sugars decreases complications. For every 1 percent lowering of the A1c toward normal, there is up to a 37 percent lowering of microvascular complications (such as eye, kidney and foot damage). Those are pretty good odds.

“I don’t want to talk to anyone at the clinic because they’re just going to yell at me.”

For the most part, we don’t yell. But we do get excited. Especially about A1c numbers coming down, weight coming down and sugars getting better. With those things improving, we often see cholesterol profiles improving and blood pressures getting better.

“One thing you didn’t tell me, Doctor Vainio. Ever since my diabetes is in better control, my sex life is better.”

That one is NOT a myth or misunderstanding. But don’t just believe me, prove it for yourself. Make an appointment to see your provider. He or she can help you get your diabetes in better control. The blood sugars and A1c will be proof of your better diabetes control. Smug looks and silly grins will be the proof of your improved sex life. We’ll all be watching for them.

Arne Vainio, M.D. is a Family Practice Physician at the Min-No-Aya-Win Human Services Clinic on the Fond du Lac Ojibwe Reservation in Northern Minnesota.

He can be reached at: This email address is being protected from spambots. You need JavaScript enabled to view it..

 

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