Tuesday, October 6, 2015


So, we are studying the endocrine chapter and I had the opportunity to refresh my knowledge about diabetes. I've railed about this for years here, and the typical response is along the lines of, "Yeah, people need to quit stuffing their pie holes". This is more of the same I guess, but I really would like a response about why my outlook is wrong. I think this link is worth taking a look at http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

I've made a point before that I think it is ridiculous for men to bitch about paying for contraception in light of how much we spend on diabetes. The link above and this graphic AND my time spent in clinical this past year have further cemented my beliefs. I found another link here that I also think is kind of interesting http://www.theatlantic.com/business/archive/2012/03/the-fiscal-conservatives-case-for-spending-more-money-on-birth-control/254442/

As I have learned from my textbook, 90% of all diabetics in the US are Type II diabetics. In the case of Type I diabetics, who are unable to make insulin, there is really nothing they can do about it. The cells in the pancreas that make insulin are destroyed and they are dependent on insulin for the rest of their life. In the case of Type II diabetics, there is a strong genetic component, however, there is also a lot that an individual can do to either stave off the disease, or stave off complications. In the past year, I have taken care of several patients who, after receiving a diagnosis of diabetes, promptly went on a diet, increased their exercise, and were off of medication within six months. Some other patients, on the other hand, who also seem to hate Obamacare, have gone in precisely the other direction and are on not only medication for diabetes, but are also on medication for cholesterol (note, not because of genetics) and are also on blood pressure medication. All of which are subsidized by private insurance or government funded insurance. In short, I am not only subsidizing their unhealthy lifestyle by paying for their medicine, I am also enabling their behavior because I will be able to prescribe medication for them.

Philosophically, I just cannot see any difference in the position of people who bitch about paying for someone to have risk free sex and my view that paying for diabetes like we do enables a set of behaviors that are equally gluttonous and void of personal responsibility. If conservative men have legitimate reason to complain about paying for a lifestyle they don't approve of regarding contraception, can they really be taken seriously. According to that article, 62.4% of the cost of diabetes is paid for by government insurance. Shouldn't we have the exact same gripe about diabetics? What about smokers?


  1. As an addendum, I want to say that in fairness, I fully understand that my argument above is not 100% cut and dried simple. At the office I do my clinical work in, we have taken care of some enormously, chronically ill people. Even though a condition like Type II diabetes is much more treatable than Type I, the reality is that when an individual has spent decades living a certain way, they simply may not possess enough reserve strength to make the changes necessary to alter the course of their diabetes. In such cases, it is what it is and possibly the best that person can do is get their medications down to 2-3 from 5-6 and I still consider that a victory. That said, Type II diabetes is still, IMO, a disease that really picks up in the face of a lifestyle of excess and my original question stands. If people can be allowed to opt out of paying for contraception on religious grounds, I honestly don't see how the same case cannot be made here on the grounds that gluttony is one of the seven deadly sins just as lust is.

  2. Points that I have made before.

    Their is much more to the diet exercise equation than either the food industry or the pharmaceutical industry and by extension the medical industry to share.

    1. Fast carbs act in insulin creation and subsequent insulin resistance in exactly the same way... Mashed Potatoes and gravy will make your blood sugar spike as rapidly and for a similar duration as pure sugar. People who use diet and exercise to control their diabetes and are successful at it for any significant amount of time MUST reduce and as much as possible remove almost all grain, pasta and root vegetables (Except for Sweet Potato). Exercise at the right times is essential. For instance if you take a moderate walk before dinner little except for exercise is gained but if you do the same walk right after you will almost kill any spike in blood sugar. Obviously your mileage will vary depending on pre-existing resistance and damage to your insulin producing pancreas islets.

    2. The use of statins is another topic of great controversy and very large studies in Sweden show that women actually have a better all cause mortality rate with levels deemed to by high by most western standards. The UK for a brief period of time decided that anyone testing with a 20% of heart disease within the next 5 years should be put on statins... that was reduced to 10%. With so many side effects and results inconclusive at best and the whole cholesterol subject as contentious as it is, it amazes me that doctors will put someone on a lifetime regimen for arguable results.

    3. We spend a lot of time and energy in the western culture protecting the feelings of our poor little darling selves... so much so that we now have an industry that caters to and glorifies being fat and as you say, rather than people taking the self discipline road of diet and exercise to prevent limb amputation, doctors routinely give them pills to compensate for the food they eat and totally let them off the hook for exercise.

    4. We force employers to hire these people who, regardless of their technical experience, show a clear lack of will power and resolve to control themselves. These people then become a productivity drag, sick day drag and potentially an image drag on the business.

    5. Because we are turning this not only into a public health issue but a publicly financed health issue, government will find the need to further regulate people behavior, through laws, regulations, restrictions and interfering in the pricing mechanisms of products people who exhibit self control wish to buy rather than let people associate with people they want to.

    As a side note. People who try to be prepared often times by things ‘just in case’ that have a shelf life and must be replaced from time to time. Many people have allergies to things like nut and bees so are advised to have an epipin handy. Now, the medicine in the epipin is not on patent and as of about a year ago according to friends, you could buy them for about $18 a pack (2 epipens) . Because our government makes it easy in the medical industry for people to do and price things that in other industries would see people in jail. A few firms have been given the rights to distribution... the cost this year is $500. It is my understanding the EMS folks can still get the 1mg vials for about 4.25 (3 doses) and the syringe (same as used by diabetics) is pennies.... You can’t buy it in Canada or Mexico of course because it is illegal... Canada will cost you $150 for a pack.....

    1. TS, You completely ignored my question with your lengthy filibuster. This is not to say you don't have some valid points, but it would be nice if you stayed on topic. In advance, I accept that the constitution does not allow for government sponsored insurance and undoubtedly, you can show with excruciatingly long detail that the government is to blame for obesity. I am not interested in that. This is a pretty straightforward question, IF people are going to say they shouldn't have to pay for contraception on religious grounds, can't the same argument be made that I asked about above?

      To your points
      1) 90% agree with the exception of the carb depletion. Complex carbs, in a balance with other vegetables and proteins is not a problem. That said, diabetics, to control their sugars, must be much more mindful of carbohydrates and sugars.

      2)I take strong exception to your second statement because it is the exact kind of thing that spreads ignorance. Mind you, not stupidity, but ignorance of the entire picture. Early generation statins DID have side effects, but those have improved substantially with each generation. You mention a study and provide no detail. In deciding to place a person a statin today, their cholesterol level is but one of multiple inputs. Did the Swedish women smoke, did they have diabetes, did they have high blood pressure? If they didn't have those things but had higher cholesterol, their risk for a heart attack or stroke will be way way lower despite the fact they may have overall higher cholesterol. I have not done the constitutional studying that you have, but on this issue, I feel quite confident my views are rooted in science that is up to date.

      3) Agree

      4)An interesting point, but I don't think we "force" employers to hire people who seemingly have no self control.

      5) My problem with this point is that IMO, private insurance is as much of a socialist program as public insurance is. IE, healthy people who don't consume resources pay for those that do. But because middle men who shuffle money around make a profit, we believe it is something other than what it really is. It's the same issue though. One side of the free market makes a shit ton of money selling garbage food that addicts people, and once they are addicted, other parts of the fabulous free market create drugs to fix the side effects of bad behavior. The free market rewards this behavior as surely as any government program you care to complain about.

    2. You wouldn't be asking the question if you believed #4. Let a less qualified person who was healthier and fitter get hired over a highly qualified obese person and let that obese person have any idea whatsoever that they did not get the job because of their weigh... let the discrimination suits fly.

      I did say "all cause mortality". Here is a link to an article... I can't find the study. I read it last year. Not searching for it correctly or something:

    3. I get it, you simply don't want to answer the question that posed.

    4. so here is the link to the actual study http://www.jnrbm.com/content/10/1/6 I'm not really impressed with the findings. First of all, this was a period studied nearly 15 years ago now, statins have gotten better, and the criteria for prescribing them has changed quite a bit. Second, you should read the discussion section at the end a little closer.
      "However, we do not know how much of the statins dispensed by the pharmacies in this study that were actually consumed, but adherence with statin therapy is shown to be rather low"
      "Data on life-style factors such as smoking, dietary habits or leisure time physical activities were not available on a municipality level. However, changes in life-style factors may be of much higher significance for changes in the incidence of AMI or mortality rates than statins "

      Also in the discussion, they noted that there WAS initially a reduction in events for me, and to me, this makes complete sense because women have much higher levels of HDL, or good cholesterol than med do. But, the doses used were also low doses of statins. By today's standards, there are low, medium and high dose regimens.

      For the record, I don't believe in prescribing a ton of medicine and as i said above, the free market is demanding that doctors provide relief for symptoms of a bad lifestyle, relief that drug companies have created. People demand medicine and are seldom pleased when my preceptor will not give it to them because he deems it uneccessary. That said, today's standards for prescribing have clearly changed in 15 years time, as have the medications that are prescribed. Data from a study conducted 15 years ago is a little old by today's standards, especially when prescribing guidelines and the drugs themselves have changed. Lastly, I didn't see anything in that article that talked about the all cause mortality you mentioned. If we are talking about the same study, which was mentioned in the link you posted, this study was very specific about measuring whether statins reduced acute MI's

    5. I don't know Max. Finally this month I get to start cutting back on medication from my stent placement last October. the one I don't lose is the one I hate the statin. There are numerous side effects still. Though nothing as serious as in the past they are just uncomfortable and annoying side effects. But hopefully I will get away from them within the next 6 months.

    6. There is no doubt, some people do not do well on the statin, IE they have muscle pain. In the clinic, we put people on CoQ10 simultaneously,and we also switch people around to different statins, try lower doses, or try to just have them take them as many days a week as they can tolerate. And even though that helps most, there are one or two who are just so sensitive they just will not take them. Muscle pain seems to be the biggest complaint.

      For those genetically screwed, cholesterol is just not manageable without a statin, though I've only seen that one time, and that was in the ICU. This guy had a total cholesterol over 600, and you just can't get that without genetics. Most though, if they really ramp up the exercise and really change their diet can't get down. not an easy process though. Have you tried CoQ10 with it? Most people here get whatever one is available at Costco and most say it helps quite a bit.