Friday, January 28, 2011

Whatever works

Dr. Grumpy: "How's the diabetic nerve pain been?"

Mr. Typetwo: "Awful. My feet burn constantly."

Dr. Grumpy: "Then let's increase the Neurontin dose..."

Mr. Typetwo: "No, I want to leave it as it is. The pain reminds me not to eat sweets."

15 comments:

Old MD Girl said...

Hey man, whatever works for her.

Grumpy, M.D. said...

I absolutely agree.

Lars said...

Talk about commitment.

Mark In Mayenne said...

Reading stuff like that reminds me not to eat sweets

medrecgal said...

Yep...just another reminder of why I've been trying to work so hard on losing weight. Don't want any of that DM stuff in my future, and I see it all day long in the records. Dude seems a little harsh on himself, though, but I guess whatever helps...

Anonymous said...

I would suggest that his current level of pain is not that bad(at least,not
to the screaming-give-me-drugs-now stage) since he doesn't want an increase. One day it probably will be.

Moose said...

Oh for crying out loud.

Medrecgal, body weight does not CAUSE diabetes, weight gain and/or difficulty losing weight is a *sign* of type II diabetes, coming from the insulin resistance that marks the more common form of the disease in people under 60. [Older people tend towards simple pancreatic insufficiency; the pancreas slows down.] This is actually a well established fact. Until very recently diabetes symptoms always listed them, until it turned into a "blame the victim" campaign of "if you're fat, you caused your diabetes," which is bunk.

If being fat were all it took, *every* fat person would develop diabetes, which is far from what happens. And please don't give me the "there are more fat people and more diabetes cases!" argument, which is a failure of the correlation-is-not-causation type. I learned that in 4th grade science, thank you.

Despite what the mass media, and, worst of all, medical 'journals' too often claim, nearly 50% of the people who develop type II diabetes are not medically obese. There is only one thing that guarantees whether you will get type II diabetes: Genetics. If either of your parents have it, your chances are very high. If both do, they are about 100%.

You can struggle to lose weight, but if you have the genetics for it you will almost certainly still develop the disease. Instead of obsessing over your weight, exercise - it is the best way, perhaps, really, the only way, to combat insulin resistance. If you can slow down insulin resistance you can slow down the development and progression of the disease.

Also, for the record, "eating sweets" will not trigger the onset of diabetes, either. However, once you have diabetes, *most* people can eat sweets, you just have to figure them as any other carbohydrate [or carb + fat, if needed] in your diet. Even the American Diabetes Association encourages diabetics to indulge - once in a while.

Anonymous said...

My primary thought my foot pain was a symptom of incipient diabetes.
Turned out it was a reaction to statins. It went away after I stopped taking them, hasn't come back and I still don't have diabetes, even though I'm fat. I walk to work & back every day. And now they say it may also prevent dementia. Bonus!

Anonymous said...

Ow. I would find another way to motivate myself.

Melissa

Jules said...

Moose, relax. I don't think Medrecgal was necessarily suggesting that diabetes is caused solely by obesity. It sounds like she wants to lose weight and maintain a healthy lifestyle in general to avoid future problems, including diabetes.

Anonymous said...

This is one disease I do not want so I have turned into an exercise fanatic. Type II runs in my family so if what Moose says is true then I am totally screwed. But if I stay thin (BMI 18.2) and exercise for 60-90 minutes a day I think I can avoid it. Time will tell.

medrecgal said...

Moose,

I didn't say it was a cause and effect relationship; I was suggesting that there is a statistical correlation between the two conditions. Of course I'm completely aware that obesity per se is not the cause of diabetes; however, in some individuals obesity causes metabolic problems which, in combination with things like genetics and age, eventually lead to the development of diabetes. It is a multifactorial problem that is not specifically tied to one cause or another. Yes, exercise helps, because it changes your metabolism in ways that reduce insulin resistance. And of course there are people of all sizes who develop diabetes. I'm curious where you got that 50% statistic, though. The numbers I see every day don't seem to support that. (Perhaps that's just our particular patient population, who knows?) There aren't relatively equal numbers of thinner and heavier people with diabetes. They are skewed towards those who are either heavier, older, or both. Usually those who are thin and diabetic are either type I or else really old. Of course, your mileage may vary.

thegooddrlaura said...

love it.

Anonymous said...

Anyone know anything about these new treatments for diabetic foot pain being advertised on TV? I've not seen a whole commercial, just heard about it from my mom who wants to try it. They use some kind of machine on the foot or something.

lovinmyjob said...

Not to mention, Neurontin increases appetite and decreases inhibitions. It makes it harder to say No to those sweets. I got a lecture from my neurologist about being complient with my Neurontin (800mg qid) so I decided that it was good advise and buckled down. Eighty pounds later I decided I would rather deal with the pain than to end up diabetic with heart disease.

 
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