Posted by: notdeaddinosaur | August 11, 2008

How Not to Treat Diabetes

THUMP. THUMP. THUMP. THUMP.

This is the sound of a very angry dinosaur approaching.

Very nice 60-something patient with coronary disease, hypertension, hyperLDL, gout (the usual) and relatively mild diabetes. A1c’s over the last two years ranged from 7.3 to 7.8%; ie, not perfect, but not horrible, MANAGED WITH DIET AND EXERCISE*. Already taking eight different meds for coronary disease, hypertension, hyperLDL, gout (the usual), so I was emphasizing exercise, diet and lifestyle management. Certainly considering adding some metformin at the next office visit.

So this patient is admitted for some chest pain (after going to the ER without calling me first) which was presumably found to be non-cardiac. (I wouldn’t know; I never got any info from the hospital.) While there the blood sugar was found to be over 300. (I don’t know if they checked an A1c; I never got any info from the hospital. ) I saw the patient in follow-up the other day, only to find out…(wait for it:)

They had added three (3) diabetes medicines:

  1. metformin 500 mg BID (not just once a day, but twice!!)
  2. glyburide 5 mg BID (not just once a day, but twice!!)
  3. Januvia 100 mg.

Three new meds; all at once. Not one pill; not two pills; but five more pills a day were added to the medication regimen, when the A1C isn’t even over 8%.

Ok, all you cardiologists, (and endocrinologists; according to the patient one of them came by also) since you obviously weren’t paying attention on the second day of your third-year Medicine clerkship back in medical school; does this sound familiar:

Start low; go slow.

Hello!!! That means starting only ONE new drug at a time and WAITING to see how the patient does on it. MONITORING patients over “time” (that means not all at once.) You’re not going to fix the patient’s diabetes in 48 hours by loading up on meds in the hospital.

Ok; this isn’t working very well (since my hands are still quivering with rage) so I’m just going to have to try channeling the poor man’s CrankyProf:

You ignorant idiot fucktards! Bacteria in the bovine stomach fermenting grass into bullshit do their jobs more intelligently than you. It’s a wonder you figured out which end of the pencil to take your Medicine Boards with, especially since it was probably stuck up your ass to begin with. Scarier still is that ignorant innocent patients entrust their lives to you. Morons like you make me want to beat you over the head with a 2 x 4, just to try and knock some sense into you. Here’s the only problem with that: Why ruin a perfectly good 2 x 4?

Still hopping mad; this approach is simply not working. I’ll just leave it at this, then maybe go punch something:

Ignorant assholes posing as docs piss me off.

(*References: Exercise, diet and lifestyle management is the cornerstone of diabetes management.)

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