Failure to Diagnose Diabetes: The Silent Risk Providers Cannot Ignore

We have seen core groups say, “I Am an Alcoholic, “I Am a Drug Addict,” “I am a Veteran who was exposed to Agent Orange.” Among those who were exposed to that chemical used to defoliate the jungle floor, we were introduced to a plethora of diseases. This is a large part of what people in general and HCP do not understand about veterans. I am not talking about PTSD; that tragic sequela still lacks the treatment to stop the suicide rates among veterans. These poor men and women not only smell the jungles, the blood on a battlefield, hear the cries of the wounded and dying, have tinnitus from the rockets, grenades and gunfire, and the constant noise of the choppers that brought us into an area and, sometimes, evacuated us. One of the sentences that you do not hear is, “I am a Diabetic.” Unfortunately, many who have this disease are unaware of it, until it starts destroying other organ systems. I can thank Agent Orange for my diabetes and because I was a combat medic in areas where this was used; I look forward to all of the other problems related to it such as renal disease, cardiovascular disease, severe neuropathy in my feet that sends shocks and a burning sensation to them without warning. I was spared from the PTSD because I had a spiritual experience in Vietnam that changed my life. You might say that I found the Pearl of Great Price.

I was reading an article from the National Blood Test Clinic entitled” Diabetes: The Silent Killer Hiding in Your Bloodstream.” It is silent because it is like hypertension: you feel surprisingly good most of the time. Others may notice that you visit the latrine a bit more often, but this could also be BPH. Initially there is not a burden of feeling lethargic or thirst more often, or that your vision is becoming a wee bit blurry, but this too will occur as the monster starts its inevitable tour of your blood stream and affecting these organs. We are all aware that there are three types of diabetes: prediabetic, type 1 diabetes, and type 2 diabetes. Type 1 is often picked up by a pediatrician; prediabetes is rarely considered except for results from a Total Metabolic Panel. Type 2 rears its ugly head with progressively higher numbers and matching elevate HgbA1c. This is also where renal impairment is found with EGFR, creatinine, and BUN.

What are the types and severities of the disease process in the average human being? A visit to an ophthalmologist will cause the discovery of diabetic retinopathy, which damages retinal vessels and if not found because it was not part of the patient’s orders or they were non-compliant, it can cause blindness. Non-healing wounds are also an indicator of this monster as wounds take up to six weeks to heal and I am talking about minor wounds and scratches. Deeper wounds take much longer and the smart victim of this disease will go to a wound care clinic. Wounds are more apt to have an infection and, due to poor circulation in their feet and neuropathy, the patient can develop pressure ulcers which they are unable to observe. Remember when we used to say,

“Honey, check out my abs.” Now it’s “Please honey, look at the bottom of my feet” I have walked in shoes with a nail or piece of glass in them and was unable to feel the injury that I sustained because of my neuropathy. I just could not feel the injury. These are the types of foot problems that have high infection rates and, after many wound treatments, without control and strict orders for ambulation, cause an amputation.

Another critical disease is renal disease, which cannot be reversed and can eventually cause renal failure which requires dialysis three days a week. This is every patient’s nightmare, but we hope that with a total change in our diet, we can slow the progression of this disease. As far as cardiac disease, people with diabetes are quick to undergo a discovery of their mortality as they visit the cardiologist and the studies demonstrate loss of perfusion and vessel damage which are two to four times higher for the possibility of stroke or heart attack. We are aware that these diseases do not happen immediately, but they will come just as snow in the winter in certain countries. This is why it is a silent killer and a monster that has invaded our bodies, like The Alien.

What can you personally do to prevent this for yourself and for your patients? Weight loss is the easiest and one of the more important corrections. Thanks to a total change in diet and lifestyle and GLP-1’s, I have lost seventy-five pounds in the last two years, and my blood glucose levels have improved. My wife thinks I can reverse this disease and stop insulin altogether. The dietary changes require the help of an RD, who will give you a personal education on the need to lower refined carbs and sugar. What are refined carbs? Pizza, white bread, pasta, pastries, and sodas. This is like a death sentence to an Italian! The dietician will give you a list of other foods that will keep your blood sugars intact. We also need to move our bodies either by walking, jogging, or going to a gym. It is absolutely necessary. Take the medicines prescribed for you and start to study these new medications. And try cutting your night movie early enough to get eight hours of sleep. I love my pillows and mattress because they both help me to sustain the sleep night that I have always desired.

Now for my colleagues in medicine, I have a stern word of guidance for you: DO NOT permit your tech, CNA, secretary, or any other person check your returned labs and radiographic studies. You ordered them and, therefore, you are responsible for them. You do not want to miss a rising HgbA1c, or a lowered EGFR or a change in your creatine on this patient. If a patient has progressed to an elevated level of glucose intolerance that required treatment and has developed a number of these signs of DM, you are responsible. You are responsible if you have not called them in, discussed the prospect of this disease from blinding them, placing them on dialysis, or having an amputation. It was your job and you failed your profession and your patient and your Failure to Diagnose will follow in a litigation. Of course, make sure that you have a personal policy but remember, you have still wounded your patient. Remember your oath, “Do No Harm.”

Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor