Submitted by a reader:

Dear Editor:

I used to work in the amputation unit at one of the LA County Hospitals.  I saw the nutritionist counsel patients on how to count carbs and calories. This just does not work.  When the blood glucose remained elevated, we’d add on a 5th, or 6th medication, or increase the insulin injections. And then we’d watch the patient come in for the 2nd bout of losing their toes, then their foot, then leg.

Diabetes management doesn’t work for the patients and doesn’t work for the rest of us that are usually paying for it.

People “want” to do the right thing and they “want” to keep their kids from getting diabetes and the resulting complications. We need to change the system drastically.

Here’s a better approach:

Get local organizations to provide more neighborhood walking groups in neighborhoods and more classes and sport clubs at local schools. At one of the El Segundo school tracks near my home there are groups of people walking nightly.  Provide information on what is available, so patients can choose to show up.

Stop subsidizing or providing carbohydrates, either through government programs, food stamps, food banks or school meals. Consuming carbs is the #1 reason that blood glucose increases. It is nearly impossible to lose weight consuming the foods that most patients with diabetes eat, whether or not they count calories or carbs. Eating carbs, especially refined carbs, makes you hungrier than eating protein and fats. If you are hungry, you will eat.

Diets must radically reduce carbs and absolutely eliminate all refined carbs, and increase the amount of protein and vegetables. It’s that simple.  No carbs, no high glucose. Provide lists of what to eat and what not to eat, with words and pictograms.

If you want to subsidize something, then subsidize fish, soy protein, meats and vegetables. Nothing else, please.  This would be much cheaper than increasing drug use—which again, does not work.

If someone shows up and they have not lost weight (because they are eating poor foods and are not active) then the blood glucose, cholesterol and blood pressure will stay high.  If there is no improvement, then there is no more treatment.  There must be consequences that are immediate.

This is fair for both the patient and for the taxpayer. I’m sure some may cringe at this suggestion. Go take a look in an amputation ward and then you’ll really cringe.  What is unfair, in every sense of the word, is keep low income people dependent on a system that does not work and which leads to amputations and other complications.  It is unfair to deny people the opportunity to take personal responsibility for their actions and the rewards that come with it.

It is also unfair to expect the rest of society to pay for ineffective treatment that is increasing at an average rate of 9.3% per year—that is, until we run out of money.  Since that day seems closer than ever, we’d better figure out a better way to manage diabetes, rather than vesting more and more dollars into a failed approach.

Note: If you present this argument to clinicians you’ll sometimes hear a story or two about a patient who did everything right and still had uncontrolled diabetes.  There are exceptions. But, you’d be hard-pressed to find anyone who would not agree that the overwhelming majority of cases are due to eating poorly and living sedentary lives. Type 2 diabetes, which afflicts most patients, is a lifestyle condition. Lifestyle involves choices.

Karen Shapiro, PharmD, BCPS Manhattan Beach, CA