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Caleb Warnock: Diabetes care in the U.S. is profitably broken

Focus on nutrition is lost because there is no profit in it.

(Leah Hogsten | The Salt Lake Tribune) Diabetes patients, their families and supporters rallied for those struggling with the high cost of insulin and paid tribute to those who have died from the disease on the Capitol lawn, Saturday, Sept. 7, 2019.

Diabetic care in the U.S. is deeply and profitably broken. Patients are instructed how to get healthy by a short nutrition class. The class does not differentiate by diabetic type.

As one doctor bluntly told me, “we know the patients won’t do it.” And the doctors are right. Most of us don’t change until we are forced by our health consequences. Every day, 230 Americans suffer diabetic amputation. That rate has risen 50 percent in recent years.

In an ideal world, diabetic care would be about early nutrition intervention. This does not happen because there is no profit in it. The U.S. has chosen capitalist health care. Whether for-profit health care is, on balance, ruining or saving lives is an endless, decades-old debate. Ideal care would rob the system of profit by preventing amputation, monthly shots in the eyeballs, stroke damage and more. Capitalism touts personal agency, but everyone acknowledges capitalist health care has victims.

Diabetes is a problem of nutrition, made better through nutrition. Take for example the treatment steps from the Mayo Clinic.

“Management of type 2 diabetes includes:

  • Healthy eating

  • Regular exercise

  • Weight loss

  • Possibly, diabetes medication or insulin therapy

  • Blood sugar monitoring

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.”

Notice that steps 1 through 3 are not something doctors offer. Diabetics are left alone to deal with nutrition. We must stop expecting doctors to provide us with the first three steps.

Compounding the problem is that, too often, I see diabetic pharmaceuticals act as a crutch. Giving medication without the first three steps makes those steps seem irrelevant. Many diabetics have said to me, if those steps mattered, the doctor would walk me through them. Because the doctors ignore them, clearly they are pointless or unrealistic. This leaves some diabetics without hope that nutrition can change their quality of life.

As diabetes advances, the body’s metabolism, along with regulation of enzymes and hormones, are increasingly damaged. This in turn makes weight loss increasingly difficult. In some cases this is made worse with medications, and worse still with insulin. Sustained and results-based nutrition counseling is needed to reverse this. Such intervention can save tens of thousands of dollars and much pain and suffering per patient.

It is worth noting that there are no pharmaceuticals to do any of these jobs. Metformin and sulfonylureas are “agonists,” meaning they induce the body to change insulin levels. In the long term, this exacerbates damage to the metabolic cascade, and production of enzymes and hormones. This is why most if not all Americans suffering diabetic amputation are on insulin and diabetic drugs, yet their toes or legs are not saved.

The influence we have over diabetes is healthy eating. Every complication is either removed or longest delayed by nutrition. The sooner we start, the more complications we remove.

Caleb Warnock

Caleb Warnock, Alpine, is a diabetic nutrition specialist working with diabetics across the nation via video conferencing.

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