As indicated previously the letter I sent previously was not effective. After being dumped by my previous primary care physician I was assigned a new one. In a closed system like the VA or Kaiser Permanente you do not choose your own doctor. One is assigned to you. In a single payer system where everybody will be forced into one closed system like the one in Canada or the UK, not only will veterans get fucked over, everybody, except perhaps the richest and most powerful will. Even if Doctors are allowed to provide care on a fee for service basis, only the richest will be able to afford both the cost of fee for service care and “insurance” where “premiums” (taxes) must cover the cost of cosmetic surgeries such as abortion, unnecessary statin drugs of dubious value, and dangerous, costly, and ineffective treatments such as insulin pumps. No one, not just economically disadvantaged vets will be able to tell their doctor to go get fucked and go down the street and find a doctor who does not believe high blood sugar is low blood sugar.
Fortunately for me and for the Republic, there are still a few Doctors inside the VA system with enough common sense and courage to stand up against this tyranny. When I told my new primary care physican, “You guys can’t normalize anybody’s blood sugar if your shoveling 200 or 300 bloody grams of carbohydrate a day down their throats.”, Dr. Donald Boles immediately acknowlged this was true. In my first encounter with Dr. Boles, he wrote me a prescription for both Regular and Levemir insulin in favor of Lantus and Novolog. While this still wasn’t everything needed, it was an important step in the right direction. After Senator McCain and his aide Tom McCanna agreed to fight with me, I sent them this memorandum which was forwarded to officials at the VA.
To: Senator John McCain and Tom McCanna
The mainstream medical community in general does not believe that blood sugar normalization can be achieved safely because of a perceived threat of coronary artery disease and the perceived increase risk of severe hypoglycemia or very low blood sugar when attempting to normalize blood sugars. These increased risks, which pale in comparison to the risks posed by hyperglycemia, or high blood sugar, are believed to be secondary to the high fat, high protein diets that must be used to normalize blood sugar levels in diabetics.
As a consequence all of the protocols and guidelines used at the VA and indeed by almost all other medical professionals and medical institutions in the west are designed to accommodate the very high carbohydrate diets typically prescribed to diabetics. This presents additional institutional and bureaucratic barriers to diabetics and physicians whose goal is normal blood sugars as the tools used to employ the methods ones uses to normalize blood sugars are far less widely available. For example most of the various types insulin available today are too potent by several orders of magnitude because the common dietary recommendations which call for diets that consist mostly of carbohydrate. Carbohydrate turns into sugar in the blood. Protein also turns to sugar in the blood but much more slowly while fat does not turn to sugar in the blood (nor does it raise bad cholesterol in the face of normal blood sugars but instead only raises bad cholesterol in the face of abnormally elevated blood sugars. In the face of normal blood sugar low carbohydrate, high fat diets only raise good cholesterol and high fat, low carbohydrate diets also depress triglycerides another blood lipid like cholesterol. Elevated triglycerides are the most reliable predictor of an increased risk of coronary artery disease with respect to blood lipids).
In order to have insulin of the appropriate potency I must dilute it. The diluent I need is available free of charge from the manufacturer if it is requested by a Doctor or Pharmacist. However in order to dilute the insulin I must have a container to hold the newly diluted insulin. Eli Lilly used to provide empty sterile insulin vials free of charge to their diabetic patients upon request. They no longer do this because of recently passed federal legislation which imposes burdensome reporting requirement and now these vials must be purchased from a pharmacy or medical supply store. The VA does not provide these vials because they do not see the value in normal blood sugars.
As indicated previously I hope you can help me get the VA pharmacy to reverse its position and provide me with the diluent and the vials. Considering the diluent I am requesting is provided free of charge from the manufacturer Novo Nordisk, and also taking into account that the insulin regimen I have been currently prescribed is cheaper and more effective than the insulin regimens commonly prescribed in conjunction with high carbohydrate diets, I believe the small cost of the vials is more than justified particularly considering that diabetics with normal blood sugars do not develop any of the costly and disabling long term complications of diabetes.
LCpl USMC (retired)