This article, based on my recent experience in a hospital, is written in the hope that it will serve as a cautionary warning to others who may be miss-diagnosed by doctors with diabetes, when all they are suffering from is “induced diabetes” induced by the treatment itself!
In October 2008, I visited the OPD of an Hospital with symptom of a severe allergy. Since my symptoms included (besides urticria, popularly called ‘hives’) also low blood pressure, low urine output and fever, I was advised hospitalisation by the doctor.. During the OPD consultation itself, she had enquired whether I had informed her that I did not and that I routinely tested myself for diabetes (among other testable conditions). The OPD case paper clearly notes “No History” of diabetes.
When I was given my discharge, I was stunned to find on the discharge card that I was not only diagnosed with diabetes but also prescribed a medication. The doctor had lift the hospital premises for the day. The discharge card itself had been filled in and signatured and included a clear miss-spelling of the prescribed drug as “Glimestar” instead of Glimestar.
I was taken aback at this diagnosis, yet was disinclined to believe it, not only because I had no history of diabetes, but also because I had no history of diabetes, but also because I had none of the 6 typical warning signs of diabetes (excessive thirst, excessive urination, etc); moreover, I had none of the major risk factors for diabetes (family history; overweight; high blood pressure; high blood levels of cholesterol an or triglycerides; or inactivity). Finally, I maintain a healthy lifestyle, particularly in terms of dietary moderation and regular exercise..
I felt certain there was an error in the works, and it occurred to me that my treatment itself (in particular, the intravenous administration of dextrose) may have caused raised levels of blood sugar, I checked this premise with other doctors and at reliable websites, including nlm. Nih. Gov. using the medline database; and mayoclinic.com I found that, not only intravenously administered dextrose but steroids too are among the drugs that can increase glucose measurements (in other words, give a false positive on a diabetes test). There are several other drugs that can also give a false positive on this test, just as there are several drugs that can produce a false negative. My treatment had included both, intravenous dextrose and dexamethasone (a corticosteroid). The sequence of testing in my case is also interesting, because it explains the contradictory results obtained in the tests themselves (to which the doctor paid no heed):
The first (random) blood sample taken immediately after I was admitted (i. e., before the IV drugs had built up in my blood), gave a blood glucose value of 115 mg% that is within the normal range. The urine sample, taken several hours after the IV infusion was started (since I was suffering from low urine output and the sample could be obtained only after I had been on the IV fluids for a sufficient time) showed “Sugar –Present +++”.
The second, i.e., “fasting blood sample”, taken the next morning, just about 4 ½ hors after the IV infusion had concluded (i.e., after I had been on intravenous dextrose for 13 hours straight), gave a blood glucose value of 180% described in the report as “High”.
To confirm my suspicion about the false positives, I did a glucose tolerance test at a well-established facility. This is considered the gold standard for diabetic testing: It measures blood glucose levels not only after (at least) 8 hours’ fasting, but also at 1,2 and (at some facilities like the one I went to), 3 hours after administration of a glucose drink. Blood sugar levels rise in different intervals after there are different ranges for that constitutes “normal” levels of blood sugar at these different intervals. My tests showed blood sugar levels all within the normal ranges. Clearly, there was no need for me to get started on anti-diabetes medication. I wrote to the hospital, pointing out that:
1. Dr. Dave, who had recommended both, the tests ad the treatment, was guilty of ignorance and or negligence in interpreting the results. As a doctor with an M. D. after her name, she ought to have known at least that dextrose and steroids can raise blood sugar levels; dextrose is commonly administered to hospitalized patients, and this raises the alarming possibility that so many other patients are also landed with false positives and started off on diabetic medication.
2. The diabetes testing should not have been done in the hospital so long as there was he likelihood of the IV infusions running interference with the results. There were no indications for any urgency in carrying out this testing, and it could well have been deferred.
3. Glimestar (Glimepride) is a potent drug, stimulating the release of insulin. It comes with its own long trail of possible side-effects, contraindications and drug interactions. Also, the doctor had given no consideration to the risks and complications that such a drug can cause by decreasing blood sugar levels in someone who actually has normal levels of blood sugar! There may be so many patients who, blindly believing in the doctor and the test results, will simple start taking a diabetes medication as prescribed.
4. My conflicting test results, taken in conjunction with the absence of a medical history of diabetes, of typical symptoms, of typical symptoms, as well as of major risk factors for diabetes, should all have pointed the doctor in the direction of asking for a repeat test under proper conditions..
5. Instead, we have here a doctor who did not even care to inform me about this firt-time finding of (presumed) diabetes even during her visit to me prior to discharge. She just jumps to a diagnostic conclusion, prescribes a drug and departs the premises! I was left to discover for myself the diagnosis on my discharge card and to cope with the aftermath too. It is irresponsible for a doctor to prescribe any drug without counseling the patient about side-effects and drug interactions, or even providing complete dosing instructions (there are several for Glimepride, as I found out in the course of researching this drug). Additionally, even if her diagnosis of “mild diabetes” had been correct, it was a cavalier act for the doctor to straightaway prescribe a powerful drug instead of first providing me with he option of trying to regulate my blood sugar level through diet modifications and exercise alone.
6. There kind of miss-diagnoses not only bring on the burden of personal trauma, expense and lifestyle impact, but also contribute some invalid statistics to the number of diabetics in the country.
In my letter, I said that Dr. M. K. Dave, as well as the hospital owed me at the least an apology fro both, the faulty diagnosis and the lapse in not recommending a repeat test in the circumstances, before prescribing a diabetes drug.
This was about 20 days ago. The hospital has not cared to revert to me. Perhaps it considers silence an expedient response in the circumstances; perhaps the unresponsiveness is part of the bigger picture of medical arrogance which continues to be rampant. Having given notice of my intention to the hospital, I wrote to the Maharashtra Medical Council, seeking action in the matter.
As a letter (by an M.D. –qualified doctor) in the New England Journal of Medicine had suggested (many years ago, but the comment is still valid), doctors should do business the way everyone else does on a fee-for service basis, in which payment is made only when the service is what it’s cracked up to be. Many physicians cracked up to be. Many physicians would consider it out of the question to pay a plumber for should dry work (the doctor wrote), but would to hesitate to charge for a treatment that did not bring benefit for the patient (the exception to this too-for service rule, he added, being those situations where results are fairly unpredictable). How much more liable a doctor is when the patient is landed with an inexcusably wrong and traumatic diagnosis, prescribed a medication that is unnecessary and any have adverse side-effects, and not even provided with a shred of counseling regarding this newly “diagnosed” condition.
(Many doctors will, of course, howl on cue that theirs is not a job like a plumber’s, but the for profit practices that an increasing number of them indulge in are well know to their patients, at least, and give the lie to their self righteous protests.)
