Carlos M Pablos, MD

The grandmother of the med student, should have been on a diet 10 yrs ago. If she uses Lantus, Its increased by 2 units aprox every week , if she had aftermidnight hypoglycemia, probably wasnt taking a bedtime snack. She didnt mention the Hba1c values, how is her GFR, if she is on ACE or ARB drug, how many times has been hospitalized. There are many parameters to evaluate quality of care and patients compliance often affects results.

My grandmother has been going to see Carlos Pablos for a while now, he is her primary care doctor. Neither of her nor I is satisfied with him. My grandmother is diabetic and she has been now for about 10+ years. I'm a medical student, and I can tell you that diabetes control gets more difficult the more years that you have had the disease. You need to re-evaluate patients when things are not working and try to figure out were the problem lies and how can you fix it. You need to listen to the patient's needs and work around them because patients are not going to accept drastic changes, specially elderly people. My grandmother uses 2 different types of insulin, a short acting 3x/day after meals and a long acting 1x/day in the morning. She has been having her blood glucose up and down for about a year now. What does Carlos Pablos do? "Tell her to raise her long acting insulin 2 units" - he says over the phone to a nurse who relays the message to my grandma when she calls the office… concerned that her sugar is out of control. Elderly people get scared about anything and diabetes makes things more difficult because it affects your whole system, you brain, your stomach, your energy. You get depressed, you can't eat well, blood glucose continues uncontrolled = spiral. This had been going on for about a year and all he does is continue to raise her insulin, what happens when he does this? My grandmother sugar goes down at night, too low, she wakes up thankfully and drinks a juice to bring it up. How is giving her more insulin going to help? He needs to assess the system as a whole, he needs to call her and have a discussion with her as to what is going on, what has she been doing recently, are there any stresses in her life, all of this affects sugar levels. Don't just tell the patient to cont' a medication when clearly that is not the answer because the sugar is still up and down out of control. My grandmother was having problems with her stomach, they did test and found nothing, she has diabetic gastroparesis - when there is a delay in food travelling from the stomach to the intestines - this causes discomfort and the patients cannot eat properly. Do you think he thought to do a test to diagnose this? Nope! But's that's ok because he excluded everything else. Do you think he tried to put her on a diet or 6 small meals a day and perhaps added medication to control nausea? Nope! He thought of the medication but not of the diet, the medication was not going to help with the diabetes and as long as her diabetes continued to be out of control she would continue to have bouts of stomach problems (which makes her depressed and scared). I had to give advice to my grandma, as a 3rd year medical students, and I can tell you now that it's been 1 month and my grandma has been controlling her sugars, it's great, and all because I took the time to listen to her. She is still taking the meds he gave her and now that is glucose is better controlled she feels more energized. I only ask that he talks more to his patients and don't disregard their concerns just because they are old.