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November’s Diabetes Month presents opportunity for optometrist to share personal experience

November 18, 2012

Editor’s Note: In recognition of diabetes awareness month this November, optometry is putting the focus on helping patients improve their health. AOA Health Promotions Committee member Daniel Bintz, O.D., knows firsthand what it’s like for patients dealing with diabetes as he has the disease himself. Dr. Bintz talks to AOA News about his personal and professional experiences and also offers advice for all practitioners on helping patients with diabetes.

AOA News: Can you provide details of your own experience with diabetes as it relates to your choice of optometry as a career?

Dr. Bintz: I was diagnosed during spring break of my freshman year of college in 1978. I knew something was wrong because I was so thirsty and going to the bathroom all the time. I tried to be in denial and hoped it might just be a kidney infection but knew the symptoms of diabetes because of a high school term paper I had written on the subject! I just thought 19 was a weird age to get diabetes since people I knew either got it when they were under 10 or over 40 and at the time there was no family history (in the following years my two of my mom’s sisters and one brother developed type II diabetes).

I hadn’t made a career choice at the time but was leaning toward “something medical.” I had nearly ruled out med school because I grew up with kids whose dads were MDs and were never around. Not knowing how diabetes would really affect me, I decided even the stress of med school may not be a great thing. A classmate had been exploring optometry and was working for an OD locally and absolutely loved it. So she was probably the most influential person on my decision. I knew about some of the eye complications and general complications of diabetes, but after starting optometry school it seemed every topic we discussed had some sort of link to diabetes.

Self-monitoring blood glucose testing had just been introduced in about 1980, which is when I started OD school. Our patient population at the Oklahoma College of Optometry was the Cherokee Nation. Many Native Americans suffer from diabetes, hypertension, and obesity so this was a great population to study and treat. Before the school was started in 1979, there was virtually no eye care for the Cherokee Nation. So obviously we were finding both early and advanced complications of diabetes. I pushed very hard for the school to purchase a few glucose meters to be used in clinics to both educate the patients to this “new technology” and to add one more diagnostic tool for students and doctors.

AOA News: Do the majority of your patients have diabetes or what type of practice do you have?

Dr. Bintz: I wouldn’t say I have a majority of patients with diabetes but they do tend to gravitate toward our practice either through referrals from family doctors or by word of mouth. I am closing in on 30 years of practice, so my patient population seems to be aging with me! I have had a partner since 2004, and there is definitely a difference in the number of Medicare-age patients I see as opposed to what he sees.

AOA News: What concerns with your patients with diabetes do you run into the most?

Dr. Bintz: The biggest problem I see in our rural population is lack of understanding of the disease. Many have never been referred to even a dietician, and certified diabetes educators are nearly non-existent in our area. Soon after moving here, I started a diabetes support group. We met for many years, and then the audience began to shrink so we discontinued monthly meetings. Some of the area hospitals occasionally will have a lecture for patients, but not consistently.

I do think that overall doctors are finally getting more aggressive on the treatment because I do not see advanced retinopathy as often as I used to. I also think efforts are starting to pay off that encourage persons with diabetes (I hate the word “diabetic”) to have annual dilated fundus exams. Overall, I still feel that many patients are fairly clueless on the topics of diet and exercise.

AOA News: How do you feel having diabetes makes you a better practitioner?

Dr. Bintz: I think especially since I have type I it is easier for me to be empathetic with the problems people have controlling their disease. Diabetes is a very patient-intensive disease where the patient really becomes the doctor. With home glucose testing and now even home A1C testing, patients can monitor their glucose levels and know exactly what foods rapidly raise their levels and what exercises can reduce glucose levels.

Doctors who do not live with diabetes don’t fully understand the stress these patients experience on a daily basis. There is a never a vacation from diabetes for the person with diabetes or their family. Doctors seem to think that all the person needs to do is “eat right, exercise, and take their medication,” but life is never that simple.

AOA News: Do you have one case that stands out the most?

Dr. Bintz: Just this past month I had a longtime patient arrive as a “walk-in” complaining that over the weekend she figured out she could see better without her glasses than she could with them. She was over 55, overweight, and had a family history of diabetes. I reviewed her chart and didn’t see a diagnosis for her, nor any medications. So we talked about diabetes and how it can temporarily change your refractive error if your glucose levels are out of control. We did a random glucose test in the office that read 425 mg/dl (normal is 90-110).

I told her that it looked like we needed to get her family doctor involved. We called to make an appointment, and the nurse said, “Yes, we have been trying to contact her. We just got her lab results back.” Since she was a walk-in, I didn’t get to discuss diabetes with her very much before pushing her out the door to see her family physician. So I called her the next day and went over some things, and I had her drop by to pick up some resource material that we have from the American Diabetes Association.

AOA News: Do you have any recommendations for other ODs to help better care for their own patients?

Dr. Bintz: The American Diabetes Association, the National Eye Institute, and the CDC all have great patient education materials and websites. I try to give patients information on obtaining more information from these sources.

In addition, I ask each person I see with diabetes if they have ever seen a registered dietitian or a certified diabetes educator. If not, I try to schedule them with our local professionals. I also try to toss in diabetes complications information as we go through the exam.

I also have gotten much more aggressive on discussing smoking cessation with patients who have diabetes. I tell them that diabetes is the No. 1 cause of blindness in persons under 55, and macular degeneration is the No. 1 cause of blindness in persons over 55. Tobacco use quadruples the risk of developing macular degeneration, so when you add that to the diabetes, the picture for future good vision gets bleak. In addition, nicotine constricts blood vessels, which can increase the risk of hypertension and all of the complications that go along with that disorder.

And all of that negative talk is without even bringing up the cancer component! If you don’t do anything else for your tobacco users, tell them these things and tell them to get help from their family physician (or better yet, set up an appointment for them) and have them call 1-800-QUIT NOW nationwide.

Another great tool is the diabetes report form that gives a concise easy to read eye health report to family doctors (www.aoa.org/documents/AOA-Diabetes-Report-Form.pdf). This is available from AOA, as well as a tear off sheet called “Smoke Gets in Your Eyes” (http://bit.ly/RJ5H0B).

Dr. Bintz has authored several articles on this subject, including articles addressing the link between diabetes and depression, and also eating disorders – especially among teen type I females.

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