In a separate thread, people are marveling at the fact that
the average A1c in America is 9%. The logical conclusion most
are coming to is that it must be bad medical advice.

In defense of the doctors, I think people have to look at
denial and non-compliance.

I go to Kaiser in LA (Sunset, if you know the area) which
services a large central city population. My nurse-DCE has
told me that most of her patients won't even test once a day.
She rarely recommends MDI because most of her patients won't
do it. She figures she's lucky if they will take one or two
shots a day.

My sister just took the class in intro to diabetes. They of
course taught the food pyramid. After the class she asked the
instructor why she didn't differentiate between fast and slow
carbos - like whole wheat bread over white bread. The response
was that they try to limit their recommendations to what
people actually might do.

So all the advice offered is aimed at the lowest common
denominator.

A friend of my daughter's lives in South Central LA. His
mother is severely obese and diabetic. She takes Glucophage
and tests once a day in the morning when she remembers. She
runs in the 150s and figures that means she's doing good. Coke
remains her drink of choice since Diet Coke tastes awful to
her. And she's an excellent cook who does a lot of baking. Her
brother just had a leg removed. That event has had no impact
in her diabetic regimen, nor his.

These are not stupid people, just very poor. She works (rather
worked, when she could still walk) as a pharmacy tech. She
knows about diabetes and all the drugs involved. She's just in
severe denial. So are her children who are both obese and one
of whom is a diagnosed diabetic.

Everybody in this news group is part of an elite: they can
read, write and get on the internet - and find news groups. By
definition, the performance level in this group is going to
far exceed the national average.

Additionally, the encouragement and sense of community in
this group pushes people to a higher level of performance
than they would achieve with the same level of knowledge but
without the group.

So I'm not surprised that the average A1c is as high as 9%;
I'm surprised it's that low.

Jon

"JonK" <jon~the-kaplansNOSPAM.com> wrote in message
news:405E0D23.5D9F5C02~the-kaplansNOSPAM.com...
  > In a separate thread, people are marveling at the fact that
  > the average A1c in America is 9%. The logical conclusion
  > most are coming to is that it must be bad medical advice.
  >
  > In defense of the doctors, I think people have to look at
  > denial and non-compliance.
  >
  > I go to Kaiser in LA (Sunset, if you know the area) which
  > services a large central city population. My nurse-DCE has
  > told me that most of her patients won't even test once a
  > day. She rarely recommends MDI because most of her patients
  > won't do it. She figures she's lucky if they will take one
  > or two shots a day.
  >
  > My sister just took the class in intro to diabetes. They of
  > course taught the food pyramid. After the class she asked
  > the instructor why she didn't differentiate between fast and
  > slow carbos - like whole wheat bread over white bread. The
  > response was that they try to limit their recommendations to
  > what people actually might do.
  >
  > So all the advice offered is aimed at the lowest common
  > denominator.
  >
  > A friend of my daughter's lives in South Central LA. His
  > mother is severely obese and diabetic. She takes Glucophage
  > and tests once a day in the morning when she remembers. She
  > runs in the 150s and figures that means she's doing good.
  > Coke remains her drink of choice since Diet Coke tastes
  > awful to her. And she's an excellent cook who does a lot of
  > baking. Her brother just had a leg removed. That event has
  > had no impact in her diabetic regimen, nor his.
  >
  > These are not stupid people, just very poor. She works
  > (rather worked, when she could still walk) as a pharmacy
  > tech. She knows about diabetes and all the drugs involved.
  > She's just in severe denial. So are her children who are
  > both obese and one of whom is a diagnosed diabetic.
  >
  > Everybody in this news group is part of an elite: they can
  > read, write and get on the internet - and find news groups.
  > By definition, the performance level in this group is going
  > to far exceed the national average.
  >
  > Additionally, the encouragement and sense of community in
  > this group pushes people to a higher level of performance
  > than they would achieve with the same level of knowledge but
  > without the group.
  >
  > So I'm not surprised that the average A1c is as high as 9%;
  > I'm surprised it's that low.

I don't know if the number is really 9% or not, but it
wouldn't surprise me if it were. I know plenty of
diabetics who are in denial and even more who are totally
uninformed about their disease. It seems that the most
common thought people have is that they just take a pill
or two and be done with
it. And most Drs. just assume that the majority of their
patients will think this way, so they don't expect
any more. These people probably have no clue what
their A1c is.

I know people with type 1 or type 2 who use insulin who have
terrible trouble with hypos. For them, tight control is next
to impossible to achieve. So they aim for higher numbers than
the rest of us.

I think those of us here on this NG are the minority. I've
been accused by one Dr. of exercising too much. When I told
her that exercise after both dinner and lunch was the only way
I could keep my BG down, she scoffed and said nobody needed to
exercise more than 3 times a week. This same Dr. also thought
I was being too extreme when I was unhappy with my numbers
that were running over 200 for several days due to an
infection that wasn't healing or being treated properly by any
of my Drs. At least I got my Endo. to listen to me and get
some additional meds.

Knowledge is a good thing, but rather meaningless if people
don't want to learn. And that seems to be how most
diabetics are.
--
Type 2 http://users.bestweb.net/~jbove/

On Sun, 21 Mar 2004 21:46:12 GMT, JonK
<jon~the-kaplansNOSPAM.com> wrote:

  >In a separate thread, people are marveling at the fact that
  >the average A1c in America is 9%. The logical conclusion most
  >are coming to is that it must be bad medical advice.
  >
  >In defense of the doctors, I think people have to look at
  >denial and non-compliance.

non-compliance has become the catch word for diabetes. There
are some who are in denial, some who are non-compliant and
just as many who have doctors who settle for less than optimal
numbers because they either don't want to put forth the effort
to motivate the individual or simply believe it is not got to
make any difference. You also have to keep in mind that the
majority of diabetics are NOT under the care of specialists.

Mack©® Type 1 since 1975 http://www.alt-support-diabetes.org
http://www.insulin-pumpers.org

In tribute to the United States of America and the State of
Israel, two bastions of strength in a world filled with
strife and terrorism.

"To announce that there must be no criticism of the
President, or that we are to stand by the President
right or wrong, is not only unpatriotic and servile,
but is morally treasonable to the American public."

...Theodore Roosevelt
  >
  >I go to Kaiser in LA (Sunset, if you know the area) which
  >services a large central city population. My nurse-DCE has
  >told me that most of her patients won't even test once a day.
  >She rarely recommends MDI because most of her patients won't
  >do it. She figures she's lucky if they will take one or two
  >shots a day.
  >
  >My sister just took the class in intro to diabetes. They of
  >course taught the food pyramid. After the class she asked the
  >instructor why she didn't differentiate between fast and slow
  >carbos - like whole wheat bread over white bread. The
  >response was that they try to limit their recommendations to
  >what people actually might do.
  >
  >So all the advice offered is aimed at the lowest common
  >denominator.
  >
  >A friend of my daughter's lives in South Central LA. His
  >mother is severely obese and diabetic. She takes Glucophage
  >and tests once a day in the morning when she remembers. She
  >runs in the 150s and figures that means she's doing good.
  >Coke remains her drink of choice since Diet Coke tastes awful
  >to her. And she's an excellent cook who does a lot of baking.
  >Her brother just had a leg removed. That event has had no
  >impact in her diabetic regimen, nor his.
  >
  >These are not stupid people, just very poor. She works
  >(rather worked, when she could still walk) as a pharmacy
  >tech. She knows about diabetes and all the drugs involved.
  >She's just in severe denial. So are her children who are both
  >obese and one of whom is a diagnosed diabetic.
  >
  >Everybody in this news group is part of an elite: they can
  >read, write and get on the internet - and find news groups.
  >By definition, the performance level in this group is going
  >to far exceed the national average.
  >
  >Additionally, the encouragement and sense of community in
  >this group pushes people to a higher level of performance
  >than they would achieve with the same level of knowledge but
  >without the group.
  >
  >So I'm not surprised that the average A1c is as high as 9%;
  >I'm surprised it's that low.
  >
  >Jon

JonK wrote:
  > In a separate thread, people are marveling at the fact that
  > the average A1c in America is 9%. The logical conclusion
  > most are coming to is that it must be bad medical advice.
  >
  > In defense of the doctors, I think people have to look at
  > denial and non-compliance.

I think both are true. Many folks won't follow good advice,
BUT some of the advice that is given is not good. When I was
diagnosed, my doctor had a nurse call me and say "Buy a
glucose meter and take Glucovance." Literally, that was all.

I got another doctor who I think is pretty good, but I'm a
veteran, so I went to the V.A. clinic to save money on
meds. The doctor there said, "Your A1c is 8.2& That's
excellent. There's no reason for you to test so often. Once
a week is plenty."

(By the way, I didn't need the Glucovance. Severe hypo the
first one, and never took another. Made the five percent club
within six months.)

--
Wes Groleau
------
"The reason most women would rather have beauty than
brains is they know that most men can see better than
they can think."
-- James Dobson

"Mack©®" <asdnospamhere~example.com> wrote in message
newsmds50hos5rmoj0p154rpa8lh4438erli7~4ax.com...

You also have
  > to keep in mind that the majority of diabetics are NOT under
  > the care of specialists.
  >
  > Mack©®

with 15+ million diabetics in the US alone I certainly have no
way to know if that's true. but yes people probably would do
better under the care of specialists.

"Wes Groleau" <groleau+news~freeshell.org> wrote in message
news:2dOdnaEJSLPg0sPdRVn-vw~gbronline.com...
  > JonK wrote:
     > > In a separate thread, people are marveling at the fact
     > > that the average A1c in America is 9%. The logical
     > > conclusion most are coming to is that it must be bad
     > > medical advice.
     > >
     > > In defense of the doctors, I think people have to look at
     > > denial and non-compliance.
  >
  > I think both are true. Many folks won't follow good advice,
  > BUT some of the advice that is given is not good. When I was
  > diagnosed, my doctor had a nurse call me and say "Buy a
  > glucose meter and take Glucovance." Literally, that was all.

when were you diagnosed?

  >
  > I got another doctor who I think is pretty good, but I'm a
  > veteran, so I went to the V.A. clinic to save money on meds.
  > The doctor there said, "Your A1c is 8.2& That's excellent.
  > There's no reason for you to test so often. Once a week is
  > plenty."
  >
  > (By the way, I didn't need the Glucovance. Severe hypo the
  > first one, and never took another. Made the five percent
  > club within six months.)

thats great about making the 5% club with in 6 months. i think
it took me 6 months to get a 5.1 on my a1c.
  >
  > --
  > Wes Groleau
  > ------
  > "The reason most women would rather have beauty than
  > brains is they know that most men can see better than
  > they can think."
  > -- James Dobson

"Mack©®" <asdnospamhere~example.com> wrote in message
newsmds50hos5rmoj0p154rpa8lh4438erli7~4ax.com...
  > have doctors who settle for less than optimal numbers
  > because they either don't want to put forth the effort to
  > motivate the individual or simply believe it is not got to
  > make any difference. You also have to keep in mind that the
  > majority of diabetics are NOT under the care of specialists.
  >

Hi, Four years ago when researching diabetes, I came across an
Article by the British national health service. I stated that
it would cost about $6000 per diabetic patient per year to
have an specialist work with individual patients. The cost
would ruin the system in no time. The recommendation was
education in support groups. But how do you get people in
denial, or who don't care to go support groups?

Fred Henzi

Mack©® wrote:
  > On Sun, 21 Mar 2004 21:46:12 GMT, JonK
  > <jon~the-kaplansNOSPAM.com> wrote:
  >
  >
     >>In a separate thread, people are marveling at the fact that
     >>the average A1c in America is 9%. The logical conclusion
     >>most are coming to is that it must be bad medical advice.
     >>
     >>In defense of the doctors, I think people have to look at
     >>denial and non-compliance.
  >
  >
  > non-compliance has become the catch word for diabetes. There
  > are some who are in denial, some who are non-compliant and
  > just as many who have doctors who settle for less than
  > optimal numbers because they either don't want to put forth
  > the effort to motivate the individual or simply believe it
  > is not got to make any difference. You also have to keep in
  > mind that the majority of diabetics are NOT under the care
  > of specialists.

Majority of diabetics? Majority of diabetics who are regulars
on this NG, maybe, but without all the people here confirming
your statement, I really doubt
it. But, then again, unlike you, I have new things to learn.

  >
  > Mack©® Type 1 since 1975 http://www.alt-support-diabetes.org
  > http://www.insulin-pumpers.org
  >
  > In tribute to the United States of America and the State of
  > Israel, two bastions of strength in a world filled with
  > strife and terrorism.
  >
  > "To announce that there must be no criticism of the
  > President, or that we are to stand by the President
  > right or wrong, is not only unpatriotic and servile,
  > but is morally treasonable to the American public."
  >
  > ...Theodore Roosevelt
  >
     >>I go to Kaiser in LA (Sunset, if you know the area) which
     >>services a large central city population. My nurse-DCE has
     >>told me that most of her patients won't even test once a
     >>day. She rarely recommends MDI because most of her patients
     >>won't do it. She figures she's lucky if they will take one
     >>or two shots a day.
     >>
     >>My sister just took the class in intro to diabetes. They of
     >>course taught the food pyramid. After the class she asked
     >>the instructor why she didn't differentiate between fast and
     >>slow carbos - like whole wheat bread over white bread. The
     >>response was that they try to limit their recommendations to
     >>what people actually might do.
     >>
     >>So all the advice offered is aimed at the lowest common
     >>denominator.
     >>
     >>A friend of my daughter's lives in South Central LA. His
     >>mother is severely obese and diabetic. She takes Glucophage
     >>and tests once a day in the morning when she remembers. She
     >>runs in the 150s and figures that means she's doing good.
     >>Coke remains her drink of choice since Diet Coke tastes
     >>awful to her. And she's an excellent cook who does a lot of
     >>baking. Her brother just had a leg removed. That event has
     >>had no impact in her diabetic regimen, nor his.
     >>
     >>These are not stupid people, just very poor. She works
     >>(rather worked, when she could still walk) as a pharmacy
     >>tech. She knows about diabetes and all the drugs involved.
     >>She's just in severe denial. So are her children who are
     >>both obese and one of whom is a diagnosed diabetic.
     >>
     >>Everybody in this news group is part of an elite: they can
     >>read, write and get on the internet - and find news groups.
     >>By definition, the performance level in this group is going
     >>to far exceed the national average.
     >>
     >>Additionally, the encouragement and sense of community in
     >>this group pushes people to a higher level of performance
     >>than they would achieve with the same level of knowledge but
     >>without the group.
     >>
     >>So I'm not surprised that the average A1c is as high as 9%;
     >>I'm surprised it's that low.
     >>
     >>Jon

Extreme-CC's wrote:
  > "Mack©®" <asdnospamhere~example.com> wrote in message
  > newsmds50hos5rmoj0p154rpa8lh4438erli7~4ax.com...
  >
  > You also have
  >
     >>to keep in mind that the majority of diabetics are NOT under
     >>the care of specialists.
     >>
     >>Mack©®
  >
  >
  > with 15+ million diabetics in the US alone I certainly have
  > no way to know if that's true.

You are absolutely correct. Like I've said, talk is cheap.

  > but yes people probably would do better under the care of
  > specialists.

  > I go to Kaiser in LA (Sunset, if you know the area) which
  > services a large central city population. My nurse-DCE has
  > told me that most of her patients won't even test once a
  > day. She rarely recommends MDI because most of her patients
  > won't do it. She figures she's lucky if they will take one
  > or two shots a day.

Studies have shown that the level of self testing has no
affect on one's treatment. In the study (I'll see if I can
find it) subjects were grouped by level of testing...there was
no significant difference in A1c's between the two groups.
Testing is not a means to an end !

  > My sister just took the class in intro to diabetes. They of
  > course taught the food pyramid. After the class she asked
  > the instructor why she didn't differentiate between fast and
  > slow carbos - like whole wheat bread over white bread. The
  > response was that they try to limit their recommendations to
  > what people actually might do.

Most people don't know what a carb is let alone the difference
between fast and slow. The concept of GI is way over their
heads. MOST diabetics do NOT take good care of themselves
which is why the numbers related to increased risks of
everything seems so ominus.

It is important to remember in that styudy they wer doing a
survey to see what folks are actually doing about testing, not
trying to find the best approach to get the best a1c result.
If they all tested 20 times a day and didn't make diet etc.
changes accordingly, it would mean nothing about a1c breakout
info. For we t2 folk, a better study would be to see how
testing is used to adjust behaviors concerning exercise and
diet based on the pp levels and then relate that to a1c
results. Based on the self reported results here, keeping all
manner of possible limitations in mind, a1c and use of testing
would be significant.
     >> > Any idea what "level of testing" meant/means?
     >> >
     >> How often the subject self-tested (how many times a day /
     >> how many days a week...etc).
     >>
     >> Still looking....
  >
  >Nope...this is the one....
  >
  >http://www.findarticles.com/cf_dls/m0CUH/6_24/76610101/p1/ar-
  >ticle.jhtml

Mack,

I think that we have to distinguish between the noncompliance
that comes from denial--a real and prevalent problem, and the
noncompliance that results when patients try the diets and
meds their doctors prescribe only to find that they have no
effect on their control

All too often, the female patient who goes on a low fat low
cal diet and can't lose weight is often accused of being
"noncompliant" and told that she's lying about her diet, or
not counting calories correctly. I have had this happen.
When her blood sugar goes up on the 300 grams a day of
carbs the Nutritionist prescribes, it is very easy to
decide that diet is ineffective, degeneration the only
future, so what the hell.

The stats from articles writing about how great Avandia is for
control are interesting. The typical patient has a fasting
blood sugar near 200 mg/dl and with Avandia it drops 30 mg/dl.
This is hailed as a great response. But the patient is still
way too high and feels like crap all the time. Their
complications aren't getting better either.

Finally, a lot of newly diagnosed patients are hearing from
their doctors that type 2s will deteriorate no matter what
they do. A lot decide that if that's the case, why starve and
torment themselves with drugs that have nasty side effects. If
the diet and meds prescribed make you feel like crap and don't
do anything to control your blood sugar, yes, you will end up
noncompliant.

Give the patient a diet that works to control blood sugars and
meds including insulin that bring down the blood sugars
effectively, and you might see a whole different pattern with
compliance.

-- Jenny - Low Carbing for 4 years. At goal for weight.
Type 2 diabetes, hba1c 5.2. Cut the carbs to respond to my
email address!

Low carb facts and figures, my weight-loss photos, tips,
recipes, strategies for dealing with diabetes and more at
http://www.geocities.com/jenny_the_bean/

Looking for help controlling your blood sugar? Visit
http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm

"Mack©®" <asdnospamhere~example.com> wrote in message
newsmds50hos5rmoj0p154rpa8lh4438erli7~4ax.com...
  > On Sun, 21 Mar 2004 21:46:12 GMT, JonK
  > <jon~the-kaplansNOSPAM.com> wrote:
  >
     > >In a separate thread, people are marveling at the fact that
     > >the average A1c in America is 9%. The logical conclusion
     > >most are coming to is that it must be bad medical advice.
     > >
     > >In defense of the doctors, I think people have to look at
     > >denial and non-compliance.
  >
  > non-compliance has become the catch word for diabetes. There
  > are some who are in denial, some who are non-compliant and
  > just as many who have doctors who settle for less than
  > optimal numbers because they either don't want to put forth
  > the effort to motivate the individual or simply believe it
  > is not got to make any difference. You also have to keep in
  > mind that the majority of diabetics are NOT under the care
  > of specialists.
  >
  > Mack©® Type 1 since 1975 http://www.alt-support-diabetes.org
  > http://www.insulin-pumpers.org
  >
  > In tribute to the United States of America and the State of
  > Israel, two bastions of strength in a world filled with
  > strife and terrorism.
  >
  > "To announce that there must be no criticism of the
  > President, or that we are to stand by the President
  > right or wrong, is not only unpatriotic and servile,
  > but is morally treasonable to the American public."
  >
  > ...Theodore Roosevelt
     > >
     > >I go to Kaiser in LA (Sunset, if you know the area) which
     > >services a large central city population. My nurse-DCE has
     > >told me that most of her patients won't even test once a
     > >day. She rarely recommends MDI because most of her patients
     > >won't do it. She figures she's lucky if they will take one
     > >or two shots a day.
     > >
     > >My sister just took the class in intro to diabetes. They of
     > >course taught the food pyramid. After the class she asked
     > >the instructor why she didn't differentiate between fast
     > >and slow carbos - like whole wheat bread over white bread.
     > >The response was that they try to limit their
     > >recommendations to what people actually might do.
     > >
     > >So all the advice offered is aimed at the lowest common
     > >denominator.
     > >
     > >A friend of my daughter's lives in South Central LA. His
     > >mother is severely obese and diabetic. She takes Glucophage
     > >and tests once a day in the morning when she remembers. She
     > >runs in the 150s and figures that means she's doing good.
     > >Coke remains her drink of choice since Diet Coke tastes
     > >awful to her. And she's an excellent cook who does a lot of
     > >baking. Her brother just had a leg removed. That event has
     > >had no impact in her diabetic regimen, nor his.
     > >
     > >These are not stupid people, just very poor. She works
     > >(rather worked, when she could still walk) as a pharmacy
     > >tech. She knows about diabetes and all the drugs involved.
     > >She's just in severe denial. So are her children who are
     > >both obese and one of whom is a diagnosed diabetic.
     > >
     > >Everybody in this news group is part of an elite: they can
     > >read, write and get on the internet - and find news groups.
     > >By definition, the performance level in this group is going
     > >to far exceed the national average.
     > >
     > >Additionally, the encouragement and sense of community in
     > >this group pushes people to a higher level of performance
     > >than they would achieve with the same level of knowledge
     > >but without the group.
     > >
     > >So I'm not surprised that the average A1c is as high as 9%;
     > >I'm surprised it's that low.
     > >
     > >Jon

gman99 wrote:

  > Studies have shown that the level of self testing has no
  > affect on one's treatment. In the study (I'll see if I can
  > find it) subjects were grouped by level of testing...there
  > was no significant difference in A1c's between the two
  > groups. Testing is not a means to an end !
  >
  > Most people don't know what a carb is let alone the
  > difference between fast and slow. The concept of GI is way
  > over their heads. MOST diabetics do NOT take good care of
  > themselves which is why the numbers related to increased
  > risks of everything seems so ominus.

Exactly my point.

Additionally, I find that some doctors (my doctor, who in most
regards is just marvelous) are cautious and tread lightly when
it comes to scaring the patient.

When he took me off Glucophage he said that one of my blood
tests indicated kidney trouble and that continuing Glucophage
was dangerous. He didn't say that I had kidney damage as a
diabetic complication from poor control, and that I had done
permanent, irreversible damage to myself. That might have
woken me up a little more.

Jon

gman99 wrote:
     >>I go to Kaiser in LA (Sunset, if you know the area) which
     >>services a large central city population. My nurse-DCE has
     >>told me that most of her patients won't even test once a
     >>day. She rarely recommends MDI because most of her patients
     >>won't do it. She figures she's lucky if they will take one
     >>or two shots a day.
  >
  >
  > Studies have shown that the level of self testing has no
  > affect on one's treatment. In the study (I'll see if I can
  > find it)

Please do. Since this appears to be, in my mind, a strong
possibility, I sure would like to see some directly observable
data, so that I can turn it into a fact.

I suspect that a part of this comes from my doctor (specialty
nutrition) who says...... (omitted to avoid a range war).

  > subjects were grouped by level of testing...there was no
  > significant difference in A1c's between the two groups.
  > Testing is not a means to an end !

Any idea what "level of testing" meant/means?

  >
  >
     >>My sister just took the class in intro to diabetes. They of
     >>course taught the food pyramid. After the class she asked
     >>the instructor why she didn't differentiate between fast and
     >>slow carbos - like whole wheat bread over white bread. The
     >>response was that they try to limit their recommendations to
     >>what people actually might do.
  >
  >
  > Most people don't know what a carb is let alone the
  > difference between fast and slow. The concept of GI is way
  > over their heads. MOST diabetics do NOT take good care of
  > themselves which is why the numbers related to increased
  > risks of everything seems so ominus.

Frank Roy wrote:

  > There is no way that the number of endocrinologists could
  > see all the diabetic patients.

In the American Medical Association publication, "Physician
Characteristics and Distribution in the US," 2004 edition,
figures for the total number of phyicians is 853,187 and the
number of endocrinologist is 4,461 for the year 2002.

Bear in mind that endocrinologist see people with thyroid,
reproduction, and other endocrine health problems besides
diabetes. I believe that current population estimates for the
US is about 290 million people. Many people with diabetes have
not been diagnosed. Those people would not be attempting to
see endocrinologist for diabetic reasons. Of the approximately
18 million people who may have diabetes maybe 2/3 have been
diagnosed or 12 million. That amounts to 2,690 patients per
endocrinologist if all of them only saw diabetic patients.
2,690 patients divided by 260 days (if these doctors worked 5
days per week and 52 weeks in the year) amounts to over 100
patients per day and about 12-13 patients per hour or 5
minutes a piece.

Frank