Replies to This Discussion

Permalink Reply by Gerri on May 29, 2012 at 2:25am

Frightening this man is a top endo. I'd run, not walk, from a doctor who's providing nothing you list that you need. What possible rationale could there be for stopping insulin with 160-170 pp & fasting in the low 100's? You know well that's not healthy & do you want to burn out beta cells by experimenting with your body for a couple of months, especially with a baby? An endo who instructs to stop testing & shrugs his shoulders at your concerns? His recommendation is to put head in sand & come back in a few months.

What's a thyroid tremor? Not heard that one before.

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Permalink Reply by Super_sally on May 29, 2012 at 2:50am

Hi Gerri,

If one is hyperthyroid it can cause a fine tremor. I actually don't feel hyper, but my FT3 is above range, so a slight drop in thyroid dose is warranted. Hyper can also cause rapid heart beat, etc.

Thank you for validating how I feel about this guy. He is a 'nice man' but I don't want him as my doctor any more. I really don't feel he is providing satisfactory care. And he is really not listening to me!!

I am having trouble low carbing at the moment due to massive food cravings. I don't know if that's because I'm a bit anaemic, because I'm breastfeeding, or what. My bolus insulin requirements are quite low, but I do need it.... I need someone to help me work out how to do this so that it works and so I can have tight control / a cheering squad. Someone other than just myself to be accountable to.

I've been given the name of someone who is apparently a very good GP. Will try him out... maybe I don't need an endo as my front line person. Will have to see if we click or not.

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Permalink Reply by Gerri on May 29, 2012 at 11:47pm

Hi Sally,

He certainly isn't listening to you & know how you feel on that front.

Can't say anything about food cravings & breastfeeding, but that seems plausible. You may very well need more breastfeeding & corresponding basal to handle this. Imagine the hormonal changes having a baby would cause fluctuations in BG also. I believe listening to our bodies & being attuned to our changing needs.

Hope the GP is the one for you. Please keep us posted. You've done an excellent job managing BG while pregnant & sure you can continue to.

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Permalink Reply by Brian (bsc) on May 29, 2012 at 5:19am

I think many of us have dealt with these sorts of endo problems. It really sounds like your endo has rediagnosed you wants to treat you as a T2. I thought you had put this behind you, been specifically diagnosed as T1 and that this was not an issue, but apparently not. I would be hesitant to follow the advice of a doctor that suggested that a T1 should stop insulin in order to do testing and prepare to have another baby. That just seems whacked. Perhaps it is time to get a second opinion. Although your second opinion may not "trump" this "top endo" it will be easier having a second opinion backing up any further discussion you have on this issue.

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Permalink Reply by Super_sally on May 29, 2012 at 4:46pm

The problem seems to be that he doesn't want to diagnose me as anything at all. He's the one with head in sand!

All along hes been saying GD. Nice of him not to want me to have D, but I think it's time to get real.

I don't fit GD and haven't for a good while, not least that I was taking insulin even before I got pregnant with baby 2, to keep the target blood sugars. I personally think LADA.

Second opinion coming up, if I can find someone who wants me if I am moving from the "top endo". Everyone knows him! He's also a minor celebrity here because he is the Dr of politicians, which means he gets on television giving statements about their condition from time to time.

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Permalink Reply by still_young_at_heart on May 29, 2012 at 11:16am

Can you provide a cite or link for:

"Historically we've been taught that fasting blood sugars should be around 90 and post-meal numbers should be below 140 for non-diabetics, but more recent studies have shown that this isn't always the case."

Thanks,

Maurie

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Permalink Reply by Super_sally on May 29, 2012 at 6:31pm

I had a look. Latest WHO publications are:

2011 on Use of HBA1C for diagnosis. http://www.who.int/diabetes/publications/report-hba1c_2011.pdf

The executive summary stated:

"The WHO Consultation concluded that HbA1c can be used as a diagnostic
test for diabetes....

An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes.
A value less than 6.5% does not exclude diabetes diagnosed using glucose
tests. The expert group concluded that there is currently insufficient evidence to make any formal recommendation on the interpretation of HbA1c levels below 6.5%."

2006 on diagnosis of Diabetes http://whqlibdoc.who.int/publications/2006/9241594934_eng.pdf

Recommendation 1: The current WHO diagnostic criteria for diabetes should be maintained
– fasting plasma glucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose
≥ 11.1mmol/l (200mg/dl).
Despite the limitations with the data from which the diagnostic criteria for
diabetes are derived, the current criteria distinguish a group with significantly increased premature mortality and increased risk of microvascular and cardiovascular complications.

Recommendation 4 - The fasting plasma glucose cut-point for Impaired Fasting Glucose (IFG)should remain at 6.1mmol/l.

But reading through the source document, they state that these are the levels of blood sugar above which significant increases in mortality and morbidity occur. Ie. it states that rates of cancer go up significnatly for fasting blood sugars above 6.1 and 2 hour greater than 7.8.

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Permalink Reply by Super_sally on May 29, 2012 at 4:54pm

Thanks Jackie, I've calmed down now. Am also interested in the studies mentioned.

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Permalink Reply by Jonah on May 29, 2012 at 4:35pm

If you're going to go off insulin and not have him check blood sugar for two months, and you're worried that your blood sugar will keep going up and up, I suggest checking the blood sugar once a day or every other day and if two readings in a row are over 200, call it off (and call the endo). I would not be worried about after meal numbers like 160, especially because home meters can easily read high, and also, if they are consistently that high for real, it will show up in the A1c, and it won't cause short term problems. I don't suggest eating in a way that makes you feel bad or that you know causes dramatic highs.

I often have readings like those be off and don't have the endo talk to me about them because they aren't a big deal.

If you have an endo who you feel "doesn't hear you," then even iif his medical advice is sound it might be time to look for somebody else.

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Permalink Reply by Super_sally on May 29, 2012 at 4:52pm

Thanks for advice. It is nice to have different input and opinions here.

And many different views, which can help to see things from all angles.

I am a Bernstein follower (at least in priciples, though not always diet) and would like to keep things as close to normal as is practical. Though short term stopping with close monitoring shouldn't be too much of an issue. At least I'll have data to present to go look for my second opinion.

I think the bigger issue now is how he doesn't hear me / monitor things properly. So I am not satisfied with the service. I have a friend who also sees him (for thyroid) and she now feels the same way about him and is looking for another Dr.

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Permalink Reply by Brian (bsc) on May 30, 2012 at 3:15am

Remember, just because somebody is a "top endo" doesn't mean they are a good doctor nor are they a good doctor for you. You may recall my experience with my last endo. I chose that endo because he was a "top endo," he helped write the AACE diabetes guidelines and was prominent, published and well thought of. Unfortunately, non of that contributed to him being a good doctor. That was my mistake.

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Permalink Reply by Super_sally on May 30, 2012 at 3:56am

I just read your post that you linked! Wow!
But I do recall all your issues with being put on (not) on insulin.
Worst case I'll go it on my own, but would prefer not to.

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