Replies to This Discussion

Permalink Reply by beechbeard on October 4, 2012 at 12:17pm

Are you with an endo or a primary care physician? First things first, I have been Type 1 for 41 years. When I first was diagnosed by a PCP (there were no BGM's) I was told to monitor my urine for ketones!! No ketones meant I was OK. When I finally connected with my endo (same guy for the last 26 years) my A1c was 12.9%. My quarterly tests run from 6.9 rarely to 7.2 more frequently and we both consider that pretty good control. I think you will probably get better responses than this one but this is the right place to look for help.

Something like 80+% of people with Type 1 get depressed. So do NOT beat yourself up when you feel down. I did it for so many years that depression became a habit. When I finally got that taken care of, it was wonderful.

Your doctor may think he is helping but it sounds like he is taking a 100% wrong approach. Education and discussion are ok - scoldings aren't. I used to teach pre-med students in graduate school. I better stop before I go off on the breed.

Your doctor may see you for 15 minutes at a time, 4 times a year. You have to live your own life the other 8759 hours every year.

• ▶ Reply

Permalink Reply by Josephine A Ni Dhomhnaill on October 4, 2012 at 2:23pm

Yes, beechbeard you are quite right about having to live with this the whole time. I wasn't aware that 80% of D's experience depression, that is far higher than I thought.
I eat what some people would consider a lot, I love bread and I just can't see the point in being miserable without it. I work my insulin around it. I do try not to go over 30g with each meal. This can be extremely difficult at times, it is hard. It's the price I'm willing to pay though to avoid complications. After reading other people's stories here on this site, it is obvious that the lower the A1c the better, that is around 5%. I understand fully what you mean and I know at times it is harder than others, but we can do it.
Alot of our success with bg comes from trial and error. You can do it. Just like me, its the motivation to keep going that is tough.

• ▶ Reply

Permalink Reply by Pastelpainter on October 4, 2012 at 2:42pm

I think that dr. is horrid. My CDE used to be like that so I gave him away and am much, much happier. You don't need telling off, you need a helpful analysis of how you can improve, I simply don't understand the mentality of these medical people who think telling off adults is the answer.

• ▶ Reply

Permalink Reply by Shawnmarie on October 4, 2012 at 6:19pm

So sorry you're going through this. I'm only one year in, so I don't have as much experience with this as you, but one thing I noticed from your post is that maybe you're viewing this as an all or nothing deal, but really it could be about finding balance. It sucks that your doc seems unhelpful, but remember you're doing this for you, not him. You could just say to yourself, "you know, the last six months were an experiment to see what happens when I pay a lot less attention to my D." Maybe for the next month or so you'll decide to pay a little more attention. Maybe for some meals go without the carbs you really want, knowing that for other meals, you're going to allow yourself more carbs. When I was first diagnosed, I told myself I would never eat chocolate, bread, pizza or any other carby foods again. I realized pretty quickly that I can't do that to myself. My last A1C was 6.5. No, not in the 5 club, but at a place where I can live my live without thinking about my D constantly. I think you'll find your balance. Sometimes you have to tip too far one way to see the path back to the middle.

• ▶ Reply

Permalink Reply by acidrock23 on October 4, 2012 at 8:36pm

I think that if you're running higher, like all the time, it means not enough basal. If it's just high after meals or stringing up in a prolonged manner after post-meal highs, probably the bolus ratio can go up. If it's both, it's both. Maybe look at the specifics of the highs and try to fix one number at a time? I eat pretty normally, maybe a bit less than rx'ed by a dietitian but not super low carb. I've tested and adjusted since I got a pump and it's worked. I think a pump is easier to manage this on b/c it keeps track of things in a way more detail than I ever did on my own.

Another "trick" is that I will eat lest carbs to "test" rates and ratios and make the changes on smaller, more consistent amounts of carbs, during the week and then splurging on the weekends. I feel relatively normal (ha ha...) foodwise and enjoy the human urge to celebrate and my#s are ok. It's very hard but if the doc made you feel badly about your results and, particularly, if he didn't suggest changes to improve them, I'd say maybe try to find a nicer doc? I look at docs "glamour pics" online first. When I was heavier, I'd look for heavy ones but these days I try to find docs who look nice, not "hot" but just people who look kind. Frankly, I aim for minority docs b/c I think they are likely to be underselected by patients in the suburbs and will be easier to get appointments with. In those cases when I've needed them, this has proven to be the case and, when something comes up and I have to switch, I can usually get right in. Maybe that's nuts but I figure that I want a doc who's cool in a certain way. I like my GP a lot and he's hilarious and will talk about food a lot if you get him going, which I like too.

• ▶ Reply

Permalink Reply by Crashette on October 4, 2012 at 9:14pm

Thanks for the input, since this afternoons pity party I have calmed down a little. My doc knows he can not help, he has referred me back to the intern specialist who only 6 months ago announced I was doing so well that he did not need to see me for a year. unless I needed him. It is just routine for the my regular GP to call me in when test results require review. They do keep good track of it all. I know my specialist will be there to help he is really nice. My GP is too just not so well received today. That beat yourself up thing we do when we do not have good control and we know it ! It is a balance thing and perhaps the push I need to say hey this sucks. I can have decent control with little carbs, and eating smaller meals. But that is not real life and that obsessive control of eating is what I hate the most. So maybe the pump is something that will help me be more normal.... or closer to normal. I still cringe at the thought of being plugged in I just do not want to be dissapointed at all the money spent on a pump to have poor results. I also hate the recording of everything I eat and the documenting of it all. Even with the handy Iphone apps. But I guess the time has come to once again become a self science project. I just want to be in that place of a veteran diabetic that has adjusted to ( for the most part ) where it a becomes second nature to make the adjustments and see the trends. I am still looking for answers and input, I do have the medical team needed to help too, but it is everyone on this website that has the personal experience with living with D. I know some of you have gone through this path that I now travel, help me find my way. Pump users tell me why I should go for it.... I need some convincing. I am scared.

• ▶ Reply

Permalink Reply by nel on October 4, 2012 at 10:49pm

I am confused ...Do I understand ...Doc is a GP ?? Lots of PWD wish their Doc would be as blunt as yours and NOT be happy with A1C of 7.1 ; on the other hand most of us need the guidance of the Diabetes Clinic Staff /and Specialist.
Being pro-active as a patient, meaning finger poking and not being reluctant to do something with the results is up to you , not the Doc, not the Clinic Staff , not the Specialist ( Internist /Endo ) ...Becoming a Insulin pumper will not help lowering your A1C , unless you decide to become pro-active and poke more and use the results of the tests . A pump is a tool , you are the driver ...for some it works better , for some folks it does not help with the hassles and cost. Talk to several CDE pump trainers face to face and ask for advise .Hang in is my advice (next year 30 years with diabetes ) ...hugs

• ▶ Reply

Permalink Reply by acidrock23 on October 5, 2012 at 3:06am

I dunno about talking to CDE trainers as I didn't really listen to medical providers. My biggest "push" to get a pump came from my friend's wife. He was like "you should meet her and talk about it." So we did (over Mexican food...) and, like the next day, I was like "I want one!" called my doc (GP@ the time...), he said "you need an endo" so off I went and probably was pumping like 40 or 50 days later. The first day I had it, I spent a lot of time in the meeting/ training going "hmmm, 2 or 3 tacos?" I had 3 and was at like 85 two hours after I ate them and was sold. The lugging it around took a couple of days to get used to but I don't even notice it most of the time now as it's become such a part of my routine.

• ▶ Reply

Permalink Reply by nel on October 5, 2012 at 10:16am

@ AC ...I have a great rapport with my pump trainer( since 2001 ) and still do ...everyone in my community and beyond , who deals with her have the same observation .There are a lot of insulin pumpers here of all ages .And I know a person in the area where Crashette is from ( Abbotsford ,BC ) , who is a trainer , Mother of a pumper and a pumper herself ...I respect her opinions as well .All I am suggesting to talk to some of these.

• ▶ Reply

Permalink Reply by Holger Schmeken on October 5, 2012 at 3:41am

The Levemir is advertised as a 24 hour insulin. So much is true. The problem is that the insulin activity is not distributed evenly over 24 hours. With your current one shot pattern you will have hours with higher insulin sensitivity in contrast to hours with reduced sensitivity. This makes it very hard to determine I:C factors in general.

Thus I would recommend as a first step to split the 18 units of Levemir into two shots every 12 hours. The two shots will combine to one 24 hours profile with a more evenly distributed activity of basal insulin. The first day of this transition will be rough but after the seconds shot at night things will level out. After the split you likely will have to fine tune the Levemir dosage. Very likely you will end with 12/12 or similar. The right basal dosage is the fundament of your control. If your basal needs are not sufficiently covered you will have not chance to compensate that otherwise.

• ▶ Reply

Permalink Reply by beechbeard on October 5, 2012 at 5:59am

All insulins have a time/activity curve that is not flat. For a basal (particularly the older formulations) how much it "helps" at one meal may not be the same at the next. So 20 g of carbs at a meal where the basal is at a higher level of activity will require a lower bolus than at a meal when the basal activity is lower. For MDI users, the flatter the basal curve, the easier it is to calculate an accurate bolus. This is particularly true if you have a job where you meal times and amounts may vary e.g. business traveler.

• ▶ Reply

Permalink Reply by Holger Schmeken on October 5, 2012 at 6:08am

Without glucose/carbs our body can not operate. We digest carbs at certain times of the day. Excessive carbs from our meals will be partially deposited in the stores of the liver. The liver then acts as our source of glucose for the rest of the day. For this constant stream of glucose coming from the liver the healthy beta cells would create micro-dosages of insulin. In insulin dependend diabetics the micro-dosages need to be replaced by deposits of basal insulin or by the basal program of the pump. The basal is expected to match exactly the glucose coming from the liver. Not more not less. This means it MUST be possible to skip ALL meals in one day WITHOUT getting high or low blood glucose. The basal insulin alone is expected to keep you steady. This is usually tested with a basal rate test where you do fasting for 1/2 days (one day for the first half and the second day for the second half). This test is necessary to find out if your basal needs are truely covered. It is very important that the basal is really covering 24 hours. Otherwise you will have unevenly distributed I:C ratios and uneven insulin sensitivities. To really make sure the basal is correct I always recommend to split the basal. I even would recommend to split Lantus for this reason.

In contrast the bolus insulin is just for the meal. It should exactly match the glucose coming from the digested carbs. I would be very unfavourable if your bolus insulin would in part needed to cover the stream from the liver too. This would mean you could never skip a meal without being punished with higher blood glucose afterwards. This is why it is so important to seperate the effects of bolus and basal insulin.

In my Glucosurfer project I have seen many glucose profiles in which people frantically try to fight high blood glucose with bolus injections. So they correct several times a day although two injections of the right dosage of basal insulin would have totally solved their problem. It is a tragedy sometimes.

• ▶ Reply

• ‹ Previous
• 1
• 2
• Next ›
• Page