I am working with a Diabetes NP. She works with the NNMC Bethesda, for the Diabetes Institute. I am having trouble dealing with her ideas and need some feedback from you because what she is telling me doesn't make sense.
I was on a low carb diet, I feel best when my BGs are around 120 but I have lower than that BG all the time and feel good that way too. I do not feel good when my BG is high.
I have had these strange directions to follow until Tuesday. Lower my basal by 20 units, take 8 units when I eat of fast acting. Don't worry if your BGs are over 200 or even 300 for the next week. write everything down, don't make corrections and eat at least 30 carbohydrates with each meal.
Can't for the life of me figure out what the rationale is behind all this and I have felt awful this week with these high blood readings. I guess she is going to raise the short acting when I see her on Tuesday?
She has problems with the fact that my long acting and short acting is not 50/50. When I get ranges from her she likes my fasting to be 120-150! Just keeping things under 200! She keeps telling me that I have no complications and that I don't need tight control.
I don't care for eating all these carbohydrates, I feel bad with higher BGs and I plain and simple don't get it. I am not even hungry anymore.
My AIC was 6.4, I was low carbing and going for a lower one, now this. I am confused to say the least. Just tell me is this total craziness or what?
I think that having the long acting vs short acting be out of whack, can be an indication that it's time for a "reset".
A drop of 20 in basal, wow, not sure what your doses are, but that's unimaginable to me! Way too big of a reset!
Are you using MDI? What is your short acting, Regular or Humalog or Novolog or ???. Lots of times Regular is a better match to low carb meals. It is possible that your basal was creeping up if you had been trying to match the fast-acting analog insulins to low carb meals. (As in "been there done that"!)
Hi Tim, I am using MDI and my short acting is Novolog. I have lost 17 pounds too in about a 6 week period so maybe that is why the drop is so big? It is making me feel a little bit better to read what you posted. Seeing her tomorrow and thinking she may raise the fast acting. I do not want to eat all those carbs though. I would rather just count the carbs I do eat, use more fast acting with meals. She is locked into the idea that I need a lot of carbs to give my brain nourishment. . .
If you lost 17 pounds that quickly it might indeed be time to lower your basal. Still 20 units lower, don't know your current doses, sounds like more than just a tweak!!!!
If you continue low carbing, seriously think about switching from Novolog (which acts over just an hour or two) and onto Regular. You might find your bolus doses going up a little and your basal dose going down a little after doing this. For me the fast acting analogs are just too fast for low carb.
I think Dr. Bernstein mentions something about Regular being a good match to low-carb. He has a point, Novolog or Humalog can kick in way too fast.
Tim has some good ideas there
You should say to her what Donald Trump says:
Seriously. Who cares what she wants your BG to be or what your ratio is. If your body is set up so you need 60/40 or 40/60 or some other %age, I would stick with that and keep doing what you're doing. Why did you see her in the first place? At the same time, I've noticed that when I had a lot of "basal bumps" programmed into my settings, basically getting some extra that way around meals, which worked great during the week but not so well on the weekends when I didn't eat at consistent times. I deleted the bumps and went back to mostly flat basals and found that it worked better once I got it straight? If she thinks something like that is going on and bears adjustment, she ought to be able to artculate it, particularly since you or LotsOfShotsInsurance are paying her money.
Hi AR, I am kind of stuck with going to her. I am having some medical problems now, neurological issues. Eleven years ago I got hypothyroidism and in 5-15% of cases, before hypothyriod can test and show and be diagnosed patients can exhibit psychiatric symptoms. I had what was thought to be a bipolar episode. The head of the Diabetes Institute was handling my case. They suspected hypothyroidism and gave me all these tests but nothing came up for thyroid. He sent me to psychiatrist who immediately diagnosed bipolar. I was put on all kinds of heavy duty medication, a mood stabilzer, anti-psychotic, anti-depressant, anti-anxiety, and a stimuant. I have taken these medications all these years. At the time thoughI was exibiting all the symptoms of hypothyroidism and was very ill. I was so zombied out on all the drugs that I guess I just thought that I was bipolar, and that I was just sick from side effects. Soon I did get the hypothyroidism and was treated for it. The sick symptoms went away but I continued with the bipolar medication. About 6 weeks ago I got very sick again, the hypothyroidism was out of whack but they didn't catch it in the blood tests. I started to have neuro symptoms, falling down and clumsy, slurring speech, shaking hands, and feeling out of balance. I felt so sick too that I ended up in the ER at Bethesda. They kept me overnight and they admitted me for a week. Psychiatrists interviewed me and found no symptoms of mania or depression, they took a full history and determined that I am not bipolar. I was kept in the hospital for a week for a "washout" to withdraw from all the psyche meds. I had a rough time there, could not sleep or eat, started shuffling my feet, and walking around confused and started having short term memory problems. They treated the hypothyroidism and I left as soon as I could and decided to finish clearing the medications at home, it takes about 6 weeks. I woke up about four days afte leaving with shaking and really an exacerbation of all neuro symptoms. Went to the primary care and flunked the neuro test. I was put on medical leave since I can't type or think clearly ect. I am scheduled for physical therapy and for the neuro evaluation and a brain scan and the symptoms could be permanent. Anti-psychotics cause neurolgical problems especially when they are discontinued quckly.
Now I have a team of doctors all trying to fix me. A primary care, neurologist, psychiatrist and psycholgist and physical therapist and this nurse NP with good credentials. I think that she is concerned about my brain, short term memory and maybe suggesting all the carbs for that reason?
I do not think that the doctors really know what to think or what to do but they are all working very hard to unravel this very complicated somewhat perplexing situation.
All that said, I still strongly believe that keeping blood glucose in the lower ranges, and low carbing is best, but it is a weird situation so I am unsure what to do or who to trust. I just know I have been on Tu a long time and I see tons of good results with lower carbs and lower and stable numbers and my own body right now is telling me that too.
I am more on board with Tu philosophy and I have mentioned it, the site and the ideas a million times, she freaks when she sees a 70 in my glucometer and calls that hypoglycemia. She talks of studies that show that stable is better than lower and yet I haven't seen any of these studies and many more here to support the opposite.
I can't "Trump" her because she is part of the group. She is putting me on a continous glucose monitor soon, getting that in the works. I see her tomorrow and everything I feel and know tells me no to the higher carbs and that maybe the insulin restistance is due to the 11 years of psyche meds that cause slow metabolism, high BGs, weight gain and fatigue. I have the belief that things will work themselves out and she is locked into treating me like I am a "diabetic" and not an individual. Whew, bet you didn't want to be the one to get all that info! Thanks though, I have been concerned about the diabetes treatment, just think like you said I was doing okay and stopping the psyche meds and dropping lots of weight and less of an appetite, seems like I was doing fine, not broke don't fix it, you know what I mean?
I do like her and respect her and I know she is trying her best to help. Don't think that cases like this are that common maybe. Just think I was doing ok before at least as far as the diabetes was going!
Wow, you have been through a lot! And I can understand now that your medical issues are very complex and you have a team working to unravel and treat them. That does put you in a hard place not only because you are expected to comply with the team's advice, but because you need their help. The only time I've felt that feeling strongly was with my cardiologist because heart issues scare me and I don't know much about them. I may be totally off base here, but I also am very tuned to the fact that medical personnel treat patients differently when they have a past or current history of mental health issues. It makes me wonder if in addition to "not treating me like a person but like 'a diabetic' they are also treating you like a diabetic who has had mental health issue, translation: whose judgement is compromised. Like I said I could be reading too much into this but I've seen it many many times before.
You may not have the answers with the complex medical situation you are in (like I didn't/don't with cardiology) but you have lots of answers and knowledge about your own body when it comes to D and diet. I guess depending on how you read this NP, your choices are the old "smile and nod" to her nonsense or to stand up and say, "no that is not right for me" I always try to pick my battles.
Hi Zoe, I have been on pins and needles durin this whole time, 6 weeks ago I was very involved in working full time, multitasking, typing fast, involved in complex projects, doing graphics, brochures, and presentations to all the medical teams, I presented to a total of about one hundred people, and I had a good memory. I was doing good work.
I went so swiftly down hill, and when I ended up in the hospital and they determined I was not mentally impaired, and took me off the medication it was such a relief. Being off those medications feels like a thousand pounds has been lifted from me and I have been released from a prison of sorts.
I had the same psychiatrist for many years and she is retiring at the end of June, I guess she was trained in the use of the cocktail of medications, where you just keep adding meds. Now in light of my neuro-symptoms and the fact that I have had no mania or any psychiatric symptoms at all for weeks being off medication, I guess the team has ruled out the mental aspect or at least put it low on the list right now.
I have written a letter to all the doctors on my case and the letter was 7 pages long and also addressed to the head of the heathcare system as well. I am now being treated by a team of doctors and specialists and they are coordinating care and communicating with each other. Even the doctor who first had me in the beginning with the hypothyroid issue has been consulted. I really feel that the doctors are on my side and feel that they respect me and are trying to give me good care and to recover.
I just think that with so many complications and from their own admission that they don't know what is going on with what or what is causing what at this time. I think that Brunetta had a great comment about the care of diabetes in general and that it is in a very strange state.
It just seems to me that I am having trouble with this philosophy of treatment that high is okay and that my brain needs the carbs, like why would too much glucose in the brain be helpful? She is adamant about it.
I hate to argue with someone who has a mindset and treats people with diabetes like this and I have read so many discussions here about people encountering the same thing over and over. I want to keep the peace, but I do not want to continue to follow this treatment plan. I am hoping tomorrow she sees the dismal numbers and decides the basal is too low and an increase in meal basal is needed as well and she will have to deal with less carbs because I am not eating that many any longer, some carbs yes but not that high amount.
You should eat the number of carbs you want but 30 per meal really isn't that high if you're eating 3 times per day especially if you actually count fiber and green vegetables
Glad you are off the meds and that was most definitely an old school cocktail!
Looking back at your original post, the thing about formulas: When I first read Using Insulin I compared the formulas to what I was actually doing and I didn't match any of them. I still don't. I have come to take those formulas as guidelines only and real-time data as way more important.
As for the carbs, I know you are used to low carb and you should absolutely do what feels right to you and gives you good results. But just for a little perspective: 30 carbs per meal - 90 carbs a day is not "high carb". It's about what I eat and I consider it moderate/low. Your average person eats way, way, more than that. But again, I totally respect and admire people who low carb and it obviously works well. I agree with your approach, that if she can show you documentation why any of what she is saying is correct, or more important if it has some special application to your medical condition that is one thing. In your place that is the question I would be asking. But frankly, her general approach - which I assume is irrespective of your medical issues and what she tells everyone: "Fasting 120-150, stay under 200 and under 80 is bad" lead me to have very little faith in her ideas.
Oh sweetie, what a horrendous ordeal. What you've endured! So very sorry for the torment.
Hard to have trust in a medical system that didn't diagnose your hypothyroidism initially that caused you suffering & put you on a psychotropic med nightmare. I'm also hypothyroid (Hashimoto's) & walked around for decades feeling hideous because I was told I was borderline, it was nothing & therefore ignored. My symptoms meant nothing. All that counts to doctors are tests. Absurd. For one thing, the test ranges are wrong. For another, they weren't doing the correct tests. TSH was all that tested. Useless. I fought long & hard to finally get Free T3, Free T4 & Reverse T3 tested to prove I was seriously hypo. I was about to pay for the tests myself. Now, it's another battle to be put on natural dessicated thyroid, rather than Synthroid. Closed medical minds on that topic.
Understand your dilemma. Not the same situation as yours, but none of my doctors or CDE were supportive of LC. CDE gave me the usual brain starving myth. I've explained gluconeogenesis to several medical professionals. They've obviously never heard of it:) So, not surprised she's adamant. I know what works best for me & refuse to discuss it further with people reading from the same playbook issuing one-size-fits-all, incorrect advice. You know what work bests for you & no one can control what you eat.
I wouldn't take insufficient insulin doses either. Only you are responsible for your BG control. Please don't be concerned about "keeping the peace." It's your body & your life. Pointless to be a compliant patient.
According to David Mendosa, the problem is that the brain's need for glucose is confused with a need specifically for carbohydrate.
I see this repeated often and stated as fact. If anything, I've experienced improved cognitive function, since switching to a LC diet and stabilizing my BG levels.
I agree with Zoe that 100g/day is relatively LC. USRDA is 300g. But, I have noticed that once your body has adapted to 20-30/day, eating significantly more than this can really wreak havoc with your BG control.