The Strangest Thing
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?
Replies to This Discussion
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Permalink Reply by Sam Iam on -
You are already receiving excellent advice in this thread. I have very little to add, except it sounds like you are doing a great job of managing your D under very difficult circumstances. If you are severely under weight and dropping quickly, you just need to adjust your diet.
You sound very stressed out. Relax. Don't overthink things. It can be very intimidating and difficult to disobey someone in a position of authority. You are an adult. And for better or worse, ultimately responsible for your own health and decisions. Maybe it would help if you made a list of problems with her recommended treatment, data to back up your criticisms, references and explanations when necessary. Present them to her calmly and rationally. Best case scenario: you both learn something. Worst case: figure out how to work around her.
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Permalink Reply by smileandnod on -
Good advice, Sam.
Thinking of you, lotsofshots, and hoping that today went well for you. :)
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Permalink Reply by Kathy on -
Hey. dear friend. I had no idea you were doing such hard travelin' these days.
But I'm so pleased that you are getting such good advice from the community. We have so many knowledgeable and experienced people at TD - people I'd trust 100 times more than a NP who probably has some dumb_ss cookbook recipe for treating db. Makes me furious.
If I used 8 units to cover 30 gm cho, I'd be on the floor in no time. My normal dose would be about 3.
When I was in the hsp for my ruptured spleen, they wanted me to have juice when my bg was 80 too. In that instance, I think part of it was that they didn't want to bother having to come back to my room and retest in an hour.
......sigh. Stay strong sister. You are very intelligent and have dealt with the db long enough to know what's what.
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Permalink Reply by catlover on -
Gee, Lots. I had no idea you have had so much trouble with the medical "experts." We know our bodies best and should listen to them before we listen to the experts. I was told when I was a patient in 2 hospitals ( for non-D related conditions), the medical professionals feel more comfortable when diabetics have high BG. Maybe your NP feels better when your fasting BG is over 120. I was told they panic when a D has a low BG. Low to them is anything under 70. Remind her that the reason you have no complications is because you do tight control. I will be anxious to hear how the appt. went today. Cat
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Permalink Reply by lotsofshots on -
Well, I went to my appointment yesteday. I put my basal back where it was and ate what I saw fit the day before, took corrections, and used my short acting insulin the way I always do. My BGs started swinging back into place. I ate my regular diet, counted my carbs and everything improved. I documented everything, all my readings, my food and my changes.
The first thing I said to the NP when I met with her was " I like my way better." She looked at the week of records, the numbers and what could she have been thinking I don't know. She didn't look happy at all, kind of appeared a litte confused.
She wrote me new recommendations and said that she thought that the reason things didn't go well was because she thought the Lantus was not covering me the full 24 hours. The funny thing about that was that I had been already taking the Lantus twice a day when things were going well, and she had switched it to once a day when she lowered it when she made the changes.
I am back to my old regimen, with her recommedations the Lantus is still a little lower than it was, but basically I am pretty close to where I was as far as her new recommendations are concerned.My plan for the coming week is to document everything, all my readings, everything I eat, all my insulin doses and then make adjustments if necessary. I don't have to go in to see her but only to email my log to her. I am pretty confident that things will swing back into place in short order. The data should speak for itself.
My BGs are already much better. My mind is clear, and my stomach feels better, plus I just feel more energy and well being. I am one of those people that really don't feel comfortable with blood glucose levels in the 200s and I know that makes perfect sense.
I was feeling a bit "controlled" and I wanted to cooperate because I like to keep people happy and I do like this NP and have had a long relationship with her. I feel her heart is in the right place anyway. She is supportive and I consider her a great person, but I decided that I know what I am doing and that her recommendations do not apply to my specific needs.
Now I am fired up to concentrate on dealing with getting my life back together. I am working hard to be strong and active, I am exercising within reason, eating healthy, and planning on pouring over all the information available on Tudiabetes and reviewing the basics. I am rereading my bible, "Think like a Pancreas" and I am so thankful for all the support and the comments and the information from everyone. I can't say thanks enough and I want you all to know that I don't know what I would do without you! I am feeling so optimistic and I think that things are going to fall into place with the neurological symptoms and I am going to be able to recover.
Thanks again for all the great information, the emails and the caring and thoughful support. Life is good!
What a relief to be a part of such a wonderful place. Thanks!
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Permalink Reply by Brian (bsc) on -
I'm glad things have worked out.
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Permalink Reply by Zoe on -
Fabulous!!! You stood your ground, did so calmly and reasonably (and with documentation!) and she heard you! She may not have acknowledged you were right, which I guess is too much to expect from some medical professionals, but hopefully she will think about the experience later and realize that some PWD's do indeed, know how to manage their own Diabetes. Congrats. I has a happee for you!
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Permalink Reply by Shawnmarie on -
That's great! And a week from now when she sees that what you're doing works, she'll convince herself that everything you're doing is what she suggested. :-)
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Permalink Reply by BadMoonT2 on -
So glad your mind is clearing and you feel better,seems like she needs to read "Think like a Pancreas".
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Permalink Reply by jrtpup on -
OMG, I love LOL cats and LOL dogs. Your last post sounds... well, like lots! I haz a happee for you toooooo.
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