I was fortunate that, in spite of being 50, my primary doc diagnosed me as T1. Based on little more than my crazy high A1C, he referred me to an endocrinologist. I underwent the usual tests and was started on MDI immediately. With the help of the wonderful folk on this site, I’ve worked hard to test often, manage my carb ratios and lower my A1C. I eat a moderate carb diet (about 120/day) and am on fairly low doses of insulin (about 15 TDD) split pretty evenly between Lantus and Humalog. (My C-pep test showed that I was still making a bit on my own). My last result was a 5.4 with only a few hypos and even fewer very high numbers. I strive to be between 70 and 120 and am usually pretty close. I don’t beat myself up for higher numbers but, do correct for anything over 160 or so.
The problem: My endo makes is very clear that he thinks I’m obsessing too much. At each appointment he wonders aloud if I’m suffering from anxiety or if I’m letting diabetes “control” me. He claims that most of his other patients worry about highs OR lows, not both. At my last appointment he downloaded my meter and declared that my numbers were “too good” and that my A1C is “too normal”. I assured him that I was living a full life. I work a full-time job, have two young kids and a rock-solid marriage, stay active, eat a wide variety of food and enjoy a glass or two of wine when I want to. At my last appointment my endo told me to relax my ratios. When I pointed out that I’m not having many hypos he said, “I’m not sure you need to manage so closely. Wouldn’t it be nice not to have to someday?” I indulged him and faxed in my log with the predictably higher numbers. No response.
My question to the wise people reading this is, should I simply find an endo who doesn’t make me feel like I’m crazy? Or might he have a point? Am I experiencing tight control because I’m lucky enough to still eke out some insulin? Might I not need as much insulin? Is it possible to inject too much without going low by overworking some other mechanism in my body (alpha cells)?
Thanks in advance for any guidance.
New doctor, new doctor! I had a similar experience in that a prior endo told me I was testing too much and that a couple times a day was sufficient. She said they worry about burnout when people test too much. I switched docs and I LOVE my new endo! She says "test as much as you need to." She doesn't try to micro-manage me and simply asks whether I'm concerned about any hypos that show up on my meter when she downloads it. In general, I know why I have any hypos and I tell her they don't worry me. Same with high numbers. She asks if I have concerns about them, and because I usually know why they happened, I don't stress about them. I'm not in the 5 club (last A1C was 6.4), but I'm okay with that. So far, so good with the new doc!
I believe you're right and on some level I guess I know I need to switch. But, I also want to make sure that I'm not overtaxing my alpha cells by being "too good". Thanks for the sanity check!
I agree that if you are leading a full rich life and happy with your D management, then all is great! The only concern I would express to you is that you know that things may not stay quite that stable once your honeymoon passes. There are some people on here who stay "between 70 and 120 all the time", but they are few. Most of us Type 1's have more variability and just correct and tweak as needed. Your expectations might not be as reasonable down the road, so as long as you stay flexible, it's all good!
Thanks, Zoe! You're always so helpful and inspiring. I'm afraid he's trying to wean me off inuslin as an experiment. In the past 18 months or so, I've probably preserved my remaining beta cells, right? I do have variability (40-180) but, I usually know why. I hope my luck (honeymoon) continues.
If you're not going hypo all the time do not let him wean you off insulin! I was diagnosed a little over a year ago and I'm still on only bolus, averaging about 7 units a day. My doctor has never suggested that I should try to go without. Even with bolusing, I can seem my PP numbers soar if I haven't calculated things correctly. Clearly, my pancreas ain't doing the job on its own. Sounds like yours is the same.
And yes, the theory is that we're preserving our beta cells by giving them a break with exogenous insulin, but even if that theory is incorrect I'm preserving my body by not having BG in excess of 200 every time I eat!
Most doctors only dream of having a compliant patient with regard to keeping their numbers under control. I would suggest that if you are not happy with your current DR, then find one where the communication is more to your taste. Then maybe you could talk out your concerns about overtaxing your body. If there is no real concern with that, then I say HALLELUIA!!! Keep doing the good works for as long as you are able/comfortable doing them. I wish I could have had better control earlier on because, once you have complications, I am not sure they can be reversed.
Take care and good luck holding a very positive attitude!
I hate the word compliant.
Maybe your making it to easy for him and he feels treatened. Maybe he's a control freak that can't leave well enough alone. Or maybe he is concerned that you really are obsessing to much and he's really concerned that you will burn out. You seem to be well grounded but some just aren't wound that tight to start with.
With the rock solid life you appear to have I would just ignore him and if he gets on your nerves to much I would dump him.
New endo, for sure! It's YOUR body, and you deserve to have precise control! New endo ;)
I echo everyone's comments here, I think endos and actually most people in the medical profession are just trying to cover their butts from a legal perspective. But if your endo is not on board with you taking good care of yourself, then find another one. After 37 years of D, I have just recently gotten a CGM and it has cut way down on my need to test. I went from 12 times a day to about 3.
I switched endos this summer because I discovered my endo had basically caused my hypo-unawareness by keeping me on a sliding scale of insulin instead of carb counting. I will see the new endo for the first time next week and I hope she will be an improvement. If not, I can always shop around.
Basically you have to look at medical care from a consumer's perspective and as a consumer you want to get the very best for your hard earned money. You hire or "employ" a doctor to give you the best advice possible, if they aren't or you feel they aren't then as a consumer it's incumbent upon you to find another one. JMHO
My vote is to switch if you want to but otherwise, just keep doing what you are doing and see him every 3 or 6 months for your prescriptions. It might be that he was taught that such a low a1c is caused by too many lows....not your case, or that it is just too hard to maintain those numbers, again not you. I find it sad that the medical community is not always supportive of the optimum care you provide yourself and the fabulous results...unless they know something we don't? I am thinking not! Good job!
I think I have decided that endo's see so many patients who don't take care of themselves that they don't know what to think about those of us who do, and those of us who may be a little bit on the obsessive side (me).
When I am interviewing with a new doc, on the first appointment I lay it out about how I am, what I am ok with and what I am not ok with, like being lectured or having a finger shook at me like I am a child. And if they can't respect what I have to say and see me as part of the "team" with valuable thoughts and input, then... see ya later.
You have to be your own advocate!