Kind of surprized by Endo

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Permalink Reply by Helmut on October 23, 2009 at 5:57pm

Dump the endo. I filled out the paperwork for a dex and asked my PCP to sign it. I got my dex in the mail a week later. My A1C was consistently in the high 5s. I wanted the dex because my bg variability was too high for my taste. My bg standard deviation was about 60. I saw bg in the 200s almost every day. Now my bg standard deviation is 30 and I no longer see bg in the 200s. Bg above 160 is rare. For me the dex is the best thing since sliced bread. For the first time ever I believe I have a chance to avoid complications. Fight for a dex.

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Permalink Reply by Rebecca on October 23, 2009 at 6:07pm

If you've pushed your Endo and they won't agree to sign the paperwork then it's time to move onto a new Endo. Switching doctors is hard and takes a lot of work but if they doctor you have isn't willing to work with you for your best health then you need to find a new one. With that said make sure your Endo realizes how passionate you are about this first. Technically the Endo shouldn't say yes or no. If you can prove you've got undetected lows, an A1C over 7ish, or high glycemic variability then the Endo has no case and should be signing the paperwork as soon as you ask. If your doctor is preventing you from achieving the control (and the security) you desire then it's time to get a new one.

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Permalink Reply by Jacky Del Hoyo on October 23, 2009 at 6:23pm

I fillled out the paperwork and sent it into the Dexcom, sales rep explaining in an e-mail the unexpected respose I got from my Endo. I think if he won't sign the paperwork, I'll just move on to another endo. Shame, because I liked him, but I think he may not a real good grasp on what it really feels like to have diabetes, to be in the middle of a perfectly wonderful day, then have a slight strange feeling in your leg muscle, do a quick BG check "just in case", and discover a 50, with a unit or 2 of IOB-how that can really not ruin the day, but take away from a perfectly nice day. If I had the dex, I could have seen it coming, and maybe stopped it, before it messed with my day. Guess you just don't understand that unless you live with it every day : (

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Permalink Reply by Don on October 23, 2009 at 6:41pm

Yep, exactly! I think a non-diabetic (doctor or otherwise) can't comprehend the peace of mind of knowing where your bg is headed at any time. Finger-sticking won't tell me whether I'm headed up or down and how fast, unless I stick my fingers every 15 minutes, and even that is primitive compared to an automatic reading every 5 minutes. It was a great security blanket knowing it would warn me if I was headed for a low or if my meal bolus was falling short. I liked it so much I was happy to lug the receiver around (this from a person who won't wear a watch). My doc let me try out the Dex for 3 days. I was a skeptical at first but the peace of mind was so tremendous I've never forgotten it. Unfortunately, I doubt my insurance would cover it since I am not hypo-unaware, rarely go below 50 or above 180, and have never landed in the ER :(



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Permalink Reply by Helmut on October 23, 2009 at 6:56pm

I never landed in the ER either. I thought that I was not hypo-unaware. I know now that I must have slept through thousands of lows. Lows just don't wake me up. Since the JDRF study came out last fall the insurance companies are more likely to approve a CGM. I thought I never had a chance of approval. I never ever had to visit the ER and my A1C was good. You will only know when you send in the paperwork.

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Permalink Reply by etta v on October 24, 2009 at 4:45pm

I feel the same way about having slept through lows, unaware. I had three episodes where I was in the 20's and my mumbling woke up my spouse. I opened my eyes to see a team of medics at the foot of my bed, after my husband called 911. I am so thankful to have this amazing tool that gives me the ability to hang on to the brain cells I still have!!

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Permalink Reply by Jacky Del Hoyo on October 23, 2009 at 7:11pm

I think the best analogy I came up with after wearing the dex for a few days was, It's like driving a car on a road all by yourself, with no other cars around you to gauge your speed, and looking down at the speedometer every 2-4 hours to try to tell if you are "in range". Now, I can usually tell if I'm really low, or really high, but seriously, even doing a BG check once an hour cannot compare to the CGMS. I think I better start interviewing Dr's pretty soon, I'm not so sure my Dr, nice guy that he is, really "gets" it. Wish I could find a Doc who lived with D himself, preferably type 1, but someone who would understand the significance of a CGMS, not look at it like a nice luxary item : (

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Permalink Reply by Helmut on October 23, 2009 at 7:17pm

You don't need a doc who is as passionate about CGMs as you are. He/She just has to sign at the dotted line. The rest takes care of itself. And since there is no downside for the doc to sign at the dotted line it should be easy to find one.

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Permalink Reply by Helmut on October 23, 2009 at 6:41pm

I got the signature from my PCP first. She is not really into D. She told me that she wants my A1C to be below 6% and that she would kick me out if my A1C ever came back above 6.5%. I can manage my D. I need her for everything else. When I showed her my dex during my last visit she was genuinely unimpressed. She is just not into D. All she had to say was: "Your A1C of 5.5% is that of a person without D. I wonder whether it is too low.". I spent a couple of minutes explaining the importance of bg variability. Bottom line: I know what is good for me and my PCP helped me to get the insurance pay for it. That is all I ask for.

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Permalink Reply by Helmut on October 23, 2009 at 6:20pm

I totally understand if an insurance company wants to avoid the cost of a CGM. But an endo blocking it? Run as fast as you can.

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Permalink Reply by Sarah on October 23, 2009 at 7:09pm

Find a different endo! I know you've heard it already, but if you aren't happy, you need to find someone who will work WITH you, and not against you.. that's really important. Asking for a CGMS as a T1 should really be a non-issue, especially if you are hypo-unaware or you have any other issues that are difficult to manage otherwise - like overnight. If there is any struggle involved, it needs to be between you and your INSURANCE, not your Endo. I recently got a Dexcom and I got NO resistant from my D team at all. I was shocked, to be honest, because I didn't even request it - my CDE asked if I'd like to wear one that the office had and sent me on my way all hooked up, and with the paperwork signed to get my own "if I wanted to"... no pressure, no hassle. Since I had met my deductible this year with my pump purchase, I figured I had nothing to lose.. and it would be stupid NOT to go ahead and get one. I had no trouble getting approval from my insurance.

To be perfectly honest, being in "good" control doesn't eliminate all of the benefits of wearing a CGM... just wearing it is reassuring most of the time. I don't second guess myself nearly as much. I can often tell from the Dex whether to be more aggressive with treating a high, or if I'll probably come down on my own. Or if I'm heading to a low and need to take steps to prevent it from it becoming a "bad" one. I can see how well (or not well) some combo boluses work with certain foods. I've also been able to catch bad infusion sites within hours (one tonight, actually, that pushed me up over 350, despite two large corrections in the 3 hours prior)... MUCH faster than if I was relying on fingersticks alone. I was able to take a correction shot, change my set, and now I have the reassurance of SEEING that my BG is coming down now, rather than just assuming or waiting another hour for the the next fingerstick.

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Permalink Reply by Jacky Del Hoyo on October 23, 2009 at 7:18pm

I'm starting to think my Dr is a bit out of date anyway, I wish I had the endo I had before moving out of NY, she was a great Dr, really worked with me, and was very good. I'm not so sure this Dr hears what I am saying, I find it bit hard to get a word in edgewise, and sometimes get the feeling he's not really listening, that is a pretty yucky feeling to have for your endo. They have Dr recommendations on this site, right? I'll have to try and find another one, even if he does sign the paperwork, I donm't think he's really working with me, yuck!

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