Comment by Gerri on July 1, 2010 at 12:18am

Yes, he wins the award & you'll see many stories here of close runner-ups. You were treated horribly, disrespectfully, rudely & received no help. Gee, what else is left to further mistreat a patient!

Get the following books. Using Insulin by John Walsh & Diabetes Solution by Dr. Richard Bernstein. Also, check out www.bloodsugar101.com.

Doctors typically start patients on a ratio of 1:15 for Humalog. One unit of Humalog for every 15 carbs. Begin with something that you're certain of the carbs. Better to start with something that's 15 carbs. Test before you eat. Test again 1 & 2 hours after the meal. If you're within a reasonable range (not terribly high or low), then you've got the correct ratio. Eat the same amount of carbs at the same insulin dose for three days to get the full picture. After three days, adjust the dose up or down by only 1 unit of insulin. Don't make wild changes. Log all your readings & doses.

Most rapid acting insulin peaks in two hours & lasts 3-4 hours. Good to space your meals 4 hours apart to avoid stacking insulin that will cause lows.

Lantus dose, taken once or twice a day,is based on weight for starters.

The general guideline is take Humalog 15 minutes before eating. This is something that may need adjusting to see what works best for you.

People often have different insulin:carb ratios for different meals. Morning tends to a time when the ratio is smaller. Lunch can be a higher ratio & dinner lower.

Using Humalog to correct highs is also important. This is loosely based on weight, but everyone is different. For example, I weigh 105 lbs & use Apidra for rapid acting. One unit of Apidra lowers my BG by 60 points.

To correct lows, you'll need to experiment to learn how much 1 gram of glucose raises you. Use fast acting glucose, not food. Also by way of example, 1 gram glucose raises me 10 pts. It can take up to an hour to see the effects of glucose.

Test a lot, write everything down & go slowly & conservatively. You should test first thing in the morning, before every meal, 2 hours after meals & before bed. Test before you drive & if you feel low or high. You don't need to snack.

You don't need to use alcohol or anything to clean your injection site. Wash your hands & dry them well before testing. You don't need to use alcohol swabs on your fingers either.

You shouldn't use needles more than once, but people do. Keep needles for Lantus & Humolog separate, if you're going to use them again.

Comment by Tim on July 1, 2010 at 5:48am

Your "world's worst endo" is clearly at least in 2nd place.

In the 90's I went to an endo that had been highly highly recommended. He refused to treat me until I took a glucose tolerance test. I thought that was really weird because I came to him with a log sheet of all my bg tests and insulin doses in the past couple months, but he refused to look at those. I knew that the glucose tolerance test was several hundred grams of carbs; I asked if I was supposed to take my insulin before or after the test. He told me I was supposed to stop taking insulin until the test was done.

He told me that because I was an adult that I couldn't have "Juvenile diabetes" anymore and needed the glucose tolerance test.

I never went back to that guy!

The thing was, he was regarded as a "god" by many of the other docs in the area - they swore up and down he was the best at treating diabetes and had been doing it for many decades.

That really fundamentally altered my perception of the medical system.

Tim.

Comment by Trudy on July 1, 2010 at 5:52am

Gerri, what good and complete advice. I would add just one thing: lows are much less likely to occur with Lantus (or Levemir) if the dose is divided into two shots. I would be forever traumatized by such an unthinking endo!

Comment by Xanthasun on July 1, 2010 at 6:48am

I'm sorry your first endo had to be so bad...but the way it was written was well done (I enjoyed your thought comments! when you were writing the dialogue)
It's rough when your endo seems to have no interest in helping out and even is discouraging because you already have enough to deal with especially when you're new!
I recommend reading what you can (Gerri's book recommendations are good) but also come back and ask questions. There's a number of newly and newer diagnosed people on the site as well as 1.5 types and those trying to figure out what they really are.

Comment by Joe_h on July 1, 2010 at 7:01am

wow sorry for your troubles that guy is a tool. your A1c is 6.0 and they want to put you on insulin to get it even lower?

Comment by Bubbaluv on July 1, 2010 at 9:15am

I would put him in the larger pool of worst professional, let alone worst Doctor or Endo. I don't get his statement regarding "it wouldn't change your treatment". Excuse me? I'm pretty new to all of this, but i have spent a ton of time reading and researching and since you were not originally on insulin at dx, i would think if you were in fact T1, your treatment plan would be significantly different.

Gerri's suggestions are great, whether you end up being T ot T2 or something else (LADA, MODY, etc). I'm not on insulin so haven't the read the John Walsh book yet, but bloodsugar101 was my first read and Bernstein the second and both provide great resource for overall healthy living with D.

Its hard enough as a D managing things we know about, particularity early in the process (diet exercise and things like that). Its that much more difficult when we have to learn skills like treatment plans, MDI, pumps, Medications, how each works and how they interact. That's what docs are for and its unfortunately that there times we have to manage it ourselves. But your not alone and at you have the ability to identify there is issue and start working the process.

Comment by Sidney Partridge smile on July 1, 2010 at 11:01am

I don't know what you can get away with in Canada but here in central Illinois. I definitely stand up to my rights. I'm 60 years old and a 20 year type 1. I knew what I was talking about. My wife and I are team players together and well informed. Lost my doctor to sudden death on tennis court. This new doctor was young and full of it. He discounted my questions on lower leg issues and says it was not diabetic related. He did not like the challenging questions we had. He said that I was copping out. That was it. We ended it right there and walked out. Told the nurse that we will not pay the bill and certainly not $60 for a toothpick for poking my feet. We told her that he was an arrogant ass h--- and fired. We asked her to inform him of this discussion and will tell others to avoid him as a doctor. She was not too surprise. Now have a doctor who is perfect. He ask lots of questions and we banter.

Comment by Tim on July 1, 2010 at 11:24am

I'm not claiming he's the most perfect doc in the world. But I look at what you write (just like he listened to what you said) and come to the same conclusion: you're T1/LADA and the insulin will do you good. C-Peptide tests are popular but some things are obvious enough without the C-Peptide test. I take insulin for the past 30 years and I myself would scoff at anyone suggesting that it would do any good to have a C-peptide test run on me - I see my scoffing reflected perfectly in your endos remarks! It's too bad your endo couldn't fill you in like you deserved to be, though.

You have some of the tools (pens, prescriptions, bg tests) and a little reading will get you far more up to speed than another 15 minutes with the doc would've.

Today most hands-on training by CDE's would be regarded as primitive by those who know how to crack open a good book or just use google.

Comment by nel on July 1, 2010 at 1:22pm

You may want to complain , followed up by a letter as you described the conversation here ...I am uncertain if the BC Medical Association can direct you .Did you not have any contact with CDE's??
What training does a DCM have ?

Comment by Ligetia on July 1, 2010 at 2:50pm

I really appreciate all the responses, advice, empathy and shared stories. It makes a huge difference to have this network esp. when new and trying to figure out what to do and how to manage all the various aspects of life with D. It can be overwhelming, and it's just such a shock to have a nasty endo who just makes everything 100 times worse. Gerri, thanks for all the practical advice on using the insulin. I'm going to start tonight...

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