Re: my first visit to an indocrinologist today

[Guest guest]

What kinds of lows were you having several times a week? I don't think

lows several times a week are dangerous as long as they are only mild to

moderate lows. If you are having multiple severe lows where you require

help and/or are having seizures then that is not good and it would make

sense to change insulin doses. Otherwise it seems like a pretty drastic

change; although when I switched from NPH to Lantus my insulin usage

went from almost 80 units per day to closer to 40 and my control

improved dramatically, so it is possible to use way more insulin than

you actually need.

I used a CGMS for a week just over a year ago and it was by far the most

enlightening diabetes experience I have ever had. Make sure you get

copies of your graphs so that someone can describe them to you in

detail. It's fascinating to see what happens during the times you are

not testing. I would buy one of these systems out of pocket (most

insurance companies don't cover them) to use periodically if I wasn't

spending gobs of money on graduate school at the moment.

The results of the c-peptide test should be interesting, as well as how

the changes in insulin regimen affect you. Seems to me that you are

taking less than half the insulin you were taking previously for bolus

doses and readings of 176 and 186 are not horribly high considering such

a drastic change. Hopefully things will work out. Keep us posted.

Jen

[Guest guest]

I'm no doctor, but sounds to me like this person is on the right track. Time and

outcome will certainly tell.

The greatest of all miracles is that we need not be tomorrow what we are today,

but we can improve if we make use of the potential implanted in us by God.

- Rabbi M. Silver

tracyduffy@...

(that's also my messenger contact)

Skype: trace.type.girl

twitter.com/todayinbraille

my first visit to an indocrinologist today

I certainly do hope this indocrinologist Dr. Welch knows what she is talking

about. I find some of her recommendations rather strange. Of course she said she

is coming at me with an entirely different direction than most of the diabetics

she encounters in her office. Whereas most of her patients have a high A1C level

I have the exact opposite in her opinion, since my latest A1C is5.7, according

to her quite low. It seems that her goal is to increase my A1C to a 6.5 or a

7.0, which would be quite acceptible to her.

She looked at my medications and she did a calculation that she said shows

that an insulin requirement for me would be 24 units of Lantus per day. This is

quite different from the total of 64 units of Lantus I presently take. She

ordered a c-peptide test today and she is prescribing that I only use 1 unit of

Humalog for every 5 grams of carbs I consume.

This recommendation amounts to an extremely large reduction in the Humalog I

presently dose at a insulin to carb ratio of 0.56. Her recommendation amounts to

an insulin to carb ratio of 0.20.

If you multiply every thing by a hundred, this amounts to a 36 point reduction

in the I:c ratio. Quite a large reduction in my opinion, and it is guaranteed to

raise my glucose levels higher and higher, which apparently she wants at this

point, and Later she will address how to lower it. She equates having a

hypoglycemic reaction as being equivalent to having a stroke, and she wants to

ward off dementia in my case due to having hypoglycemia, from time to time,

which does not bother me but scares the hell out of my wife, who claims I have

had seizures in stead of a seizure, a single one instead of numerous ones as she

claims. I admit the single seizure I had, which I do not rememger was entirely

my fault, since I forgot that I had dosed Humalog for supper to cover the carbs

I consumed and dosed the same amount of Humalog a little while later , which

meant I gave me a double dose of the same amount of Humalog to cover a single

episode of carb consumption, which most diabetics know is not a good idea. Maybe

this forgetting on my part is a sign of early dementia, which the doctor and my

wife fears. According to the indocrinologist an A1C of 6.5 to 7.0 in a diabetic

is just as good as a 5.3 in a non-diabetic.I do not have a cost-benefit analysis

regarding A1C levels in a diabetic as compared to a non-diabetic, so I don't

know if this is a true statement or not.

The doctor's concern and my wife's concern seems to be the same, the

prevention of hypoglycemic responses, strokes or dementia. As I follow her

recommendations I can assure you I will have no further hypoglycemic reactions.

She also recommended I increase my statin drug Pravastatin from 20mg to 40mg,

but no prescription was given to me. Maybe she means what she says or maybe not.

I do know I had the c-peptide blood test drawn today and after a while in a

couple of weeks, I am to have a CGM inserted into my abdomen for two or three

days. The CGM is a continuous glucose monitor. So the experiment begins today.

At lunch I consumed 50 grams of carbs and dosed 10 units of Humalog. My

pre-lunch glr was 176.

My pre-supper glr was 186 and I consumed 20 grams of carbs and dosed 4 units

of Humalog.

Bedtime glr is coming up.

She wants me to reduce my Lantus consumption from 64 units per day taken in

two doses of32 units at bedtime and in the morning to 30units of Lantus at

bedtime and 15 units of Lantus in the morning a total reduction of 19 units of

Lantus per day with 45 units per day taken compared to 64 units per day taken.So

let us watch the rise in my glr as we merrily go along with this experiment and

measure the pre prandial carbs three times per day and the bedtime glr for the

fourth time per day.

So instead of having a hypoglycemic reaction two or three times per week the

goal now is to have none.

So I will keep us informed as to the recvommendations and prescription and

tests performed by an indocrinologist, so that we may all benefit.

Happy experimenting, Harry