visit with the nurse practitioner

[Guest guest]

I just got back from my appt. It was a mixed bag.

The NP is studying to specialize in diabetes. She said that the A1c test

isn't needed more than every three months because the life of the blood

cells is about 2 months so checking any more often is pointless. Despite

that, I noticed that she checked off the test for my next blood test

(fasting, so I'll have to go have it done tomorrow). She also said that

insurance won't pay for more often than once every 3 months, so now I'm

thinking that I might have to pay for this test myself.

She DID prescribe metformin, 1 500mg tablet daily. There's a tab on the

bottle that says to " take with food " . Just now I went to look at it again

to see if I was supposed to take it morning, noon, or night and all it says

is " take as directed " . Sighh. Their office line is busy. Isn't this the one

that some said they could take " just before a meal " for their BG? I got

through and my directions are to take it with breakfast. I don't see that

this will help with dawn effect at all, except maybe to stop it.

I tried to get a prescription for more test strips but she said (again)

that they've tried and tried and argued and argued but the insurance

companies won't allow for more than 2x a day unless you're " acutely

insulin-dependent " . I see the prescription she gave me was for 3x a day

and it's renewable for 12 months. I'll use them up way too soon, of course.

I'd better start saving my pennies now.

I completely forgot to ask about the neuropathy...too much work getting a

word in (once she starts explaining things she hardly stops) and I'd not

written it on my notes. 8-(

She'd be willing to change the ACE inhibitor type BP med I take for an ARB

inhibitor but pointed out that the ARG's don't have calcium channel

blockers so I'd have to have yet another med for that. She'd not heard of

the " ACE 2 " inhibitors (someone on the list mentioned them, said they

didn't have the dry cough side effect) and she's going to look into that.

She didn't like the fact that I'd not taken the Lipitor she'd prescribed

but I said I didn't like the idea of statin drugs because of all of the bad

press. The only non-statin she knows of is Zitia. I know nothing about it.

She also mentioned Crestor, which I gather is a new statin drug. In any

event, my cholesterol is high despite high " good " cholesterol (sorry, I can

never remember if it's the LDL or the HDL that's good) but the bloodwork

tomorrow will do the lipid thing again. If it's still high I guess I'll

have to consider a statin drug because I have a family history of heart

problems. I know many take them, and I don't want to get into an argument

about whether statins are " good " or not.

She also noticed an irregular heart beat and sent me for an EKG. I'm also

scheduled for a uh...stress echocardiogram with doppler/color flow. Of

course I'm really thrilled with this heart thing since I've been a bit

stressed lately anyway.

At the moment my bowl of cherries has turned into a bowl of steaming cow

droppings. Sorry to whine...I know many of you are dealing with so much more.

sky

[Guest guest]

Metformin: The company says 1500mg is the minimum dose; however, I have

heard people say they saw results with less. Sky, start this drug at

the end of your meal, if you encounter no intestinal distress (and,

believe me, you will know if you do!), start moving in back thru the

food. First half way thru your meal, then with the first bite of food,

and finally before you eat. Give each change a few days to " settle " in.

As for the morning time, well, I suppose you have to cooperate, but I

would take it with dinner, to help the morning rise. But cappie takes

hers in the morning to combat that rise.

Testing: You can make three strips a day work, even tho you are at the

beginning. If you know that certain meals always have the same effect,

skip that test, except for spot checking. Save the strips for the times

when things change. OTOH, I don't think it would be a bad idea for you

to check with your insurance, yourself. You may very well be told we

will fill what the doctor prescribes.

Why does the NP think you need a calcium channel blocker? I am taking

diovan, an ARB, because I coughed with the ACE. I do not have a bp

problem, I am taking it to protect my kidneys.

Cholesterol: You want the HDL to be high and the LDL to be low. Zetia

is usually given in conjunction with a statin to potentiate the statin.

Crestor already has a bad history, I would definitely stay away from

that one! Policosanol has been recommended for bringing down

cholesterol. Now I take lipitor and it has worked well for me, but I

come from a family that makes a lot of cholesterol. My mother, before

she died, had a total cholesterol of over 500 and tris over 1500. If I

could get away without lipitor, I would.

Did I get it all?

Helen

[Guest guest]

I wrote:

>She said that the A1c test

>isn't needed more than every three months because the life of the blood

>cells is about 2 months so checking any more often is pointless.

my typo. What was said that the life of the blood cells is 3 months, not 2.

sky

[Guest guest]

At 04:52 PM 11/18/04, Helen Mueller wrote:

>Metformin: The company says 1500mg is the minimum dose;

The information in Dr. Bernstein's books lists 500mg. Did you do a typo

there with the 1500mg?

>however, I have

>heard people say they saw results with less. Sky, start this drug at

>the end of your meal, if you encounter no intestinal distress (and,

>believe me, you will know if you do!), start moving in back thru the

>food. First half way thru your meal, then with the first bite of food,

>and finally before you eat. Give each change a few days to " settle " in.

The food poisoning episode is still too fresh in my mind for me to want

to deal with intestinal distress, but I can put up with it for awhile if

this stuff works.

>As for the morning time, well, I suppose you have to cooperate, but I

>would take it with dinner, to help the morning rise. But cappie takes

>hers in the morning to combat that rise.

I'll consider your reccomendation for how to take it and look forward to

hearing from cappie.

>Testing: You can make three strips a day work, even tho you are at the

>beginning. If you know that certain meals always have the same effect,

>skip that test, except for spot checking. Save the strips for the times

>when things change. OTOH, I don't think it would be a bad idea for you

>to check with your insurance, yourself. You may very well be told we

>will fill what the doctor prescribes.

I should check with the insurance. Thanks for mentioning that.

>Why does the NP think you need a calcium channel blocker? I am taking

>diovan, an ARB, because I coughed with the ACE. I do not have a bp

>problem, I am taking it to protect my kidneys.

I think it has to do with controlling BP. Just another route.

>Cholesterol: You want the HDL to be high and the LDL to be low. Zetia

>is usually given in conjunction with a statin to potentiate the statin.

oh well, then why take two pills when you could just take one and get the

same benefits (and risks).

>Crestor already has a bad history, I would definitely stay away from

>that one!

The name seemed familiar to me but I've tried to injest so much information

lately I'm on overload.

sky

[Guest guest]

About the strips issue. The companies who send you strips go strictly by the

doctor's

perscription and when mine got messed up it was because the doctor's office had

screwed

up. I have Medicare and a private work insurance and I get 3 months supply at a

time for

3 times a day which works out to 300 in each delivery as the vials hold 50 ea. I

think

these companies charge too much but I get them totally free.

Lou

Sky wrote:

>

> I just got back from my appt. It was a mixed bag.

>

>

>

> I tried to get a prescription for more test strips but she said (again)

> that they've tried and tried and argued and argued but the insurance

> companies won't allow for more than 2x a day unless you're " acutely

> insulin-dependent " . I see the prescription she gave me was for 3x a day

> and it's renewable for 12 months. I'll use them up way too soon, of course.

> I'd better start saving my pennies now.

>

>

>