Re: Insulin and doctors reluctance to give it

[Guest guest]

In a message dated 11/6/2004 8:57:19 AM Central Standard Time,

whimsy2@... writes:

> So...doctors are poorly educated as to how to manage insulin, and in

> turn, they educate their patients inadequately.

I just wanted to say that most docs don't do the education....a diabetic

teacher does...who must pass the ADA test to get her job......

And they teach the patients.....so I would say that the problem lies in both

the physician's fears of promoting insulin and the inappropriate teaching

that most patients receive.

I did go for the teaching...mostly to see what they had to say. When I told

her I lived a low carb lifestyle..her eyes rolled....when I showed her my food

diary her comment was... " You are the only person I have seen who does low

carb right "

I was started out at 1 unit for 15 carbs....if I had not had help from Ron I

would have been on the floor more times than I can count. My personal dose

was closer to 1 unit for 30 carbs....but it took work and time to get to that

point. Most diabetic teaching programs can only give so much time to each

patient....not the intense program that was necessary to help me.

It a good thing we have the internet to allow us to communicate and learn

from each other. My doc asks about you all the time...<grin>

Ressy

[Guest guest]

At 08:57 AM 11/6/04, katakaniki wrote:

(snip)

> I tell her that I am

>extremely tired at every appointment. Blood work doesn't show

>anything else wrong with me <thyroid etc> other than diabetes......

I've been tired, too. Is that an effect of too high BG? Seems like I'm

tired most of the time.

>My question is why do you think doctors are reluctant to prescribe

>insulin? It's the only thing that I can see that makes a difference

>with my BS. The oral pills are just draining my pocket book and

>they all have side effects, not to mention they don't work for me.

><oh maybe a point or 2 lower>

I've heard, on another list, that given the error percentages of the meters

we use (5-7%) just a few points difference in readings may not mean as much

as we'd like it to. 8-( It was mentioned that my 114 reading one time and

the 128 another time may actually be for the same actual BG in my system. I

found that depressing. It was also suggested that eating something in the

morning to stop the dawn effect should only make the reading higher (as it

would be if you eat food) and I should actually go a couple of hours longer

until I ate and then take the reading. Yesterday it was 127 at 6:48 a.m. in

the morning. I ate two eggs and when I checked two hours later it was 139.

Then it went down the rest of the day, regartdless of meals. This morning I

decided to do as suggested but was remembering it as needing to wait 45

minutes instead of a couple of hours. Even so, the reading at 7 a.m. was

126 and then at 8:45 a.m. still not having eaten, it was 142! I don't like

THAT at all. I ate then and only discovered I was supposed to have waited

about 2 hours after when I got back to the computer to read the old email.

I can't imagine what it might have been if I'd waited an entire two

hours. Eh, well, I seem to have gotten off on a tangent. Sorry.

> I shudder to think about these

>doctors getting some kind of monetary kickback for just pushing the

>pills and they know insulin works better and is cheaper. My husband

>always points out to me how those drug pushing representatives are

>always in her office making me have to wait for my scheduled

>appointment.

It's the pills that pay the bills? I know that doctors are courted by drug

companies and that they'll often prescribe the newest and latest copycat

pill (ie: it does the same as older meds on the market) just because " it's

new and therefore must be better " and because of awards won for X pills

prescribed, etc. This sounds cynical, I know, and I know there are doctors

out there who don't buy into that, but I think the vast majority do.

sky

[Guest guest]

I think Ressy is absolutely right on this question. Doctors are not

used to seeing diabetic patients who are proactive. Most diabetics are

also very reluctant to test more frequently, although frequent testing

could alleviate the fear of hypos.

Further, it is a RARE doctor who tells a patient to base their insulin

on carbs eaten -- although pumpers use this method 100% of the time.

Instead, they prescribe a set dose then tell the patient to eat the same

amount of carbs at each meal to match the insulin taken. This is a sure

recipe for failure, IMHO. Also, from what I've read, the vast majority

prescribe NPH, which forces the patient to eat on a rigid schedule,

which patients, quite naturally, find very difficult to do.

So...doctors are poorly educated as to how to manage insulin, and in

turn, they educate their patients inadequately. The result is diabetics

who are prone to failure for one reason or another. I daresay a lot of

doctors would just rather not deal with the whole insulin thing, which

is why they're reluctant to prescribe it.

IMHO, what is taught in medical schools about diabetes management needs

a drastic overhaul.

Vicki, LADA, getting off soapbox once again

Re: Insulin and doctors reluctance to give it

>

> In a message dated 11/6/2004 7:58:49 AM Central Standard Time,

> kpaulmt@... writes:

>

>

>> My question is why do you think doctors are reluctant to prescribe

>> insulin?

>

> well....according to my doctor...who with his wife are our closest

> friends...they are afraid of the hypo's. Hypo's can be deadly and

> must be treated

> immediately. I treated a guy at Home Depot once....looked

> drunk...sweaty...fell

> to the floor..confused. I just asked him if he was a diabetic...he

> shook his

> head yes....he did not have glucose tabs...I send one of the workers

> for a

> can of soda..full sugar and made him drink at least half....once he

> was himself

> again he told me he had taken his insulin and didn't have time for

> breakfast....duh.....

>

> Those are the stories that scare docs to death. Insulin is powerful

> and

> unless you have a patient who is going to understand the treatment and

> comply with

> all the ramifications of insulin you could have much more trouble than

> you

> want

>

> Once I was on insulin...glucose tabs were everywhere.....I have two

> working

> meters at all times.....I tell my dh immediately if I don't feel

> well....I

> also am more rigid with mealtimes and exercise times.

>

> My doctor would prefer people be on insulin but until he can be sure

> that

> they understand and will comply with the treatment, he is hesitant....

>

> Of course I get my way all the time...NOT....<grin>

>

> Ressy

>

[Guest guest]

Ressy wrote:

> > My question is why do you think doctors are reluctant to prescribe

> insulin?

>

>...they are afraid of the hypo's . . .

Really good answer, Ressy (and nicely complete). Wish I had held off on

mine 'til I found yours <g>.

Sandy

T1 - 1979