Re: new diabetic with questions

July 6, 2005

I've heard that from a lot of people. At least now I'll have someone more on the

ball to help me manage my diabetes. He must have skipped that class in med

school.

Mike

Re: Re: new diabetic with questions

BGs that high can mean DKA - diabetic ketoacidosis - which usually sends

folks to the hospital. You were lucky. But I have less than good faith

in your doc who sent you home with BGs that high.

Vicki

July 6, 2005

> Hi Alan

>

> I've always had good luck with this doctor for the past 5 years.

OK Mike

By now, you've read all of the other replies and I'm sure you've also

had a few private emails.

I'm not going to beat you 'round the head any further.

Sit back, take a deep breath, and relax. This is usually a slow-moving

disease. It's not been clear from your posts whether you are type 1 or

type 2, but your doc obviously doesn't see urgency, so I'm presuming

T2 for the moment.

I suggested two things in my post, but you only answered one - the doctor.

Did you read the link I provided? If not, please do. In case you lost

it: http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

If you want to keep trusting your doc - fine, that's up to you.

However, do a little research on your own body. Please try an

experiment tomorrow. Note every morsel you eat (and drink) in a diary

and, in addition to any tests the doc wants, test your BGs one hour

after you finish eating each meal or snack. Then come back and post

the diary and BGs. If you don't want to do that publicly, email me

direct. That's it - no drama, just a few extra tests and a log.

Good luck,

Cheers, Alan

July 6, 2005

On Wed, 6 Jul 2005 14:24:48 -0000, " Mike Brown "

wrote:

>Hi Alan

>

>I've always had good luck with this doctor for the past 5 years. So, I hate to

change doctors. I have been to this diabetic type class twice now, and she

mentioned adjusting my Lantuns. She was out over the holiday and is supposed to

call me today. The only thing I may be doing wrong is serving size, so from

today on, they will be small. My doctor said 256 isn't bad, as I was 503 in the

office and I was also 565 at home once. I had an aunt pass away at 62 with

kidney failure, and lived the last 2 years of her life on dialysis. I want to

get on top of this disease, because I've seen first hand what it can do.

Mike, it is generally accepted that anything over 140 does damage,

even if the level is only for a little while. There is increasing

evidence that damage starts as low as 120. Using the " better safe

than sorry " approach, my limit is 120. Sometimes I miss and go over a

little but NEVER EVER over 140.

Lantus is to control your basal value, e.g., your fasting BG. It does

not and cannot address meals. That is what a fast, short acting

insulin like Humalog or Novolog is for. Once you get your basal dose

correct (fasting BG in the 85-100 range) leave it alone, other than to

compensate for changes in your body. Correct meals with one of the

above fast insulins.

You need to do two things. One, cut down on the carbs so there isn't

so much post-meal glucose to treat and two, get a script for a

fast-acting insulin.

Your doc simply doesn't know how to treat diabetes. If you like her

then stay with her but find someone else for your specific diabetes

problem. Or if she's amenable, educate her. One approach might be to

tell her that based on your research, you desire to control your BG to

near non-diabetic levels and that you need a script for Novolog or

Humalog (I prefer Novolog because it is faster) to do that. If she

gives you the script without argument, then you're set.

There is a standard sliding scale to compute the dose to get your BG

under control. Once there, you compute your carb and BG sensitivities

(how much insulin it takes to offset a carb and how much to bring your

BG down a specified amount.) and dose based on your meter and the carb

content of the meal you're about to eat. Then you test at some time

after your meal, a time you determine by measuring when your post-meal

BG peaks, and administer a trim shot if necessary.

This so-called " basal-bolus " method is a NEW way of controlling

diabetes, made possible by these wonderful new genetically engineered

insulins that have arrived on the market in the past few years. This

method approximates what can be achieved with an insulin pump at the

small expense of lots of testing and many small shots. A small price

to pay for non-diabetic type health, IMHO. Any doc who does not do

continuing education specifically for diabetes or read the journals

will not know about these techniques.

As many of us say more than once a day in various forums, diabetes is

an intensely self-managed disease. You can rely on your doc for

general guidance if you like, and for the lab tests like the A1C test

to evaluate the quality of your self-management but if you rely on the

doc for detailed instructions, you'll never gain control.

---

De Armond

See my website for my current email address

http://www.johngsbbq.com

Cleveland, Occupied TN

July 6, 2005

256 is alot better than 503, and there could be reasons why our doctor has given

you a high target - but it is not good.

I have a web page of diabetes information at

http://www.geocities.com/tiggernut24/diabetes.html

Yours,

Dora

Austin, Texas

villandra@...

new diabetic with questions

I probably had diabetes maybe 6 months before being diagnosed by my

doctor.

July 6, 2005

Mike my husband started out with over 700 and they won't be happy until he

gets it under 200. He goes in and it is still over 200, after 4 years, and

they get really upset with him and tell him and tell him he has to get it to

be closer to 100.

Don't be fooled, it is better but not good enough.

Kathleen

>My doctor thinks it's ok since when it was first caught, it was 503.

July 6, 2005

Yep. That's the point where I walked out on my diabetes " education " class -

never to

return again.

First thing they say: Avoid sugars!

Next thing they say: All carbs eventually turn to sugar.

Third thing: Eat all these carbs.

You shoulda seen the look on the dietician's face when I asked " So, uh... why

are you

telling me to eat 45g of sugar? " Priceless.

SulaBlue

> Thanks... yes, they talk about carbs and you should have x amount for this

meal, and so

on. Sounds like you hit the nail on the head.

July 6, 2005

Yes, type 2 Alan.

I have the " newly diagnosed " booked marked.

I don't think my MD is going to be playing much of a part in my treatment now.

The nurse that runs the diabetic clinic raised my Lantus from 30 to 34 units.

And she said she would call this coming Monday to see if that made any

difference.

I should be able to come up with a decent diary for tomorrow.

They told me to wait 2 hours after my evening meal to do my evening test. And do

a fasting test when I get up in the morning. I would think I should test more,

but both the doctor and the RN at the clinic said twice a day was enough.

I can call our HMO and they will send a book out of all the doctors in the plan.

I'll check that out.

When I was first diagnosed, maybe a day or two later my vision got really

blurry. It's improved, but still not as good as it should be. The eye doctor

said it wouldn't do any good to make a new pair of glasses until my diabetes

stabalizes. I've got a ways to go on that.

Thanks again Alan and the rest of the group for listening to my sob story today.

Mike

Re: new diabetic with questions

> Hi Alan

>

> I've always had good luck with this doctor for the past 5 years.

OK Mike

By now, you've read all of the other replies and I'm sure you've also

had a few private emails.

I'm not going to beat you 'round the head any further.

Sit back, take a deep breath, and relax. This is usually a slow-moving

disease. It's not been clear from your posts whether you are type 1 or

type 2, but your doc obviously doesn't see urgency, so I'm presuming

T2 for the moment.

I suggested two things in my post, but you only answered one - the doctor.

Did you read the link I provided? If not, please do. In case you lost

it: http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

If you want to keep trusting your doc - fine, that's up to you.

However, do a little research on your own body. Please try an

experiment tomorrow. Note every morsel you eat (and drink) in a diary

and, in addition to any tests the doc wants, test your BGs one hour

after you finish eating each meal or snack. Then come back and post

the diary and BGs. If you don't want to do that publicly, email me

direct. That's it - no drama, just a few extra tests and a log.

Good luck,

Cheers, Alan

July 6, 2005

Yah...but what I'd like to know is...what was her answer??

I'd really like to know how they can justify that.

Vicki

Re: new diabetic with questions

> Yep. That's the point where I walked out on my diabetes " education "

> class - never to

> return again.

>

> First thing they say: Avoid sugars!

> Next thing they say: All carbs eventually turn to sugar.

> Third thing: Eat all these carbs.

>

> You shoulda seen the look on the dietician's face when I asked " So,

> uh... why are you

> telling me to eat 45g of sugar? " Priceless.

>

> SulaBlue

>

>> Thanks... yes, they talk about carbs and you should have x amount for

>> this meal, and so

> on. Sounds like you hit the nail on the head.

>

July 6, 2005

I seem to remember a stunned deer-in-the headlights look, a very long pause, and

then

the " Well, carbohydrates are the body's main fuel. " spiel. The only thing I got

out of that

class was a free meter, thanks to breaking down in hysterics when my insurance

gave me

the runaround.

You see, I'm with United Healthcare. We can't just get a prescription and go

down to the

pharmacy to get one - we have to go to a medical supply place, even tho the

pharmacy

would likely be cheaper! The closest medical supply place to me, at the time,

was 50

miles, one way, through horrible snarling traffic. And, when I got there - I

couldn't *FIND*

the place at first, and when I did, they didn't have the one I was prescribed

(Lesson learned

on calling first!). My insurance is obviously run by idiots. The other medical

supply place

they tried to send me to was Petticoat Fair. Now, tell me - how many blood

glucose meters

do you think they have at bra shop? *GRUMBLES* Idiots.

SulaBlue

> Yah...but what I'd like to know is...what was her answer??

> I'd really like to know how they can justify that.

> Vicki

July 6, 2005

I've had a ton of email to read Vicki, and I appreciate all the help. Yes, my

diet calls for 60 carbs for breakfast, and 60 for lunch. And 75 at the evening

meal. So, this is just shooting myself in the foot? What foods and how much will

bring my numbers down? I've read about fast acting insulin, which I don't have.

Just 34 units of Lantus ever day. Grains are bad for you also? Darn, I've

turned into one who eats a lot of oats with Splenda on them...ha It that's bad,

I can change. My wife and I are really confused when it comes down to what I

should be eating. I've seen first hand what this disease did to my aunt, and I

really want to get a handle on it.

Mike

Re: Re: new diabetic with questions

Mike: Did you read the newby letter I earlier attached? It pointed out

that carbohydrates -- which turn into sugar in the body -- are as

important to avoid, if not more so, than just avoiding sweets.

It does sound like you've been fed the traditional ADA line, which calls

for a certain number of " servings " of carbs per day. Despite the fact

that many professionals think the ADA is the last word on how to manage

diabetes, it just ain't necessarily so. The ADA plan encourages people

to eat a lot of carbs (absolutely NOT necessary for health) then take

meds to reduce high BGs caused by eating those very carbs.

IMHO, it makes more sense to avoid those foods -- i.e. high GI carbs --

in the first place.

So if you're interested in lowering your BGs, you need to avoid high GI

carbs (the fast acting ones, such as anything made with grains, and most

root veggies) as well as sugar. My earlier post also pointed out the

importance of frequent testing to learn how different foods affect your

body.

Vicki

July 6, 2005

On Wed, 6 Jul 2005 14:44:06 -0000, " Mike Brown "

wrote:

>Yes, I've had an aunt who passed away a few years ago who was diabetic, and she

spent the last 2 years of her life on dialysis. So I'm very well aware this is

nothing to play with. This doctor has always been great in everything else, and

we've been seeing him for at least 5 years. I'm on 30 units of Lantis once a

day. What bothers me, is I've had it in the low 100's even a couple of 80's. I

haven't changed my diet or anything and this past week it just keep spiraling

up.

Are you counting carbs? If not then you should. You probably have

loaded up on excess carbs and don't realize it.

If you are counting carbs, then any of the following may be the cause:

You're about to get sick with an infection.

You're under excess stress.

Your Lantus has lost its potency from age, heat or both.

A lot of people report rises in BG when they're about to get sick,

when their bodies are starting to fight the infection. Allergies may

cause a similar response.

I know that stress sends mine skyrocketing. It doesn't seem to take

much at all.

Lantus seems to be a picky critter. Even though the circular says it

can be stored at room temperature for a month, based on what I've read

in my research, I keep mine in the 'fridge. Be sure to warm the

syringe to body temperature before shooting, as cold insulin burns.

If yours has been sitting out in a hot room for a month or more (at 30

units a day, it'll last longer than a month) then it might have lost

its potency. Opening another vial and trying it is the only way to

know. I'd do this after I eliminated everything else, however.

I'd bet on excess carbs as the most likely candidate.

---

De Armond

See my website for my current email address

http://www.johngsbbq.com

Cleveland, Occupied TN

July 7, 2005

How are you supposed to know how different meals affect you if you only test

twice a day?

Answer: You *CAN'T.* Twice a day might be fine once you get some set meal plans

down,

composed of meals whose effects you're familiar with. Until then: The doctor and

the Rn

are both wrong.

SulaBlue

> > Hi Alan

> >

> > I've always had good luck with this doctor for the past 5 years.

>

> OK Mike

>

> By now, you've read all of the other replies and I'm sure you've also

> had a few private emails.

>

> I'm not going to beat you 'round the head any further.

>

> Sit back, take a deep breath, and relax. This is usually a slow-moving

> disease. It's not been clear from your posts whether you are type 1 or

> type 2, but your doc obviously doesn't see urgency, so I'm presuming

> T2 for the moment.

>

> I suggested two things in my post, but you only answered one - the doctor.

>

> Did you read the link I provided? If not, please do. In case you lost

> it: http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

>

> If you want to keep trusting your doc - fine, that's up to you.

>

> However, do a little research on your own body. Please try an

> experiment tomorrow. Note every morsel you eat (and drink) in a diary

> and, in addition to any tests the doc wants, test your BGs one hour

> after you finish eating each meal or snack. Then come back and post

> the diary and BGs. If you don't want to do that publicly, email me

> direct. That's it - no drama, just a few extra tests and a log.

>

> Good luck,

>

> Cheers, Alan

July 7, 2005

Mike,

I agree with SulaBlue. I'm a newbie myself. Only been diagnosed since

March of this year. I had to tell my doctor how often I wanted to test

and why. He only had me testing twice a day as well. Once upon rising

and once prior to my evening meal. Well for me, both of those numbers

were great. It wasn't until I started testing after eating that I found

out my numbers were still going way too high. I even told him that I

wanted to change the time of day I took my meds to see if that helped. I

for one have a great doctor who is not only willing to continue learning

but who is willing to let me in some part direct my care. It is very

important for me to get this disease under tight control. My family runs

rampant with heart disease anyways and this will only affect me further.

You have to be pushy to get the care you need sometimes. Either make the

doctor you have work for you or find one that will. You are the ultimate

player in how well you get this disease under control.

To me, this list is a God send. Some of the people are a tad pushy in

their views but I feel that it's only because they have everyone's best

interests at heart. Ask one question and you may get 50 different

opinions. Some of them you'll like - some you won't. Don't let your

feelings sit on your shoulders or they are bound to get hurt. But there

is a ton of useful information on this list and years of advice from

people that have been battling this beast for what seems like forever.

Good luck and hang in there.

, diagnosed 3/05, type II, Amaryl and Actos

<<How are you supposed to know how different meals affect you if you

only test twice a day?

Answer: You *CAN'T.* Twice a day might be fine once you get some set

meal plans down,

composed of meals whose effects you're familiar with. Until then: The

doctor and the Rn

are both wrong.>>

SulaBlue

July 7, 2005

Mike, my husband was told to have 40 at each meal and I was told 20 for me.

Kathleen

I've had a ton of email to read Vicki, and I appreciate all the help. Yes,

my diet calls for 60 carbs for breakfast, and 60 for lunch. And 75 at the

evening meal. So, this is just shooting myself in the foot? What foods and

how much will bring my numbers down? I've read about fast acting insulin,

which I don't have. Just 34 units of Lantus ever day. Grains are bad for you

also? Darn, I've turned into one who eats a lot of oats with Splenda on

them...ha It that's bad, I can change. My wife and I are really confused

when it comes down to what I should be eating. I've seen first hand what

this disease did to my aunt, and I really want to get a handle on it.

Mike

July 7, 2005

This list gave me some great information that may help. I'm on Lantus, and I got

a vile at the doctor's office that I have been using, and I think all was well

there, when I finally go through with the vile they gave me at the doctor's

office, then I started using the one I got at the pharmacy. In reading here, I

have read that it is only good for 30 days. So, I have been using some Lantus

that was probably around 45 days old. I talked to the pharmacist and picked up a

fresh bottle tonight, so I hope that helps. I really don't want to change

doctors, but for a doctor who said 265 wasn't bad, then I think we have a

problem. I've had it down in the 80's to 120 range several weeks back, then it

started this climb. No doubt it will still be high tonight, but I take my shot

at 8pm and maybe (I hope) I'll see some improvement.

I have to stay on top of this also as heart problems, high blood pressure (I

have that also) and the fact that diabetes runs in the family.

Wish me luck!