Guest guest Posted June 13, 2006 Report Share Posted June 13, 2006 In a message dated 6/13/2006 9:12:03 P.M. Eastern Daylight Time, alykidwear@... writes: I don't have a family doctor, and am getting rather uncomfortable leaving my care up to people who don't specialise in the health issues I've got. Would it be a good idea to get in to see an endo? Hi Aly, I have a family doctor and I trust her completely. Whatever doctor you see, there must be trust or you will not succeed. Other things you need to consider when choosing a doctor is: How long do you have to wait for an appointment? If you have an emergency, can you get in to see him/her immediately. hugs Eunice Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2006 Report Share Posted June 13, 2006 I was diagnosed with T2 3 months ago, and attempted to control it via diet. I haven't been doing too great at that, and have slipped in my testing regimen (I honestly can't remember the last time I tested). I had my first A1C done a week ago, and it was 6.5. At my diabetes education class in April, we were told to aim for under 7.0, but the sheet says above 6.1 is high. Either way, it's lower than I expected considering that I've not been paying much attention to my health. Anyway, the doc prescribed Metformin for me. He wrote the script for 1x500 mg 3 times a day, but said that I can start at just 1 time a day if I want. What is the usual starting dosage? I should mention this was just a GP at a walk in clinic - not an endo or anything. I asked him if I should be seeing an endo, and he basically said to see my family doctor. I don't have a family doctor, and am getting rather uncomfortable leaving my care up to people who don't specialise in the health issues I've got. Would it be a good idea to get in to see an endo? Thanks for any help, Aly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2006 Report Share Posted June 13, 2006 I would get a family doctor or internist AND an endo. If you want the best decisions made and choices given to you then you needs doctors that know you. That is my opinion anyway. ~Marisa dx. 2/21/06 __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2006 Report Share Posted June 13, 2006 Aly: I take metformin xr. I started with just 500 mg once a day. I am now taking 500 mg twice a day. Your HbA1C is not horrid - If you were enclined you could work a bit with diet and exercise and see if you can manage without meds. Mostly, that involves doing some exercise each day - 30 minutes or so.. And adopting a low carb eating style - and the other key is test, test, test, test. Then you will get a feel for how your body handles certain foods and activities. Also, research a doctor. See if there are docs in your area that offer " meet and greet " appointments - that way you can get a feel for their style of practice. Good Luck! C Medication question I was diagnosed with T2 3 months ago, and attempted to control it via diet. I haven't been doing too great at that, and have slipped in my testing regimen (I honestly can't remember the last time I tested). I had my first A1C done a week ago, and it was 6.5. At my diabetes education class in April, we were told to aim for under 7.0, but the sheet says above 6.1 is high. Either way, it's lower than I expected considering that I've not been paying much attention to my health. Anyway, the doc prescribed Metformin for me. He wrote the script for 1x500 mg 3 times a day, but said that I can start at just 1 time a day if I want. What is the usual starting dosage? I should mention this was just a GP at a walk in clinic - not an endo or anything. I asked him if I should be seeing an endo, and he basically said to see my family doctor. I don't have a family doctor, and am getting rather uncomfortable leaving my care up to people who don't specialise in the health issues I've got. Would it be a good idea to get in to see an endo? Thanks for any help, Aly Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2006 Report Share Posted June 13, 2006 > > Anyway, the doc prescribed Metformin for me. He wrote the script for 1x500 > mg 3 times a day, but said that I can start at just 1 time a day if I want. > What is the usual starting dosage? > > I should mention this was just a GP at a walk in clinic - not an endo or > anything. I asked him if I should be seeing an endo, and he basically said > to see my family doctor. I don't have a family doctor, and am getting rather > uncomfortable leaving my care up to people who don't specialise in the > health issues I've got. Would it be a good idea to get in to see an endo? Metformin usually starts at 500 once a day. At one point, I was taking 1000 twice a day. It just depends on what you need. As far as the doctor goes, I'd find a family practice or internist... so you can start developing a consistent care plan and relationship for ongoing care. Most family practice and internal medicine physicians are quite capable in developing a plan of treatment for diabetes. If an individual patient is particularly difficult to manage, or has additional complications or presents unique problems, a referal to an endo may be in order. Probably the most important aspect of your care will be through a diabetes education program and through you following the plan of treatment you are given. It doesn't make any difference if you see a random GP in a walk in clinic or an endo... if you don't follow your meal plan and test, what difference does it make? Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 Very good points to consider. Thanks Eunice Aly Re: Medication question Hi Aly, I have a family doctor and I trust her completely. Whatever doctor you see, there must be trust or you will not succeed. Other things you need to consider when choosing a doctor is: How long do you have to wait for an appointment? If you have an emergency, can you get in to see him/her immediately. hugs Eunice . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 I am doing low-carb for the most part, and was doing awesome with that, and with testing 3-4 times a day, for about 6 weeks...and then I went out of town for a weekend, and ran out of test strips b/c I didn't make sure I had enough with me, and I didn't have access to proper meals for that time frame...and apparently that was all it took for me to slide back into a lot of my old habits. I am trying to get more active, but it is difficult at the moment. I used to be very active, but when I got pregnant with my son 5.5 years ago, I got very lazy, and I've been paying for it ever since, strength-wise, as well as weight. I am currently at least 130 lbs heavier than when my husband and I got together, though it's likely more like 170 heavier. I hadn't been weighed in several months when we got together, and had lost more weight. At any rate, I am trying, and it seems to be helping. I think that's partly why my A1C was as low as it was. I was honestly expecting something more in the range of 8 or 9 because when I have tested, my sugars have ranged from 142-212. My FBG on the bloodwork was 130, which is actually low for me. My average FBG has been 176 since diagnosis. But, prior to getting the bloodwork done, I'd been walking for 10 minutes. It seems like most endos here are by referral only...One of the bad parts of socialized medicine, I guess. (I'm in Alberta, Canada) Aly RE: Medication question Aly: I take metformin xr. I started with just 500 mg once a day. I am now taking 500 mg twice a day. Your HbA1C is not horrid - If you were enclined you could work a bit with diet and exercise and see if you can manage without meds. Mostly, that involves doing some exercise each day - 30 minutes or so.. And adopting a low carb eating style - and the other key is test, test, test, test. Then you will get a feel for how your body handles certain foods and activities. Also, research a doctor. See if there are docs in your area that offer " meet and greet " appointments - that way you can get a feel for their style of practice. Good Luck! C . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 Thanks The sheet says it's the 2003 CDA guidelines...so, that's new-ish I guess lol (Canadian Diabetes Association). It also says 'Recommended target HbA1c 7.0% or less for males and non pregnant females greater than 12 years old. Recommended target HbA1c 6.0% or less for pregnant adults. " and the target range it shows is 4.3-6.1. Hmm...so according to that, I'm within the target range, but...? B/C I am definitely not a pregnant adult LOL Thank you for the info re: usual starting dosages.I will definitely google it, but wanted to ask from those who have BTDT first Aly Re: Medication question 7 is the ADA " target " range to stay under for A1C. But most endos prefer less than 6. My endo explained that at 7 you can still have damage in the future. Some are beginning to lower target ranges. Maybe the sheet you have reflects a newer number or maybe it refers to a normal range. Most often people take 1- 500 mg tablet of Metformin for the first week, then the 2nd week take 2 per day (one morning, one evening), and add the 3rd on the 3rd week (not sure about when those are taken as I never got past the first week!) It sounds like he left the option up to you. But if he didn't say how to progress this call him back to make sure. The reason for starting slowly like that is to minimize side affects. A lot of people have upset stomachs with it. By starting with lower dose you can adjust better. I'm not saying you should do it this way but just wanted to answer your question about starting doses. You can also view this on the Metformin website or check back with your dr. There's lot of info regarding Metformin on a google search. . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 I have seen this site before, but didn't really have a frame of reference since I just had my first A1c done. Thanks Aly Re: Medication question Aly, On my previous post I meant to include this link for you to see what the various BG levels are at various A1C levels. You can see just what your 6.5 would be in terms of averages for the day. I think that really helped me. My endo was the one to mention this. I just thought in terms of the A1C not daily numbers. http://www.geocities.com/diabeteschart/bloodsugarchart.html . Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 Many good points. Thanks Mike. Regarding the meal plan...I have been roughly following the guidelines we were given, but not very strictly, and I have slipped a few times. It's primarily the testing that I need to get back into. I tend to freeze up and it takes me a few minutes to build up my courage to do the finger stick. I keep hearing that it's not supposed to hurt to prick your finger, but my fingers usually end up aching for at least a half hour after a test, and that's with the lancet device set to the highest setting. I'm not sure what more I can do to minimize the pain, or if it's even possible... Aly Re: Medication question Metformin usually starts at 500 once a day. At one point, I was taking 1000 twice a day. It just depends on what you need. As far as the doctor goes, I'd find a family practice or internist... so you can start developing a consistent care plan and relationship for ongoing care. Most family practice and internal medicine physicians are quite capable in developing a plan of treatment for diabetes. If an individual patient is particularly difficult to manage, or has additional complications or presents unique problems, a referal to an endo may be in order. Probably the most important aspect of your care will be through a diabetes education program and through you following the plan of treatment you are given. It doesn't make any difference if you see a random GP in a walk in clinic or an endo... if you don't follow your meal plan and test, what difference does it make? Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 The question is simple. Do you need the medication? I don't know where you were before you started but let me give you some numbers. I was dx with 6.9 a1c, 149 FBS. In 3 months - with only six weeks of it really under any form of control - I hit 6.1 120. The doctor was put out because he knew I wouldn't go on meds if I hit something reasonable because of our history on blood pressure medicine. I wanted facts and studies that showed I needed it. At 6.1/120 nobody responsble was saying I needed meds. Three more months I hit 5.6 119. Why then do doctors prescribe meds for someone? 1) Many doctors have seen major problems with diabetes complications. They want to prevent them. (I agree with that). 2) Many doctors have seen people start out with diet control and get lazy, come back in 5 years with major complications. If they put the person on meds they have a string to pull them back every three to six months. It isn't the patient flow they want, I believe most of the sincerely think it is the best. (I agree with their assessment.) But if the person is going to take the disease seriously, in fact more seroiusly than the doctor, then this is the wrong course unless the person cannot control. Right now I have a good level of control. My a1c this time will be in the 5.3 to 5.8 range, based on tesing. Medication will only increase drug risks without any benefit. But what if I could not eat enough to live (right now I am slowly losing weight, that cannot continue indefinitely) then I must go on meds. Since I would like to loose about 10 more pounds I am not interested in meds at this time. The other thing I am noticing is I have some more tolerance for carbs than 10 months ago. If I went over 33 at one meal at that time I was spiking. Today I can get over 40 before that happens. At 40 I may become weight stable. In addition this seems to be because of weight loss. I may hit an equilibrium point. If there are two things diabetics need it is informed consent and discipline. My doctor wanted to put me on Lipitor the next time (not sure if i need it why not now, my chlosterol numbers are about 1/2 top good values. My HDL is low. I asked if there was evidence that this would increase the HDL, there is none. I told him that I would go on Lipitor but wanted to go off one of the blood pressure meds, which one should I stop. I have been assured the BP meds are more important. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2006 Report Share Posted June 14, 2006 Hi Alyson! Although I do not have any pain with the lancets...I too avoid doing the finger sticks. I don't know why, I guess just lazy with my 3 kids, working 9 hours a day, going to the gym for 2 hours a day then taking care of our dog. Maybe you and I can encourage ourselves to do the finger sticks. I wish that someone would just come up with another way. You know how they have the thermometers that just go on your head or in your ear? Maybe we can all devlope another way to avoid the finger pricking. Who knows? Maybe as a group we will develope something and become Millionairs!!???...doesn't hope to dream! Quote Link to comment Share on other sites More sharing options...
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