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Should I trust my Dr?
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singlenscared posted:
I hadn't been to a Dr in 5 years. Decided to have a physical ....Dr said my a1c was 11 and put me on insulin that day. I do have a diabetes education class scheduled but have been doing research on the internet. It appears to me that most people start out on a pill then as the disease progresses move to the needle. Should I trust my Dr. or get a second opinion?
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mrscora01 responded:
To my mind, your doctor is on the money. An a1c of 11% translates to an average glucose of 269. So a lot of the time you are even higher than that and you have probably been running that high for quite some time. Significant damage is occurring and the sooner your sugars are under better control, the better. Once things are better controlled, there is always the possibility of stopping the insulin. But you can't take back the damage. It can take 6 weeks or more for a drug like metformin to take effect, but th einsulin works fast. That's my take on it anyway.

Are you also cutting carbs and exercising more? Also, have you been tested for type 1? That is always a possibility too. What is your insulin regime? Just long acting or short acting before meals as well?

Anyway, it seems to me that your doc is concerned with preventing any additional damage and is looking at your long term health.

Cora
T1 1966, Dialysis 2001, kidney transplant and pump 2002, pancreas transplant 2008
 
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debs_bears responded:
A1c's do not lie - if it says 11 then that means your diabetes is not controlled.


Your doctor most likely put you on insulin to get your numbers down quickly so that you do not reap the ill effects of the disease.


Once your diabetes is controlled and your numbers lowered he/she can put you on the pill.


In my opinion stay with the doctor who diagnosed you and go to the classes and learn all that you can about diabetes.


Unless you have type 1 it is my understanding you can be transitioned from insulin to the pill (usually Metformin) once you are stable - and sometimes with a lifestyle change in foods and exercise you can get off all meds if you are type 2.
May the Blessings of the Lord be with you always. If you want to know more about me press on my picture. Debbie
 
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auriga1 responded:
Single, there is no reason not to trust your doctor at this moment in time. As MrsCora stated, your average glucose is very high. Your A1c is an average of your blood glucose 24/7 for three months. Insulin helps keep your sugars in check and works almost immediately. You may have to adjust your dosage if your readings don't come down.

I don't know what type of regimen your doctor put you own. We are each different in how we manage our diabetes. There are no black and white areas when it comes to this disease.

I was diagnosed as Type 2. My endocrinologist put me on two insulins to help me get my A1c down from 13.2. Even though I am diagnosed as Type 2, my doctor believes my pancreas no longer makes insulin. I will be using insulin for the rest of my life. I use a basal insulin and a rapid-acting insulin. My A1c has come down to 5.6 using insulin and eating a much lower carb diet these days. I am also physically active which helps immensely. My dosages have been adjusted back and forth. My physical activity caused a lowering of my basal insulin from 40 units to 26U. It's important to keep moving as much as possible.

As the other posters stated, you may be able to get off of insulin. Keep your weight within the normal range for your frame and keep physically active along with lowering your carb intake. All of these things help bring your blood sugar levels down.
 
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brunosbud responded:
"...Should I trust my Dr. or get a second opinion?..."
Use the insulin per your doctor's instructions and go get a second opinion. This way, you can be safe and in denial at the same time.
 
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singlenscared replied to brunosbud's response:
Thank you all for your responses. I am not in denial, I suspected for a while that that would be the diagnosis. I am frustrated more than anything. Everyone talks about diet and exercise. I eat a good diet. 3 carbs for each meal, one carb for snack, 3 snacks a day. I walk 3-5 miles a day. 10 of Lantus and my bs rides consistently at 190-240. Yesterday my dr increased my lantus to 16 at the request of the dietician, Today, I see no difference in my bs, low of 199, high of 238. I am so frustrated, I have never had a bs of less than 171. What else can I do????
 
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bigred53 replied to singlenscared's response:
Hi. I don't claim to be an expert and I've never been on insulin so this is just my opinion. You might try cutting back on the carbs.

I rarely eat starchy carbs - bread, rice, potatoes or pasta. When I do have bread it's whole grain. It's been months since I've had rice or pasta and probably two months since I had a plain baked potato.

Lately I've been eating mostly sugar snap peas, cucumbers and celery during my work day and I usually have a grilled chicken salad for dinner. I've also been eating several servings of blueberries or blackberries a day since they've been on sale. Now that it's cherry time I've been having some of them too.

Some of us diabetics are more sensitive to carbs than others. Also if you're just starting out it can take a while for your body to adjust to the insulin or meds.

My last A1c was 5.6. When I was diagnosed it was 13.9. Two years ago I was getting a bit crazy and got up to 7. I can't remember the last time my fasting was even close to 100 let alone over that.

I'm a food addict and if I can lose weight and get my diabetes in fairly good control anyone can. Sure I take meds but I still have to work at it to keep my blood sugar where it needs to be.

Keep coming back and asking questions and reading prior posts. Learn as much as you can.

Michelle
 
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brunosbud replied to singlenscared's response:
It may take weeks (longer in some cases) to dial in proper dosing of insulin. Insulin in the hands of the misinformed injures or kills, everyday. What do you think happens to physicians who over prescribe insulin to their newly diagnosed patients...after they pass out while driving their kids to school? Doctors who prefer to stay in practice tend to exercise great care and err on the side of safety when introducing insulin to newly diagnosed diabetics.

I understand your frustration. Diabetes is all about frustration and relearning how to live. But consider this. An A1C of 11 represents an "average" BS of 269. And, you haven't seen a doctor in 5 years. That could mean you've been living, at moments throughout the day, with alarmingly high levels (300 ) of sugar in your blood for a while, now...3 months? 6 months? A year? 5 years? How would you know?

Your doctor's been treating you, what...30 days? You been eating "3 carbs each meal" for how long? 25? I often remind my wife, "Honey, do you know the quickest way to ruin a marriage?" By adding two words to the end of every need..."right" & "now"


(Well, every "need" except one, of course!)


SS, I realize you're scared. But, from my perspective, being "scared" is not always a bad thing. Especially, when it's critical that action be taken. And, that's exactly what you are doing! Kudos. One last thing, you did not mention what Type of diabetes you have (1 or 2). Do you know that Type 1s must use insulin?
 
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singlenscared replied to brunosbud's response:
My dr has not told me if I am type 1 or 2. I guess I thought that it must be 2 because it is often called "adult onset" I am 42 yrs old, 5'3'', 140 lbs and very active.

My diagnosis was made in May so yes I have been on insulin and eating this way for about a month. My dr and dietitian told me 3-4 carbs per meal and 1 carb per snack. 3 meals and 3 snacks a day. I have been very strict about this. I cheated once.......I could not resist a tootsie roll. ONE tootsie roll. I eat basically the same thing every day. turkey, cheese, on wheat toast sandwich for breakfast. Cheese and 6 saltine crackers for snack. Another sandwich for lunch. 1 oz peanuts for snack. Salad with turkey and saltines and vinaigrette dressing for dinner, cheese or peanuts for snack.

I think that I am on the low side for carbs, most of my meals have only 2, but I want so badly to get a bs less that 100. I don't know what to do.
The other day after increasing my insulin (Lantus) to 16 I felt nauseous and couldn't eat. My bs was over 200, and I watched it every hour, it dropped to 171 by 2 pm, then at 3 pm it went back up to 176. UGGGHHH! By 5 I decided that saltines might help my nausea and ate 3-- a serving is 6. Bs at bedtime was back to 208.
I went to diabetic class and all they said was eat less excersize more. I walk 3-5 miles a day at work, I work 5-6 days a week. I also do 1/2 hour a day on the wii. I have and walk my dog and do all my own housework and yard work. Even when I mow the lawn, my blood sugars remain close to 200.
Should I cut out my bread and crackers? Get my carbs from fruits? Do fruits make you feel full?
 
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bigred53 replied to singlenscared's response:
SS try to relax. Diabetes is a learning process. I think you need to be in contact with your doctor more often since you are just starting out. It is my understanding that when starting out on any insulin a doctor will titrate the amount of insulin upwards gradually to the point your blood sugar levels are within range. It can be a slow process and it sounds like your doctor is being conservative and careful.

Btw I lied about the rice yesterday. I'm getting old and losing my mind. ..lol. I had a Mexican salad that had rice and black beans in it. One hour after eating it my bs was in the 170 range. The next morning my bs was 60 - a bit too low but I took a swig of juice and I was okay. My bs rises really fast right after I get up even though I don't eat for a couple of hours.

This is what I usually eat during the day while I'm at work - two fat free Greek yogurts with either blueberries or blackberries, a serving of pistachios and I snack on sugar snap peas or raw green beans. For lunch I'll have a cup of low fat cottage cheese and a plate of cut up celery or cucumbers with a V8 juice. On my way to work I get a sugar free vanilla iced coffee. I mostly drink water and sometimes a sugar free blueberry flavored green tea during the day. For dinner I usually have some kind of salad - usually grilled chicken. Occasionally I'll have a small cheeseburger with a small side salad. I do occasionally have a bean and cheese burrito and a taco also.

For the most part I'm pretty good with what I eat. I do have my crazy times as I call them when I over indulge and I try not to beat myself up about it.

Imo fruit and a piece of cheese is better than crackers and cheese. More nutrition for the same amount of carbs.

You can still go out to dinner with family and friends. More and more restaurants are offering healthier choices. I will usually eat half of my entree and have the other half for lunch the next day. You can also check out the menus online and decide what you're going to have before hand.

Don't be scared. Diabetes is doable. Communicate with your doctor about your concerns. Communicate with us too as often as you need to.

Michelle
 
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debs_bears replied to singlenscared's response:
You are saying you are eating 3 carbs per meal - are meaning 45 grams of carbs per meal? Plus 15gms per snack times 3?


I am thinking that might be too many carbs for your body.


When I was first dx'd I was told to eat no more than 30 grams of carbs a meal and no more than 2 snacks a day eaten with protein.


I am not a doctor or dietician but something isn't right if you can't get your numbers down, that's why I am thinking too many carbs or the wrong kind of carbs.
May the Blessings of the Lord be with you always. If you want to know more about me press on my picture. Debbie
 
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auriga1 replied to singlenscared's response:
Single, the best thing I had ever done was to keep a record of foods and everything I have put into my mouth for a month. This record also included BS readings. The BS readings were taken in the a.m. (fasting), before a meal, two hours after a meal and at bedtime. That was eight times a day of testing. All of this was doctor's orders so that he could see what was going on. I didn't have to do it, but I did not want to have any more damage done to my body because of high BS readings.

You will see this over and over again; we are all different in what we can eat and how are bodies react to the carbs we eat.

Do you really "need" three snacks a day?

I am not a physician or any kind of medical professional. I only speak from experience. 16 units of Lantus did nothing for my blood glucose readings. As I said, keep track of your BS readings. Call your doctor and tell him/her that your BS is not coming down. It should immediately with the right insulin dosage. I started out at 15 units of Lantus. As I said, it did nothing for my BS. My doctor wanted me to call him every two days with my readings. I finally wound up going to 40 units of Lantus to get my BS readings in normal range.

Insulin needs change if one loses weight (if they need to), if their eating habits have changed, if their physical activity has changed, or if they are ill. My Lantus dosages go up and down because of physical activity or illness. Nothing remains static when it coms to diabetes.

I have a second insulin to go with meals. Carbs raise my blood sugar every time I eat.

"What else can I do?" Call your doctor. You may need a change in dosaging and/or regimen. Your doctor should be on your side. He/she wants to help get your numbers down.
 
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singlenscared replied to auriga1's response:
Thank you to all of you who took the time to talk to me and give me advice. Just thought I would let you all know that I had my lowest BS since I started testing last night at bedtime. 156! Yes I know that isn't great, but for me it is cause for celebration!

I am still up in the air about my Dr, she doesn't seem to care about me much, neither does her nurse. When I call in with a concern or question, I get told to keep doing everything I am, or told to go to urgent care. I am not feeling much like they give two hoots about me. We will see, I guess.

On the brighter side, I took some advice from all of you! I cut out snacks unless I am truly hungry, I cut out all refined wheat starches and replaced them with fruits. I started and additional 1/2 hour on the WII, yoga, not a lot of activity, but trying to relax a bit.

I will keep coming back here, you guys did more for me here than my Dr has done. Wish I could send you each a bowl of blueberries in payment!!

Thanks again!!
 
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auriga1 replied to singlenscared's response:
Single, good for you for taking action. You are your own best advocate and coming here to ask questions is really a big deal.

Regarding your doctor, I truly don't now what to say other than (if you can) find an endocrinologist (specialist in glandular distors, including diabetes.) I have had the complete opposite experience than you have had with your doctor and office. My doctor wanted my fasting number to be in the normal range and that entailed all the recording of food and drink intake along with all my BS readings. All your reading and research idicate that you know your numbers are not yet within the normal range. Basal insulin at the proper dosage will get you within range. I know this from experience. It took many weeks of tweaking my dosaging of Lantus until my fasting number came down to 100 or below.

If you test 2 hours after a meal, your number should be under 140. If not, the carbs you ate have given you a higher BS reading. Make note of what you ate that may have given you a rise in blood sugar.

Fruit is good and nutritious. The thing I have discovered is that most fruit will raise my blood sugar. Many fruits are just naturally high in sugar. Take a look on the net at the glycemic index and you will see where foods fall on this index. Try and avoid those high on the index or eat very minimal amounts to avoid spiking your blood sugar. Eat plenty of protein and fiber with any carbs. This combo slows down the absorption of glucose into your bloodstream. Eating simple carbs will raise your blood sugar quickly; and just as quickly your BS tends to drop dramatically.

FYI, I have switched doctors when I have not been happy with the "services" rendered. There is no loss on either side. If you feel you are not being taken care of properly, make some phone calls.

BTW, I LOVE blueberries! LOL. Cherries are even better, but they are not in season here in the Midwest.

Activity is good. Very, very good. Anything to help your muscles utilize that glucose in your bloodstream. Glucose is used as fuel for your muscles, so the more movement the better!
 
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bigred53 replied to auriga1's response:
Auriga I wish I could send you some blueberries and cherries too. I went to the grocery store this morning, blueberries were $2.99 for an 18 ounce container and cherries were $2.50 a pound. The blueberries are huge too. I hope they get some blackberries back soon. Those three and strawberries are my favorite fruits. I usually get the strawberries from a field stand as they are fresher and sweeter imo. Sorry if I'm making you jealous.

If I remember correctly those four fruits are lower on the glycemic index than most. I'm not an expert so I could be wrong. I'm an expert at eating them though. ..lol.

Michelle


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