Well perhaps not infamy, but it will be a milestone in my journey with diabetes. As promised in the last post this post will be about my visit with the endocrinologist after being completely dumbfounded and discouraged by my primary care provider.
I couldn’t see the new doctor until a month later so it was up to me to do the best I could with what I had. The PCP wanted me to stop ALL carbohydrate intake, if I wasn’t going to stop all food except on weekends. After I left the PCP I went to breakfast at Bob Evans. They have very good omelets. They also have scrumptious banana bread! I don’t do things half-assed. As much as I really wanted the banana bread I stuck to my guns. 3 egg omelet with diced ham and cheddar cheese. There. No carbohydrates. Of course now I had a different conundrum. No carbohydrates meant no variable to adjust insulin dosage. Where’s your logic now PCP?????After a little thought I figured it out. Breakfast arrived. It wasn’t as much as I usually got but it was enough and it was quite tasty.
The next 30 days were challenging. There were days that were just as they should have been. However, there were more days with 200-300 fastings, correction doses to get it under 150 only to repeat the rollercoaster again when I woke up. It was clear that my body was pumping out its own glucose! AS I had been told by the PCP that I was taking dangerous amounts of insulin, I had started to reduce the basal amount by 10% every three days. I had been taking 100units at bed and had worked it down to 88units of Lantus (glargine i-100).
Not only was I feeling like crap because my blood sugar was consistently elevated with intermittent ketosis, but the hyperglycemia was impacting my productivity at work. I couldn’t concentrate, my vision, already impacted by diabetes, was blurry – I stare at 3 monitors for 8 hours plus a small print reference manual. Not to mention frequent trips to the bathroom.
Finally the appointment day had arrived. The last time I had been in this office I had been talked down to by the Nurse Practitioner, questioned if I was really a Type 1 and because she would not help me put my socks back on – refused to look at my feet which she had asked to see. She told me next time not to wear socks so she could look at them. So to say I was a little anxious would be a safe bet.
I was called back and the usual things occured – height, weight (315lbs), medication lists, a finger stick for an A1C in the office and a download of my meter readings. Next step – see the endo. It was like waiting for the Great Oz to appear from behind the curtain. A knock upon the door and it was show time…do or die.
Introductions were made. Then straight on to the heart of the matter. “Why are you here today?” I replied, “Because my PCP says I am taking too much insulin and I should eliminate all carbohydrates from my diet.” The obvious next question was “How much insulin are you taking?” “I am taking 48units Novolog before meals and 88units Lantus before bed.” He then proceeded to review the numbers from my meter. He was making notes on the paper, he pulled out his phone and punched numbers into the calculator. Then he stopped and looked at me. “Well, the problem is you are not taking enough insulin. You should be taking as much basal insulin as your combined bolus doses. But first we need to get your basal amount increased.” Again the calculator was employed, more notes written. “OK. Let’s start here and go up every three days until your fasting is under 180. As far as the carbohydrates, you need carbohydrates in your diet. You can reduce them but do not eliminate them. Any questions?” “Yes. What is my A1C?” “8.3%.”
With that I left the office with a renewed confidence in managing my diabetes. I had finally found a provider who bought into the team approach, listened to what I had to say and what my goals were and together we develop a dynamic plan. I also had new prescriptions for “massive amounts” of insulin to take to the pharmacy.
So what is the take away from this post? You need to find a provider who is going to work with you without dictating your care. We are the ones who must “suffer” this condition and unfortunately there is not a one size fits all for treating and managing this condition. Lastly, the new endocrinologist confirmed that I most certainly was a Type 1 AND I was markedly insulin resistant.
Went back for my second follow up. I am currently taking 35units U-200 bolus and 87units U-300 basal. I have been on Invokana (canagliflozin) off label for 3 months. Drum roll……….. my A1C—-> 6.4%. In my 38 years of being diabetic I have rarely seen it at 7% let alone under 7%. Maybe this day will live on in infamy, for me at least!
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Until the next time, when I will discuss and review some technology tools out there for us sugar testers. Remember, be good and if you can’t be good at least be as good as you can.
Peace+ Tim the DiabetesDude
Here is a book that you may find useful in your quest to make sense of this rollercoaster ride. I have no relationship with the author or the publisher other than receiving a commission through AMazon if you like it enough to buy it.