1 hr at 140 Harmful?


I think that is a good idea to keep that appointment but try to find someone else. When I was already in early dka but didn't know it, I called my neighbor's endo to get an appointment and they said they couldn't give me an appointment for 3 months if at all, I can't remember now what they said exactly... even with symptoms of dka, it was crazy. At least you have an appointment which is better than nothing. 25g is a good amount, there's plenty you can eat and you can add more fat/protein too... 123 is great!

Many endos will tell you their next opening is at least 3 months away. Why? Because they have a ton of diabetic patients who all schedule their next appointment three months out and a good endo will totally max out and stop accepting patients. And this is made worse by endos booking new patients for a "long" appointment.

Fortunately there is a trick that you can often use to get in earlier. Turns out life is complicated and large number of patients have to call and reschedule. And they do it at the last minute, creating an opening "this week!" Tell them you wish to be placed on the wait list and if any opening appears you want to get in and see the endo. You would be surprised at how much this works.

Melitta, I just wanna say: I love you! your answers are always so good and informative, where in the world is the 1000x like button?!?
Keep up the good work you do for our community!!!

Thanks Brian for the good advice! I just called and had the new endo office put me on the wait list..fingers crossed that I get one of the better doctors. I did some research on them and there are 2 of the 6 that had bad reviews :)

I hope you don't get my former endo. I now refer to him as "He who shall not be named." I wrote about my search for my current endo back in 2011, you might find it amusing (and disturbing).

With normal bg's, exercise does indeed help improve insulin sensitivity.

After bg's get high enough that sugar is spilled in urine and dehydration becomes an issue, there is a marked decrease in insulin sensitivity (some might write this as "insulin resistance") and exercise just accelerates the snowball effect.

Yes, this is true. I had this problem before I was properly typed. If I exercised too much I'd be like 250 mg/dL with ketones . I always wondered about that , but I recently found out that the body gets all screwed up when you exercise and don't have enough insulin in your body. I can exercise now that I'm on insulin, and have no negative effects unless it' really intense then I might go low. I keep my exercise very low intensity like a nice walk or something and it doesn't have a big impact on anything either way.

I was lucky that I was able to get in to see my endo a few weeks (I think 2?) after I called, mostly because I told them how much being untyped distressed me and they were like Oh my god I"m so sorry we need to help you then. I see my doctor at the private practice and not the big diabetes center that might take 3 months or more to get an appointment at all at.

That explains a lot for me...if my RA is under control (inflammation) I can do low impact stretching exercises and my GBs drop, but if RA is not under control and I still exercise my BGs swing high. I thought with the weight loss since my D-diagnosis (now up to 45 lbs); but, it's just the opposite.

I've been on a rollercoaster ride with creeps (spikes) and dips (drops). It's like my pancreas takes short breaks and then it decides, "it's time to get to work" and overdoes it and I drop and have to scramble to get it back up.

Lil Mama, I try to do low carbs and it works well for breakfast and I can make it to lunch without a mid-morning snack within range. However, after lunch sometimes I'll either plummet because digestive dumping resulting in a low and a rebound. Or, I'll remain in range until I an hour before I leave work or while on the road heading home.

I assume traffic jams causing stress is the cause; however, I am not fond of snacking. Do you have any of these issues with your low carb diet? Due to food allergies I am limited with snacking choices and food choices in general so that makes my overall choices for food difficult and quite repetitive.

Initially, My levels were very wacky and reaching over 500. 3 months later I was to have my Endo appointment. I got put on a cancellation list and got in a few days later. What a relief!

Update... The nurse from NIH just forwarded me a response from a diabetes educator regarding my request for a referral for a second opinion on treatment since the endo (fellow) at NIH told me there is no treatment. Below is what the diabetes educator said:

"It seems the literature is inconclusive in terms of sparing Beta cell function in patients with LADA. There were some studies using Januvia or metformin. Some with insulin on board as well but there were no major benefits that were much different than the watch and wait approach. Medications may have side effects but the lifestyle adjustment and monitoring blood glucose and A1C approach is something to be done either way. The literature stresses that it may be months to years (one study average was 11 years) before the need for insulin in patients with LADA. Her GAD result is 0.05 with normal being less than 0.02. I did not see where level of GAD made a difference in progression. I do not see a problem with her asking her PCP to refer her to an endocrine specialist but our Fellow may be right-there is no proven approach to take at this time."

I am still trying to digest her statements and don't know how I feel right now. Any thoughts or opinions?

Thatt's kinda crap, not gonna lie (well I have a better word but that'd be censored) . You have antibodies, you have had readings over 200, you should not be denied treatment further. Your life is not what it should be as you're not eating a lot and you don't feel great. Not treating diabetes has much more major side effects than taking low doses of medication , watching and waiting is not gonna help.

That's just my opinion but I'm someone who advocates for early insulin in people with slower onset type 1. You're a type 1, there's no room for mistreatment.

There are so many inaccuracies and falsehoods in the statements from the "diabetes educator" that I don't even know where to begin. I would go to a different doctor/different practice. Some people here on TuD have had good luck with connecting with other adult-onset Type 1s in their area, and going to the recommended endo. Maybe that is possible for you?

Bottom line, you are GAD positive and have results over 200 mg/dl, which according to the ADA guidelines is a diagnosis of Type 1 diabetes. There is one treatment for Type 1 diabetes, and that is exogenous insulin.

I disagree with her assessment. If you weren't eating the diet you're eating now your a1c would be much higher so I would stop that for a week or two before you see your new endo and keep good records. She said she has no problem with a referral so that is your green light. Find a good endo, get and appointment and keep the one you have. A second or third opinion never hurts. Keep going till you find someone good to treat and follow you.

There is certainly evidence that maintaining normalized blood sugars leads to better retention of beta cell function (for all diabetics). While Melitta and I differ in our opinions of whether oral medications have any role in treating LADA I think we would both agree that what matters is normalizing your blood sugars.

I would focus on treating your diabetes tightly controlled not treating your LADA. What you really care about is getting early and aggressive treatment to help you normalize your blood sugar. You need a PCP or endo who agrees with that goal and will step back from wanting to "wait and see" on whether your A1c has finally reach 7%. You want a doctor who will help you figure out how to normalize your fasting blood sugars and reduce your mealtime blood sugar surges so that you are safely back to normal levels after meals.

Thanks everyone for your advice and support--it is very much appreciated! I told this diabetes educator that I was eating 25 grams to keep my blood sugar under 140 at all times and she said that I probably could eat 30 if I make sure I balance the carbs with protein and NOT high fat. Anyway, I would be interested in connecting with other people who have Type 1 in my area, but I'm not sure how to do that other than to say I live in southeastern PA. If anyone knows a good endocrinologist in this area please let me know.

Good luck in finding another practice! 5 grams of carb usually translates into about 25 points on the meter. So if you're really, really precise and careful you can eat a very restricted diet and regularly look at numbers around 160-200 (even if they do come back down in an hour or two).

You're being provided with state of the art treatment circa 1915.

Is the 5 grams with a rise of 25 on top of the premeal glucose?