Do we have an Im-poster?
A poster who is assuming the identity of someone with diabetes?
Hmmm . . .
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Hey Jen. Changed site (kinked cannula on insertion) and corrected with Afrezza.
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@Jen - awesome post.
@gonetotown - I hear what you are saying but my Endo, who I have a very, very strong relationship with, encourages me to make adjustments on my own. Regardless, itās a valid question posted by both Jen and Sam, do you have diabetes? This isnāt out of hostility, just helps us all with context regarding your questions and comments.
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That was sort of the point of my original comment ā DONāT jump to a conclusion and presume itās just some minor issue with āinsulin resistanceā or excessive snacking. Without a detailed history of when the symptoms started and under what conditions, etc, itās practically impossible to ascertain a specific etiology.
Moreover, one might reasonably assume that the OPās endo has a long term management plan of some sort. Now, on his own, the OP has chosen two approaches ā intramuscular injection of RAI and stacking two different RAIs ā that are risky and which, I suspect, his endo would not approve without knowing more about what is going on.
I really donāt see how anyone could argue with a simple phone call to the endo to make sure the OP isnāt perhaps shooting himself in the foot.
Youāre getting my point backwards. My post said DO conclude that tiās a known cause if you know the cause, before assuming that itās something that a doctor has to get involved in. Why would you do otherwise? What you are saying is illogical and makes no sense in the context of diabetes management.
Detailed history of symptoms and etiology?? Do you understand that this is DAILY LIFE for people with Type 1 diabetes?! I understand that itās a hard concept to grasp, especially if you donāt have diabetes yourself (which, since you havenāt yet said you do, Iām going to assume that you donāt), but itās one of the things that makes diabetes so different from other diseases, and itās one of the reasons the disease is so difficult.
Because we would be calling our doctors EVERY DAY if we did what you are asking us to do. Seriously, I am not exaggerating with that. Unless someone is newly diagnosed, or unless something is an emergency, it is okay and routine and normal to make oneās own insulin adjustments. Plus, most of us see our doctor every three months and can, if we wish, talk about persistent control problems at that appointment.
Assuming that you are here as someone without diabetes, which I am now assuming since your posts are making no sense in the context of living daily life with diabetes and since you havenāt yet answered my question, it annoys me that you, as someone without diabetes, are trying to tell people who have been living with diabetes for decades that they are doing it wrong when they arenāt. It would be like me telling an engineer that theyāre putting together a computer wrong, even though Iāve never touched the innards of a computer in my life, but Iāve watched a YouTube video and read a website, so clearly I know more than their three decades of experience. Itās rude, if Iām being honest. And Iām going to agree with @Sam19 and @mikep: if you are here as someone who isnāt living with diabetes, why exactly are you here?
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. . . or telling a pilot he is flying an NDB approach incorrectly when you have only ever read about it in books.
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Also, where do you think people with diabetes learned about IM injections and stacking (the latter of which I donāt even see)? Thatās right: endocrinologists and diabet s educators. Search the Internet and youāll find these techniques, though advanced, are not uncommon. If stacking insulin were so dangerous, insulin pumps wouldnāt allow the user to override their suggested bolus, yet they allow it.
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@Jen, this person doesnāt give a $hit about anything youāre saying. They came here to attempt to discredit people whoāve reported great success with afrezza. Likely because they have some paltry amount of money betted on its commercial failure. Now theyāre chiming in to coach us about how to manage diabetes.
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Since we havenāt yet gotten a straight answer, perhaps this should be asked more simply and in a post with no other questions/comments:
DO YOU HAVE DIABETES?
A simple, straightforward answer to this simple, straightforward question will suffice.
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I saw this issue emerging last evening and decided to wait to form a reply to @gonetotown and get a full nightās sleep first. Thank you @Jen, @mikep, and @Sam19 for making some important points.
@gonetotown, youāve taken a position that Iām dealing with a āchronic, recurring problem and not a simple one or two time adjustment.ā This comment and others do make me wonder about your knowledge of living with insulin dependent diabetes. Diabetes requires dozens of decisions every day.
Iāve lived with diabetes for almost 33 years. Thatās over 280,000 hours of living with a metabolic condition that demands that you pay attention. I have paid attention. Iāve used many different formulations of insulin including NPH, porcine Regular, Lente, Ultra-Lente, all the rapid acting analog insulins, and most recently Iāve experimented with the basal insulin, Tresiba. Iāve worn an insulin pump for 29 years and I use most of its features including carb bolus, correction bolus, various basal profiles, extended boluses calibrated to fat and protein consumption, temp basals, and super-boluses.
Iāve learned from personal experience that most doctors and many other medical staff do not have the depth of experience that I do. I used to think that an endocrinologist was the āhigh priestā of all things diabetes. I went through a five year period when my diabetes was out of control. I knew it was and I was not in denial about it. I saw three endocrinologists in five years, two of them at a leading major city teaching hospital with an excellent reputation for their diabetes clinic. I consulted with dietitians, certified diabetes educators, and nurse practitioners. These medical people had a sincere interest in my medical well being but they could not untangle my troubles. I went through many blood draws and other tests to rule out other conditions/complications.
After participating here for a while I concluded that during that period I became insulin resistant. Any semblance of control required twice the insulin that it used to. I learned that many other patients benefitted from reducing the carbs in their diet. The last thing I wanted to do was to change my way of eating. But I was desperate. I cut my daily carb consumption and my blood glucose control immediately returned. I lost 25 pounds without trying while I cut my insulin usage in half. The effects were so dramatic, it astounded me.
Then I wondered why all these medical people that I sought help from never mentioned insulin resistance. Perhaps they didnāt because I am diagnosed as a type I diabetic. This is when I took full ownership of my day-to-day diabetes management. After 28 years I finally learned that blood sugar control is not achieved by discovering the āperfect formulaā of pump settings, eating, and exercise. Good practices insulin dosing, healthy eating and regular exercise simply put you āwithin rangeā of very good control. Thatās when youāre required to make mini-adjustments to finally arrive with spending most of your time in range.
As soon as you think youāve got it all figured out, diabetes throws you some kind of curve ball. Itās the nature of diabetes. We play a game where not only the target moves but the very ground beneath our feet moves up, down, and sideways. Very few doctors understand dosing insulin as well as I do. I used to be angry about this but I realize that doctors and nurses donāt know everything. Iāve found that they know the basic fundamentals of dosing insulin but little of the fine art of it.
Donāt get me wrong. I respect what doctors know. But I know the limits of their knowledge when it comes to things like reeling in an overnight high problem. Iāve got that. Hereās last nightās CGM trace.
I am pretty good at this. I know when to seek a doctorās or nurseās help. I donāt ask them about day to day tactics because I found that my knowledge outstrips theirs by orders of magnitude.
Sorry for the long-winded reply, @gonetotown. Youāve only been on this forum for less than a month. I suggest that you do a bit more reading here so that you understand the context of our discussions. You have no idea as to the incredible depth of knowledge of members here. Weāve been around the block a few times.
And Iām curious as well as to your connection to diabetes. Do you or a loved one have diabetes? How long have you been around diabetes? Iāve noticed that youāve ignored this question upthread. I wish you well. Donāt worry about my health and welfare. Iām in good hands.
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@Terry4, @Jen, as usual, your comments are excellent. However, I believe @Sam19 is correct; Iād not waste time trying to argue anything with that person specifically.
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Donāt feed the trolls, @Terry4
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@Dragan1, @Sam19 ā It seemed reasonable to me that a casual reader of this thread could get the impression that my take on using medical profession expertise was too cavalier. And it goes to the heart of my personal philosophy of treating insulin dependent diabetes. Iām not certain that this commenter is simply getting his/her jollies engaging with people like me. Weāll see. Thanks for you interest ā you may have well diagnosed this situation correctly!
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Iāve had my eye on them since they joined terry, his suggestions to you are the very first posts theyāve made that werenāt simply a direct attempt to discredit afrezza usersā usually referrencing things on twitter. I guess they decided to spice things up with the tremendous pearl of wisdom that you should discuss your diabetes with your doctor or diabetic nurse (is that even a thing?)
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Lol, ask your Endo what to doā¦ now thatās funny.
Im going to suspend my Afrezza in solution and use in my pump. 
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Donāt we have admins on this site? They can block trolls.
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S/he acted alarmed that Iām stacking insulin and injecting corrections intramuscular. I guess that could seem like risky behavior to a beginner ā or an ignorant small-time speculator!
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The health care system in the UK, the National Health Service, uses nurses with the title of Diabetes Nurse Specialist or DNS. When s/he mentioned this term, I thought s/he might be from the UK.
To me, a diabetic nurse is a nurse with diabetes.
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This reminds me of the clever New Yorker cartoon from 1993. Itās incredible how relevant this cartoon has remained over the years.
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Canāt disagree with any of that. However, Terryās post was so beautifully written and thoughtfully concise that it ought to be a blog somewhere. Iām saving a link to it because there are certain to be times when Iāll want someone to read it.
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