Do you change your basals or your doctor does it?
- I do it
- My doctor
- My doctor set them in the beginning, but I set them now, with help if needed.
Do you change your basals or your doctor does it?
I suggest a third choice.
My doctor set them in the beginning, but I set them now, with help if needed.
I do everything. He writes Rx’s.
Even at the beginning, my diabetes, my pump, my treatment plan. We always discuss ideas and changes, but always my call.
I report them after I have done them, but I do them. Always have.
Sorry. It made me laugh.
Nobody but me.
With diabetes educator help. Doctor rx only.
My doctor helped me initially set them when I first got an insulin pump a long time ago (before CGM even existed), and I rarely changed them because my only data was the BGs (which there were also less of, because they required more blood and insurance didn’t want to give unlimited strips like they do now). However, I did occasionally make 1 or 2 tiny adjustments that we would review with my doctor at my appointments. Although now, with CGM, I tweak them more as necessary (which is hopefully less, since we don’t want to need to change them at all), since I can see more patterns and numbers without stabbing myself every hour. But since I upgraded to the 670G with Auto Mode, basal does not exist, but there are other settings that get tweaked (carb ratios, etc.), and I adjust most of them myself, although I do normally upload my pump and notify my doctor (because this is very easy with Carelink and other things available on the internet), so if they have any objections or modifications to my tweakings they can let me know.
I set my basal rates and all pump settings myself. I’ve lived with T1D for 34 years and treatment decisions such as basal rates have evolved from doctor specified to a collaborative decision to one made exclusively by me.
Looking back on my long time living with diabetes, I can see that in year 28, faced with a daunting diabetes complication diagnosis, I finally took full ownership of my diabetes. Since I’ve devoted so much of my time and attention to insulin treatment issues, I’ve come to realize that my expertise in this narrow slice of my care has completely outstripped any doctor’s ability.
I don’t say this to demean the ability of doctors, especially endocrinologists, to make well-informed decisions. But I’ve concluded that my ability supersedes the doc’s ability by orders of magnitude. Doctors still play a key role in my diabetes treatment; it’s just that their insulin decisions are no longer needed. I’ve told my current doctor that I do not need any insulin dosing advice unless it is explicitly sought.
I’m not shy about asserting my confidence regarding treating me with insulin. I let the doctors know: thanks, but no thanks. I got this. I would never allow my doctor to change settings on my pump. That is a boundary I will aggressively enforce.
Short question, long answer.
When I was diagnosed 13 years ago, I weighed only 150lbs and was released from the hospital with instructions to take 80 units of Lantus daily!! And the had me on Humalin R instead of Humalog! I nearly died every day for weeks and was calling my doctor constantly to ask if I could lower my dose. I eventually pulled the plug on the Doc and started making dosing decisions myself. Eventually getting myself down to 18 units. Luckily I survived that ordeal and learned a valuable lesson: When it comes to diabetes and my body… I know best! Oh, and for the love of God, avoid the hospital at all costs!
I sat down with my endo once when I started MDI. I changed the numbers within a week.
Same thing when I started on my pump.
I asked her a few questions once in a while when I was starting, but I do all my own numbers.
We discussed a initial dose when I started insulin and then I adjust my doses on my own. Based on my GD and T2 pregnancy groups that’s pretty unusual for people with GD or pregnant T2s.
My doctor(s) have no input as to my day-to-day diabetic care, nor should they. All type 1’s need to take ownership of the attention they give their disease.
Much of the professional advice we’ve been given over the years has been rubbish.
There’s no one who knows your disease better than you
I couldn’t agree more. Asking your endocrinologist what amount of insulin you should be taking, whether basal or bolus, is like asking a driving expert how fast you should be driving down Main Street next Thursday at 2 P.M. Since the answer is, ‘it depends,’ the expert can’t possibly tell you how fast you should be driving then and there, and only you, the person on the scene, can judge that.
My definition of an endocrinologist is someone constitutionally incapable of understanding that blood sugar levels in diabetics vary spontaneously, so I stay away from them to keep them from embarrassing themselves.
My endo is a type 1 with a type 1 daughter. So while I trust her more than anyone else, my numbers are my numbers.
I am also lucky, she thinks its GREAT that I fine tune, manage, and otherwise take full control of my diabetes.
Now, on the other hand, the Dr at the VA are beyond useless. They WANT me to eat 200 to 250 carbs per day. And the ones they recommend are crazy!
that sounds like malpractice to me.
I agree, but that is typical VA treatment.
which is why I’ll not go there again. I wasted a lot of gas, time, and effort to have them cover me for Agent Orange. Their crazy rules cover only T2’s. Also, they don’t have many of the meds I receive for non-diabetic issues. All in all, the VA is only useful (sort of) for someone with no other method of receiving medicare “care”. then again, as a former air force brat, I spent 18 years w/ military medicare care (and it was BAD), followed by another 4 years of active duty “care”. They screwed me over so much and actually LIED about my medical conditions when they filled out the paperwork prior to me being discharged after my 4 year stint.
Endos who have type 1 themselves are usually the best ones. Their own daily experience with the disease, plus their qualification - that is a combination that is hard to beat. If they are also receptive to looping, carb reduction, sugar surfing (and I guess most such endos are), then you struck gold.
As for the 200-250g of carbs, that’s crazy high for a T1D. Sure, there’s the old “we can eat everything” mantra, but good glycemic control with so many carbs is night impossible.
I agree, and endo that has diabetes will typically be the best because of their intimate experience and knowledge.
As for the VA and their guidelines… Even when very first diagnosed as type 2 (incorrect of course,) I knew that they were telling me to eat WAY too many carbs!
Problem is, there are patients who use that as an excuse to eat more carbs because they were told to… I knew one of those people. Couldn’t change his mind to save the world, or his life.