Do I need a "Plan B"?

The more I read, the more I learn about how difficult it can be to get the kind of help we need from our health care providers. I've already had one rough experience with an associate of my family doctor's. I'm seeing my endocrinologist for the first time on Friday and have no idea what to expect from him.

I will take with me my BG levels and carbohydrate numbers for the last six weeks. I'm hoping that he will agree that it's a real problem that my BG doesn't come down for hours after I eat, even though I'm only eating about 20g of carbohydrate--and never more than 30g--per day.

I'm having my A1c level tested tomorrow and expect it to be lower than it was in mid-October. My BG these days hovers around 6.4 mmol/L most of the time, but will spike quite a bit higher after meals or even after walking the dog a couple of miles.

I will ask the endo to put me on insulin, but will he do it?

Metformin wreaks havoc with my digestive system and the 1000 mg I'm taking now doesn't really seem to make a difference to my BG. I don't want to take any sulfonylureas, at all.

I would appreciate suggestions about what I should ask for, and in the event that he just wants me to take drugs instead, what I should be ready for then.

Blood sugars can rise after exercise. If you exercise after eating you blood sugar is naturally higher, but when you add the exercise, it can actually increase because of the body releasing adrenaline. When it is released, glucose is released as well.

When you see the endocrinologist, make sure you are evaluating them as well. Not only are they trying to improve you health, you at the same time are looking for someone who will work with you in order to do that. I have had doctors that were uninspiring, negative and disconnected from you my life is. Hopefully this one is in tune with you.

Thanks, Brian. Right now, I'm wary of exercise, period. It will raise my BG by 2.0 mmol/L and keep it there for four or five hours. I can't eat, have the elevated BG that comes from eating, wait for it to come down and exercise if I'm planning to have dinner at any normal time of day because my BG won't have come down enough. I have to work during the day, so there's really only so much time available to me. It's frustrating!

Hi Ann: I would suggest you ask the endo for antibody testing (full suite of GAD, ICA, IA-2; not just GAD) and a c-peptide test. Let him know how hard you work to keep your blood sugars in range, and be emphatic that you believe you need exogenous insulin. Then, we'll hope he/she does put you on insulin--be sure to request the appropriate training and education. Good luck, be your own best advocate, and let us know how it goes!

Thanks, Melitta. I've made notes about the antibody tests and the c-peptide. I appreciate your advice a lot! I hope he'll take me seriously and also note that my A1c has dropped from 13.1 to 8.8 in just 40 days. That should be good confirmation that I'm working hard to keep my blood sugars down, I hope!