In a follow up to my previous post of an email I sent to my primary care doctor and CDE. Here is the email I sent to my former endocrinologist who kept me on a sliding scale of humalog insulin for the past 10 years.
I wanted to first thank you for recommending I see Mary and get started with carb counting instead of still using a sliding scale for my insulin doses. Since I started actually tailoring my insulin doses to the amount of carbs I consume I have 1. lost 15 pounds 2. started to regain my hypo awareness 3. lowered my LDL to 53 and my A1C from the mid 7’s to 6.1 and most recently 6.4 % 4 achieved a sense of control I have not had since I was pregnant with my son 22 years ago. I attribute the changes in some part to a change in diet with a more wholesome approach to what I eat, but also to not overdosing on humalog at every meal and then having to counteract the lows with a bunch of carbs. It’s a roller coaster that is not a fun ride. When I look at the sliding scale I realize it pretty much treated me like a robot. Having the same thing to eat every day at every meal, the same number of carbs it just makes no sense at all. I now realize the only correct dose of humalog on your sliding scale for me was breakfast because I am fairly insulin resistant in the morning and I don’t generally eat breakfast so I could get away with taking 4 units of humalog and not having to cover it with much more than my coffee. I currently average about 20 units of humalog in an entire day, that was the dose for dinner on the sliding scale. It’s really sad that I spent so much time out of control when just a simple “ you know Clare I think carb counting would help you better tailor your insulin needs to your activity level and food intake”. Not “ do you think you want to try carb counting ? It’s not as though I have ever been one of your “non-compliant” patients. I pretty much have done what I have been told.
You’re the doctor here and I respect your knowledge as far as endocrinology goes, but as far as relating to me as a person and as a type 1 diabetic of 37+ years I really think you fell short.
Sincerely,
Clare T. Fishman
Wtg Clare!!! Keep up the good work :)
Well done Clare, extremely restrained too ;) Thanks for posting!
Thanks, as I read it I realize I may have been a bit too restrained in my contempt, but can't see the point in burning bridges. I may need him at some point in time for something so I'd rather keep it civil.
Always the best way to go. I try to vent my rage first, then write LOL
There are times though... especially on here where I have to stop myself before I hit the "add comment" button. I do a lot of censoring - or more editing to make sure I don't step on any toes and I don't come off sounding like a know it all. If I have some personal experience that I can share I will because that seems to be the whole point of this site. Learning from each other. It does drive me crazy though when I read some of the posts with Dr's saying 200-300 is "normal" for anyone especially after being T1 for 15 years. When I first read Gregg's post about puking when low I was going to comment because nobody else had at that point, but I decided to let cooler heads prevail and wait to see what the consensus was. I agreed with everyone but kept it as low key as I could. I understand how hard it is to actually ask for help and show your frailty/igonorance but obviously it is a lot easier and safer here than any where else.
+1
When I was diagnosed in 1987 my primary doctor adviced me to not go to the hospital we had envisioned. He had very good connections and told me that the team in one of the smaller peripheral hospitals is on top of diabetes research. This advice was very helpful. In the first years I followed a very rigid pattern with fixed amounts of carbs. But in 1990 this became much more flexible by using hourly insulin factors. The right person at the right time can make all the difference. This is what makes it so important to educate our doctors.