I was looking at my medical record online, and my doctor has me listed as a Type 1 diabetic-uncontrolled.
I know I don’t have the BEST control, and my blood sugars frequent the 300 range far more than I would like, but my A1C is in the 7 range, and I think my bg is normal more than not.
I was a little upset to read that she think I don’t have my diabetes under control, but maybe I’m just being too soft on myself, and I’m just biased because I don’t like her.
So what do you think? How would you define “controlled diabetes?” Is it A1C levels? Average blood sugar? Number of complications?
I’d be upset also to see this in writing. If it helps motivate you to do better, than perhaps a blessing in disguise. Control is a very difficult thing to define. No doubt everyone will give you a different answer. I believe control is being able to stay within a fairly narrow BG range so there aren’t wide swings between highs & lows. Standard deviation should be relatively low. A1c is part of evaluating control, but it sure doesn’t show a full picture.
Its a tough one. I go full out. I define control as having the same A1C and blood glucose as would be expected of a person with a healthy pancreas. A1C below 6.0 and BG below 140 after and 110 before a meal. I am not there yet, but I am not gonna stop improving things till I get there.
My goal is to postpone all diabetic complications until after I die of something else.
This is an insurance coding “thing”. e.g. ICD-9 250.01 (controlled) vs 250.03 (uncontrolled).
The doc simply has a preference for writing it up one way or the other. Some endos I am told write up all T1 cases as 250.03. Others (like mine) write it all up as 250.01. Maybe, just maybe, it has something to do with insurance payments to the doc. ???
Tim, that maybe true. They make more for the latter, but the first post concerns me. BS that frequent 300 and think they are normal most times. She need to do alot more sugar tests to see how it is through out the day. Only then can she say the doc has her catorgised wrong!
I asked my endo what it would take to graduate from 250.03 to 250.01, and she said "an A1c lower than 7.0."
Hoping for just that at my June appointment, from a 7.4 in March.
Personally, I define “controlled” as retaining the ability to count and shoot…
Iit is too possible! LOL, ok, maybe not all the time but well, you know. I will never admit it!!
I suspect that most endo “practices” probably have standards b/c there are reports they have to write or whatever? I think the ICD-9/10 codes are developed by insurers working with medical providers to provide a means of communicating that doesn’t involve anything besides code numbers and $$$$.
I have read a few medical reports (@ work…) and am always shocked that there tends to be very little from the docs in the “PLAN” part of their “S.O.A.P” notes about what to do in the cases where the people are listed as “uncontrolled”. For a couple hundred bucks, they should at least offer a plan I think. My endo recently said “there isn’t anything I can tell you” or something like that and I was too suprised to ask for some of my money back.
LOL, youth @ 43! I totally figure that I could be cheating on the BG by exercising a lot and wonder what would happen if I got hit by a car or had broken my ankle instead of spraining it when I wiped out in January (runs upstairs to check date n leftover rx for Voltaren…best anti-infllammatory I have had the fortune to be rx’ed…I saved 4 and had one after the 1/2 marathon and will try to save the other ones for after the marathon in October, although there’s a bunch of long training runs leading up to it too? heh heh heh…)
I think what doctors write for insurance purposes and what we ourselves feel about our D are too different things. I remember SOAP from when I worked in a psych hospital. It was my first job in the field and my supervisor said I spent too much time on my notes. He said they were great but that it was more important to spend time with the patients than to write about them and that the notes were A) for insurance and B) so other staff working with the client knew how they were doing. I noticed many of the medical personnel writing ridiculously brief notes. As I got on in my career I settled in the middle. Since I was doing work beyond my licensing level I often purposely kept things vague. When I did a very dramatic and cathartic regression with a patient where she was for all intents and purposes 6 years old again, I wrote she “got in touch with her feelings from when she was a child.” LOL.
Ok, back to the topic. I personally feel that most of us who spend much time on TuD are “controlled” even though we have very varied A1C’s. Let me explain. I’ve mentioned before I believe there is an unknown “something” I call for lack of a better term “the luck of the draw” that makes some of us be blessed with good blood sugars perhaps with relatively little effort and others of us cursed with wildly swinging numbers despite our best efforts, and most of us somewhere in between.I also talk about how we make lifestyle choices based on various “quality of life factors” such as how much we restrict carbs.
But just by virtue of being here most of us differ from the cliche of uncontrolled diabetic of either type because we are committed to learning and working to do the best we can to manage our conditions. To me, that makes us “controlled” whatever the actual outcomes of numbers. In contrast to the person who is in denial about their diabetes and just ignores it or does the minimum the doctor tells them to like taking NPH one or two times a day, or Metformin for a type 2, but doesn’t count carbs or change their diet or exercise habits. I call those uncontrolled even though some of them may be meeting the (admitedly low expectations) of their doctors.
So you’re saying my endo gets paid more if my diabetes is uncontrolled?! That really bothers me. I don’t think she’s a very good doctor…she just tells me I need to eat less and quit snacking and that’s why I have high blood sugars. Occasionally changes my basal and then tells me to see her in a few weeks.
I’m not perfect, and I’m never happy with high blood sugars. It used to be much worse, but I’ve gotten better. I test at least 6 times a day, even though my prescription is for 5x a day (I’m still not sure how I always end up with just enough strips, but it’s probably because I get my prescription refilled a couple weeks before 3 months is up). I know I could be better…but saying that I’m uncontrolled just feels like a slap in the face.
I spent about 2 weeks when I actually went to the gym every day, and my sugars were awesome, but then I got the flu and lost all motivation to go… perhaps if I got that motivation back and “cheat” too!
I know the feeling Kelsie. I have had mine under decent control for 2 years up till last month. I am now doing 10 -12 blood sugars a day to figure out if my new dosage is working. Most Doctors treat us as if we are a page in their text books and don’t understand we are only human. What I had to do with mine is I email him everyday with my sugars, carbs eaten and dosage.
Your Doc may just need the same to help you get the sugars back under 300 and to try and see at what point you are going high and see if it has to do with food intake, wrong dosage or other issues. Call the endo and see if you can get them to buy into it and maybe see what criteria they set to have it seem under control.
My problem that started last month was my sugar was crashing while I am asleep and it lead me to the EMS coming to my house when I failed to get to work. If that happened on a weekend I would have been dead since no one would have know I was out until Monday morning. It turned out that I have become too sensitive to the lantus and now my endo would like me to go back on the pump. I have been living with the D almost 30 years. So everything you are going through I have been through alreay many times. If your endo does not want to really help then you may need to find a new one that is a bit mpre proactive in your treatment because they don’t have to deal with the results. We do!
