I am new, and have a few questions about upcoming doctor visit

I have had diabetes for about 6 years, as a side effect of medication for bipolar disorder. I have had absolutely crappy care from ALL doctors since then, so last year I just plain fired them all, gave up meds for both, and well, I just gave up.

In the beginning I was told exercise and diet...eventually I was put on Metformin because my fasting sugars were in the 200 range. 1000 mg 2x a day did not bring that down, so they added another glim-something drug, which made me crash several times a day, but I still had high fasting numbers. Took me off that. My A1C's were always 5.4 or so, so then they told me I did not have diabetes. I could not get serious help.

We lost our insurance due to the economy hitting us hard, and so I found a community clinic. Great doctor, and he listened. He put me on a tiny dose of Glimeperide with the Metformin, telling me he thought that would take care of the crashes. I still crashed. So then he put me on Victoza, and I became extremely ill, but he just lowered the dose. Still ill, and I could not get a call back. I just gave up. I quit taking care of myself completely.

Fast forward to about a month ago, and I found bloodsugar101.com, which led me here. I started monitoring again, and I started taking the Metformin I had left at bedtime, because my fasting sugars were about 125-140. I am exercising again, and I am eating low carb (mostly). I called the clinic and made an appointment. I have a different doctor this time, and I see her on Tuesday. I want to be ready, and aggressive in my care.

My fasting sugars are about 110 now, but that is not low enough. What happens to me when I eat breakfast is that my sugars drop. I do not understand it. I wake up with a FS of 110, I eat breakfast, check an hour later, and my BS is 86. This has been a steady phenomenon for me all these years, and I can not get a doctor to believe me, even when they look at my log. So they add the extra meds, and then I crash.

I mostly have normal sugars during the day, unless I cheat and eat a cookie, which I try not to do. But I need those FS readings to come down without crashing me the rest of the day. I just took a home test A1C because I was really worried, and I tested 6.0. I don't know how reliable those are though.

Does anyone have any experience with this, or any ideas that I can take to the doctor with me on
Tuesday? I need to be taken seriously, and I am not sure what to ask for at this point.

Thank you for any replies

There’s an interesting thread by a user lil mama where she noted her own elevated bg but they weren’t “high enough” so she was exercising after every meal and testing a lot, sort of watched the numbers and eventuallly got through to the doc. The whole story is there if the thread is stilll around it might be worth reading? I agree that you should take it seriously but a lot of docs don’t get serious unless yr bg is like 200…

Hi, Kruser. "Crappy care from your doctor?" Check out my experience.

I am 58 years old. I have always had a weight problem like everyone in my family. In December 2008, after feeling strange for several months, my sister (who has been diabetic for 25 years) tested me with her meter & my blood sugar was 491. She dragged me to the ER where I got 2 shots of insulin & a meal that included turkey, gravy, a box of sweetened cranberry juice & chocolate pudding which my sister advised me not to eat. After paying the $2,400.00 tab, I was instructed to make an appointment with an endocrinologist & I was sent home with a prescription for Metformin, daily aspirin & NO dietary advice. My sister suggested buying a meter on the way home. None of the two doctors or RN's suggested getting a meter & testing. I started taking the Metformin as instructed. My appointment with an endocrinologist a few days later was another eye opener. As soon as he walked into the room, without even looking at me or my meter which I brought with me with 80 stored blood sugar readings, he said "You need insulin." Then he started to do a physical & said "You need to be hospitalized with an IV because you're dehydrated; do you have medical insurance?" When I said "no," he said "Get some Pedialyte and Gatorade & drink 6 glasses of each per day." I asked "Don't those drinks have sugar in them?" He said "Not really." He gave me a prescription for "Januvia" ($400.00 for 100 tablets) & directed me to take two/day. He then handed me an 1800 calorie/day diet (complete with drug ads on each page) & disappeared. After paying the $1,200.00 for the visit & labs, I started taking the medication as directed.

Luckily, I chose not to follow the doctor's advice about drinking Gatorade or Pedialyte; an RN I spoke to later told me "6 glasses of liquid sugar per day might have put me in a coma or killed me." After two weeks, the medication made me too ill to drive or exercise. I also had to get up 3 or 4 times each night to eat. I phoned the doctor several times over the next week to get a different medication but he never returned one single call so I stopped taking the medication. I was afraid to eat anything because I was afraid my blood sugar would climb. At my next visit, when I told him the medication was making me sick, he said "Just keep taking it, the symptoms will subside when your body gets used to it." He said my A1C was 8.9%. One week later, I found a different doctor but my new doctor wasn't interested in seeing me unless I paid him another $1,200.00 to repeat the physical & labs from two weeks ago even though I had a copy of my labs & he could consult with the other doctor. I was running out of money after spending $4,000.00 in two weeks. I'm not insurable due to "preexisting conditions" — diabetes and carpal tunnel.

While doing research on the web, I came across Dr. Fuhrman's website (www.drfuhrman.com) & ordered "Eat to Live" & "Eat For Health" & started the program. With all the weight loss/nutrition books out there from Atkins & a bunch of others, I was skeptical. I started following the recommendations in the section "Advice for the Diabetic Patient" weighing 220 lbs on 1-8-09 — the same day I stopped taking all diabetes medication. Within 3 months, I weighed 195.

I had new blood work completed on 4-8-09 with a new doctor. She downloaded my blood sugar numbers from my meter & said "Whatever you're doing, keep doing it because it's working." I explained "Eat to Live," my typical meals & snacks & told her I stopped taking medication on my own three months ago. She later phoned me with my lab results: A1c: 6.0% which she said was in a non-diabetic range (4 - 6%). She also said, "There is no reason to take any medication."The improvement from 8.9% to 6.0% in 3 months on "Eat to Live" was far better than I expected. I would have been happy with 7.0% or 8.0%.

Subsequent lab tests in 4-2010 showed A1c still at 6.0%, BP & cholesterol - all normal & still no medication for anything since 1-09. I now weigh 180 lbs.

Kruser, your fasting sugars are in line with many diabetes experts who say "For a diabetic, a fasting BG of 130 or less is fine." Who told you 110 is too high? Also, keep in mind that diabetes drugs do NOT reduce the risk of complications; they only give you lower numbers when you test. Lowering your risk is accomplished by diet & lifestyle - not medications.

I've learned that how well you do with diabetes has a lot to do with you and very little to do with your doctor.

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Here is some interesting info about CDE's and a reply from an endocrinologist who is a consultant on "The Biggest Loser." His reply is most interesting and honest: (from another diabetes forum)

At my support group meeting, someone brought lots of literature from a diabetes convention. I browsed through a folder with information, including a “Food Pyramid For Diabetics” approved by the American Diabetes Association. The name “Merck” appeared on each page. It recommends 6–11 servings of starches & grains/day. Sounds excessive to me. I’d love to eat that much starchy food but I think I’d need lots of Merck’s drugs if I did.

Another booklet was entitled, “Diabetes and You...Your Guide to Better Living With Diabetes.” The inside cover says “Favorably reviewed by AADE – American Association of Diabetes Educators.”Also: “These Novo Nordisk patient education materials were developed using information from the following sources: American Association of Diabetes Educators, American Diabetes Association, and American Dietetic Association.” One page reads: “Following your meal plan and staying active often are not enough to keep your blood sugar in check. Medicine is almost always necessary.” It also says, “Insulin is often a main part of diabetes care for type 2 diabetes.” What a coincidence....a drug manufacturer saying things like that.

Well, actually they’re correct....following THEIR meal plan will not be enough to keep blood sugar in check – not with 11 servings of starch per day.

None of this “information” is outdated; it says “February 2011”

It certainly reveals where diabetes educators get much of their education they pass on to us – from study materials developed by drug companies.

Hmmm, if I wanted information concerning the need for drugs & insulin, I wouldn’t ask the manufacturer of drugs & insulin.

Here is the doctor's candid reply:

Michael Dansinger, MD’s reply: Xring, regarding your original post, I agree with the general direction of your concerns. As many are aware, I am very concerned about the natural progression of type 2 diabetes, the under-utilization of lifestyle support, and the over-reliance on medications. I do believe the phamaceutical companies are partially responsible for the prescribing habits of many clinicians. It is the companys' responsibility to their shareholders to try to do so. We in the medical profession bear the greatest responsibility for clinician prescribing habits and lifestyle support habits. I am disappointed with the medical profession on this front. I blame them (us) much more than the pharma industry. Doctors should know better than relying on the pharma industry to educate the patients about what to eat. I believe they'll promote as much starch as they can get away with--doing so sells more drug. 11 servings indeed!

You see how it works - CDE's education is funded by drug companies, so naturally there will be lots of bias.

I'm not surprised that a CDE would say a fasting BG of 110 is too high; I'm sure some doctors would say it too. Pharmaceutical companies also pay for doctors' continuing education.

Recommended reading:
"Overdo$ed America" by John Abramson, MD

"Worried Sick - A Prescription for Health in an Overtreated America" by Nortin Hadler, MD

"Selling Sickness" - How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients" by Ray Moynihan & Alan Cassels - Pharmaceutical Policy Researchers.

The 110 morning fbg may be due to dawn phenomenon, producting of glucose in the liver. When the liver is the cause eating a bit sends a signal to it, production stops, and bgs go down as yours did. Some find metformin helps with dp. Others find eating a bit of protein prior to bed slowly releases a minor amount of glucose through the night but just enough to keep the liver from thinking you're starving and kicking in. Exercise helps some people and keeping the pp readings down long term helps others.

What you're doing so far is really good and you're to be commended. Sometimes doing the same thing for a bit longer will get results. Others time we need a little help. I hope you find what works ideally for you.

I have to tell you, mornings can be a challenge for many of us. Some of us have high blood sugars in the morning and are more insulin resistant. The morning highs are often due to something called Dawn Phenomenon (DP). In your case, things may be a little more complicated. I am not sure what you are eating, but you may find that when you eat some carbs in morning, your body overreacts a little bit, hence the 86 mg/dl.

First, if your blood sugar is in 110 mg/dl in the morning but better (80-100mg/dl) throughout the day, then you really don't have an issue. If you are 110 mg/dl fasting all day, you could increase your dose and modify your breakfast. If you really read bloodsugar101, then you know that carbs drive your blood sugar and if you lower the blood sugar spike in the morning, you can reduce the "crash" (actually we call that crash reactive hypoglycemia). You could try a breakfast of sausage and eggs and I bet that helps. By all means avoid a pure carb breakfast, no matter how small, you need protein and fat to exend the blood sugar surge in the morning.

I don't have anything positive to say about the vegetarian or raw vegan diets, as far as I am concerned, those don't help. If you are concerned about animals and not about your health, that is your choice. But in the end, for us, it comes down to the carbs.

ps. Understand, I am T2 on insulin, I still struggle to get my morning blood sugars below 110 mg/dl.

I am a T-1, but the same info holds true. So called "diabetes educators" incl. endos. do not always know how to treat us. When you see this new doc on Tuesday, do not be intimidated by what he/she says about how you are handling your D.

I think your FBS of 110 is really fine. Literature shows ( incl. Bloodsugar 101) that if you keep your daily BS below 140 you will likely not get any complications of D. As long as you monitor you BS regularly ( even if your doc says it is not necessary to do more than 1 or 2x a day) you should be fine. You now have all the members of TuD as your sounding board. I think that the support and info you can get here is far superior to the medical professionals anywhere.

Welcome to TuD.

I still take metformin and have taken it for years. I actually stack most of my metformin so that I more in the evening. So you have found that taking metformin in the evening helps, that is great. Everyone is different, so finding something that helps for "you" is great.

One thing that I found is that I "need" to eat breakfast. If I don't eat breakfast, my blood sugar also rise throughout the morning. Just eating something, even if it is just some protein and fat keeps my blood sugar from rising.

Kruser, your sister's "doctor" is nothing more than a legalized drug pusher (like my first two). Not all doctors are like that but far too many are.