Neither of the scenarios that you describe make up the kind of blood glucose swings that I think cause metabolic harm. The kind of swing I'm talking about starts with a sustained, greater than 20-30 minutes, of sub-60 mg/dl low. That means that adrenaline gets secreted along with other counter-regualtory hormones, like cortisol. That adds liver sugar as well as insulin resistance to the mix.
This then leads to a 3-4 hour 220+ high that resists both exercise and insulin corrections to bring it down. When it finally does come down it often repeats the cycle with another low followed by another high, the classic gluco-coaster.
I read in one medical study recently that posited this hypo to hyper glucose swing causes a lot of harm to us.
I don't think post-prandial highs of even 160-170 mg/dl cause much harm provided that don't last too long and level out in your target range before the next meal. Anyway, that's my diabetes-lay-person-that-pays-attention opinion.
The problem is, we can't know who is or isn't trustworthy, and people are full of their own anecdotal recommendations. And someone who is may not be reliable over time. I was seeing an endo for years who was one of the most recommended in the area, but a few years into it she started pushing me off on her P.A., who spent very little time with me. I started insisting on seeing the endo, but I'd get there (2 hours away) and still end up with the P.A. Thankfully there is now an endo in my area, and he has called out some problematic lab results that the prior endo never had. The best we can do is move forward, and remember that we have something very important that is broken in us, so we do the best we can.
The problem is, we can't know who is or isn't trustworthy, and people are full of their own anecdotal recommendations.
At first thought, I agree with this notion. On second analysis, I see a another side to this. When I read anecdotal accounts on this site of carb-restrictions to help manage blood glucose in diabetes, I decided to give it a try and see how it works.
I had immediate success with this tactic. I lost weigh without trying, cut my daily insulin dose in half, and dropped my A1c 0.5%, with a drop in the number of hypo episodes. Like Sandy, I came to resent the 28 years and six endos worth of little to no real help with my diabetes other than writing Rx's. A well-informed, motivated and engaged patient is the critical element in this whole equation. Betting too much on the doctor factor, however, may keep one from seeking other solutions that can work.
I wish you good luck with your new endo. I have a healthy respect for what doctors can do like monitoring lab results to flag further inquiry. I don't expect them to have a clue when it comes to insulin dosing in the day to day real world. There are exceptions, but not many.
The fact is, regular participants here all know each other and each other's particulars about their diabetes substantially better than any of our doctors know us.
It's no fault of theirs -- it's a practical matter. We spend hours and hours and hours sharing with each other here -- our personal lives, our diabetes issues and concerns, and our diabetes treatment experiences and strategies (successful and not!). There simply is no substitute for community, and we shouldn't judge our doctors too harshly for having to work within the limitations circumstances make inevitable.
Like my car (I'm an amateur hobbiest mechanic and car enthusiast), I know far more about it from the bboard I visit daily than from any mechanic I've ever taken it to. Also, I do a far better job on anything I do to it than a paid mechanic, in most cases. This is just the nature of the beast -- I can put in the time on a saturday to install something perfectly, while a mechanic is on the clock, with the lower "good enough" standard.
Not a perfect analogy (of course one's health differs in many significant ways from car repairs), but not useless either. I am just very thankful to be a 52 yo diabetic in 2014, when I have all this technology available to make this condition a cakewalk compared to when my grandfather was struggling with it in the 70s. And that technology includes computers, the internet, and the communities made possible by that tech.
I agree. I don't find there's stigma at all in terms of people who seek out therapy. Seems half this country is on some type of 'mood' medication(s) for something. I agree too that it's about finding a good therapist. Fear often comes from an experience (bad or negative) or the (anxiety of the) unknown. Very few therapists know anything about type 1 diabetes, they know about type 2, but haven't a clue about type 1, what it even is. So, if ones trying to explain bad hypos/hyper episodes, the ability and challenge of every day life just to trying to deal with this hideous disease, they can't even begin to understand. Type 1 can be a head trip and it's never ending, it's exhausting.
I agree, I went to counseling a few years ago and stopped because my therapist was a crook(words used by someone at my insurance company when I told them this- he overcharged me by charging more than my insurance would pay and wasn't supposed to) and he said counterproductive things to me which were really abusive so I stopped. I'm hesitant now to try again, however my endo recommended someone who specializes in helping people with type 1, so I will prolly try again.
BTW, I'd modify your self-label to, "highly-experienced-actively-curious-diabetes-lay-person-that-pays-attention". Those 4 additional words make all the difference for me, and I add them based on reading your contributions here :-)
You raise a good point about the "good enough" standard. I think many docs are more reparative in their approach than preventative. So they don't bring up worsening trends or issues until something needs to be done about it starting now. This is an ongoing issue in the overall healthcare arena, of course. I've started requesting a copy of my lab results each time and log them in an Excel spreadsheet so I can keep an eye on trends, even if they aren't problematic at the moment. I think as T1D's we get so dependent on our vast array of medical professionals to keep an eye on things, and they just can't. I kind of wish I had studied to become a doc so I can have a better understanding of all the terminology and what to look out for.
You should have been seeing a professional from day 1… I personally do not struggle with this and I have never met another diabetic who struggles to the point where they can't function. I think a therapist who specializes in food issues/diabetes/chronic diseases will be very helpful for you.
Yeah, I’ve only had the DM since the end of February. I work as an RN in a hospital so believe me, all I see typically are the complications of disease and I have to constantly remind myself that it’s people who didn’t take care of it. Oddly enough it’s almost always Type 2’s who were poorly educated and managed. Not too often do I see Type 1’s.
Either way, I am always freaked out. After 7 months I am in something of a honeymoon but it is absolutely freaking me out! I don’t trust it, I immediately go to the worse scenario. I need to relax but man, I am still so upset about it… On my mind 24/7… You are not alone.
