I am a type 2 diabetic, have been for 12 years. I have been on oral meds for since day 1. I have a low carb diet of 60 carbs a day, and exercising 4 - 5 times a week for over and hour. My last A1 C was 6.3, and pretty consistent for the last three checks. I also have arthritis, have been diagnosed with anemia recently, but have been with that for my life time. I have a PA for my PCP; live in a smaller town where the docs are in short supply, and the nearest Endo is 200 - 350 miles away. Not an easy trip to make in one day, and very expensive. I was one insulin for awhile, while I was receiving injections for arthritis and degenerated knees between 1 - 3 times a year. Yes, I know it's not a good thing, but you choose between the healthiest choice and second healthiest choice sometimes. So my diabetes educator and I are going to talk about going back on the insulin permanently this week. Then he will take it, as will I to my PA. She sees a doc for the final decision. I felt 100% better than I do now, my numbers were better, my levels were more consistent. After 12 years and being 60, I feel that it's time to put the insulin on board to give my poor pancreas, liver, kidneys a break from working so hard. So what I am looking for are ideas on how to approach this with the PA and the Doc. Any thoughts?
It sounds like you felt better w/ insulin. I still remember how ghastly I felt right before I was dx'ed, in 1984. I guess that's T1 vs T2 but I suspect the sensation would be similar and, if you are confident you'll feel better, I think that's a great idea. I hope that the dealing with all the doctors isn't too much of a hassle.
I agree about taking some muslin. I am a type 2 on levemire ,it works well. Do you take metformin? This can cause low B12 making you anemic. Taking oral B12 did the trick for me. He now checks my B12 levels every 6 months. Keeping good records is very important as I am sure you are well aware in helping your doctor with this puzzle. Good luck. Nancy
In my view, we own our own diabetes. We should be the ultimate authority in guiding the course of our lives. Insulin works. Far better than any oral medication. And while there are some risks from hypos and weight gain, there are risks from any medication. If you want to move to insulin, then I support you. And you should feel like you have every right to request a move to insulin when you talk with your health team.
I am on Janument, 50/1000, that works well for me. However, my dh is on Metformin, I will tell him to mention the B12 to his doc as he is feeling rather worn down, and we do need him and I both to stay healthy.....
Having done the insulin previously, and not gained weight, I don't think it is a problem for me. I've lost a total of 90 lbs in the last four years, so eat very carefully, exercise much, for that I am proud. I know I have the right to be in charge of my own diabetes, and any other medical problems I have. It is just a shame that we "need" docs to get us our meds etc; and that they or some feel they are the only ones who know what is right for us.
As an aside, I have been battling orthos for 15 years that surgery is NOT the only option when it comes to knees. But according to them, I am "being silly" about surgery. No I am being true to myself. I don't agree that this is the ONLY way to treat arthritic knees, it is one way, not my way. I tell them that when they walk on my knees for a week, and show the kind of determination I have shown in these years to try all option, they can tell me what to do.
While our situations aren't 100% duplicates of each other, there are some very strong parallels.
I have been T2 for going on 20 years now. For almost all of that time I was managing it -- rather haphazardly -- with diet, exercise and oral meds (metformin and glyburide). A bit more than a year ago I had an epiphany of sorts and decided that I had had all the good luck one person could reasonably ask for and that it was well past time I took responsibility for controlling the D the way it needs to be controlled.
So, I set out to learn everything I could, reading all the right books, surfing the relevant web sites, and plugging in to this community where I could get the benefit of others' experiences. ("Learn from the mistakes of others; you can't possibly live long enough to make them all yourself." LOL)
Of the several conclusions I reached, one was that with an A1c that stayed firmly in the high sixes no matter what I did or how hard I did it, insulin was the only thing that would ever give me the control I require. Fortunately I live in a state where Regular insulin, as well as syringes, can be purchased without a prescription. So I got some and slowly, carefully began using it while keeping a detailed log so I could plot the results. At the same time I went doctor shopping and found one who said "I don't know everything" (verbatim quote) and who is willing to work with me to achieve real control, treating me as a partner and not a subordinate.
It's a year later. I've dropped 35 lbs, kept it off all this time, and my A1c is in the mid fives and still improving. I wish I had done this years ago. Truly. Isn't hindsight wonderful?
As others have said here and elsewhere, you need to take ownership and control of your own management. Nobody else has as much skin in the game as you do. In case it's not obvious, I think you are on the right track. Go for it! And please keep us updated on how you're doing!
Best,
David
I noticed on your profile that your last A1C was 6.3, That's not to shabby in my book. That being said I fully support your decision to ask for insulin if that's what you wish.
I started insulin 2 years ago not because I wanted to but rather because I had to. So far I have not looked back. I lost a bunch of weight also but it just wasn't enough. I have managed A1c's in the fives and do feel much better.
As far as the Doctor goes you may be surprised at how willing he/she may be. Doctors sometimes hesitate to prescribe insulin because of resistance from the patient but unfortunately not all doctors are comfortable prescribing it.
It never hurts to ask.
Actually, it's not every country where we "need docs to get our meds, etc.". I lived in Guatemala for two years where you could buy any medication at the pharmacy with no need for a prescription. To get a lab test you just appeared at the lab, told them what you wanted, paid, and came back a couple days later to get your results. If you then wanted to take those results to a doctor and discuss them, that was up to you. Sort of like grown-ups, no? The U.S. is very paternalistic in its attitude toward medical treatment.
It would be very nice Zoe if everywhere there were no restrictions on taking care of ourselves, but currently I live in an area where there are restrictions on what I can do for myself, ie, meds, tests, etc. So learning to work with in the system and still get what you want is an education in itself. Tough situation when you know more than the docs
No my tests are not shabby, as has been pointed out to me on numerous occassions, I am harder on myself, expect more from me, than anyone does, I am what is known as a "completely controlled" diabetic. Which is what you want, but if I don't feel in control, what is the recourse>
This forum is wonderfull to follow and hear/read the comments.
Best wishes sdkate and keep up the good work.
Working the system can be as you indicate a charming challenge.
Wow. That's cool!
Hi sdkate
You're the boss and only you will ultimately fight for what's in the best interest of your health. I wouldn't worry about how you broach this. They work for you. I make sure I never forget that when dealing with medical professionals.
Regarding insulin: as others responding to this post have said, it is the most surefire and natural way to tighten up control. It's been a godsend for many of us.
Good luck!
Christopher
I understand the sentiments issued here but humans are humans and I would not leave out trying diplomacy, respectful response and charm to see if Doctor shifts stance and helps. If not, Ok, this Doc is not for you and I would politely move on.
The last thing I want to do is go for full battle stations and move the defcon status to highest response level.
JIMS, that I have done. I have great respect for these people. If I didn't I wouldn't be there....but when you live in a small community with only one doc that knows something about diabetes other than what drug reps tell them, you don't have a choice to move on, You get along, or you travel 200 miles to the nearest doc who does know something, Many times, I will take in articles, information that I have received and very, very respectfully tell her that I have found this information and although it might or might not pertain to my situation, it was interesting and might give some insight. She can toss it when I leave, but I have tried. I just want her to know that this is my life, and if I refuse to do a treatment or ask for something different, it's no reflection upon her. But that doesn't always work either,
sdkate:
I apologize for adding extra steps in resolving issues. If you did that then one ends up where i sometimes do and that is to do what one must.
my only point was not to leave one open for cheap shots and criticism from those supposedly trying to help. If one has done the steps and walked the dog/duck - well, it is not your fault hey were stuck on target chasing flares and being obstinate.
I do sympathize that the time lost and interference trying to get ones health under better management/care can be very frustrating never mind totally unacceptable.
Otherwise, Sdkate, admire your spunk, determination and care you show and wish you all the best. One hopes you do not have to replicate Sherman's march through Georgia to expedite the dead beats!
Jims, you quake me up. This should be a fairly simple process of "I am this, you know that,please share what you know". But I am almost 99% positive that those huge medical school egos get in the way, and I am "just" the patient who only reads and does research on many things. In an unrelated issue to my diabetes, I have two knees which are bone on bone...but they haven't always been that....the first ortho I saw said, "hmm, rehab, therapy, and we'll see where that goes" he moved to a larger city about 6 months later. My current ortho said after one 15 minute visit, "the only thing, the ONLY thing that will help you is to replace both knee caps". That was 15 years ago, my "spunk" as you call it, has done her homework and knows that there are many other options, some worse than surgery, some less invasive, but I have to locate those and put the wheels in motion. Your spunk is my ortho's word for stubborn. :) Thanks for your support and info, keep it coming,
sdkate:
Great rejoiner.
The real problem encompases part of what you indicated. You , me and many souls like ourselves are not standing on the same level in a positional power basis in our society as our Doctor, Shamen, village witch doctor et all. The worst faux paus for us is for us to assume we are speaking on a level field and especially that of our good Doctor and standing in his world. This is an unconcious sort of thing but there just the same and the extent of impact reflects back to your original comments and how well we can communicate with our Doctor and how good and understaning, flexible he/she is. Sometimes we are very lucky and other times the dance isn't worth it.
The dance becomes trying to maintain communication with a technical professional yet not acerbate his/her physcological soft spots and reduce communications.
That said, your current approach is extremely critical to keep moving forward and solving problems. As has been said firmness in ourselves is seen as stubborness in others.
Its a tough flim-flam game to stay in control pushing for ones best care while carefully observing the physcological etiquette power issues keeping unintended que cards from disrupting the communication channels. ie; you and Doctor look at each other and each one's brain while unspoken is registering turkey/difficult person/trouble. oops, here we go again.
The tragedy is that your efforts investigating the science, health, issues and current thinking actually help the Doctor do a far better job working with you but can equally scare Doctor should you be a few steps ahead of him.
For me, I find that the investigation and research you/one does is very critical but one may have to do a passive agressive approach with Doctor and end up in ones mind having to say nice but maybe I should be looking elsewhere while smiling.