New Endo

My old endo has retired after being my doc for 25 years. I went to a new Endo and he is turning my world upside down. He wants me on the pump (which I don't want) I have hypo unawareness and his solution is to have my blood sugars over 200 for the next two weeks. I am extremely uncomfortable with this. He said New studies say that LOW blood sugars are much worse than HIGH blood sugars, which is the total opposite of what I have been taught. I know I should remain flexible and open-minded but what do you think of these things? Is this just crazy? Or do I do as he says and wait to see the results? HELP PLEASE!!

What sort of problems are you having with MDI therapy?
What is your "in target" range?
Are you spending a significant amount of time under 70 mg/dl?

I was always taught that both lows and highs are worse than "normal".

Lows cause more immediate problems (passing out, insulin shock, brain damage, death), while highs cause longer-term problems (kidney failure, heart attacks, limb amputation, blindness, passing out, death).

If he is wanting to put you on a pump, he may need to show that you have some problems with your current protocol such as hypo unawareness, long periods with high blood sugars, problems with two different insulins (basal and bolus).

Having said that, you need to sit down with the endo and get all your questions answered, while making sure he fully understands your concerns.

If he wants to take the approach that all his T1 diabetic patients are on a pump (and you will be too), then he is asking you to modify your therapy to make HIS life easier, rather than modifying his practice of medicine to make YOUR life easier. I would then consider finding another endo.

Hi Mike: Thanks for answering. He wants my blood sugars over 200 for two weeks so that I might become more hypo aware. This really doesn't make sense to me because as soon as possible I am going to go back to my target of 120. Yes, I agree that HIGHs and LOWs are damaging to our bodies.

I hate how sometimes new docs seem to want to change everything you're doing, like their marking their territory or something. The best docs I've ever had are the ones that'll talk to me about what therapies they like and give me solid reasons why they think it's an advantage to what I've got going on, but in the end will respect my choices. I try to return the favour by listening to the reasons behind their suggestions, and actually thinking about what they're saying.

I agree with your discomfort about being over 200 for a couple of weeks. That sounds weird. Can this doc produce any actually studies that show something like that will increase hypo awareness? How bad is your hypo awareness? Does this doc have legitimate reason to be concerned that you're putting yourself at risk?

From my understanding one of the things that creates hypo unawareness is spending significant amounts of time inn the hypo range, aka below 70. So, if you could keep shooting for your goal of 120, but reduce the number of lows, I would think that you could achieve a similar result.

I also agree with you that if his theory is correct, then once you go back to a goal of 120, you will eventually become hypo unaware again. So is he proposing spending two weeks over 200 on a regular basis?

Basically, I don't like his proposed approach.

Thanks for your input, Mike. It sure helps to talk with fellow diabetics because normal people just don't understand. Hell, I hardly understand!! yes, I think I am just going to stop shooting so much insulin and try to stay 120 to 150 i don't like this docs controlling attitude and yet where I live I don't have a lot of choice in doctors, especially endocrinologists. So I am afraid I might be stuck with him! Yes, I have been having many lows and at all times of a day. Every time I excersise it goes low and I might start out at 220! I go low a lot at food. etc etc.

I will agree (with your endo) that from your brief description of having many lows and going low after exercising, that a pump might be a good therapy for you to pursue.

Again, a question that you might ask the endo is: Are you asking me to spend two weeks @ 200 so you can more easily justify the pump to an insurer/gov't program??

But I want to reiterate that I definitely hear you about exercise. When I was on MDI, I always wanted to be over 200 before exercising, because of the lows.

Granted, I still have lows on the pump, but generally find them so much more manageable. Using the temporary basal rate has allowed me to exercise in a much more serious and regular way.

At the same time, I know there are folks on MDI who exercise and have a handle on how to modify their basal/bolus protocols to enable their activity. So another question to the endo could be: "I hear you on the pump, but I would like to stay on MDI. Are there methods you can suggest to help me manage MDI better to avoid lows (different insulins; reducing basal doses; taking lower basal doses more times each day; eliminating basals and increasing bolus frequency; etc, etc, etc)"

IOW, "Doctor, you are the endocrinologist expert on MY team, but while you know way more than I do about the disease, I am going to make the final decisions on MY treatment. Let's work together!"

Maybe the new Endo would arrange for a loaner CGM. hat would show exactly where the hypos are in the course of a day - for a week. You may be able to adjust your dosing and stay with MDI, or you may decide to pump. I personally would never go back to MDI, the pump suits my personality (very detail oriented and I like that I have different and adjustable doses), but it would allow you to see when your hypos start .

I like the idea of the loaner CGM for a week to get an idea what's going on.

You might want to think of eating some slowly-digesting carbs at night before bed and before exercise as it might help fuel your body and avoid the lows. Also, if you're eating before exercise, are you bolusing as you would for a meal at a "normal" time? Maybe bolus a little less in anticipation of the carbs getting used up quickly?

Thank you all for your replies, I am thinking about each and every one of them!