I went to a new Endo yesterday , because my last one threatened me that he will take off of the pump . His reason being was because I didn’t have a blood sugar log to present him . I’ll be honest in all these Years that I’ve been type 1 diabetic I have been very bad with keeping logs ( it’s all in my head , I can prob recite to you what I’ve been every am , every lunch and every dinner for the last week and that is because I’m always seem to be in a similar range around each one of those pre and post meal times) but he wasn’t going for that . Anyhow that dr lost a patient cause just because he’s a Endo that doesn’t mean that he can take away my pump , I’ve been on it for the last 12 years and even though my bloodsugars are not as tight as they should be they are much better that they were When I was on reg and nph ( that was a nightmare , I can remember haveing a low of like 34 2 hours after breakfast and then another low an hour later due to the nph peaking )
So at this new drs office I explained to him how I’ve been haveing to take like triple my dinner bolous and when I get a number above 250 it takes so much insulin to bring it down ( like sometimes 7 units without any food , when in the past 2.0 units would bring me down) so this was his explanation he told me that even though I have bin a type 1 diabetic since 1990 ( 22years) he believes that I am now a type 2 also , that would explain my insulin resistance and that is why medformin works for me when I take it before dinner . I had explained to him that I’ve bin taking medformin before dinner for the last 4 years and it seems to help with my bl . Recently I stopped taking it for about 2 weeks because that other Endo ( the one who threatened to take me off the pump said that it is very dangerous for a type 1 to take medformin) but those 2 weeks were just miserable high everynight I would eat like 30 carbs max ( a salad with breaded chicken and dressing and need like 20 carbs threw out the course of the night . So this dr explained to me that if I weren’t also a type 2 diabetic than medformin would have no effect on my bl . So he raised my dose to 1 pill before breakfast , 1 before lunch , and 1 before dinner and let me say that I am back to using only 1 unit for every 15 carb at night again and my bl have not gone above 180 which is good for me when I was dealing with 300 every night !
So I would like to know if there are any other type 1 diabetics who have or are going threw a similar problem with there bl , where insulin alone is not good enough?
Who told you you were a type 1 and how where you diagnosed as a type 1? did you test positive for the antibodies, have a low cpeptide? And, yes...they can take away your pump if he/she is your prescribing doctor - endo and they are the one you see for you D management and insulin. They're basically liable - responsible for you and your D management or they can just refuse to continue seeing you if they think (feel, believe) a pump isn't safe for you.
I'd be skeptical about any endo who said "you are also a type 2 diabetic". Yes, Type 1's can develop insulin resistance, but that doesn't make them type 2's, just type 1's with insulin resistance.
I'm also confused about his berating you for not having logs. I'm pretty old school about it and do keep meticulous log notes with pen and paper, but many people on pumps do not and he can just download all the info from your pump!
I will not tolerate doctors who berate or threaten. It's hard enough to do everything we have to do to the best of our ability without being treated like a child. I'd switch doctors to someone who can educate and explain rather than threaten. Like Zoe, though, I am old school and keep a handwritten log and notes. My memory is not as good as yours. :)
I think the terminology endos use vary. I've heard some refer to people as having "double diabetes" (that is, they are a type 1 first and then develop the insulin resistance that is seen in type 2s). My endo told me it's more common in women with type 1 diabetes, especially those who have had type 1 since childhood, as the constant administration of insulin increases body fat among type 1 women, especially those who are administering insulin as they go through puberty.
For some reason I've developed a lot of insulin resistance over the past few months. I've been Type 1 for over 20 years now. Six months ago a unit used to cover 12g of carbs, now it covers about 6g, and my basals and ISF have also gone up a lot—six months ago basal was 22 units a day, now it's closer to 30 units, and ISF used to be 1 unit would bring me down 2.4 mmol/L, now it's 1.2 mmol/L.
I did tell my endocrinologist about this when I saw him in December and he didn't seem concerned at all. I don't think it's that uncommon for people who have had Type 1 for a long time to develop insulin resistance. I don't know that I would call it Type 2 unless you are taking really massive amounts of insulin, like a few hundred units a day, or also had some of the other problems associated with Type 2 like high cholesterol or high blood pressure.
What kind of pump are you using? I use the Minimed Revel and I've never had to write a single thing down with it - I simply download all my data into their system and my endo can access their system via her office. I've always been horrible with logging, and one of the reasons I've stuck with the pump is because it makes logging so much easier. Writing things down old school style just doesn't work for me, but using my pump, I never miss a single thing because it captures each and every BG test, bolus, and meal.
I did experience some insulin resistance a few years ago. Had gained a bit of weight and was eating more carbs than usual. I took metformin for a bit, but my new endo took me off it because she said it was too dangerous for my kidneys. I don't seem to have any insulin resistance now (still at a consistent 1:15 I:C ratio), except for before my period - during that time, my BG shoots up and it takes way more insulin to bring it down. But otherwise, I'm fairly insulin sensitive. My endo said that she doesn't like to use metformin among type 1s unless the insulin resistance is so bad that nothing else works. She said it's a balancing act of protecting the kidneys, but dealing with the insulin resistance.
Another thing that has really made me more sensitive to insulin is exercise. I've always been very active, but had a brief period of slacking off and not doing exercise that was as intensive. Once I got back to that, my BGs improved and my insulin sensitivity came back (sometimes I'm a little too sensitive after intensive exercise!)
that's what i was thinking too, just download the pump? but, if they (the doc's office) don't do that - download, they need something..ya know. the endo - doc is responsible for that patient on the pump. i don't think they can 'take it away' but the can refuse the patient. HYPOGLYCEMIA is real and can kill us, it's their biggest feat. we can't always blame THEM, ya know..IMO. Maybe he saw something concerning..the patient has to participate too.
If you were 'correctly' diagnosed as a type 1, cpeptide, antibodies, DKA (whatever) you're always a type 1, maybe you just have insulin resistance, as Zoe mentioned. That can happen too, especially if one is overweight, been on insulin a while, etc..
I think doctors' offices need to work with patients. We don't all have the same technological capabilities, expertise, etc. IMO, if an endo's office is prescribing a pump to a type 1, they should have the ability to download everything at the patient's visit. All the patient would have to do is bring the pump and the USB stick/cable and have an online account set up (which the endo's office could do). Then, at the visit, it would take all of 2 minutes to upload all the data and review it.
What worries me about hearing things like this is that there's a lot of research looking into "patient characteristics" that warrant more expensive medical treatment. For example, what kind of patient does "the best" with an insulin pump and therefore should have that treatment covered? If the research shows that people with more education/higher income do better because they have access to certain technologies, than this could wind up meaning that people with less education aren't able to access pumps because endos won't see them as being skilled enough. It's a slippery slope as to where something like this could lead.
In managing a disease like T1, I don't think a doc should ever berate or threaten a patient. That's just wrong. A doctor does have the right to say that he/she won't work with you any longer, but to "threaten" to take something away is just....wrong.
true! that's why i found a new endo who does all this download stuff. it's the patient's responsibility too to find out if they do download stuff, what they have in terms of monitoring for patients, do they work with pumps, CGM's etc...if i was making an appointment with a new endo, i'd be asking...do you download my pump..how do you check my blood sugars. not all of them have the technology, unfortunately so we as the patient have the right to go somewhere else, to an office/endo/provider who does.
Maybe he didn't know how to download from a pump and didn't want to admit it!
Yeah I agree, they can't "take it away" (visions of the repo man coming to your house). But if you need a prescription or even scripts for supplies ongoing they can refuse to write it. On the other hand, I wouldn't stay with an endo who would pull that kind of stunt.
well, there are characteristics in terms of insurance companies paying for a type 1's pump. The too have to protect themselves. If one is mentally off balance, incapable of operating a pump...they won't get one, of course. Medicaid (as far as I know) covers pumps for type 1's, so I don't believe income or higher education have anything to do with it.
I agree with everything MyBusted has said. It's always seemed ironic to me when I hear some people being refused a pump because their A1C is too good (as in they don't need it) and some because their A1C is too "bad" (as in they don't manage their diabetes well enough). All of that is based on a couple misconceptions: That improved A1C is the only reason one would want a pump (ease of lifestyle is another equally important one) and that people with high A1C's are "non-compliant". In general it just makes me think that nobody is doing their homework!
just depends, i guess, on who's paying, typically if the Endo does the medical necessity paperwork, writes the Rx and the patient's insurance company covers insulin pumps, they're not that often denied.
also, this is circumstantial too, if one has a very high A1C because he/she maybe doesn't know how to properly count carbs, isn't taking their insulin, isn't trying to manage their BG's, why would any Endo want to put them on a pump, it's more difficult, at least in the beginning and takes more attention with a learning curve.
Has anyone ever thought that maybe just maybe humolog insulin is being made even a slight bit differently all of a sudden ? Cause I’m going threw insulin resistance and there are alot of stories from my friends on this site who are dealing with insulin resistance . My body used to be so sensitive to insulin that I used to be able to eat a chocolate cream dounut and take like 2 units for that and still be 120 an hour later , but now a days 1 small cookie like 10 carb would require like 2 units . Yesterday I was 130 before breakfast I had 2 eggs with 2 cheese and plain coffee with a drop of cream ( o carb meal) and I went up to 244 an hour later . I had not given any insulin cause I was planning on going to the gym and I’m still confused with the amount of insulin to take for an all protein meal cause protein does raise my bloodsugar !
I'm using Apidra ... I've actually tired using Humalog a few times in the past few months to see if it might be the insulin, and it makes no difference. So I'm pretty sure it's my body. (I also tried my old Cozmo pump to see if it was my Ping, and that also made no difference.)
Whatever it is, it's making losing weight VERY difficult and I find it extremely frustrating to have to take the same amount of insulin as I did before even though I have more than halved my carbohydrate intake.
I don't like doctors that threaten. I once ask a doctor if he would recommend another doctor after he threatened me. I look at it this way, I'm the one paying the bill and I will not be treated that way. As I was leaving I told him that I was looking for a doctor when I found him and was very willing to continue the search. I think you made a wise choice in finding a new doctor. He sounds like a good one.
I've never been allowed to see an endo at Kaiser because my A1C is too low. I have multiple complications, but that doesn't qualify. Grrr.
I use Humalog too, and the last two months I have really noticed an increase (and it's probably hormonal) in insulin resistence more so than I've had before about a week a month mid cycle around ovulation. But I've been on Humalog for around 6 months now, and its only just the last two months I've noticed that. Can't say it's happening all the time, but yeah that is odd several of us are experiencing issues with it. Normally I am very insulin sensitive, but during those weeks I've had my pump craked up to about 2 units a hour and its barely keeping me where I need to be. Normally 2 units an hour would put me in a hypo coma, lol.