Newly dx'd, none of my doctors seem knowedgeable =(

Type 2
1

I was Dx'd when I went in to get checked out for upper abdominal pain a little over 2 weeks ago. My high BG was an incidental finding as the differential dx was expected to be gall bladder dz (I'm 44, female, overweight).

DX: T2, and my U/A revealed microalbuminuria, A1c is 9.9%, Hypertensive
44 yr old, overweight female
Rx: Januvia 100mg PO SID

*newly added Rx today by the Cardiologist: Zestril
(haven't picked up the script yet)

I'm working on lowering my numbers, fasting numbers average 120-140mg/dl and 2 hr post meal Bg's are 112-120mg/dl. I'm seeing my lowest numbers in the noon to 2pm time frame, but they seem to climb after that.

Evening numbers are not the best, 130-150mg/dl. I've cut all starchy carbs, eating only meat, cheese, cream, veggies. I'm wondering if taking my Januvia in the afternoon will help blunt the spikes I'm seeing.

Anyone have any experience with that?

2

Not for using sophistry to excuse lack of knowledge; the biggest issue is your doctors may be very knowlegdable on certain specific elements of treatment and yet not emcompasis all the knowledge that encompases type 2 diabetes contrary to the blame game crowd and arm chair instant experts.

Frankly you will need to also include CDE, dietitions, web sites like this and DIabetes self Management, Diabetes Forum and others as a web of experts to help sort this mess out.

After 30 years chasing this mess and finally in last 5 years getting the crud stopped ( notice I say stopped not cured), it will take time, patience and perseverance arresting the mess.

If you go to Doctor with broken bone, obvious condition smoked out by lab tests and easily attacked by antibiotics; yes Doctor has clearer and more direct shot.

On this mess its a partnership where the patient needs to help on diets, eating, exercise, measurements, self learning and finding folks fighting your varient and seeking out those who should be able to supply knowledge and hopefully focused direct assistance on your specific situation.

Best wishes and good luck and yes not all help is the same and you may sense that quickly.

3

I'm surprised they didn't start you on metformin. With the diet you are following it's all many people need. Maybe it has something to do with your gall bladder. Just my 2 cents.

4

Also surprised you weren't put on metformin. At least you have a dx though my doctors aren't thorough either..because apparently I'm "young to be diabetic" and my high bg readings aren't THAT high yet lol...I'd go to another dr if you feel like you're being ignored :)

5

Thanks everyone =)

Metformin was the first choice but they hadn't ruled out gastric ulcers at the time of Dx. They were ruling out gall bladder & ulcers, I'm pretty sure my casual BG of 266 surprised everyone because I was told my labs were all WNL & set up for an abd U/S to rule out/in gall bladder, & a gastric scoping to rule out/in ulcers. (Labs done in office, sent out to lab later that day).

Two days after having my labs done & told they were normal, I was called in to the office about an 'urgent' finding on my labwork.

The GI doctor apparently never looked at my lab work because he sounded surprised when I told him of the news. I opted to hold off on scoping because he said the results of my abd U/S were all WNL except that I had excess fat around my liver. I realized that this was part of my uncontrolled BG, so opted out of the GI scoping, for now.

To this end, Metformin was the first choice, but due to abd. discomfort (euphemism) that led me to seek medical attention in the first place, the second choice was a sufla drug (to which I'm allergic).

That left Januvia third on the list.

On a brighter note, I've been testing like crazy & found that my BG's tend to spike around 2 to 3pm no matter how I eat, currently less than 25 g or carb per day. While I am seeing better numbers since cutting down to this amount, I'm still seeing late afternoon spikes.

Yesterday, I took my Januvia @ 4 pm and the numbers were 131mg/dl @ about 7pm (2 hr pst meal and about 1 hr post 45 min dog walk), and 110mg/dl @ 10pm (2 hr post meal). This morning I woke up at an all time low, 112mg/dl (yay!)

I'm going to continue this course & see if the trend continues...is it bad that I'm putting off filling my script for Zestril?

I almost feel like if I have a few weeks of less turbulent numbers & lower numbers, & the doctor still says I'm hypertensive, then ok, I'll fill the script. Is this a newbie mistake?...I've never been sick before & all of this is very, very new to me.

6

I'm not familiar with the medication Zestril, but if it's prescribed by your cardiologist and it's for high blood pressure, I would take it. Those are not things to mess around with.

7

Update:

I've seen 3 doctors in the last 2.5 wks since Dx on 4/13. None of them commented on high blood pressure, I even asked one nurse if my BP was normal & she said yes.

I called all 3 doctor's offices & got the BP readings & called my Endo.

While he was noncommittal about whether or not Januvia had induced hypertension, (for that, he said he'd need 5 yrs of BP data pffft)he did concede that it was odd that only since my starting Januvia did I pop hypertensive.

To this end, I asked him if I could try something else, he gave me Metformin 750 extended release. I'm still waiting to hear from the Cardiologist about his opinion, but am thrilled the Endo considered what I had to say.

He was impressed with my BG numbers, and said he'd be happy with up to 180mg/dl 2 hrs post meal as long as it went back below 140mg/dl 3 hours post.

I'm trying for better =D

I'm picking up a blood pressure monitor today to compare the objective data to see if the hypertension really is due to Januvia.

A helluva ride.

8

Hey girl, welcome to the club. What you need to do now is set your goal at being the least active member possible. That doesn't mean you don't do anything, it means you become The Boss.

I have no credentials to be dishing our advice, other than the marks on my fingers, but I'm going to anyway.

First, hold your head up high! I took various meds, which were adjusted every-other time I saw the doc over a period of a couple of years. Fortunately the results of my "if he can tweak the meds and correct the problem, it must be his and not mine" attitude apparently didn't result in any significant long term effects. It finally got to the point that long-acting insulin at night before bed was in order and a year or so later saw me "progress" to test and inject before every meal. That's when I began to get involved. You are starting on the right path-take it seriously and do something about it -- I salute you!

Second, this "manage your diabetes" game seems to have rules that are different for every player. The treatment regimens, medications, dosages, and unfortunately the results, vary significantly from person to person.

You mention testing at various times of the day. I suspect your doc is looking to collect some more information before selecting a path to travel. I found that my doc isn't the "solution provider", in fact when it comes to my diabetes the Diabetes Education and Support Team is my strongest resource. In order to properly use these resources I had to:
- get actively involved in the game, that means keeping records;
- develop some knowledge and understanding of what is going on so I can ask meaningful questions and recognize changes.

The record keeping is absolutely critical! A diagnosis and treatment regimen used must be based on reality, not just rules of thumb. The only generally applicable rules of thumb are eat regularly and eat right, loose some weight, get some exercise, and in most cases reduce carbohydrate intake. From your comments I'd guess your doc gave you that sermon and now the ball is in your court. You are the only one that can get the information needed to support a diagnosis. The information needs are blood glucose testing, food-intake nutritional values, weight, exercise, blood pressure and pulse, and medication usage.
I got really frustrated with trying to interpret the information I was collecting. After a number of months I developed some software to address the problem as I understand it.

I decided 2-hour-after testing was too hard for me to consistently do, and being The Boss I decided to adjust the playing field. I settled on before-meal (which I had to do anyway to calculate insulin dosage) and before going to bed testing. That gave me a fasting-test in the morning and about 4-hour spacing during the day. It didn't take long to see the patterns by meal and by day of the week, Saturday is my fall-off-the-wagon day. I just targeted carb-intake to about 45-grams per meal, didn't worry about calories or fat. In about 12-18 months I'd gotten my A1c to 5.5-5.7 area, dropped 40-pounds, and have now discontinued using any insulin.

You have the right idea, use life-style as the treatment, it's cheaper than meds and it does wonders for our self-image.
This diabetes thing is a challenging game. You are not the only player, but you are the only one that really counts.

Hang in there girl, as the man said "We shall over-come".

9

excellent comments. best wishes.

As a 30+ year type 2 I wish I had gone on the insulin far earlier than the glyburides, glucotraol, starlix etc all.

In Europe I am told they go direct to insulin.

Yes life style - diet and exercise is critical but you may still need some meds depending on age, medical hiccups etc. For me myanswer is 33% meds, 33% diet and 33% diet.

There are no magic cures and skip the snake oils salesman. Goal is to get the rot minimized and stopped and getting the numbers down as naturally as possible.

Good luck on your health.

10

I'm a T1D and don't have much to offer about your medical treatments. I do have some definite opinions about using doctors to your advantage. The first thing that I realized is that endocrinologist generally have low expectations. I guess that they get worn down by all the patients they see that do not follow their recommendations.

I operate from the philosophy that my doctor is a part of my diabetes team, but s/he's not the captain! That's my job. I hire, fire, and pay the bills. And I am only one that lives with the consequences of any medical decision.

I would have a big problem with an endo that accepted 180 mg/dL 2 hours post-meal as a good goal. I know that I can do better than that. Of course, you'll have to make your own assessment of your capabilities, but don't let the doctor compromise your goals and your health.

Participating in this community tells me that you care about your health and are willing to accept responsibility for it. Curiosity and willingness to ask questions and execute a plan based on your values makes all the difference! Good luck. You will do well.

11

I wonder why you take januvia at 4 pm?? Also check out dawn phenominon, morning elevated blood sugars. Testing, like crazy…make a plan when to test strips are costly. Watch your portions is one of the easiest ways to help control things. Read,read,read teach yourself. I have a great endo , but in the end this is my disease , my responsibility. excerise? Walking is free. I walk,swim,garden shovel snow depending n the season. Most type 2 take blood pressure medication in prevention of kidney disease. I have been a type 2 for 20 years. Best of luck in your new journey. Nancy

12

Hi JimS, good to chat with ya again.
When I finally decided to be a player in this game I did a BUNCH of looking around. Somewhere I've got a link to a doctor, in fact I think he's an OD rather than an MD, in Ohio, Kentucky, not sure, but his approach is hit it with insulin right-up-front (When I find the note I'll post it here). His theory, as I understand it, is high glucose says your body is being over-worked, provide some relief with the insulin and then you may well be able to back off. I'm happy to say that is exactly what I've experienced.
I recently read an article that that said belly-fat (course I never had any of that) plays a big role in reducing the effectiveness of the body's insulin. To me, that explains the "loose some weight" verse in the doc's song.
I don't believe in a "cure", I think it's like wearing glasses, once the genie raises his head out of the bottle he is there to stay, BUT, he can be managed with a properly applied stick, and that is where being The Boss comes in.

Hang in there my friend, and stay healthy!

13

thanks for all your replies everyone =) what a difference a couple of days makes.

Here's the update...

I'm still waiting to hear from the cardiologist after having left a mssg with his secretary last Friday afternoon. Though it's only been a few days (since fri. p.m.) that I started Metformin & discontinued Januvia, my BG's are much better and so's my blood pressure!

The mysterious abd. pain I had endured after eating & bloated gassy pain is gone & has not returned. I guess since I was getting used to a new normal, I hadn't noticed that I was bound up on the Januvia as well. In short, I feel fantastic!!! No side effects from Metformin that I can see so far.

On Metformin 750 mg PO @ p.m. I have FBG's of 110-115 mg/dl, 1 hour post at about 112 mg/dl, 2 hour post at about 115 mg/dl.

I was taking the Januvia in the late afternoon because I noticed every day btw 2 and 3pm, my BG would spike regardless of what I ate. I had been taking my BP daily a couple of times a day, just to get a baseline for fluctuations. Thankfully, since getting off the Januvia, my BP is within normal limits. Systolic is always below 100 and diastolic is btw 90 and 70. Soooooo, yeah, I'm not hypertensive. Glad I didn't fill that script.

I also got a PolarFit 4 heart rate monitor. On Metformin, my BG's are stable until that mysterious 2 pm spike. I've found that if I get my HR up & keep it within a certain range (with the help of my HR monitor) I can drop my BG level to btw 90 and 100 mg/dl from 188mg/dl.

I agree that being in the driver's seat is where you're at & need to remain as long as it's a situation of management. I'm keep a log as someone suggested with all the data, BP's BG's pre and post, times, meals etc. I'm going to see if I can get someone to make me a spread sheet.

I'm learning to trust my body and common sense more. Now that my BG's are under control, and I'm working on conditioning my heart, I hope to be able to maintain ground and maybe even gain some =D

14

Good job! Wear your The Boss hat with pride.

15

thanks! =)

16

Have them check for gallstones. You might have a duct from the pancreas blocked.
Pancreatitis can also be a suspect.

About Pancreatic Stimulants - see if they can switch you to insulin. It can give your pancreas a break.

If you want to blunt the spikes, drink a mixture of apple cider vinegar (1/2 ounce) to 15 ounces of water with your meal.

Sometimes it can slow spikes, but won't hurt you.

Apple juice can help dissolve soft cholesterol bile stones. It takes a lot and over weeks to get the benefit. That too won't hurt you.

Avoid all FAT if at all possible. Fat can aggravate gallbladder problems.

You are trying to rule out problems the cheap way :-)

17

OMG Bernard, that is exactly what my CDE and I have talked about numerous times. That our bodies are so overworked that at the very least our pancreas needs a break. 6 months or a year of insulin would be the time the pancreas may need to regroup, you would know by your numbers if you are doing the right thing....BUT when I asked Dr. about it, she said, no, we're on the right track now, which is true, I am a very well controlled diabetic, BUT, I felt better when I used the insulin for 6 months...would love to say I am going back on it, and then tell her.

In answer to the writer's questions, Docs probably get very few hours in diabetic education, and true, they do know less than we know about our bodies, our diabetes, how we react to foods, drugs, etc. I keep a notebook with questions, reactions, etc to take to all appointments, so I can share that with her. IF I find a great article or a posting here, I will share it with her also.Unless they are diabetic themselves, they need more hours in education, if the only way to get them to educate temselves is to have us do it, then so it is.

18

Doctors are taught to treat acute illness (take out your appendix, cure your pneumonia, zap your cancer, etc., etc.). They are not trained in the day-in, day-out management of chronic conditions. A four-year medical school course typically spends one or two days on diabetes.

19

I've read articles that talk about the significant difference between Type-1 and Type-2 diabetes and the focus historically having been on Type-1. That would be consistent with David's comment.
I bet another factor is the pharmaceutical industry's influence. With the large numbers joining the Type-2 club research and medication focused on the Type-2 factors is a more attractive/profitable target. It's too bad that a lot of those are joining the group through life-style rather than medical avenues and are receptive only to the "magic" solution.

When I began using insulin before every meal, after several years of meds and my "it's not my fault, it's medical, or it's age, or ..." perspective, I watched carb-intake. That's it - carb.intake - and I dropped 40-pounds. I was amazed when I looked at the nutritional info on sugar-free cookies to see the carb-content.
I'm no longer using insulin, I wear pants that are 6-inches smaller in the waist, and I still focus only on carbs. I do walk on my treadmill for 30-minutes most days, so maybe carbs don't get full credit, but I don't worry about calories or fat, or burning it off. I do see the calorie-content of my meals because I include it in my record-keeping, bit I don't focus on it, it seems to align pretty well with carb-content.

There is no diabetes history in my family, and I am sure that life style and eating habits were at the root of my experience. I'm obviously not one of those people whose metabolism will never introduce diabetes, but it's pretty clear that I'm also not one that can ignore it.

Since starting the insulin routine a couple of years ago I lean heavily on the Diabetes Education and Support Team, rather than my doc, for diabetes. The team's focus is diabetes education, treatment, and management, the doc's is all of the other stuff. My doc told me I had a choice, let him lead or let the Diabetes Team lead. He said that they are a stronger player, in fact his relationship with them is "Yes ma'am" about 98% of the time, at it was the RIGHT answer for me.

I believe the REAL answer is for the patient to get involved. Until you put on a The Boss hat this is a tough fight, wearing that hat levels the playing field and if you aren't able to WIN, you can certainly reduce the power of the opposing team.

20

In every state escept alaska, you can legally buy human insulin and syringes over the counter.

go to isletsofhope.com

They have a great list.

Walmart has the cheapest insulin (Relon 'R') and NPH, and syringes usually cost about $15/100 last I checked.

Be advised that you have to use human insulin about 1 hour before eating. NPH can be tricky. It peaks about 5-6 hours after eating.

For me, no insulin works in the time frame it is supposed to. Even Apidra can take 3 hours before kicking in.

Note: most pharmacists love to give people grief about syringes.
Explain to them that you know your rights and you have the right to buy OTC without a Rx. You do not need to prove you are diabetic.

I threatend a big lawsuit against both walmart and target for not wanting to sell me the syringes.

They CAN make you buy insulin at the same time as the syringes, but you need it too.

Some can limit how much you can buy at one time.

Since I have a valid Rx for Apidra, pen needles for Levemir, and syringes, I don't have problems any more.

Now, if any of them make you prove you are diabetic of deny you the sale, get their name and file a complaint with their corporate office and threaten a lawsuit under the Americans with Disabilities act.

They will jump through hoops to sell it to you.

Under the ADA, they are not even allowed to ask you what your disability is nor require proof.
The same goes for landlords and renting. If they can't ask you anything about it or any disability nor deny you anything, then neither can a pharmacy.

Do not give them your doctor's name. It is possible that they can let your doctor know what you are doing behind their back.

Be forewarned, do not take diabetic meds AND insulin (or NPH) at the same time or on the same day. You can die very easily if you aren't *very* careful.