I am reading Dr. Bernstein's book (finally) and am determined to manage my blood sugars as aggressively as he does. Problem is, how do you locate a doctor who is (a) philosophically inclined to help you do that, and (b) open minded enough not to be a prisoner of his/her own upbringing? (Medical upbringing, that is.) For me the problem is particularly acute because I live in a rural area where doctors are scarce to begin with. It's a tough nut to crack. Anyone have any light to shed on this?
I also live in a rural area. I haven't found a doctor who's accepting of low carb. I've gotten the head shaking, the your brain will starve & all the other misinformation. I tried politely educating, but that didn't go over well, as you can imagine.
Since I manage my own diabetes, as most of do with medical input or approval, I do what I've found is best without discussing it further with people who disapprove. Would be nice to have someone supportive, but you don't need a doctor to aggressively manage diabetes. It's up to you & you can do it. Lots of good info in Dr. B's book to guide you.
Thanks for the feedback. I pretty much figured out that I'll have to do this on my own. No problem, the book is so detailed that I expect it has all the information I need.
When I posted the question I was thinking more of logistical stumbling blocks. For instance, if my GP isn't supportive of what I want to do, it may be difficult to persuade him to write the Rxs I will need -- insulin, for example. That's the kind of resistance I'm not sure how to overcome.
GP's are typically resistant about prescribing insulin for T2's. It takes more time to educate & guide patients on insulin & most don't know how to. Insulin also carries a liability for them. Doctors are paranoid about possible lows. More endos are now open to T2's using insulin when oral meds aren't effective, if you can get a referral to an endo.
If push comes to shove, Humulin R (Regular) is available without an Rx. Syringes can be purchased without a prescription in most states. R is an intermediate acting insulin. Realize it's a scary thought to venture into insulin territory on your own, but others have done it when they didn't get cooperation from doctors. People can guide you about dosing.
I live in a rural area too, but from all the stories I hear on tuD a sympathetic Dr. can be hard to find no matter where you live. I got lucky, I spent 6 days in the hospital on diagnosis, and since I had no Dr. a Dr. who was new in town, and thus needed patients agreed to take my case.
I left the hospital armed with the exchange diet. By the time I went in for my 2 week follow up appointment I had discarded it along with a glycemic index diet, because my numbers were still too high, instead I had started low carbing. I was already seeing good numbers so it was a fait acompli. I was dreading his reaction, a la what Gerri described, but he didn't say anything. In the nearly 3 years since I've tested frequently and always print out reports from my meter detailing my numbers. I also report to him what I've done as far as fine tuning my diet.
So we have developed a collaborative relationship which I hope will make it possible to get him to prescribe early insulin for instance, although I'm sure he would at first fight such an out of the ordinary step.
Finding a Dr. like this is really just a matter of luck. If you can find someone like this I think it is important to be open and frank about your goals and what your readings are. This will help you if and when the time comes to be active in deciding what course of treatment to follow. I think the younger the Dr. the better in this regards, older Dr.s came up in a time when Dr.s were considered gods and expected their orders to be followed without question. Today in the age of the internet many patients expect their ideas to be considered and so a younger Dr. stands a better chance of being open about more patient involvement.
If you can't find someone like this, unfortunately, Gerri's advice is probably better. There's really no point in beating your head against a wall. Your Dr. will simply put you in the "kook" category and not listen to anything you say.
Another book I would recommend is "The Art and Science of Low Carbohydrate Living" by Phinney and Volek. The authors are researchers with lots of letters after their names. The book is totally based on publish research which would help you make your points if and when you need to argue the safety and efficacy of low carb. I think Dr.s see a lot of patients who bring them printouts from various websites and this type of information has a low probability of being taken seriously, without supporting evidence from published studies. Luckily lots of research has been done, especially recently, and every one I've seen has been positive about low carb being a viable alternative. A printout from a peer reviewed journal carries a lot more weight than one from a website describing a miracle cure.
I think one of the best ways to get buy-in is to show the numbers. Most doctors/CDEs biggest complaint about patients seems to be "non-compliance" (a term with its own problems) so if you can show labs with a good improvement in A1c/cholesterol etc, then you're off to a good start, but ultimately, people who really buy in are few and far between.
I think this is what worked for me. After 3 or 4 A1Cs < 6 it becomes obvious it's working and the patient is having no trouble staying on the diet, which is one of the other reasons given why low carb is not a viable alternative. So, frequent testing and downloading to a computer for later retrieval has value beyond just knowing what your numbers are.
I had to teach myself how to use insulin, even with a prescription.
I'm on medicaid so I was stuck with my clinic, through my state's program. My nurse practitioner was freaked out because my blood sugar was 500. She put me on metformin and it stayed 500. She increased it to the maximum dose and I was still at 500. She finally buckled and gave me Lantus. After increasing it to a dose where I woke up at 100, I couldn't eat anything (And I pretty much mean anything. I didn't know about Bernstein yet and I was doing the vegan diabetes thing at the time, but I was trying to live on broccoli and lettuce because those would only send me up to 250) because I'd go up to 500 and stay there all day, so she added Novalog. It took me 6 months of being at 500 most of the time before she finally gave me Novalog -- by that point, I was calling the clinic nearly daily, begging for insulin.
But she didn't know how insulin works and there was a two month waiting list for people on medicaid to get to see a diabetes educator so I got a book called "Using Insulin" by John Walsh and taught myself. By the time I got in to the educator, she asked me what I already knew and I rattled it all off and she said, "unless you have a specific question about anything, there's nothing I can do for you."
So I would HIGHLY recomment Walsh's book to anyone in the position to have to teach themselves how to use insulin.
I taught myself also. The good thing about being self-taught is realizing you can without medical interference. Staggering how little the medical community knows about diabetes. Like many, I was given a sliding scale & told how to correct a low. That was the sum total of my professional diabetic education. Started from square one on my own. I went to a diabetes ed class through the hospital. Useless. I was the only T1 in the class, though what T2's were being told was equally useless.
Give this a listen when you have time. It's an interview giving advice on how to handle non low carb docs.
From the link onesaint provided a list of low carb friendly doctors http://www.lowcarbdoctors.blogspot.com/ thanks onesaint!
I'm sure I originally got that link from you. Your Google-fu is strong, BadMoon! =^)
Thanks to everyone for the good feedback. Next time I see my GP I will go armed with much more specific and detailed records than he has seen before (at least from me) and we'll have a real heart to heart. I don't want to prejudge him; we haven't had a conversation in that kind of depth and maybe he'll surprise me. One can hope. What I would really like would be referral to an endo, but that might be too much to hope for. Well, we'll see. In the meantime I'm going to try and interview some other doctors around here. You can't get lucky if you don't try.
And I have ordered a copy of Walsh's book. Thanks for that tip too.
I'm in Los Angeles, king of strange diets, and finding an endo to support LCHF has been a huge chore. I ended up emailing Bernstein's Publisher, Steve Freed for a reference. The logs I take are 2 weeks worth of 10 readings a day, my CGM logs, 2 week food diary and those flat trends that result from LCHF eating.
My new Endo (a very well known one in D circles) was taken aback. Her comment, "Wow, you're really doing it (controlling D)."
I never had a real problem with the diet thing. Most doctors are clueless when it comes to diet. They can tell you to eat something, but they don't control your food and they would just as well fob off the whole diet thing to a dietician or nutritionist. The real problem for me was that I wanted "normal" blood sugars and the majority of doctors want you to have "mediocre" numbers. All my doctors were fine if I had an A1c of 6-7%, they considered that just peachy keen. But a normal blood sugar does not reflect an A1c of 7% or even 6%, it is really about 5%. And that is where I had trouble. I had to fight to get medication. I had to fight for any tests. And when it came to insulin, I had no luck and eventually just started on my own with R and NPH I bought at Walmart. My new endo thinks I am doing great, is a fan of low carb diets and thinks that the low 5s is fine as long as I manage hypos. But I don't know whether she would have initiated insulin therapy (Bernstein would).
Tim -- You pinpointed my #1 concern: finding a doc who will prescribe insulin. I haven't even finished Bernstein's book yet, but everything you said mirrors my thinking exactly. 6.0, even if I could do it, is not acceptable. I have already figured out that insulin has to be part of the answer. I've never really been teed off at the medical profession before, but I'm beginning to be genuinely angry with the stubborn, closed-minded way they cling to their indoctrinated beliefs in defiance of plain simple logic.