Wow, Tim! You have a great Doc!
Dietician in hospital told me to eat 180-225 carbs per day! Gosh, I’d have gained SOoo much weight!
No one ever talked about I:C. I kept food/insulin/weight journal and that helped so much to keep tight control!
Lol-another diabetic asked my A1C - told him 4.7. He said “oh, then you aren’t diabetic”.
Umm-yes, I am…
My experience was similar, except that it was T2, it was the doctor and not a nurse, and insulin was never even mentioned or suggested. I had to go in and demand it following several years of steadily worsening results, combined with self-education exactly as you describe.
David - yeah, they need to get off their high horse and realize - type 1 or 2 doesn’t matter. Science is WRONG!! People don’t get DM because of eating, lack of exercise, etc…Unfortunately, they’ll probably not figure it out in our lifetime.
And why would they want to? There are $Billions to be made on DM’s.
There’s a saying: “Diabetes is not a disease; it’s an industry.”
Exactly!
I can get 200 strips from Walmart for $36 out of pocket, or I can get my Verio IQ strips from pharmacy for $319.98 before insurance. (Co-pay $30)
What a racket!
David, hope you see/comment on post ‘Does Anyone Realize’.
Shadow - I too believe it’s such a sham!
I was in ICU 1st 4 days of DKA, but when in stepdown unit Hospitalist wanted me to get colonoscopy. (I adamantly refused - never had any GI issues and a colonoscopy had NOTHING to do with my DKA). He was so mad he discontinued morphine for serious pain). Then he recommended EGD. I again refused. He just got angrier and insulted my college education. Then he ORDERED physical therapy (lame). I did it just to pacify him, but why would a 57 y.o. need a physical therapist to walk them in the hall after only 4 days in ICU?
Just to add - I looked up the statistics on colonoscopy. Don’t recall specifics but findings of abnormalities was way off per procedure. (I want to say 1:100,000 abnormalities). I may be wrong.
Versus those 14(?) pts that contracted a lifelong serious viral illness related to poor cleansing of equipment.
No thanks, Doc!
Well, let me ask “what are you doing to keep your A1C low?” I just came off the pump. I am taking Toujeo-34 units, & Novolog . I count carbs b4 meals and add insulin from a sliding scale. I am experiencing it all: feet-on-the-floor and dawn phenomenon. Totally frustrated!! Do I need to go back to the pump?
Do you wake up with a high blood glucose (BG) and then go higher or do you wake up in range and then go high? Does your morning BG go higher if you skip or delay breakfast? Could you post some BG examples with times to give context to your question?
While I can do OK on multiple daily injections (MDI), I do exhibit a greater need for basal insulin from about 3 a.m. to 10 a.m. For me, the pump meets this need better than MDI.
@Gallen - i replied to you in wrong thread…
I eat very low carb and take lg dose of Metamucil once or twice/day. (Helps with hunger pangs).
My Levemir dose has gone down from 40u/day to 15u/day.
Humalog down to appx 8-10u/day.
Of course my Doc doesn’t know this - gotta stockpile b/c insurance bites.
Amen to stockpiling. Not only does insurance bite, but you can’t ever tell when they are about to change the rules or pull the rug out from under you. Happens more and more often these days; twice in the last 12 months for me. My stockpile had dwindled and I’m slowly, painfully building it back up again.
@David_dns-yes, my insurance has caused me such great angst! Had to authorize 2 ‘emergency’ refills before things were resolved. All coz they screwed up my presciptions…never again - (I hope).
@David_dns: (I have 9 boxes Humalog stockpiled now. I use 2 pens/mo. So have enough for nearly 2 yrs)
YES and Yes - Was hard enough to accept the very beneficial CGM STUCK in me everyday and a pump at this time is out of the question. 1 extra unit of rapid for every 50 above 150 (with occasional + or - depending on the menu).
Thx Terry4. Yes, I experience both. Yesterday I woke up at 0730 with BS=79. I went for an MRI.Three hours later when I was ready for breakfast it was 315. Lunch=220,dinner =237,bedtime =48. I eat every 4 hours. This am=337. I over corrected the low and should have injected, but did not. Oh the joys of diabetes!
Everybody is different, but for me right now, on MDI, my Tresiba can often enable me to do great overnight and awake with a good blood sugar. But once my feet hit the ground my blood sugar starts rising so I bolus right away, just a couple of units, but enough to offset a rise. If I awake high it is even more important to bolus. And this has nothing to do with breakfast, just that Darn Phenomenon.
Brian, Good morning. I will bolus 3units b4 checking my bs at breakfast time.
Actually, it’s from the science that we are learning that Type 1 and Type 2 are far closer than people have thought for more than 100 years. The issue is often that doctors can’t (or won’t) keep up with the medical research, which tends to be about 10-20 years ahead of clinical practice.
Also, medical researchers and pharmaceutical companies aren’t the same thing 99% of the time. The good people that do DM research in universities (where almost all the basic science is done) are not making a lot of money. Not my field, but I’m a research scientist with a PhD, and I make a pretty modest living (and sometimes not enough of a living to pay medical bills).
Ok, rant over 
It is definitely true that the US medical establishment (and this likely applies in the UK and Canada to some extent) are not great at dealing with diabetes on an individual or society-wide basis. However, the science is why we have everything from analogue insulins to portable blood glucose testers to continuous glucose monitors to laser surgery to repair retinopathy to … you get the idea.
Yes, I use sliding scale. I’m a bit irritated that when I mentioned that in a question I raised a while back (not about sliding scale) the consensus seemed to be that I’m somewhat dim-witted for actually following my doctors instructions.
I adjust the amount of Humalog I take before meals based on my pre-meal blood glucose reading. I also carefully monitor the amount of carbohydrates in everything I eat or drink. I know which foods will kick my blood sugar through the roof and deal with it at the next meal-time blood glucose reading.
My A1C has been below 7.0 for the last three years using this approach. I have adjusted the base value for the sliding scale on my own a number of times but have always discussed it with my doctor and he’s told me that I’m competent to manage it on my own. I adjusted it recently and think that the next A1C results should be significantly lower. I trust my doctor’s judgement and he has an excellent reputation as a doctor (not an endocrinologist) who knows how to manage diabetes. I have not yet seen an endocrinologist… I thought about it but don’t feel the need.
As far as I’m concerned, there’s no point in paying doctors for an appointment if you’re going to hide things from them. If you disagree with your doctor’s approach to diabetes management, say something… have a meaningful conversation about it. Your doctor can’t help you deal with your disease if it’s not a cooperative endeavor.
What we have here is really a terminology issue.
@MikeStarrWriter, what you’re doing makes logical sense, so it’s no surprise that you’re achieving satisfactory results with it.
However: what you’re doing isn’t really the traditional “sliding scale” that gets bad mouthed so much, so it’s also not surprising that it’s doing a good job for you.
The old “sliding scale” that was standard practice for so many years was lacking one ingredient that your method includes, and the missing element is absolutely, utterly critical. That element is—surprise!—carb counting. In the bad old days, diabetics were instructed to use an amount of insulin based on their pre-meal reading . . . . and that’s it. Nothing about calculating how much insulin the specific food would require. In effect, the old way of using a “sliding scale” assumed that a green salad and a chocolate cake were equivalent. That’s just dumb, and the reason the phrase gets a bad rap today.