Third new Endo and still discouarged

Type 1 and LADA
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Went to new endo who entered the room, sat down looking at me (good start) and described my other two endos, (one a NP who works with him) as “you have had a Mercedes and a Porche, and I am a Chevy”. I told him “you are the Mercedes”. Then went on to say the NP and he were a team. He asked me what I do for fun…travel? Are you kidding with Type 1?? I had been “seen” by his intern for over 30 minutes…asking about meds, how much Novolog a day etc. The intern did not know what Dawn Phenomenon was and I gave her some printed info I had from Mayo clinic internet.

Real endo did not discuss much about my high BG or changes from Lantus to Tresiba and results. I didn’t get to talk to endo about Dawn Phen.as he basically just started to talk about AID and how they are all good and depends on my preference. I asked how many of his Type 1s DO Not have an AID and how is their BS management. No real answer as the next comment was “how many minutes my intern spent with you and how long endo has been in here”…(I hadn’t timed it this time, but prob 35 minutes). And how other patients are waiting….etc. I said “I was told it was a 45 min appt………..’’’’ He went on about which pump I would choose, saying all had drawbacks. Fortunately I had been exposed to most pumps by a dietician……but I asked about Twiist, how effective. Saying it was not available in my region….to which he replied that he had two patients on Twiist for three weeks. He got up to leave, wanting my choice for pump, looked aT MY libre CGM record, no comment on my 8.5 GMI. I asked if I was now his patient (he had not been taking any new) and he referred back to the NP I had seen and how he may be retiring………..Another disappointing contact with an ENDO…..I feel like I’ve been hanging out on a tree limb for three years of being first diagnosed Type 2 for 18 months and then getting Type 1 dx. I tried to ask him about my GAD antibody results…what that meant and how much insulin I have…can it be determined? He said (sounding angry) “You produce no insulin!!!” My C-peptide was .81 and the range was .80-235. I said, I have more than the lowest range……..that’s when he said angrily “You have no insulin”.
Without this community I would be totally ignorant and without clear direction with these medical people. THANKS FOR LISTENING.

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Yeah, so much to respond to here, lot of familiar territory. I think the main thing is to figure out what you actually need these guys for, in terms of expectations. Someone a while back posted about a visit to their endo, where the doc said “Sometimes I think you just want me to renew your prescriptions and otherwise leave you alone.”

I mean, bottom line, yup. It’s a little extreme, but in many cases that’s the best you can hope for.

But if I gather correctly this is relatively early days for you with T1 and there’s a lot of stuff you do need help with. So from my vantage of 42 years T1…

Sigh. Only one of the most common phenomena in the whole T1 world. I get that you’re on basal-bolus MDI. Its really hard to control DP on that unless you want to get up at stupid-oclock and inject some Novlolg. Some people have some luck with splitting their long-acting dose and taking half at night, but I don’t know how effective that is. Metformin at night is another tactic—-I was prescribed it for DP when I was on MDI. Didn’t really do much. Really the only thing that finally nailed it was going on a pump. Even in the pre-AID days the whole thing is you can set different basal rates throughout the 24-hr period and it’s easy to put one in for DP starting at 3-4am or whatever. So I suppose that’s maybe partly why he wanted to talk pumping with you.*

Umm… It’s really well known that a lot of LADA T1’s retain some endogenous insulin production, as your c-pep indicates. So this is right up there with “DP? What’s that?” I would say, though, that it’s not a question of how much do you have but the practical issue of how do you handle it. Here your CGM is your friend. One thing I’ve found is that however much I do still produce, it tends to kick in in the late afternoon. Kinda handy to have my BG start to dip going into dinner time, though it seems to be gone by 7pm-ish. I do have to change my basal setting and I:C ratio to account for it, but sometimes I end up going higher than I should post-prandial because it kinda peters out. I generally do restricted carb though, so not a huge problem. But another reason pumping would be a good option. You CAN figure your own patterns out by fasting and keeping an eye on your CGM. This IS something I would expect an endo to take an interest in helping you determine and account for, but it’s not hard to figure out on your own if they’re, well, unhelpful.

This I actually find a little concerning, but more about your perspective than his. It sounds like you’ve got a much bleaker view of your diagnosis than I would want anyone to have. Not at ALL to minimize the shock of it and the difficulty and the steep learning curve that never seems to end. But with the tools we have now, compared with the 80’s when I was dx’d (or earlier) you SHOULD be able to have fun and travel and whatever. The old regimens were far more restrictive because of the way the old insulins worked, and without a CGM it was SO much easier to get blindsided by hypos, plus you absolutely had to orchestrate your life around when the peak times were going to hit–and hope nothing happened to throw things off. Really a tightrope walk back then. Not to say that it’s easy now, but it’s certainly easy-ER, and a lot of the old shackles have come off. This is probably another argument for trying an AID system. Your fellow tribe members (all us T1s) want you to have the freedom to enjoy your life and not have T1 be such a heavy restriction. It does take learning and effort, no question. But we’re here to help, even when endos are of limited use. I’ve learned FAR more about how to manage this condition from other T1s than from doctors, though I’ve actually been pretty lucky with having endos I’ve liked and respected over the years.

*ETA: AID systems differ but one reason I like the Tandem is that its algorithm takes your self-determined basal settings into account rather than having the system make all the decisions. I was on one of those other systems and found it just would not respond rapidly enough to get ahead of my DP. The fact that I couldn’t just TELL it to start ramping up at 3 am drove me nuts.

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I think we have to look at it this way; regardless of how much insulin our bodies can still produce it is not enough and that is dangerous.

The first step IMO is a CGM, that’s part of an AIDS so presumably both NP and surgeon would go for it. It’s incredibly informative and does not require anything of us; it just tells us stuff.

But we can all do this ourselves now that CGMs are available on demand throughout the world in exchange for money (well, ok, a small % of us can). Get a CGM ($50 on Amazon even in the US) check your BG see what is happening. I don’t trust doctors, my mother (a nurse) never did, I guess I get it from her so I do it myself. We all can.

So, yeah; never do anything to your body that you do not want to happen. I use an AIDS; Dexcom G7, Omnipod Dash, xDrip+ and AndroidAPS. That’s my choice; I’m not recommending it, it’s just what I do.

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DR BB: Thank you for your thorough and elaborate answer………would like 1% of that from my endo crew.

I was dx. Type 1 two years ago and Type 2 erroneously for 18 months before that. The metformin was stopped when My type 1 was diagnosed. I don’t just want prescriptions renewed…..I don’t even know if they are correct or the dosages. I “expected” to get reprimanded for my AiC of 8.5. That was not mentioned and he jumped into incomplete references to various pumps. As he walked out the door I felt compelled to pick a specific pump and said ILet but had an interest in the Twiist. Thought it was not available in my region but endo said he had a few patients using it. I wanted to explore that possibility more but session ended so abruptly without even discussing DP with him. Now I looked up Twiist in more depth and want to try that….now I can only hope the iLet has not been ordered. Endo also told me (as he walked out door) that I cannot get a different AID if I wanted a change. I can also assume that it is because health insurance (in US) will only pay for one AID system..(endo stated cost was $7000).
What do you know about Twiist? Thanks for your expertise and willingness to share knowledge.

Andrea8

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Thank you, John. Once again the forum is way more informative than medical personnel. I do have a
Libre 3 Plus CGM and have had for two or more years. I would go crazy without it, and my fingers would be sore (I notice how sore they get when not wearing CGM) from FP glucose. I would only check it in the morning (like Type 2’s do) and be wildly out of range all day or crash with a hypo (If I identified it).
That’s one reason I will try the Twiist. My endo said I could only get one AID system and if I don’t like it, that’s it. Maybe because insurance will only pay for one. Endo added that they cost over $7000 (if I wanted to private pay). We’ll see if Twiist is covered. I didn’t get a chance to have the differences, plus and benefits explained before he walked out of office (I had kept him too long, other patients to “serve”).
The dietician I first went to got me onto a CGM………life would be even more hell without it!!
I plan on doing some of those tests you recommended to determine my I:C ratio and how rise in BG comes per carb…….Thanks for that tip.

Andrea 8

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“Dosages”: just to be clear, have you been trained in carb-counting, figuring out your insulin-carb ratio and correction factor and bolusing/correcting accordingly? Or are you using set dosages given to you by your doctor, e.g., 20u Basal/day and 8u Novolog per meal or something like that (sometimes called sliding-scale)? A lot of docs start patients out with the latter because it’s simple and they have to get you going on Something. But you can’t really get down from that 8.5 that way. It seems like docs are starting to get the idea you can skip all that and just go straight to an AID pump on the assumption it will do everything for you without you needing to have a clue what’s actually going on. Much easier for them that’s for sure. But it’s really important to know that stuff, because pumps break—they have a LOT of failure points—and being able to do bolusing accurately on your own is a pretty critical skill that will help you get the most out of whatever pump system you end up with.

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You all have me do this…back in the day. I still do it if I am off the pump - half the long acting NPH before bed, and half when I wake up in the morning.

@Andrea8, Go ahead and post a day worth of BG records and we can discuss how to analyze your dosages, if you want to.

Everyone does this differently because we all use different tools, but I posted some examples of my insulin dosage tests.

Here I am running some tests on my dosages at meal time. I want to see a BG that is (almost) the same, 2 hours after I eat and take bolus. That meal bolus should last about 2 hours (shown here in yellow).

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Testing sensor accuracy:

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Basal tests:

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Testing the background insulin. I can’t have any correction or meal insulin running during these tests because I want to test the background insulin dosages.

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I don’t think that’s correct in the case of Twiist and it certainly isn’t correct in the case of Omnipod 5. Both are AID systems, the main difference is that Twiist is iPhone only and the O5, which was originally Android only, now has an iPhone app as well as a stand-alone controller. I assume you are using an iPhone given that you talk about Twiist but it must be at least an iPhone “17”. There will be similar restrictions for the Omnipod 5; minimal phone versions required. but the controller is a third option.

CGM support is also different; Twiist only does the Libre 3, Omnipod 5 does Dexcom G6, G7 and Libre 2+ but the latter doesn’t have 'phone apps yet.

In both cases it seems that the systems are pure pharmacy benefits; that means you don’t have to make any commitments, e.g. from https://www.twiist.com/faq:

There is no contract obligation. People living with type 1 diabetes can try twiist without the four-year commitment required by many traditional AID systems, but with the flexibility to manage their diabetes on their terms. Additionally, if you are using an AID system that is in existing warranty, you do not need to wait until your current warranty is up to try twiist.

Check your insurance and search for coverage for Omnipod and Twiist under the pharmacy benefits, or, perhaps easier, just telephone customer service. My insurance companies web site has been broken for well over a month now; they are apparently rewriting it.

I use Omnipod (Dash pods not O5 but O5 comes out the same). It just costs whatever it costs per month; no tie in.

Medicare is considering switching to rental pumps to avoid the tie in; locking people out of tech changes for 3-5 years doesn’t make any sense medically! If that switch does happen I suspect the insurance companies will follow suit so you are probably better off with a pharmacy benefit pump until that is sorted out.

Twiist is a bit weird at the moment; it is apparently not available in “all areas”. My (pharmacy) insurance lists it but I can’t see the price because of the web site mess. Best bet is to talk to Twiist directly if you can. Insulet (Omnipod) certainly has a direct contact to help new users with insurance:

Note that they also offer a “free trial”, I assume Twiist does too but it seems like it might be hidden behind a location check since they don’t currently support the whole of the US.

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I had been “seen” by his intern for over 30 minutes…asking about meds, how much Novolog a day etc. The intern did not know what Dawn Phenomenon was and I gave her some printed info I had from Mayo clinic internet.

Being seen by an intern/resident/fellow is part of the price all patients may be asked to pay for seeing a provider in a teaching hospital. They have to see patientss (us) or they will never learn their trade.

If you actually saw an intern in August, it’s not suprising that they didn’t know much. An intern(first year resident) has less than two month’s of experience in August. Now a fellow - a physician in their final training before going into independent practice should - and probably does - know about DP and may well be better able to help you than an endo who is just counting down the days to retirement.

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The Omnipod 5 uses a learning algorithm which calculates the basal requirements over a week or so. So far as I am aware the twiist requires a basal number, however twiist uses TidePool and there is a well established program to deduce basal requirements from a week or more (preferably a month) of TidePool data.

So far as I am aware the Omnipod 5 still requires a carb/insulin ratio. twiist just has a bolus button but it apparently requires entry of the numbers and “type of food” so I think it does require the C/I ratio (sometimes confusingly called the “IC” ratio but it’s g of carbs covered by 1IU.) That wasn’t the impression I got when my endo discussed whether I wanted to swap from the Omnipod to twiist (he raised the possibility) - at the time I thought twiist did not require any carb entry, just information that something was to be eaten, so I’m not sure about this.

All AIDSs have some measure of correction. Omnipod 5 and Twiist are hybrid closed loop (some form of carb entry is required), I think Twiist is almost full closed loop (no carb entry required) if it doesn’t require carb counting. The loops mean that basal, bolus and carb counts can be very approximate; they get corrected automatically.

I use a loop system with Omnipod Dash pods but I set everything myself based on all the measurements and experience I’ve got over the years. My basal is deliberately low; the pump delivers extra “micro boluses” throughout the day and night to correct for this. My bolus is based on an eyeballing of the food which my wife does. It typically comes out as “45g”. The system I use also supports a “full” closed loop where no carbs are entered (ever); I tried this but it didn’t work as well as my current setup (I thought :slight_smile:

There are a number of standard ways of determining insulin requirements depending on the age of the endo (methods have changed over time), whether this is initial treatment of a newly diagnosed diabetic (no time for detailed testing) and whether a strict diet is followed (constant carb count every day).

It’s a simple bit of math to calculate the requirements to a high degree of accuracy if you are fairly consistent in your diet - fat/protein/carb mix - but change your carb intake substantially on different days. This depends on logging exactly how much food you eat on two different days along with how much insulin you take (basal+bolus) and BG at start and end of the day.

What type of C-peptide test was it? I.e. what did they have you during the test, also what are the units of the numbers you quoted; they will be somewhere in there, “ng/mL”, “nmol/L” or possibly something in µg though I think that was only for the urine test and I don’t think that is used any longer.

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A diabetes diagnosis is a rude awakening. To make it worse, the helpers that you’re inclined to trust have shown themselves incapable of really listening to you and yet don’t seem to know how diabetes works.

I offer you some ideas that have proven useful in my 42 years of living with T1D LADA. I bring up LADA but it’s just a footnote for me. My pancreas has not produced much insulin beyond my first few months but I realize your case is a bit different than mine. Your endo should have known better about your failing but not yet done pancreas!

Please know that not all the medical professionals who treat diabetes are equally inept. Unfortunately, the amount of misinformation among the diabetes medical professionals is a sad fact of life that we must contend with.

There is only one sure way to fix this situation for yourself. Set out to learn all you can from your diabetic peers, books, and conferences. You need to know more than your doctors about your metabolic health. This will have a huge impact on your quality of life, confidence, and well-being. This is a long-term project that should continue for the rest of your life, or until you’re cured!

Take ownership of your diabetes. It took me until year 28 of my 42 years to own my diabetes. I no longer looked at my doctors as the ultimate experts of diabetes. I finally learned that I was the expert of my diabetes and doctors, while certainly proficient in some diabetes dimensions, could not know what I know about my body, insulin and glucose metabolism. I live with diabetes 24x7x365 or 61,320 hours every year! In 42 years that equals 2,575,440 hours!

We are (or can be, if we pay attention) experts in our metabolic health in a way that no diabetes doctor can ever be! If any doctor does not respect the knowledge of a person who lives with diabetes, all day, everyday, then that professional is foolish.

After 28 years with diabetes I was diagnosed with a complication that truly woke me up. It brought to a quick end all the silly rationalization that I did to excuse the poor glucose control that occurred because I thought I should be able to eat like non-diabetics. I was advised that I could eat anything, just dose for it! (What I didn’t know then that I know now is that even non-diabetics should not consume a constant stream of hyper-palatable and highly processed “food.”)

That was 13 years ago for me and I don’t think I’d be alive commenting on this thread if I hadn’t made important changes to my life. I changed my way of eating as I cut out all the highly processed carbs from my diet. I also cut out most other high carb foods. The effect was dramatic. My total daily dose of insulin dropped from the low 80s to less than 30 units per day. My A1c fell from the low 7s to under 6. (My last A1c was 5.4%.)

Before that my glucose variability as measured by my Dexcom standard deviation was 60+ mg/dL. It fell to < 20 mg/dL. This alone quieted the metabolic mayhem of my daily life!

Most people with diabetes do not do what I do. They prefer to keep eating x, y, and z foods because they say that life is not worth living without them. Some of them even figure out various complicated insulin dosing schemes to allow them their comfort food. It’s a high-wire act that just seems needlessly risky to me. All I know is that I’m healthier living this way and I don’t have to live with all the food cravings that gnawed at me every day before I took ownership.

I feel for you as you try to negotiate a healthy and workable path through this mess. I wish that you can find your solution sooner than I found mine. It’s not as complicated as it appears to you now. Take ownership, begin your continuous diabetes education, make a plan and start to make it a reality.

Books I recommend: Think Like a Pancreas by Gary Scheiner, Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me by Adam Brown.

I wouldn’t rush the insulin pump decision. Definitely continue with your CGM – it’s an all-important part of your education. Learn how insulin works, the two books I listed above are good places to start. By the way, I love insulin pumps; I’ve now worn them for almost 40 years. Learning about how insulin works is more important than quickly adopting a pump.

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Rather than respond to the specific instance, I think it is more relevant to consider how you go about choosing your specialist.

At one time, I would refer to Connolly’s best doctors, but one endocrinologist on the list dismissed it as being political. Nowadays, I start with US News and Health, look for the best institutions in my area. Living in Manhattan, we are fortunate to have some of the finest hospitals, but that may not be beneficial for you.

https://health.usnews.com/best-hospitals/rankings/diabetes-and-endocrinology

From there, I would navigate to the institution’s site and find available appointments in endocrinology, and from there find specialists in T1. Although some might search for the best doctors at the hospital they choose, those doctors are notoriously hard to get appointments with, but younger doctors are often available and updated with the most current knowledge.

Once I have available doctors, I use a broad internet search to see patients’ experiences. I wouldn’t focus on just one site for reviews, but look at the range and consistency of online reviews across multiple sites, if available.

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@Andrea8 did not state the units on the C-peptide nor what sort of C-peptide it was; blood or urine, fasting, 2 hour post-prandial after an OGTT, post-prandial after a simulated meal etc. Without that information the number “.81” can mean many things:

It should be noted that c-peptide will be expressed in nanomoles per liter in this article, as opposed to picomoles per milliliter, picomoles per liter, or nanograms per milliliter, which are often quoted in the literature (1 nmol/l = 1 pmol/ml = 1000 pmol/l = 3 ng/ml).

The article I quoted from, published in 2017 by Springer, seems to be a very good summary of C-peptide at least 8 years ago:

A Practical Review of C-Peptide Testing in Diabetes | Diabetes Therapy.

(The search terms are from the Google AI.) Look for the testing methods lower down the page. I guessing the test was done by Mayo, mine was and I live in Oregon!

C-Peptide, Serum Result
Normal value: 1.1 - 4.4 ng/mL
Value <0.1Low

Test Performed by:
Mayo Clinic Laboratories - Rochester Superior Drive
3050 Superior Drive NW, Rochester, MN 55905
Lab Director: William G. Morice M.D. Ph.D.; CLIA# 24D1040592

Mine was a fasting test but a fasting test does not make sense to me for a change from NIDDM to IDDM; that requires a post-prandial test because if the result is below (on the Mayo test scale) 1.1ng/mL that might be OK when fasting but not, for sure, post-prandial.

But numbers don’t mean anything without units and numbers with units don’t mean anything without context.

To leave with a relevant quote from the Springer paper, I won’t add emphasis because I think you can add it yourself, given the likely cost my insurance company incurred sending my frozen serum to Minnesota:

It is our view that serum c-peptide testing after stimulation is superior to rCP, fCP, and urinary testing. Despite the fact that fasting or random non-fasting c-peptide measurements are easier to perform, are less expensive, and can often be carried out in a clinic setting, their ability to detect subtle levels of c-peptide is significantly limited. This difference could be important in T2DM patients who may be unnecessarily started on insulin therapy despite having adequate beta cell reserve.

(c) John Bowler

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Some endos can be helpful, sometimes a DE (Diabetic Educator) Can be helpful and sometimes a PA or NP can be helpful, and sometimes not. I think a lot of us have come to the conclusion we have to figure out most of it ourselves if we want good control.

I went to a DE at the beginning when I wanted help and she was not allowed to tell me anything about insulin dosing, just this is what you should eat every day. I went to another DE when I moved because she was on island, no endo here. She could get scripts written, she could give you adjustments on your insulin dosing or on your pump if needed, you could also call her at any time for advice and see her as needed. She basically was the contact for any type 1 or type 2 on the island. She was also a type 1. But I see the endo by telehealth mostly just for script writing and had no need for a DE to continue with her.

The only people that will truly understand, especially with good control are other T1’s because education is limited at med school to fitting into a box of general rules. But we vary and sometimes an endo can take their experience and give you helpful advice, sometimes not. Even with a helpful endo most T1’s are considered to have poor control.

So for example, DP. It’s handled many different ways and a pump is the most helpful for it. It’s one reason I’m hanging onto my omnipods even though sometimes i have to change them daily and I also do MDI with it. When I totally stopped my pump, I just knew I would be higher and did a correction dose when I woke. I also split my Lantus dose twice a day, one dose is right before bedtime, because it’s peak time is at about 6 hours so that 6 hours hits in timing for my DP.

But we constantly change what our bodies decide to do. On my pump adjustments, my DP can cause a need for 1 extra unit while I am sleeping or it has caused a 5 unit adjustment and the total pattern can change next month. There are ideas out there to help with DP, I know I’ve tried a lot and never found an answer that worked for me. I have 4 different basal programs on my pump for different circumstances. Besides any daily adjustments I make.

See the problem? That’s just one person and their requirement, no way can an endo tweak it week over week for adjustments. It would be nice if you got an endo that would tell you start with this and it solves it. But ….. The best bet probably is an endo that has type 1, they truly understand. But they still have to fit you into a general box and hopefully go from there and they only see you 3-6 months apart. My second one was a type 1, and she is the one that tested me and diagnosed me right. She always knew about the latest tech, had monthly group meetings for type 1’s. But by that time I had already had to figure out what I needed to do with insulin. She is the one that talked me into a CGM and a pump. She has started a concierge practice now.

But to me more importantly is mental health happiness, we are prone to problems because type 1 can take it’s toll. We need to know Type 1 can be worked around.

There is no reason you can’t accomplish what you want to do. Granted you won’t be able to be or do certain things. Military pilot I bet is one and astronaut is another. But traveling is fine with a little forethought in planning. I know lots of T1’s that travel, one that travels all over the world constantly for her job. .

I snorkel for hours at a time and it took some figuring out. Going out into the ocean for even a half hour at a time took some adjustments. But snorkeling 1,000’s of feet from shore for hours with no one or thing nearby but hubby, who is mostly clueless about what I do took some extra planning and work at what works. If you really want to do something, you figure it out. If you want to travel, lots can help you! Don’t block yourself, sure it can take extra work that no one else but us T1’s have to do, but if you want to, you can!

It takes a while to learn what you need, and frankly some never do. They just do whatever the DR says and that’s it. But if you want really good control, it will come from you and what you learn and figure out.

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This was in a private established practice…..The endo told me that the intern was a doctor….(finished medical school and got license??). Presumably she may have graduated from med school in June, 2025. She knew more than i expected but not Dawn Phenomenom……which I have yet to be examined for…..Was told by my CDE when she heard about high evening BG.

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John, I called my endo’s office today, asking had they ordered the iLet and had not. (I was left with impression that endo would order it as he walked out the door). I told them I wanted Twiist. I asked receptionist if I was stuck with whatever one I got and she said until the warranty runs out (1-2 years)
then could order a different one. More info than I got from the endo.

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He isn’t the endo for you. I’ve been there, it sucks. Did the emotions give you a weird low that day? Gotta hate diabetes when you’re already sad from talking about the disease then the sadness+low BG makes you feel worse. But that was last week. This week call and make appointments with 3 different endos. When you find one that is helpful cancel the rest of the appointments.

Did you get a piece of paper last week with a treatment plan? If not go back to the office and ask the receptionist if they can print you a copy.

After a while when thinking about the appointment doesn’t feel so bad here are some tips for your future appointments.

  1. The person you first talk to about your meds, takes your blood pressure, etc, does not matter. Take a printed list of your meds* that you can hand them. Answer their questions with very short answers. Get them out as quick as possible to maximize your time with the doc.
  2. Just like when a man says “I’m not good enough for you” when a doc says it walk away and block his number.
  3. The question about what you do for fun is a typical and clumsy way for docs to try to make a connection. Go with your gut and if you’re okay sharing name something. It can help the doc treat you as a human. If your creep alarm is going off lie and say your diabetes is taking up all your free time and bring the conversation back to how can you lower your A1C.
    *Be honest about the meds you are taking, don’t just list the ones you are prescribed. Keep your list up to date. Speaking of which I need to print mine, going to play a game of is it cancer, wart or nipple with a dermatologist tomorrow.
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CP peptide was fasting morning

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Chris, You’re absolutely correct about the first person who came in office…..intern who the endo said was with me a certain amount of time (don’t remember). She did not do a poor job but was slow in recording my answers, didn’t know what DP was I, the patient gave her my printed online stuff to “inform her”.
I guess the red alert was when he said “Amanda (NP) and I are a team”, implying you could be her or my patient. (I was told he was taking no new patients when I got NP).
Appts take too long to get and I don’t have the energy to pursue right now. I will have to be the monitor of my diabetes as you guys have advised me. I did call and say to order Twiist pump.(we’ll see if ins covers)
Thanks for answering.

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Omnipod and twiist are both pharmacy benefit pumps, no contracts, no commitments. You could alternate between them from month to month, but I really wouldn’t recommend that. I used Omnipod UST400, Omnipod Dash, Omnipod 5, iAPS with Omnipod Dash, and started twiist two weeks ago. It’s my first tubed pump. I paid nothing out of pocket for twiist. It’s late in the year and I have already met my deductible.

twiist is still being rolled out slowly across the country. I agree with them doing that. I have experienced some early manufacturing glitches as they ramp up production.

I switched because O5 was lowering my TIR (70-180) instead of improving it. O5 is great for most people with T1D LADA. It’s not complicated and improves T1D management for people who are struggling. My TIR was already >85% with Dash and O5 was pulling me down to <80%. O5 just isn’t right for me. I liked iAPS, but could do without the technical hassle.

Two weeks with twiist and my TIR has gone from 80% to 95% (of course everyone’s results will be different). I like Tidepool’s algorithm, so far.

I hope that you can find a doctor that you can trust. I realize that I am fortunate that my endo has T1D. She’s great.

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