This reminds me of one doctor who came into the room and said, "You don't have diabetes. Go home and eat a candy bar." Turned out he mixed up my basal rates with my boluses and thought I was giving a just unit for each of my meals. We never saw that doctor again.
Anyway, it's possible that your endo is afraid of burnout for you. But it's strange that he's worried that much about it. My endo and my doc say that they're excited to see me on the patient list, mainly because I have good control (relatively).
Probably it's time for a new endo. Does he encourage you at all? Seems like he's focusing a lot on the negatives and not enough on the positives of your control.
Exactly the reason, I think, that I ignored all of the symptoms until I was in bad shape. I especailly explained away being tired . . . how could I not be, right?. It's been 18 months now and we're all a little older and hopefully wiser. :)
So there's nothing to be concerned about in terms of my alpha cells? If insulin protects the beta cells, does too much harm the alpha cells? Or just cause hypos which I'm very, very rarely having? I'm not worried about me burning out, just my cells. I'm well motivated to take care of myself for the long haul.
Thanks for the sanity check. Now for the hard work of finding a new endo.
Now that you mention it, zero encouragement at all. I keep going to my appointments expecting a gold star and instead leave there feeling confused. If I think about it honestly, my hardest D days are the ones immediately following seeing him.
The alpha cells produce glucagon to raise the blood glucose by glucogenesis. I think you fear that by having too many lows your alpha cells might be harmed. Thus you would loose the capability to fight lows. It is true that many T1 diabetics only show limited glucagon response. But the causation is a bit different. Our lows are always induced by excessive insulin. This insulin is also regulating the response of the alpha-cells down. In healthy people excessive insulin does indicate that carbohydrates are coming from the digestion. Thus there is no need to waste valuable deposits of the liver. This role of the insulin to down-regulate the alpha-cells is the reason why the glucagon counter reaction is broken by design for insulin dependend diabetics. The theoretical model behind this is called the "switch-off" theory first formulated here: the insulin production has to switch off first before the alpha-cells can start to increase their glucoagon release. In other words you are concerned about alpha-cells that can not help you sufficiently against insulin induced lows.
Yes, he should be asking you to give seminars for his other patients! When I told my endo that I dosed 20 - 30 minutes before eating, when reasonable, he acted like he had never heard of such a thing! They don't like radicals!
My understanding is that the alpha cells which produce glucagon are unaffected by T1. Also, our bodies react to challenges by adapting. If you "demand" more glucagon, your alpha cells grow and adapt to the increased demand. As Holger points out, with those of us who use insulin, the normal counterregulation response to a low is disrupted. As Holger points out, the "switch-off" suppression of glucagon plays one role in the, insulin also inhibits gluconeogenesis (production of glucose by the liver), all which leave us vulernable to hypos.
Personally, I would hardly worry about alpha cell burnout. If anything, an occaisonal hypo might actually keep your alpha cells working in tip top shape.
I think a lot of doctors have a sort of formulaic response to lower A1C type of numbers, as was mentioned, because they get used to seeing higher ones. If you are low, their "manual" says "they must be zonked out of their gourds all of the time." I don't have a huge level of engagement with my doctor but she has revealed that she's smart and I trust her to be helpful, from the few times issues have arisen. If the current doc is shoveling on the test strips, that may be something in his favor. If you shop around and find other docs, there may be pros and their may be cons but a doc you know may be better than one you don't?
I am seeing a new endo next week and I think I will use your approach. I don't need a supervisor, I do need someone on my team who respects not only my intelligence but also my desire to improve my control. I have already set my goals for myself and I know I have managed to reach 3 of the 5 goals I set for myself, now I will need help setting more. I hope she can help me come up with some. I've only had 1 really good endo and after 37 years I would have hoped that number would be higher but it isn't.
I found this amazing Tu community early on my journey. With Tu's help, I developed a plan considering insulin as the vehicle, myself as the driver and counting on my endo to provide a map. He thinks I'm ignoring his directions and have become a stubborn a navigator. I thought I was too new to dump him (c'mon, he went to med school after all) but, am gaining confidence about plotting my own course. Good luck with the new endo. I hope that s/he turns out to be your second good one.
Thanks! I think that I've been too afraid to switch because he does rubber stamp all of my requests. It would be refreshing though to have a conversation with a more like-minded doc. Perhaps you folk are fulfilling that need. I appreciate your input . . . . I've been reading your helpful responses for 18 months and admire how well you take care of yourself. Hope to be able to manage, run and party in your club some day.
I tried to have that conversation with my (second) endo last year and he laughed. Said I was too stubborn for such a newbie. After only a year, I was hardly in a position to argue. I'm not interested in arguing anyway ..... just finding someone who will hear me out. As I gain confidence I hope to get better at your approach. Thanks for your input!
