I have a question as I am formulating a research idea… Do you think, leaving out the particular type of diabetes, that insulin use would have an effect on the standard of care you receive from your physician, or how you are educated and encouraged to take self-care measures?
Not sure I totally get what you’re asking but… As a general matter, insulin is a much more complicated drug to self-administer than, say, Metformin or other oral BG-lowering agents. So if by “your physician” you mean the average GP, I’d expect a lower standard of care just because it’s hard for a generalist to have the specialized knowledge it takes. If you don’t have access to a specialist–as I did not for the first 20 years after DX–you can expect a much more conservative, not to say timid, approach. Sliding scales and the like. I was kept on R/NPH far past the time Lantus-Novolog MDI had become standard treatment simply because my PCP’s were hyper-cautious about changing anything. They just aren’t very well set up to guide you through carb counting, testing to figure out your I/C ratios & basal requirements etc. that are requirements for MDI or pump therapy. Can’t blame them–it’s not that common a need in your average practice.
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You actually can’t “leave out” the particular type of diabetes because the perception of Type 2s that have to go on insulin is that they “failed.” (Utter doo-doo, BTW). If you’re talking about a GP or internist, it depends on their experience. Once I went on mealtime insulin, my internist set me up with an endo and generally left the diabetes stuff up to my endo and me.
It also is VERY dependent on HOW the providers treat diabetes generally. From the moment I became a diabetic, I suddenly had a “team” of doctors, nurses and specialists. If my internist was the conductor, my endo was the concert master (first violinist).
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I’m going to go out on a limb here and say that the system will provide a lower of standard of care for non-insulin users. For instance, you won’t be able to get the same level of test strips and your doctor will set more lenient blood sugar targets. And if you don’t use insulin good luck getting something like a CGM even if it really could help you.
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Seconding what @Brian_BSC and @DrBB have each said.
I am T2 on insulin; I have never met with an endo. My PCP is aware of how aggressively and painstakingly I manage and pretty much just writes the scrips and assumes I’ll let him know if and when I need additional resources. (Not that we don’t discuss what’s going on in detail, we do. But he seems satisfied that he couldn’t manage this any better than I am doing.) But it’s clear that I am outlier. I have no empirical data to point to, but I’m fairly sure that the “average” T2 insulin user, and for certain the non-insulin user, receive a lesser standard of care.
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I’m thinking the same thing. I was running regressions on a different question, but the results are leading a different direction. I’m trying not to be too vague, but research is touchy.
Initially diagnosed as a t2 diabetic due to my age and weight my GP told me to exercise and diet and she’d see me 6 months later. We met in the intensive care unit as I recovered from a near death DKA event 5 months later. Seems my weight loss was not due to diet and exercise after all. I was not allowed to leave the hospital until I completed their T1 training program and have built a great medical support team since…can’t tell you how many co-workers with t2 tell me they never get any medical assistance with diet and excercise unless they make a special request.
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Very much what I suspected.
And, separately and apart, yet another example of misdiagnosis based on outmoded stereotypes that just won’t die. Sigh. 
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Is it just me or wasn’t the whole effing reason they adopted the T1/T2 terminology and dropped the old “Mature” vs “Juvenile” designations was because age of onset wasn’t a determining factor in diagnosis? I remember feeling rather silly telling people I’d been diagnosed with “juvenile” diabetes when I was in grad school (1983) but even then my Dr told me the terminology was being changed because it didn’t have any bearing on reality. I mean, one thing for the general public not to have got the point, but doctors are supposed to, y’know, know things about medical sh** ‘n’ stuff. Sigh indeed.
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Still doctors and insurance providers play the statistics game when providing care. How likely was it for me to have T1 at age 45? I’d had a high BG reading on an employer provided health screening. Had I known anything about diabetes at the time I might have connected my symptoms with D rather than focusing on correcting my weight - I did feel a failure for causing my condition so kinda avoided the topic. I did seek medical treatment but initially got a cursory response - I’m sure there was a pamphlet involved! I spread my story with others now as a cautionary tale.
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If you’re not on insulin, you probably don’t have access to an endo and you may not have (ongoing) access to a CDE. My PCP notes that they “ship [juvenile T1s] off to the endo”, while they handle T2s in-house. That said, my T2 Other Half is on three orals and still not meeting anywhere near goals. IMO, he should have been moved to insulin, but since that’s not handled in-house, he just gets more and more pills.
That said, he should be modifying his diet more than he has been. (For that matter, I should be back at my immediate post-diagnosis diet, but it’s not manageable in our current circumstances.)
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Thank you all for your input. I am seeing some difference play out in the data, and obviously it is happening in the real world (I’ve complained about the differences between the care my type 2 brother gets versus my own care as a type 1). I guess I’m wondering why we would have such different ‘standards’ for care (both from the physician guidelines and self-care) if the end result is the same in attempting to prevent diabetic complications? Doesn’t this seem counter productive?
*As a side note: I was so excited to get back to my data analysis that I forgot my insulin pump on my bed. I guess I know I hit the right graduate program. 
Which would be less bad if misdiagnosis weren’t so common.
Maybe I see what you are getting at…? By setting higher blood sugar targets (by defnition a lower standard of care?) the Doctor is backing off, admitting inability to manage the condition from the clinic or Rx pad…this leads to situation DrBB above pointed to with being on old regime treatment far past the dawn of the new regime…not being open to new insulins like Afrezza that render the adoption of higher A1C targets absurd if not malpractice…?
Before I was on insulin, I saw multiple PCPs over years looking for someone who could be bothered to care about my diabetes even 1/100th as much as I did. None of them did anything other than tell me “diet and exercise” and literally blamed me for having diabetes. I have lost count of the times I have been told “If you would only lose 10 lbs, you would be cured”…
Well I lost 60lbs, wasn’t cured, (gained the weight back) and eventually found a doctor willing to prescribe insulin and refer me to an endo. Once I moved onto insulin, everything changed completely. I now have a CGM, am looking into a pump, have access to a CDE, get advice about managing my blood sugars beyond “diet and exercise” and am no longer being blamed.
¯\_(ツ)_/¯
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So, in my case I’m still floating as an “in-between” diagnosis. My PCP initially diagnosed me as Type 2 because of my age (40) and because “I know you’ve put on at least five pounds in the last few years.” I mean, I’m over 6’0" and have the build of an (aging) competitive athlete… 5 lbs was an insignificant blip, statistically. Anyhow…
My current (new) PCP and a metabolic specialist think that I’m early-stage LADA or Type 1b, since my antibody tests came back negative but with very low insulin production. Right now, I’m on a standard Type 2 treatment: 2,000mg Metformin ER, diet, and exercise. And it’s working. My 90 day avg from meter readings is 90mg/dL, same as my average fasting BG for more than five months now. I’ve only had a postprandial spike over 126 mg/dL once in the last 90 days (and that was 128 mg/dL). The cost, unfortunately, has been a very restrictive (and for me unpleasant) diet. And a probably unsustainable amount of exercise.
But, as to the standards of care: I’ve had to fire one PCP (he told me my A1c of 5.1 was “dangerously low” and wanted me to stop taking Metformin, add back all carbs to my diet, and aim for a “sustainable” A1c of 6.5); pay for a Metabolic (Type 2) specialist doctor out of pocket (and she doesn’t think I’m Type 2); and I’ve got a new PCP (same doctor as my wife and son have) because she’s young, awesome, and willing to back me up to insurance companies. I’ve had to fight to keep my prescription for three test strips a day: first my PCP told me “you don’t need to test but a few times a week,” and after I fired him the insurance company tried to tell me that “once a day should be fine” for a Type 2. Sigh
I might be headed towards insulin at some point; most certainly if my doctors are right in thinking I’m LADA. My insurance company won’t pay to see an Endo unless I have some “critical event” like DKA or hypoglycemic crisis (which would be hard without exogenous insulin). Since I do create a small amount of my own insulin, I’ve often wondered if for someone like me (insulin sensitive, low insulin resistance, but producing insulin) bolus insulin only might be a reasonable treatment. I could eat more like a normal human being (I’m officially full-Keto as of last week from “eating to my meter”), and I wouldn’t have to exercise 6-10 hours a week. I like exercise, but that much is difficult to sustain while also trying to be a productive scientist, a husband, a father, and a friend.
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That’s actually how I began, bolus only to prevent or knock down postprandial spikes. It was only after several months of that that I concluded I could obtain even flatter results by adding basal to the mix. Each case is distinct.
As a T1/LADA (GAD65 positive), I needed only bolus insulin for 18 months and it worked just fine. Then the morning fasting number started to creep up and it became apparent that basal was needed. I still have a very small basal requirement.
I’ve said this before*, but for me this betrays the motives of the insurers. They say, “Sure, we want to promote preventive, healthy living, but not until you’ve shown you’ve suffered ill consequences!”
Can’t have it both ways, that’s just lame.
*https://forum.tudiabetes.org/t/starting-on-dexcom-and-kp-nw-coverage/56502/6
Yeah, exactly. Like the major credit reporting agencies declining to put a long-term fraud alert on your account until AFTER you’ve been victimized by identity theft. Idiots.