My start up w/ pumping (24 years ago) was taking my previous dosing with injections to basal dosages. It took some tweaking but my first day on the pump I went to Disneyland. A good endo knows no rule works for everyone. You know YDMV ( your diabetes may vary) and yes my does. I make most changes on my own but always welcome input.
I had diabetes for 37 years before I understood there was a difference between basal and bolus. It was only when I decided to get actively involved in my own self management that I learned what they were and most of that education was done here.
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Hi Nell1,
from time to time I imagine how nice it would be have a partner in all of this⌠but for now I guess I am ok to do it alone for now⌠my hba1c is decent and I am not having lows. My thyroid levels are fine and I donât seem to have symptoms (except for trouble with weight management).
One of the reasons I stopped seeing this endo is that he never did anything other than palpate my thyroid and tell me I was doing great and he had nothing to add. Then he would ask me when I was going to get pregnant again. I thought a good dr should be doing overall health monitoring not just looking at 1 thing and 1 thing onlyâŚ
I have never had a foot exam. I have never been recommended to have an eye exam. He never requested general screening / checks such as kidney, etc.
I did try to see another endo quite a few years ago. Her response was to tell me she didnât believe I was hypothyroid (my TSH has always been very low) and stop my thyroid meds⌠that took months to recover fromâŚ
Every major medical event / decision / treatment has always been precipitated by me⌠imagine⌠I had appendicitis and no one would believe me (they were talking about discharging me from hospital and wait and see) until finally my Obe insisted on exploratory surgery - and lo and behold, it was appendicitis (and I was 3 months pregnant at the time). My endocrinologist did have the grace to apologize over that.
Anyway, bottom line is I am extremely skeptical about medical profession.
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Donât forget @JustLookin that no one has to be alone here @tudiabetes! The sun never sets on our empire together!
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Terry4, re my having an Endo who takes time. This is true but⌠the Endo checkout staff told me this week that their practice is the only Endo practice in western NC! Certainly the only one that takes Medicare. They have a waiting list of new patients and us long time regulars are now having trouble getting a 3 mo. appt. So, things may change but I hope not. Even running late, my dr did take the time needed.
JustLookin, I was thinking more about your diabetes. I know that many folks on here are happy with their own self management but I prefer working with someone. Perhaps the 3rd endo would be the charm for you! But, thankfully, you do attend to your bodyâs messages and get help when needed.
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I,ve been on insulin since 1936
We used to call it long acting & short acting
Only recently did I learn the words basal & bolus since I,ve been on pump since year 2000
So don,t be surprised
We live & learn
T1d 78 years
Shoshana
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Thatâs a bit of an eye-opener. Not that I wasnât intellectually aware of it, but living in the Boston area, land of 1,000 universities and 10,000 hospitals, itâs all too easy for me to assume that what I think of as the standard of care is by no means the norm nationwide. Itâs easy to forget that for a lot of us the do-it-yourself approach isnât a choice but a practical fact of life. If specialists arenât available, YOU are the specialist.
To clarify, I mean group practices but there is only one other Endo in the Asheville area and she doesnât take Medicare. There are few âbig citiesâ in WNC (11,000 sq miles and about 1.5 million people). Asheville is the only city with more than 40k population, at around 80k+ metro area.
My internist would love to work with my db but he has focused on T2 and admits to not being up on T1 practice. He is fascinated by my cgm! Most internists in this area are similar, I would think. So T1s really are tough out of luck if new to area especially.
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Funny that my u-name has reverted to Nell1. I used to be Nell, then Nell1, then Nellje, now back to Nell1. I guess that means I have deniability for some comments if needed.
Before I cut it back quite a bitâbecause I know I do go on sometimesâthe longer version of my comment had noted that T1s are more likely to have problems in this regard because if youâre a GP in an area where there specialists are harder to come by, youâre going to put what time you have into understanding the vastly more common variant of the disease. Which is entirely understandable, butâŚ
I used to follow what my doctor advised in terms of insulin dosage but never the recommended food regimen. That was during my first 5-6 years of diabetes when I was in school and college and I never had a HbA1C reading < 9. I was also not on a basal-bolus insulin treatment at that time.
Once I started working, I could afford the more expensive basal-bolus insulins which did help me achieve better control. Reading up on them helped me a lot. Previously I used to check my blood sugar level as rarely as once in a few weeks and would treat lows based on the symptoms since testing strips are expensive. But after having an episode of DKA after a bit of recklessness, I have totally revamped my lifestyle and medicines and I have never had a HbA1C > 7.5. I test at least twice a day and count carbs to determine my insulin dosage. My doctors are still recommending something like âat so and so time of the day eat so much, have something in between meals, do exercise and take so many units of insulinâ which I have found to be useless in managing my sugar levels. So I always do carb counting and use experience to determine my dosage and also for bringing down my blood sugar level to normal and that works wonderful, ymmv.
Every time I visit my doctor, I mention an average dose range but I vary it on a case to case basis.
P.S. I live in India and a lot of advances that have happened in the diabetes treatment havenât yet reached us or are prohibitively expensive. Most, if not all, doctors do not like their patients going against their fixed recommendations and doing something like this.
It unfortunately is a one-way traffic from my doctor to me. My doctor just allows me a leeway of adjusting a couple of units here and there. On follow-up visits, he/she tends to adjust the dose based on my answers to questions but many times it does tend to be arbitrary.
I try to follow whatever I can from my doctorâs advice but I manage my insulin dosage no matter what.
Guruprasad - Good for you that youâve started to take more action regarding your insulin dosing. Doctors can be helpful but they donât live in your skin. Counting carbs is a good practice. I encourage you to get a simple digital scale and weight your food portions. This is a real education in the actual carb value of what you eat. I pair the scale reading with using Calorie King, a web-based nutrition site. Digital scales can be found online for about $20 USD.
Good luck with your continuing efforts to control your blood glucose. It is so worth it.
Hi Guruprasd!
Nice meeting you through tudiabetes. Both my parents are diabetic and am aware of the consequences of uncontrolled diabetes. For nearly 15 years ( since 2001 ) I closely monitored and kept my BS under control with diet and exercise till 2014 occasionally my BS go out of range. But my BS during 2014 ranged 180- 230 marks some how I missed to take notice of those high BS readings. Suddenly it dawned upon me that my BS is starting to go out of bound, then I started straight away taking 30/70 iu insugen (Regular and NPH ) with 10 iu as initial dose in the morning and 10 iu 30/70 insugen in the evening before my dinner. With lot of testing my BS 8 - 10 times daily and measuring my carbohydrate intake ( mostly white rice ) using a digital balance now I managed to get non-diabetic BS readings and my last HbA1C is 4.3. Which I am sure would not have happened without the help of number of diabetic forum in the www which guided me a lot and take courageous decisions.
But I am of the view to achieve better control of BS one may require physician guidance, more than that it requires lot of self awareness, self control with respect to our carbohydrate intake ( in any form ), dosage of insulin, timing of food intake and insulin dose all this play important role in our effort to meet the target and manage diabetes.
Your A1c is in the ânormalâ range. Good for you! I agree that physician guidance, or a least someone with a good understanding of BG control tactics, is often needed for better control. The typical physician, unfortunately, is not very well informed on the many tactics that can be used. I still think that the patient needs to shoulder the responsibility and learn as much as possible him/her-self. There are many books targeted at diabetes patients. Think Like a Pancreas by Scheiner and Using Insulin by Walsh are two good ones.
Keep up the good work!
Thankyou Terry4, for your suggestions. In India diagnosis and followup of diabetes is at snails pace. Though all the techniques and expertise available elsewhere in other parts of the World are available in India also, I think we have to make a lots of leaps and bounds to come close with what is achieved in other parts of the World in combating Diabetes.