dealing with dr's/np's

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dealing with dr's/np's


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Old 08-01-2015, 00:55   #1
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Smile dealing with dr's/np's

has anyone ran into the issue of your health care person
being happy with numbers still too dangerous?
for example being happy if you reach a 7% a1c and
dont care if you dont achieve better?
and won't help by increasing/adding meds.

and how did you get them to help you achieve better?
for example if you wanted a healthier number like 5%?

i havent had this happen yet but would like to have
some info. that might help if i do
because i keep reading info. on how 7% is a good goal
but it's not

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Old 08-01-2015, 01:08   #2
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Most doctor's are so scared of lows, they prefer to have those numbers up, plus they still hang tight to those oh so incorrect ADA guidelines. Luckily my doc doesn't hold to the ADA standards...she is however fussing that my A1Cs are too low, blah blah blah

If you have a doc that doesn't want to assist in helping you get to a reasonable goal, find another doc if possible.

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Old 08-01-2015, 01:09   #3
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Quote:
Originally Posted by mondaycat View Post
has anyone ran into the issue of your health care person
being happy with numbers still too dangerous?
for example being happy if you reach a 7% a1c and
dont care if you dont achieve better?
and won't help by increasing/adding meds.

and how did you get them to help you achieve better?
for example if you wanted a healthier number like 5%?

i havent had this happen yet but would like to have
some info. that might help if i do
because i keep reading info. on how 7% is a good goal
but it's not
This is purely hypothetical. Please, don't deal in hypotheticals...it's a waste of time.

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Old 08-01-2015, 02:10   #4
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Yes....I was at A1c of 6. for a little over three months on the LCHF eating life style. My doctor was very a happy as all my bloods were great! My weight was down 23lbs. and blood pressure at 125/75 from 131/89. He asked me to not let my A1c go below 6.0....crazy he is!

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Old 08-01-2015, 06:40   #5
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macksvicky is right about doctors and endocrinologists being afraid of lows. In fact they become irrational when some people get below 6.0. A member of our support group and I have left our endo because they wanted me to raise my A1c above 7.0 and closer to 7.5. They actually terminated the member when he had an A1c of 5.2.

We have had other members need to leave their doctors and find other doctors. Finally we had one doctor tell us that it depended on our age and the medication we were taking as to how low he would allow people to have a certain A1c.

My friend above in presently 77 years young and on the same insulins I am using. He is eating between 20 and 25 grams of carbs per day and as a result needed very small amounts of insulin. In the three months before he only had two readings below 70 - one of 68 and the other of 66. These were on two days when he was sick and used no insulin. The period before, the endo had told him to get his A1c above 7.5 to 8.0. All members of our support group are people with type 2 diabetes and the majority are on insulin.

Ages are not mentioned in the posts above, but I thought this might help answer some reasons why doctors don't get concerned about elevated A1c's. People on metformin normally do not need to worry about hypoglycemia, but if they are on a combination that includes other oral medications that do, the doctors
do seem to come unglued at A1c's below 6.0.

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Last edited by RobertIA; 08-01-2015 at 06:44. Reason: Add information
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Old 08-01-2015, 12:39   #6
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My mother is 86. Her doctor told her that a good target A1c is 1/10 of her age. So, neither she nor the doctor is going to be too concerned if her A1c is 8.0. And if my mother is happy with that, so am I. High BG does damage long-term, and at 86, "long-term' isn't that big a concern for my mother.

I'm assuming the target only works for the elderly. Not sure how the "1/10" rule would work for someone age 30.

I admit that reading about lows scares me quite a bit. I'm T2 and currently just using exercise and diet to control my numbers; A1c is 5.3 at last check. Metformin doesn't frighten me, but insulin does. I live alone and don't plan on getting married or taking in a roommate in case I go low in the middle of the night - so hypos seem scary-dangerous. In that sense, I understand why doctors would prefer a 7.0 with no hypos to a 5.3 that means I'm going low frequently. I think I might prefer that, too.

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Old 08-01-2015, 13:08   #7
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You put your finger on the issue. In the absence of injected/inhaled insulin or a drug that forces the production of insulin, the risk of going into a real hypo is low. Our body will fight us tooth and nail to stop it happening.

If circumstances require the use of insulin, then care is needed to ensure that hypos don't happen. The best approach to this is to follow the concepts described by Dr Bernstein in his "law of small numbers" The link will take you to the extract of his book "Diabetes Solution" where he explains what he means but put simply, if we keep our carbohydrates down, we can keep our insulin dose down too. That way a mistake in dose doesn't deliver a disaster.

As for HbA1c, I still feel that we should be encouraged to keep that measure in the non diabetic range - i.e. under 5.7% but not by roller coasting with severe hypos and hypers in the mix. Again - the law of small numbers ! The fact that medical advisers tend not to worry about the figure for their elderly patients reflects their rather old fashioned outlook that it's not worth the bother. A year is still long term for an 80+ year old.

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Old 08-01-2015, 15:50   #8
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Quote:
Originally Posted by mbc1963 View Post
My mother is 86. Her doctor told her that a good target A1c is 1/10 of her age. So, neither she nor the doctor is going to be too concerned if her A1c is 8.0. And if my mother is happy with that, so am I. High BG does damage long-term, and at 86, "long-term' isn't that big a concern for my mother.

I'm assuming the target only works for the elderly. Not sure how the "1/10" rule would work for someone age 30.

I admit that reading about lows scares me quite a bit. I'm T2 and currently just using exercise and diet to control my numbers; A1c is 5.3 at last check. Metformin doesn't frighten me, but insulin does. I live alone and don't plan on getting married or taking in a roommate in case I go low in the middle of the night - so hypos seem scary-dangerous. In that sense, I understand why doctors would prefer a 7.0 with no hypos to a 5.3 that means I'm going low frequently. I think I might prefer that, too.
As I understand type II diabetes, if you are taking no meds, you have an extremely low chance of having a dangerously low BS. Being a diabetic the other extreme is more likely as you body has trouble getting rid on sugar.

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