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Shanny 08-31-2012 13:18

Well, it can be a lot more exact than many docs are willing to trouble themselves to be. I'm going to keep saying this until my face turns blue and I keel over in a dead faint:
Quote:

Every single solitary patient who presents with diabetic symptoms should be tested for GAD antibodies and c-peptide - period.
Automatically diagnosing by age, weight, gender or any other idiotic variable should be cause for malpractice, and this from me who deplores our litigious society. But the tests are available and they are definitive. They need to order the damn tests!




John.in.France 08-31-2012 13:56

Shanny,

I agree with your sentiments. Two problems .

First as a complete new boy, the patient doesn't know what should be happening.

Second, and compounded in my case by the language differences, they don't know what tests have been done since some hospitals (like those in France) don't automatically share the information with the patient.

I only discovered that they'd done an HbA1c and Lipid profile when I got my lab results for the next set of tests and saw the previous values.

Perhaps doctors should go on a course to teach them to talk to their patients!

VeeJay 08-31-2012 14:05

Quote:

Originally Posted by John.in.France (Post 115412)
Perhaps doctors should go on a course to teach them to talk to their patients!

Amen to that. Too many Drs. House

foxl 08-31-2012 15:42

Well, now ... there are researchers who believe that insulin is needed to stabilize a pt whose beta cells have shut down, in DKA. There are some pretty good articles studying DKA in non-classic-T1D's and how to handle them, and one article recommends insulin until it is not needed, which may be as long as 6 mos as those beta cells heal and come back online, maybe forever if too many are permanently lost. Regardless of the initial cause of D, DKA compromises your pancreas.

I think it is great you started on insulin, and also great that you got off it.

Me, I was given insulin for 2 days, then sent home on a cocktail of 3 oral medications, and deemed a Type 2. 6 mos later, after low-carbing, getting my A1c to 5.7 or somesuch, and insisting repeatedly to my doctor that I needed GAD-65 antibody testing ... I was confirmed as having T1 and after further 8 mos FURTHER runaround, I got BASAL insulin ... and another 8 mos or so later, finally got rapid.

But, I digress ... take-home message: I am all for early use of insulin, regardless of type, in DKA. Oh, and, YES, GAD-65 and maybe other antibodies, at minimum for diagnosis in DKA, preferably for EVERYONE at hyperglycemic diagnosis. Not gonna happen without diagnostic guidelines ... and AACE is stalling on issuing them.

John.in.France 08-31-2012 16:09

foxl,

I agree with your point on early use of insulin. For myself, should I need to use medication to control my PP numbers, I'll push the doctor to give me insulin and nothing else! The oral drugs are generally too suspect for my taste.

On the DKA treatment, I can't fault the French hospital. After the event I managed to find an authoritive statement from somewhere I trusted (and then I lost the link when my computer had to be rebuilt) and the hospital followed the procedure to the letter.

My only issue with them is on communication.

At the start I wasn't quite at my best but even then I managed to find out what the various items being added to my drip feed were for - but I had to ask. No one volunteered any information. When I was off the drip, my medication came round. Three pills - again, I had to ask what for? A painkiller - but I wasn't in pain. Potassium to compensate for the saline feed - fair enough. An antibiotic - also fair enough.

On the Monday, when I showed the doctor my meal plan for the previous weekend, I got ticked off for the lack of starches in the mix. Why? no explanation. Then the medication change. Again no explanation. Levemir at night, the potassium and something for the blood sugar management - (Prandin, I discovered later).

Very much the old fashioned "do as you are told and don't waste the doctor's time by asking questions!"

As I said - communication was where they needed to take lessons!

Sad:(

Shanny 08-31-2012 18:38

Oh yeah, I'd forgotten that, Linda . . . you're our poster girl for 'type 2 with antibodies'! Is it any wonder we don't take our doctors' words for gospel?!





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