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Hi everyone, I am a new member. I am a medical provider practicing family medicine and am not new to diabetes but new to my Animas pump. I thought I would come here to get some ideas from those of you who have been on one for a while. I am intersted in starting combo bolusing. I take care of many diabetics but have few on a pump (that will change, for sure). I have been practicing medicine for 30 years and will readily admit that unless you have this disease, it is difficult to understand what a patient really deals with, regardless of your training or education. I do...

Thanks for letting me participate...looking forward to meeting you all.

Dr. Bob
 

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Welcome, Dr. Bob! I'm sure you will find all kinds of support and interesting feedback on this forum. I am very glad to have found this site. It has helped me tremendously in getting through those first few weeks after the original diagnosis. There are many wonderful people here!

Looking forward to getting to know you!

Sandy
 

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I have been practicing medicine for 30 years and will readily admit that unless you have this disease, it is difficult to understand what a patient really deals with, regardless of your training or education. I do...

Dr. Bob
Thank you Dr. Bob and welcome! It's so frustrating as a patient when you know your Dr. isn't understanding what you're going through and you get that strange look when you're trying to explain something and a "hmm that's weird" response. :confused:
 

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Hello again Dr. Bob. I see you are making the rounds, like me. I am pleased to see you here.
 

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Welcome Dr Bob. Right now I am able to control my bgs with metformin and low carb diet but we do have lots of pump users. Online support groups are great places to share our successes and our problems.
 
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welcome DrBob :) having diabetes yourself, no doubt you are more understanding of your patients than most. Experience gives a different perspective. I'm sure your patients really appreciate that. I'm not on a pump myself, although I know we have plenty of members here that are pumping. How do you manage your own diabetes?
 

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welcome DrBob :) having diabetes yourself, no doubt you are more understanding of your patients than most. Experience gives a different perspective. I'm sure your patients really appreciate that. I'm not on a pump myself, although I know we have plenty of members here that are pumping. How do you manage your own diabetes?
Well, I am on the standard diabetes therapies, an ARB, a Statin and an Aspirin a day as well as Janumet and Novolog in an Animas Pump. The pump is only a month old, so I am learning to handle this thing that is now my new Siamese twin. Prior to that I was on oral meds. Those of us in medicine know that eventually (assuming we live long enough) all of us will end up on insulin, and sooner is usually better than later.

I don't manage my own diabetes now that I am at this stage, I did for 15 year prior, but now I have a diabetes eduator who is my new best friend and she is my "boss" now.

Dr. Bob
 
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yeah I'm on insulin now too... I think I perhaps should've been on it a lot sooner as you say because I noticed that oral meds just were not working. I had to insist on getting GAD and C-peptide tests done after being so sick all the time. My endo finally agreed in February 2010 and it came back to prove my point... oral meds won't work as I don't produce enough of my own insulin anymore (goodness knows how long it had been like that). I didn't fair too well on metformin either, but my docs kept changing dosages, etc... and I was on it for over 5 years and felt quite ill on it. I'm now being treated by a gastroenterologist who is still trying to figure out what my stomach is doing and put me on the appropriate treatment (I've been on several drugs already with no success). My thought is that metformin started the stomach upset for me as I've pretty much not recovered from being sick since being on that drug. I've had a tonne of antibiotics mind you which probably didn't help... I think I've averaged 20 weeks worth every year since 2007.
 

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Discussion Starter #10
yeah I'm on insulin now too... I think I perhaps should've been on it a lot sooner as you say because I noticed that oral meds just were not working. I had to insist on getting GAD and C-peptide tests done after being so sick all the time. My endo finally agreed in February 2010 and it came back to prove my point... oral meds won't work as I don't produce enough of my own insulin anymore (goodness knows how long it had been like that). I didn't fair too well on metformin either, but my docs kept changing dosages, etc... and I was on it for over 5 years and felt quite ill on it. I'm now being treated by a gastroenterologist who is still trying to figure out what my stomach is doing and put me on the appropriate treatment (I've been on several drugs already with no success). My thought is that metformin started the stomach upset for me as I've pretty much not recovered from being sick since being on that drug. I've had a tonne of antibiotics mind you which probably didn't help... I think I've averaged 20 weeks worth every year since 2007.

Well as you may know, metformin doesn't cause to you make more insulin like some of the other meds do. Metformin makes the insulin move easier into the muscle so it works more efficiently. It also stops your liver from creating sugar that you may not need (we call this gluconeogenisis). That is the short of it. It is too bad you are having trouble with the metformin because it is a real benefit and adjunct to the insulin. It just makes it more efficiently used.

Diabetes is as frustrating for us to care for as it is for you to have.

Dr.Bob
 

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Diabetes is as frustrating for us to care for as it is for you to have.
Welcome, Dr. Bob! :welcome:

Perhaps the greatest lesson I've learned since coming here is that we're all so different. One-size-fits-nobody would seem to dictate our treatment protocols.
 

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Hi Dr. Bob - glad to see you here. I guess a lot of us participate in a few groups.

I wonder how much less frustration there would be on all parts if the basic dietary recommendations included a lower carb diet and a lot less finger pointing and guilt mongering. What do you recommend to your patients?

Jen
 

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Hi Dr. Bob - glad to see you here. I guess a lot of us participate in a few groups.

I wonder how much less frustration there would be on all parts if the basic dietary recommendations included a lower carb diet and a lot less finger pointing and guilt mongering. What do you recommend to your patients?
Plus, more emphasis on self-management and self-education (ideally, including tips on scam avoidance).

My HMO gives out misinformation because it's "easier" on the patient. Being a natural dissenter, I do get more of the real scoop from them when I persist.

But even with my rebel streak, if my levels hadn't been so bad, I would have considered 140-180 Good Enough and moved on to other things. And down the line, said things would have gone very ugly indeed.

I worry deeply about more reasonable folks than myself.

What do you recommend to your patients?
Same question! :)
 
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Well as you may know, metformin doesn't cause to you make more insulin like some of the other meds do. Metformin makes the insulin move easier into the muscle so it works more efficiently. It also stops your liver from creating sugar that you may not need (we call this gluconeogenisis). That is the short of it. It is too bad you are having trouble with the metformin because it is a real benefit and adjunct to the insulin. It just makes it more efficiently used.

Diabetes is as frustrating for us to care for as it is for you to have.

Dr.Bob
Yeah I know metformin is supposed to be the safest drug of choice... I got told that everytime I told my doc how unwell I am on it. When unwell I seriously think it's unfair to put up with those side effects just because a doc thinks something is 'safe'. I'm not so sure it is as safe going by my experience with it... I'm wondering if any study has been done on the long term effects on the stomach? I'm now facing a chronic disorder of my stomach... and I remember the days prior to metformin when my stomach was perfectly fine. I guess sometimes drugs just don't work for everyone. I wished my docs had listened to me and that they had taken me off that drug a lot sooner than they did. I hear you on how frustrating it can be to manage for your patients as I've see that frustration on my docs face often as he's never had a patient like me he has told me (especially since I started burping constantly from Dec2009... so ladylike and so embarrassing at times) and he's been practising for over 30 years.
 

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I guess sometimes drugs just don't work for everyone. I wished my docs had listened to me and that they had taken me off that drug a lot sooner than they did.
I too have been on the receiving end of a doubtful doctor and it is no fun....my heart goes out to you. There must be a way that medical consumers and medical providers can communicate better with each other. Particulary with a chronic condition like diabetes that's going to require lifelong vigilance I think doctors need to probe more when someone complains of a reaction such as the one you have experienced. They may be more educated on the science of the body, but we all live in our own skins and know when something's just not right.

It's too bad that people who are not interested in successful diabetes management seem to have poisoned the well for those of us who are. Surely there's a way for our doctors to distinguish between us.....

Jen
 

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It's too bad that people who are not interested in successful diabetes management seem to have poisoned the well for those of us who are. Surely there's a way for our doctors to distinguish between us.....

Jen
They could look at our numbers & tell pretty fast who's serious & who isn't. Like, why would Rosie's instructor hold her up for ridicule when Rosie had her numbers right there for all to see? No carbs - no spikes. Where are their minds?!

BTW - welcome to DF, Bob! :D
 

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I am also a rebel and finally learned if I was going to control this disease I would have to do better than the 140-180 that my CDE said was good control. I couldn't have done it without several diabetes forums. My doctor is always shocked with the amount of control I have. I like many others eat a forbidden low carb/high fat diet. I eat great food and bake low carb so still can have cookies, muffins and low carb breads made with other things than flour. My doctor had me on a statin like most diabetics but after a year it almost killed me destroying all my muscles. I now control it with diet alone. My HDL is almost 100 and trigs are under 100. I figure a 1:1 ratio is pretty good. This is what a low carb diet does for us. I just wished CDE's would tell their patients about it.
 
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There must be a way that medical consumers and medical providers can communicate better with each other. Particulary with a chronic condition like diabetes that's going to require lifelong vigilance I think doctors need to probe more when someone complains of a reaction such as the one you have experienced.
Jen
Yeah it's not like my docs didn't have my stats... I regularly kept them updated and I've always had regularly HbA1c tests... sometimes every 3 months. The worst experience on metformin was being placed on the slow release version... I thought I was in hell... nausea and diarrhea 24/7. I think I put up with so much of these GI effects for years because my docs said the drug was safe and didn't want to trial other drugs due to the stress it can place on pancreas. I eventually got trialled on almost all the drugs on the market anyhow. Perhaps insulin should be introduced for type 2 patients a lot sooner?... periodical C-peptide tests should be done to determine if insulin is still being produced or not. The patient shouldn't have to demand it like I had to. It seems when diagnosed with type 2 they run the diagnostic tests to start with and then just say "oh well you're type 2" and they don't think about progression of the disease so much. It's stereotyping really. Not everyone is the same. Even when I finally had the C-peptide done, my endo commented that he expected the result based on how long I've had diabetes.... well hello, why did I have to ask him to do the test then? what was I doing still stuck on oral meds and no insulin? he should have been on to it already! Enough of my venting. lol. We can't live with regrets I guess... just manage what we have and be happy. I appreciate my docs for their help, especially my GP, I can really see he's trying hard to get things right for me... it must be hard sometimes when they don't know the answer.
 

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Discussion Starter #19
They could look at our numbers & tell pretty fast who's serious & who isn't. Like, why would Rosie's instructor hold her up for ridicule when Rosie had her numbers right there for all to see? No carbs - no spikes. Where are their minds?!

BTW - welcome to DF, Bob! :D
Thanks for the welcome. I should make it clear that I am not here to dish out medical advice, although that is what I get paid for every day. It is foolish to advise people what to do on a forum like this. I don't mind sharing my experiences and frustrations with patients from the providers point of view (some people may recognize themselves (LOL)) but I am not here to be the referee between the forum member and their doctor. I hope I am accepted in that spirit.

I don't mind discussing what I know as "current thinking" in diabetes care from my perspective. I hope everyone understands this

Thanks...how do I create a "sig" with a disclaimer??

Dr. Bob
 

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Discussion Starter #20
"It's too bad that people who are not interested in successful diabetes management seem to have poisoned the well for those of us who are. Surely there's a way for our doctors to distinguish between us....."


Most of us can.....Your attitude and energy as well as your numbers. This ain't an easy disease to have or live with. But it is very manageable with a little self discipline and desire (for most of us). Unfortunately, some folks just have it bad and it takes a lot to control it...mostly a lot of work on their part. Your provider may change something every time you come in...he/she is just trying to keep this under control. We can never cure it (at least not right now). We can never "make it better"....we just try to keep it from getting worse. Remember..I have it too...I hate those facts as much as you guys do, but facts are facts.

Dr. Bob
 
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