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Dr. Bob intro

4K views 26 replies 10 participants last post by  Shalynne 
#1 ·
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
 
#2 ·
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
 
#3 ·
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:
 
#5 ·
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.
 
G
#7 ·
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?
 
#8 ·
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
 
G
#9 ·
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.
 
#10 ·
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
 
#12 ·
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
 
#13 ·
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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#17 ·
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.
 
#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
 
#22 ·
I have a feeling that many doctors and CDE's automatically assume patients won't do anything hard. That is why they don't recomend low carb diets. Instead of telling D's it is ok to run high bgs, they need to be teaching the basic fact eating carbs = higher bgs. I ran into a woman at my tennis club who was newly dx'd. She was in a total fog about how to eat or manage her bgs. Her doctor told her she didn't need to test or watch her carbs. I talked to her for a few minutes and gave several websites to check out. She was so appreciative for the information. I have the thank everyone on online formums for helping me so much more than the medical community. I'm sure your practice is different but what we need is for doctors to treat us as equals.
 
#24 ·
The problem isn't that no one teaches newly diagnosed patients, it's that there is so much to do in the beginning that you just cannot get it all in in a couple of visits. Plus, do you think that CDE's are a dime a dozen? they are very busy and few to go around. So it takes time to get a patient into one. We certainly don't have the 2-3 hours in a day to teach them...that's why we refer to them. In a perfect world every new find would get it all at once. Really..how long did it take you to grasp the concept of carbs and counting in a restaurant or fast food place? a bit of time I would say. It is easy to think we are not teaching when it takes two to learn.

Dr. Bob
 
#25 ·
The best thing the ADA could add to it's educational packet is "Eat to your meter" but they don't do that, so neither do CDEs - or at least not the 2 I saw.

The first CDE told me that I didn't need to test more than once/day (my levels were pretty high), and the second that I needed to eat 185 carbs/day. She came back with a formula for me - prescribed calories and carbs - making it seem very personalized and exact. If I hadn't done my own research, not landed here pretty quickly, then I would be having a heck of a time managing my diabetes and would still be on glipizide at a minimum.

The second CDE, when I questioned the amt of carbs said, "I have to follow the ADA guidelines." So there you have it. I get the sense that they all teach pretty much the same thing, a formulaic approach when from everything I read outside the ADA orbit is that diabetes is a very individual disease.

Teaching that one thing: everyone is different, eat to your meter - seems would go a long way towards helping people get engaged with the self-management of their diabetes.
 
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#26 ·
Moon, we represent a small number of the world's diabetics and Dr. Bob is right...think of what he knows about a plethora of illnesses and we're focused on only the one (s) we have learning all we can. Most of the people I know would not be as OCD as I have been, in fact, few of the diabetics are willing to give it this much attention. Having a physician for my late husband taught me much about how much they care and how hard it is to interest the patient in their own self-care.

Thank goodness for the internet for those of us who are willing to dig and learn.
 
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