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I went to an endochronologist a few years ago. She had one goal in mind and that was to get my A1C down. She got that accomplished by eventually raising my insulin to 64 units per day. When my A1C came down she clapped and said yay I did it! She pretty much brushed me off after she got the A1C down and kind of said you're on your own.
On my own I'm not doing very well. I try to stay low carb but the sweets see me coming and jump on board. A couple of years ago I lowered my insulin dose to 40 a day because I couldn't lose weight. Now I have lost some weight but I struggle with eating low carb so it puts me around an average reading of 300.
My new doctor wants me to go to an endocrinologist and I'm pretty sure that the goal will be the same as the other one. They're going to want to raise my insulin level and that will make it very hard for me to lose weight.
I am still trying low carb low carb low carb. But it's a very slow process for me.
I don't want my insulin to be raised because it will keep me from losing weight and also I was going to have to pay a fortune for it if I take that much per day.
If you were me what would you do? Would you see the endocrinologist and play their game and let them raised my insulin to get my A1c down or what? I really don't know what to do.
To make things worse Walgreens had a prescription of insulin for me for 90 days in their computer. I told them I'm not getting it from you I'm getting it from Express Scripts and they said okay but they didn't take it out of their computer so it looked like I had purchased it and to my insurance it put me in the donut hole where it was going to cost me $400 for a 3-month supply. Express Scripts kept telling me stupid things call your doctor and say this and this and this and this. I ended up calling my doctor about three times to write prescriptions for Treseba. She got so fed up with it she told me that she's going to send me to an endocrinologist. It seems to be just one thing after another to Slow Me Down.
What would you do? Thank you for any help.
 

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Tough place to be, Nemo; I'm sorry.

Actually, what I would do is see the endocrinologist -- but be ready, when you walk in the door, to lead the show. Don't let them set all the rules. At this point, you know what has worked and not worked for you. I would explain your situation pretty much as you did here: being on high doses of insulin seems to make it hard for you to lose weight, the cost of insulin (especially as much as you seem to need) is a concern, you're trying to eat better (in a way that's healthful and will help you lose weight and better control your blood glucose), exercise often is an issue for you, and... here you are. How can they help you approach this situation? The endo is getting measured on one thing (A1c); that's great for them but there's a whole body and mind to treat here. Perhaps there are other resources they can offer to be more holistic.

All that said, however, the science I've seen over the past few years shows that highly variable BG is more dangerous than some extra pounds. The physical effect of too much glucose on blood vessels and the roller coaster effect of glucose and insulin levels on your endocrine system is more dangerous to you on a short-term basis than (non-morbidly-obese) weight. It may not be the choice you want, but the better A1c may be the lesser of two evils.
 

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I agree with itissteve, see the Endo and let him/her know your goals. They can work with you or they won't, but you won't know unless you go.
 

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All the Endos gave me advice I did not want. Turned out they were correct.

Telling the Endo your goals is great. If you are like me. I struggle with the reality of my day to day cravings, desires. Getting up in the morning and telling myself, this will be a day I stick strictly to good diet rules -- usually means that day I will break protocol. I know that cravings are biological driven by doing one thing wrong, and my blood sugar responding by going up and down like a roller coaster. That creates more cravings.

I met a couple in a hospital cafeteria. He had a plate brimming over with several vegetables. His wife had a piece of pie. The woman said she liked that kind of pie. She could make the same pie better in her own kitchen, but if she did, she would end up eating all of it herself, which would be bad for her weight. So it was better she eat it at a cafeteria, and get here desire for it over. He said he was a diabetic. He could eat his plate of vegetables, which had about the same number of carbs as the "Little bitty piece of Pie" his wife ate (his words.) After he ate, he would feel satisfied that he had eaten a real meal. If he ate the piece of pie, he would not feel like he really had a meal. He would feel so sleepy he might let his wife drive home. When he got home, he would probably go lay down, and take a nap until dinner (last meal of the day.) If he ate the plate of vegetables, his body told him he had a real meal, with a sufficient amount of food. He would have energy for the rest of the afternoon. His experience was that he would easily have the energy, wakefulness to drive home. He had a little project he was working on in the garage. By the time he ran out of energy, it would be dinner time.

A Low Carb diet, well implemented (which I am not so good at) will have very little cravings.

On the opposite side, THE WARNING: I was on a forum some years ago, and one fellow there had gone through a radical low carb phase. He said it helped him lose a lot of weight. He also said, he was too radical. He believed the radical low carb diet caused some other problems. Loss of vision in one eye, amputations here and there. True, he had health problems in those areas before. Loss of muscle.

But my body could be declared a disaster area before I was diagnosed with Diabetes. And I truly had metabolic problems before I was diagnosed a diabetic. What about you?

Diet, Medications, Exercise working to control Diabetes is about patterns. No one action is independent in effect from the others.

If at all possible. Get a diabetic buddy to help as a support system. I guess I am talking to myself. Non-Diabetics, like family members, just like to think they are smart when they give a diabetic advice. Well, I have some harsh feelings about the dis-regard for my feelings, and my knowledge, experience from well meaning friends and relatives. The big thing is, none of them know, or care how much I suffer already. Sometimes, it is like the doctors, Educators advice is, YOU NEED to SUFFER MORE. To lose weight. To feel better. To which I would reply; None of the suffering I have done has made things better. It is like being a survivor of a ship wreck without a life preserver. I am treading water. I have not gone down yet. The advice I get, for diabetes, seems to be. Keep On Suffering.

The reality is, Docs know that it is like solving cravings. I can stop cravings by getting everything into balance. Then what I am doing should not be so unhappy, and painful.

Insulin. You did not state what your insurance is. I have traditional Medicare, and the drug supplement. I have discovered that, when I applied for SNAP benefits, used to be Food Stamps. The workers qualified me to another program, which paid for much of my drugs. From the beginning of the year, I make Co-Pays, for Insulin it is about ten dollars for a month. After awhile I get to the opposite of a Donut Hole. I do not have to make the co-pays anymore. There are a lot of programs you might not know of. So my advice is, apply for all the benefits you might qualify for.

When I was speaking to a state worker, I told her, that is not what the government web page says is the qualification is. She laughed and said, "The web site is a work in progress." So, my advice, don't make decisions on what government website says.

If you are in US --Wal Mart has a vial of Insulin for like $25.00. Might not be the same quality as what you get now. The government said that the total co-pay for any insulin is $30.00. So I missed your point about the cost of Insulin.
 

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The endocrinologist advice for you was correct? You must have different ones than we have here in Kansas. Mine told me that I can eat fruit, bread and anything I want. Just eat it in moderation. 🙄
Okay I guess she was right. If I just eat one bite of fruit, one bite of bread that will be in moderation. 😂
The government says I make too much money to receive any Aid.
I do use the Walmart $25 vials of fast-acting insulin.
Just because the government says that insulin will not cost over $32 doesn't make it true. The insurance companies must agree to sell it at that cost. If they don't join up then they can sell it at whatever price they want.
My insurance group sells it at $42 per month. But like I said after I buy six months worth then I go into the donut hole.
When I have bought six months of Tresiba that puts me in the donut hole for the rest of the year and my cost for a 90 day supply is over $400. I have Medicare Advantage.
I have a friend that used to take Tresiba but she switched to the Novoline at Walmart and does better on it. She gave me about 8 quick pens that she wasn't using. So that helped me get through last year. But when I get through my supply for this year then I'll probably go to the Walmart vials.
I know that eating low carb or no carb takes away the cravings for sweets. Eating high-fat is what takes the Cravings away. Sometimes I don't have cravings but I remember how good it tastes.
I think I know what I need but it's just a struggle everyday.
I'm the youngest child in our family. Some of my sisters and my one brother have died.
Every person that has diabetes is different than the next person. And I am learning that I have to figure out what's best for me.
I still get baffled when my BG jumps up for no reason. But that's the name of the game.
 

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Mine told me that I can eat fruit, bread and anything I want. Just eat it in moderation. 🙄
Okay I guess she was right. If I just eat one bite of fruit, one bite of bread that will be in moderation. 😂

Good you pointed out what is inconsistent with what I think, and what some Diabetes Educators teach.

Mostly, the statement, "You can eat anything in moderation." is --to me-- Diabetes Type One advice.

You are correct, you can eat, "whatever in moderation," as a Type Two.

When I said, 'No Fruit, no sugar, no bread." I was thinking of the Endo who said to use the introduction phase of the South Beach Diet for my only diet. Which part of is that; No fruit. No Sugar., No bread. No Starches, like potatoes, corn.
The Introduction part of the South Beach Diet would include all the lean sirloin steak you want to eat for each meal. The docs nurse said, "We have men who really like this diet, because they can eat all the lean sirloin steak they want three times a day." I am sure it could be also said, they have no cravings. No loss of energy. Probably a high protein diet is not of those with kidney disease. Like OP said, we are all different in our Diabetes.

Look at the example of the couple, one eating a piece of Pie, and the other eating a large plate of vegetables. Moderation for Pie, would be what, one and half bites of the slice of pie? A third of a slice? Then he is, I am guessing, going to have cravings for more. Feel not happy.

It might be better to eat his plate of vegetables, and then, eat the entire slice of pie, as it is diluted. I am guessing, that is.
When I first became a Diabetic, someone's advice was, If you have any juice, throw it away, or give it to your neighbor.
I wanted to think like you. If the portion size is small enough. Things like grape juice have antioxidants which are helpful to human nutrition. For something like Apple Juice, I determined my portion size would be like the amount of juice a small four year old girl who does not much like it. Useless for satiating me.

You are also correct in emphasizing that all diabetics are different.

I am sorry that you have problems with health care costs. Part of the American sense of public health care is, - Public health care is for those on who are old, or who are disabled, or so poor they can not afford it. Sometimes the poor can not afford is because individuals have health problems that prevent them for working.

Your situation, I am guessing is at least partially. You now achieve, or have achieved to the point you have to pay taxes for that those other groups to have health care. (and now to the Federal government to help out with COVID.)

My point being, that the US attitude should have been. It is best for Workers, people who have demonstrated their willingness to work and pay taxes to have public health care. Keep the workers, able to work. This argument is particularly true for Diabetics.

Now you are acheiving, your are paying for Diabetes, reducing the value of your previous work, earnings. Any properly acquired money I think is fair. Inherited, investments. As long as a person got it legally., More Power to them.

Further, health care for all, helps some individuals get jobs, keep jobs. Companies are not anxious to hire someone who might have a heart attack on their property. If they knew a heart atttack was not going to cost them. Why hire someone barely out of high school who hasn't decided he wants to do anything besides party.

Before COVID, I went to a local McDonalds, and listened to a bunch of retired people. They did not want to be retired, they wanted to be healthy enough to be workers. They wanted to be out there working.

I am trying to make the point, that how insurance companies, even Medicare, or its mutations implement costs on those who should not have those costs. The example they make of some who have worked hard, is don't work hard and achieve. Our society will rob you of the extra enjoyment of life that extra money should give you.

I wonder if this gets deleted. But what it is along the lines of, the Price of Insulin is too high, and not affordable to many, which would not be deleted. There is a lot of price too high for Diabetics, besides Insulin.

The background being that the "Means Testing," is all wrong in its numbers. So I say, throw "Means Testing' away. If the government wants to save money on health care. Negotiate Drug Prices for a Start. Now Medicare pays whatever drug companies ask. Drug companies pay money to investors in dividends. The US government has become a cash cow for the super rich.

If Pharma Bro Shrekli had bought a drug company that supplied mostly to seniors on Medicare, and took two years to raise prices. He would be enjoying his riches, not leaving prison to enter a halfway house.

The thing Diabetes Educators say, which most of us chose not to hear. If a person is going to be successful in their own Diabetes, "You need to prepare your own meals from real food products at home." The term portion sized, needs to be translated to very limited portion size. Also, no kind of frozen entrees is going to be helpful in losing weight (at least not for me.) Even if it says Atkins. Same thing for protein bars. Prepared foods from the grocery store will not result in my losing weight.

I am about to do the opposite, for a few weeks. I am going to go through a case of Protein Drinks. My experience is that I will not lose weight, but my heart performance will be better.
 

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Two comments from me on this:

- Us diabetics absolutely have to be our own advocates. What works for one diabetic may not (likely won't) work for the next. I think humankind has only scratched the surface of what we know about our own bodies, and that's before we consider a disorder to a (endocrine) system that ties in to so many bodily functions.

Like foodahollic, I've learned that foods which are billed as "diabetes-friendly" are not necessarily my friends. My own experience with diabetes "education" was very disappointing -- the hour spent on "nutrition" never allowed to deviate from discussion of the Standard American Diet other than to account for the insulin or diabetes drugs needed to counteract the onslaught of carbs. Maybe that's all they think new diabetics can handle (maybe so); maybe it's a system that rewards precedence and consistency over discovery and random experience; maybe there's some other force at work here. shrug

Not to say that valid scientific study should be ignored. Just that we don't live in a one-size-fits-all world and we should not be surprised that general advice does not apply well to everyone.

- As American diabetics, particularly with more-severe or longer-term instances leading to the need for additional medical care, we experience a lot of the holes created when a humanitarian process is forced to fit into a capitalistic environment. For us, preventive care is critical. Yet we live in a system that most rewards reaction to trauma.

I don't think we can change that collectively at Diabetes Forum. I'm not sure we can change that collectively acting on our own, off the site. I'm also not entirely convinced there's any one approach that works ideally. We, as we do in so many other situations, have to provide for the best outcomes for the most people. What we allow to slip in priority will make all the difference.

In the meantime, we need to be our own advocates and fight for what's best for us. I'd like to see this site be a source of help to each other in communicating how to do that -- how to challenge formulary; how to fund the medications we need; how to manage to feed ourselves better when time and money are tight. I know we have done this in the past here. I'd love to see it happen again.

Thanks to you two for a thought-provoking thread.
 

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I've gotten pretty good about what I eat. I take my meds. The blood sugar still was high. They increased my insulin and I gained 18 pounds in 3 weeks. I reduced the insulin back to where it was. The weight started to come off although very slowly. Two months ago, I got a deer head chihuahua from the pound. She is my personal fitness trainer and she walks me several times a day. At first, I thought I was going to die. Now, my daily numbers are a lot better and I'm losing weight. Everyone has to find their balance.
 

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chargette, so good to see a post from you again! I'm glad those important daily numbers are getting better. The three-month number will improve too (if you know what I mean).

I had never heard of a deer-head chihuahua before. My mom had a long-haired chihuahua but deer-head was new to me. Cute looking dog! Dogs are excellent fitness trainers. Sometimes they make excellent clocks, too!
 
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No carb locarb yada yada etc. But at the end of the day it is our total health that counts The CSIRO in Australia is a Government funded research organisation and they sell off any research findings and move on to the next project. The CSIRO is big budget with a huge reputation and they only use "world renowned experts" and they did a number on T2 using hundreds of thousands of T2s and that ended up as a "cookbook" and they sold it on and now it is available if you care to buy it. The bottom line is total health and the CSIRO cookbook is a great starting point + Endocrinologist prescribed meds. That is if you actually want the best available total good health you can have.
 

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I took a look at the CSIRO Low-Carb Diet on their Web site. CSIRO defines "low carb" as 70 grams of carbohydrates a day, but I didn't see if that was with or without fiber grams included. It's an attractive diet for people who like to cook and can maintain their blood glucose at healthy levels with eating that many carbs. It would be attractive, too, to others who want to lower their carb intake to reduce the amount of medication they need to maintain safe BG levels, too.

As a "Yank" I had not heard of the CSIRO. I appreciate your bringing them to our attention!
 

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7I had a diabetic friend who was quite bright, IQ 187, had a masters in Micro-Biology. Worked as a Medical Lab Tech.

He said that for a person to feel satisfied after they ate, they needed to have oil and protein in their meals. He did not set a limit. He also said most American breakfasts were good for a Diabetics Blood Glucose control (meaning Type Two.)
He was a fan of Pizza. Had oil, protein. He would inject insulin to cover the crust. Which worked for him, for years. Maybe not good for the heart.

I have a local Pizza Inn who will make for me a super thin crust Pizza. Still spikes my Blood Glucose too much.

Interesting, long ago a doc told me that I should eat four servings of brightly colored vegetables every day. Not White Potatoes. Some would also say not corn or carrots. I don't think I have ever done that.

I was getting this talk down from the Cardio Surgeon about I should go to a Dietitian. For which my opinion really is, it is not knowing what I should eat, it is being able to afford it. Also that my choice of a happy lifestyle is to prepare and eat several small meals a day. No eating out. For a normal person, losing weight is about taking in fewer calories than I burn off. Before I was a diabetic, I suffered from Carbohydrate Addiction (as defined in the book by a couple - Hellers) which my body was in a cycle of cravings while I tried to eat less. They also ended up suggesting a diet that leaned toward Keto, but moderation in all things.

As I think of my experience with dietitians, and speaking to other diabetics; People going to Dietitians 'hear what they want to hear.' Most individuals, me included, remember better what we think will make is more happy.

After I started trying to be a better diabetic, I told one of doctors it was surprising how little exercise it took to increase insulin sensitivity. and make my blood sugar descend. Not sure how to describe the analogy with diet.

Used to be an Australian fellow on the a Diabetes website who had written a book about determining how foods effected our Blood Glucose. Take a two week period and test. The quotes, "Trust your Meter." "Test. Test. Test." I think he left a website with all of his advice for free. Alan Shanley.. His first point on his blog. If you are a Type Two Diabetic, it is not your fault. You did not overeat. You did not get Diabetes by eating too much sugary, carby foods. (Although you may have gone through a phase of Carbohydrate Addiction, which might have looked to others like that.) Alan Shanleys point. Don't give yourself a guilt trip over being a Diabetic. Yes, being a Diabetic is not fun. In fact, I have found over time it is a lot worse than this generic advice one hears in the media. Media quotes doctors, "Diabetics can live a normal life with a few restrictions." Phooey.

Realize that if one can get their Blood Glucose into a more level condition. We will feel better. A lot better. We will be more energetic. Surprisingly, more happy.

Public media gladly furnish misinformation. Get your advice from Doctors you trust.

As for me losing weight, a hundred pounds. The medical community has ideas of -like, eat the intro phase of the South Beach Diet. As the nurse talking to me about implementing this, "You can eat as much lean sirloin steak as you want for every meal." That it, I could, it would cost more than the totality of my Social Security payment. A diet of brightly colored vegetables costs as much as steak.

As of now, I have to eat carbs/calories to accommodate how much insulin I inject. So I can not reduce my daily carbs very much. Although eating Surf and Turf every meal would help me to lose weight.

Those who could help me to reset my insulin level, and some other medical issues, are not available until three months from now. Many of their colleagues are going on vacation.

I never get a vacation from symptoms. Medical profession has long advocated, I should suffer more to have a better health, lifestyle, reduced weight, when my experience is that suffering does not work. Phooey.

I am sure it would be dangerous to my health to radically reduce Insulin injection levels on my own choice. Like the mad scientist testing on himself.

I want to figure out a plan to increase muscle with diet, exercise, Insulin Injection amounts. That is tricky. Probably obvious to the next Endo I see. Now, if the price of lean Sirloin Steak would go way down.

I did not write this just for you to listen to me complain. I wanted to give you grist for thinking. As always. Feel free to tell me where I am wrong. In life, I am wrong a lot.
 

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One can safely adjust their own insulin levels if they can obtain trusted information. That can come from conversation with or reading from those who know. You could check out a couple of authors of some highly recommended books at your local library while you are waiting on those to see in person, John Walsh wrote "Using Insulin" and "Pumping Insulin" and Gary Scheiner wrote "Thiink Like a Pancreas". They may also have other relevant books besides these I mentioned.
 
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@foodahollic, I don't think you're wrong at all. You touch on several longstanding issues diabetics face. Well, maybe not making a correct assumption on one topic, but I'll get to that in a couple of paragraphs. 🙂

You make an excellent point about the shame that many associate with diabetes. My personal lifelong observation, with a number of diabetics among family and friends, is that Type 2s seem to get side-eye for being diabetic. (T1s largely get left alone.) There was enough diabetes in my family that I was not hugely surprised when the doctor told me I had it too. I do sometimes feel a little resentment for others I see eating carby meals washed down with carby beverages and -- because I can't see their medical histories -- assuming they're non-diabetic (or maybe just okay with not caring much about their health). But I keep on my path, mostly because I have some longer-term life goals and I know I feel better with lower BG.

The cost of food -- especially these days -- is a concern. Many factors have conspired to make the most rubbish food the cheapest and most accessible. It would be a service for dietitians to tell us how to eat quality proteins that don't cost what sirloin steak costs (I've found pork steaks a good alternative and maybe 1/3 the price of beef steak) and for nutrition "influencers" to address the reality that not everyone has ready access (or the wallet or the time) to eat only organic, raw vegetables or frequent amounts of fresh/frozen fish for maximum nutrition. It's somewhat on the order of the dentist insisting we floss after every single meal. Ideal, but not something most people pull off.

I will join mbuster, though, in suggesting that you can -- and, in fact, may have to -- make changes in your insulin intake. As you noted, what we eat and how active we are has a surprisingly direct bearing on our BG. So a day spent sick and not feeling like eating, or a day spent walking lots of aisles in a store or concourses in an airport both will have an effect on us that a fixed dose of medications will not address optimally. If you're not hypoglycemic unaware and can test your BG frequently, you can slowly gain experience with the amount of insulin you need for a given amount of carbs taken in by noting the mild highs and lows you induce with the amounts you use.

I applaud your sticking to this, but I do think you can take on some more of your own treatment without waiting months for another endo. Small steps.
 
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