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Medical Forum / Diseases and Disorders / Diabetes / May 2008Gaaaaaaah! Incompetent medical people!
I am sooo steamed right now. BG still out of control, although it does seem to have come down a bit. At least it's not in the 400's. The nurse told me to call her back today. And guess what? She's on vacation for a week! She was out for a week a few weeks ago as well. She made NO effort to get back to me at all. Didn't return MY calls. My Dr. has not returned a call either. The receptionist said she would have the other nurse call me back when he comes in, whenever that will be. He will probably tell me the same thing. Increase by 2 units every 3-4 days. At this rate, it will take me next to forever to get in control, if I ever will on this Lantus. Grrr... > I am sooo steamed right now. BG still out of control, although it does seem > to have come down a bit. At least it's not in the 400's. The nurse told me [quoted text clipped - 8 lines] > forever to get in control, if I ever will on this Lantus. Grrr... > Any doctor who controls a diabetes's insulin should not be seeing diabetics!! also using Lants to control BG is idiotic. MOST people need a combination of long acting and fast acting \ I have adjusted my own insulin for many years For Lantus, the worry is the LOW point. If your low is under 100, you have enough Lantus. If your pre prandial, or 2 hour post are over 100, you need fast acting, usually about 1 unit for every 4 points of BG. That is for T2's T1's are quite different. If your low is over 100, try increasing your Lantus 1 for 4. If you use fast acting, try 1 for 19 initially and slowly increase it as necessary, with a 1 for 4 as a most probable, Your low from fast ACTING is in 2 to 5 hours after taking it (food within first hour) >> I am sooo steamed right now. BG still out of control, although it does >> seem to have come down a bit. At least it's not in the 400's. The nurse [quoted text clipped - 10 lines] > Any doctor who controls a diabetes's insulin should not be seeing > diabetics!! He isn't even doing that. He had the nurse doing it and she didn't seem to know what to do. > also using Lants to control BG is idiotic. MOST people need a combination > of long acting and fast acting So I've been told. > \ > I have adjusted my own insulin for many years [quoted text clipped - 3 lines] > you need fast acting, usually about 1 unit for every 4 points of BG. That > is for T2's T1's are quite different. Well, I just tested at 109 before lunch. > If your low is over 100, try increasing your Lantus 1 for 4. If you use > fast acting, try 1 for 19 initially and slowly increase it as necessary, > with a 1 for 4 as a most probable, > Your low from fast ACTING is in 2 to 5 hours after taking it (food within > first hour) I got two calls from the other nurse. He seems to know what to do. The second call was to tell me that the Fax from the Dr. DID come in but was apparently misplaced. So I don't know who the incompetent one is here. He told me to increase the Lantus by 8 units until we get to 60 and if it's still not good, we have a number of options to do from there. >>> I am sooo steamed right now. BG still out of control, although it does >>> seem to have come down a bit. At least it's not in the 400's. The [quoted text clipped - 40 lines] > He told me to increase the Lantus by 8 units until we get to 60 and if > it's still not good, we have a number of options to do from there. I wouldn't be going that far at all with the Lantus. I would be buying my own fast acting insulin and getting ideas from people here, but that's just me. I wouldn't have tolerated such wicked numbers for so long. You could start out with small amounts, type 2's mostly don't have that sensitivity to injected insulin like type 1's so the chances of a hypo by starting with low doses and working up would be minimal. >>>> I am sooo steamed right now. BG still out of control, although it does >>>> seem to have come down a bit. At least it's not in the 400's. The [quoted text clipped - 47 lines] > sensitivity to injected insulin like type 1's so the chances of a hypo by > starting with low doses and working up would be minimal. Well, I'm not paying out of pocket for something I can get covered by insurance. And from what I know about insulin, it doesn't seem that a fast acting one is warranted. Fast acting is just for after meals. Right? I am not increasing after meals, but most of the time, decreasing. >>>>> I am sooo steamed right now. BG still out of control, although it >>>>> does seem to have come down a bit. At least it's not in the 400's. [quoted text clipped - 52 lines] > fast acting one is warranted. Fast acting is just for after meals. > Right? I am not increasing after meals, but most of the time, decreasing. But you are saying your bg's are out of control, define out of control. > But you are saying your bg's are out of control, define out of control. I was 109 before lunch. That's fine. Woke up to 229. So somehow between then and after breakfast, the numbers came down. The nurse has me testing only before meals and at the time I take my insulin. BG has been pretty steady after meals or has come down. It does not go up after eating. Yesterday my numbers varied from 361 in the morning (highest number) to 213 at night. They came down as the day wore on. Now another thing is possible as the second nurse pointed out. I have been sick with some sort of virus. I still don't feel totally back to normal, although with high BG, it is hard to distinguish the culprit. The killer leg cramps I was having have subsided. I no longer feel like I'm going to puke and the headache is gone, but I still feel tired and weak. It is possible that the virus raised my BG in spite of the insulin and that had I not been ill, my numbers would have been lower. > >> But you are saying your bg's are out of control, define out of control. [quoted text clipped - 16 lines] > > Well, a virus rarely effects, but an infection does also, Dawn phenom like that is not uncomon. Lente was great for that cause you took it at bedtime and t peaked in the morning. Lantus is almost worthless because it is so flat. You could try getting up at 5 AM and taking a fast acting shot >>> But you are saying your bg's are out of control, define out of control. >> [quoted text clipped - 19 lines] > > You could try getting up at 5 AM and taking a fast acting shot Dr. just called me back and told me something slightly different. Told me to increase to 34 units, then go up from there. Said I should be on an even amount. Which would make it a lot easier to dial in on the pen. He doesn't feel further testing is warranted just yet. And I think I will be able to see that other nurse next time. >Dr. just called me back and told me something slightly different. Told me >to increase to 34 units, then go up from there. Said I should be on an even >amount. Which would make it a lot easier to dial in on the pen. He doesn't >feel further testing is warranted just yet. And I think I will be able to >see that other nurse next time. Well, that's something, anyway - Nurse #1 sounds a complete idiot. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>Dr. just called me back and told me something slightly different. Told me >>to increase to 34 units, then go up from there. Said I should be on an [quoted text clipped - 5 lines] > > Well, that's something, anyway - Nurse #1 sounds a complete idiot. That's what I thought. Had I followed this protocol, I would already be to this point. Woke to 136 this morning and this is where the first nurse told me to be. Said I needed to be <150. So I hope this is not a fluke and this continues. >That's what I thought. Had I followed this protocol, I would already be to >this point. Woke to 136 this morning and this is where the first nurse >told me to be. Said I needed to be <150. So I hope this is not a fluke and >this continues. Woo-hoo! Touch wood. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>That's what I thought. Had I followed this protocol, I would already be >>to [quoted text clipped - 4 lines] > > Woo-hoo! Touch wood. Shot up to 294 before lunch. So we shall see. >>>That's what I thought. Had I followed this protocol, I would already be >>>to [quoted text clipped - 6 lines] > >Shot up to 294 before lunch. So we shall see. At least that's following an understandable pattern. At least as much of a pattern as two readings in a row make :P Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 > On Fri, 09 May 2008 22:22:31 GMT, "Julie Bove" <juliebove@verizon.net> > >"Nicky" <ukc802466929@btconnect.com> wrote in message > >> On Fri, 09 May 2008 14:49:24 GMT, "Julie Bove" <juliebove@verizon.net> > >>>That's what I thought. Had I followed this protocol, I would already > >>>be to [quoted text clipped - 9 lines] > At least that's following an understandable pattern. At least as much > of a pattern as two readings in a row make :P Should have eaten lunch before the liver dump?  SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >> On Fri, 09 May 2008 22:22:31 GMT, "Julie Bove" <juliebove@verizon.net> >> >"Nicky" <ukc802466929@btconnect.com> wrote in message [quoted text clipped - 15 lines] > > Should have eaten lunch before the liver dump? Don't think so. I am spacing out my meals every 4-5 hours like she said. And on the days I was doing the 2 hour testings, even when I skipped lunch, there was no low. >>>>That's what I thought. Had I followed this protocol, I would already be >>>>to [quoted text clipped - 9 lines] > At least that's following an understandable pattern. At least as much > of a pattern as two readings in a row make :P 233 this morning. But... I got up an hour later than usual which is probably not a good thing. But I really have no choice because we are not doing lunch until 2. >>>That's what I thought. Had I followed this protocol, I would already be >>>to [quoted text clipped - 6 lines] > > Shot up to 294 before lunch. So we shall see. So what did you eat between FBG and the pre lunch test? And did you test at one hour and 2 hour after breakfast? Normalising the FBG is only half the battle. >>>>That's what I thought. Had I followed this protocol, I would already be >>>>to [quoted text clipped - 10 lines] >one hour and 2 hour after breakfast? Normalising the FBG is only half the >battle. Yeah, but it might be the key first step, given the bg heights she's had recently. She must be in glucose toxicity again. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 >>>>>That's what I thought. Had I followed this protocol, I would already >>>>>be [quoted text clipped - 17 lines] > Yeah, but it might be the key first step, given the bg heights she's > had recently. She must be in glucose toxicity again. Prolly. >>>>That's what I thought. Had I followed this protocol, I would already be >>>>to [quoted text clipped - 10 lines] > at one hour and 2 hour after breakfast? Normalising the FBG is only half > the battle. Same as I've been. Cinnamon Toast Crunch. Am not testing after eating at this point because when I was testing every two hours it showed the numbers staying the same or going down. Not going up. So she told me not to test after. >>>>>That's what I thought. Had I followed this protocol, I would already be >>>>>to [quoted text clipped - 15 lines] >staying the same or going down. Not going up. So she told me not to test >after. Surely there's no harm in testing. When my doctor tells me to test once per day, I don't look at that as an absolute command. Signatureroses are #FF0000 violets are #0000FF all my base are belong to you >>>>>>That's what I thought. Had I followed this protocol, I would already >>>>>>be [quoted text clipped - 22 lines] > Surely there's no harm in testing. When my doctor tells me to test > once per day, I don't look at that as an absolute command. The harm is to my fingers. I was getting to where it was hard for me to get blood out because calluses were developing. Plus I am allowed only 6 strips per day. Any more than that and I'd have to pay out of pocket. I am using 4 strips per day and that leaves me 2 extra for if I am not feeling well or whatever. > "Oleg Lego" <rat@atatatat.com> wrote in message > >>"Ozgirl" <are_we_there_yet@maccas.com> wrote in message [quoted text clipped - 6 lines] > am using 4 strips per day and that leaves me 2 extra for if I am not > feeling well or whatever. Are you using all your fingers, Julie? how deep do you have your lancet set to go? Ten fingers times three major areas (left, top, right) means one prick a month per area. Besides that, the sides have at least four sites and the top has at least three. I mostly use only two fingers. I feel around for a nice plump soft spot and whack it. SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >> "Oleg Lego" <rat@atatatat.com> wrote in message >> >>"Ozgirl" <are_we_there_yet@maccas.com> wrote in message [quoted text clipped - 13 lines] > and the top has at least three. I mostly use only two fingers. I feel > around for a nice plump soft spot and whack it. No. I quit using all of my fingers. My pinkies bleed the best. Or they did. I was only using those but then I started having trouble and began using my pointers. It's just a pain to do the middle fingers. I used to do them all and rotate them. I can't do my thumbs. I tried that once and it killed! Plus it was clumsy and awkward. But at any rate there is no point at this point in time to do all that testing. I am mainly concerned with getting the morning fasting down at this point and then we go from there. >> But you are saying your bg's are out of control, define out of control. > > I was 109 before lunch. That's fine. Woke up to 229. So somehow between > then and after breakfast, the numbers came down. The nurse has me testing > only before meals and at the time I take my insulin. Why are you following such an archaic tesdting regimen when you know from reading here that bg's need to be tested more rather than less with insulin. If you are not testing after meals you have no idea how high you are going. It may be taking you 6 hours to get near normal after a meal. So six hours of unacceptable number. You already have a number of diabetic complications, I can't see why you would be consciously or unconsciously wishing more complications upon yourself. Plus how do you know that the Lantus isn't dropping you overnight and causing a large rise on waking. I have heard of people on Lantus have overnight lows, which I don't beleive are supposed to happen. Try waking in the early hours and testing to see if anything unusual is happening then and go back to testing after meals regardless of what a nurse says. A nurse is a nurse, period. BG has been pretty > steady after meals or has come down. It does not go up after eating. > Yesterday my numbers varied from 361 in the morning (highest number) to [quoted text clipped - 7 lines] > It is possible that the virus raised my BG in spite of the insulin and > that had I not been ill, my numbers would have been lower. >>> But you are saying your bg's are out of control, define out of control. >> [quoted text clipped - 9 lines] > complications, I can't see why you would be consciously or unconsciously > wishing more complications upon yourself. I was testing more and there seemed no point to it. The numbers were either not changing or going down slightly. I am still testing more than I was before. And really... What's the point in testing if I can't DO anything about it? > Plus how do you know that the Lantus isn't dropping you overnight and > causing a large rise on waking. I have heard of people on Lantus have > overnight lows, which I don't beleive are supposed to happen. Try waking > in the early hours and testing to see if anything unusual is happening > then and go back to testing after meals regardless of what a nurse says. A > nurse is a nurse, period. Because I was testing throughout the night and the numbers were not changing. I am normally up till 2:00 a.m. or so. I was testing every two hours. The only time when more than 2 hours elapsed between tests was then and about 7:00 a.m. when I got up in the morning. The nurse (first one) mentioned putting me on a continuos monitor. But with such steady numbers, that didn't make sense. > BG has been pretty >> steady after meals or has come down. It does not go up after eating. [quoted text clipped - 8 lines] >> weak. It is possible that the virus raised my BG in spite of the insulin >> and that had I not been ill, my numbers would have been lower. > "Ozgirl" <are_we_there_yet@maccas.com> wrote in message > > "Julie Bove" <juliebove@verizon.net> wrote in message > >> "ted rosenberg" <tedrosenberg@iname.com> wrote in message > >>>> [ . . . ] > Well, I'm not paying out of pocket for something I can get covered by > insurance. [] Reminds me of an old Jack Benny skit. Armed robber comes up to Jack and says, "Your money or your life!" Jack assumes his signature hand-on-chin stance and stands there, brow wrinkled. Gunman reiterates, "I said, your money or your life!" Jack looks up and replies, "Wait! I'm thinking!" SignatureNick. Support severely wounded and disabled Veterans and their families! I've known US vets who served as far back as the Spanish American War. They are all my heroes! Thank a Veteran and Support Our Troops. You are not forgotten. Thanks ! ! ~Semper Fi~ >> "Ozgirl" <are_we_there_yet@maccas.com> wrote in message >> > "Julie Bove" <juliebove@verizon.net> wrote in message [quoted text clipped - 7 lines] > stance and stands there, brow wrinkled. Gunman reiterates, "I said, your > money or your life!" Jack looks up and replies, "Wait! I'm thinking!" Yep. >>> "Ozgirl" <are_we_there_yet@maccas.com> wrote in message >>> > "Julie Bove" <juliebove@verizon.net> wrote in message [quoted text clipped - 9 lines] > >Yep. We have from until after the election to get something done about health care. Then,"who are you". We will see needs in all areas and why worry about sick people. They are not productive. The great days of health insurance are about over. We ate the golden goose Watch and see the discussions about the cost and the ways to deal with it. Pay or do not call. Payment due at time of service. The pointer will say go to emergency, Then the emergency will have a sign saying closed due to lack of funds. The docs office will say "gone on vacation". . ----== Posted via Pronews.Com - Unlimited-Unrestricted-Secure Usenet News==---- http://www.pronews.com The #1 Newsgroup Service in the World! >100,000 Newsgroups ---= - Total Privacy via Encryption =--- I kept increasing my Lantus, on my doc's advice, and when I hit 140u/day my Blood Glucose leveled off and has stayed there. My doc says he has one patient on almost 800u/day. Dick >I kept increasing my Lantus, on my doc's advice, and when I hit 140u/day my >Blood Glucose leveled off and has stayed there. My doc says he has one >patient on almost 800u/day. > >Dick We need more discussion of the dosage of all diabetics. What i think i see is to many dogmatic statements the does not consider individuals. The production line specialists try to put label on people with almost no testing. It is fast but does a few great harm. I had to learn some of the basics and do my own tests. Reason I push this idea. Again MHD ----== Posted via Pronews.Com - Unlimited-Unrestricted-Secure Usenet News==---- http://www.pronews.com The #1 Newsgroup Service in the World! >100,000 Newsgroups ---= - Total Privacy via Encryption =--- >I kept increasing my Lantus, on my doc's advice, and when I hit 140u/day my > Blood Glucose leveled off and has stayed there. My doc says he has one > patient on almost 800u/day. Wow. Do you use the pens? Do you also take a fast acting? Julie doesn't. I wish she could find a sensible doctor. >I kept increasing my Lantus, on my doc's advice, and when I hit 140u/day my > Blood Glucose leveled off and has stayed there. My doc says he has one > patient on almost 800u/day. > > Dick > I am sooo steamed right now. BG still out of control, although it does seem > to have come down a bit. At least it's not in the 400's. The nurse told me [quoted text clipped - 7 lines] > Increase by 2 units every 3-4 days. At this rate, it will take me next to > forever to get in control, if I ever will on this Lantus. Grrr... what's your point Julie? adjusting the insulin by 2 units every 3-4 days IS the protocol to adjusting your insulin it takes a type 1 about 3 months to get 'close' to their insulin dose, and they have to adjust TWO insulins to get there what do you want to hear? X is the 'right' amount of insulin? because that simply can't happen............. trial and error is how you adjust insulin good luck Signaturekate type 1 since 1987 www.diabetic-talk.org >> I am sooo steamed right now. BG still out of control, although it does >> seem to have come down a bit. At least it's not in the 400's. The nurse [quoted text clipped - 12 lines] > adjusting the insulin by 2 units every 3-4 days IS the protocol to > adjusting your insulin Not when one's BG is in the 400's, and I have seen other protocols. The Dr. and the other nurse said this is wrong. Should be 8 units. Also I think it is irresponsible to tell me to call back when she is on vacation and can't be reached, and not to follow up on the Fax that she said she never got but I now know she did. > it takes a type 1 about 3 months to get 'close' to their insulin dose, and > they have to adjust TWO insulins to get there I could understand with someone newly diagnosed. But it is frustrating for someone who had, had control and now does not. > what do you want to hear? X is the 'right' amount of insulin? because that > simply can't happen............. trial and error is how you adjust insulin Well, no. But it isn't right to keep me running in the 400's when I am getting dehydrated and sick from it. > good luck The Dr. said to up it to 34 units tonight, then wait 3 days and up it another 8 points from there. That makes more sense since there is obviously no chance of my going hypo at the rate I am going. >>> I am sooo steamed right now. BG still out of control, although it does >>> seem to have come down a bit. At least it's not in the 400's. The nurse [quoted text clipped - 18 lines] > be reached, and not to follow up on the Fax that she said she never got but > I now know she did. i commented on how insulin is titrated, and you are discussing whether or not the nurse called you back.................... ok.......... >> it takes a type 1 about 3 months to get 'close' to their insulin dose, and >> they have to adjust TWO insulins to get there > > I could understand with someone newly diagnosed. But it is frustrating for > someone who had, had control and now does not. so? do you think that other type 2's going onto insulin don't have the same adjustment period? are you trying to say there should be 'your right insulin dose' guessed out of thin air so that you have instant control again? guess what?..... once you have your bg under control again, and just think everything is going smoothly, you are going to have to adjust your insulin again.......... welcome to using insulin >> what do you want to hear? X is the 'right' amount of insulin? because that >> simply can't happen............. trial and error is how you adjust insulin [quoted text clipped - 6 lines] > another 8 points from there. That makes more sense since there is obviously > no chance of my going hypo at the rate I am going. ok, the Dr found out that 2 units of insuln isn't going to affect you quickly as it does A LOT OF TYPE 2's WHO JUST GO ONTO insulin, i know a lot of type 2 diabetics who take 10 units of Lantus at bedtime and that is ALL they need to control their bg levels........... and THEY started out at 400 when they were put on insulin your expectations of the Dr are unreasonable, in all honesty >>>> I am sooo steamed right now. BG still out of control, although it does >>>> seem to have come down a bit. At least it's not in the 400's. The [quoted text clipped - 56 lines] > > your expectations of the Dr are unreasonable, in all honesty I don't think so. To expect to respond to a Fax sent by a nurse? To allow almost a month to go by before a response? When the nurse stated (although it seems wrongly) that I need additional testing? According to some of the other people here, I was not taking ENOUGH action! The problem *I* had was that I did not start out with BG in the 400's. It was in the 200's. It was only AFTER I was put on the insulin that the numbers began to climb. And the more insulin I took, the higher those numbers rose. From what I have read, this is *not* normal and I should expect the Dr. to say something about this. I now know that he *did* in fact say something about it and in a timely fashion but due to some snafu (I know not what), the information did not get to the right person. Anyway... It's over now. > > I am sooo steamed right now. BG still out of control, although it does seem > > to have come down a bit. At least it's not in the 400's. The nurse told me [quoted text clipped - 15 lines] > it takes a type 1 about 3 months to get 'close' to their insulin dose, > and they have to adjust TWO insulins to get there Well, there's "close" and there's "close", I guess. 26 years with this stupid disease, and I'm still dialing my doses up and down a half unit at a time, and according to some of the statistics spouted by others here I'm still not close enough. (Although I think I'm doing pretty good.) But Julie shouldn't be at 300 or 400 and not getting good advice on how to do something more effective more quickly. I think she's getting more attention now than before from her doc and this other nurse, and that's a GOOD thing. I think that for her, the big gotcha was that when she started on insulin the oral hypoglycemics were still increasing her insulin sensitvity, but those wore off after a few days and led her to feeling that the increasing dose of Lantus was the cause of high bg's. Lantus's real effectiveness curve is not actually flat across 24 hours and then going to zero. For me, it peaks around twelve hours but has a long, long, long tail. There are potential instabilities if I dial it up and down more often than once every two days - and I only dial it up and down by half a unit at a time. Julie has much bigger changes to make, and I feel she's actually making those changes effectively now. As the target comes into the viewfinder she'll do way better than having the target being on the other side of her head! It is very frustrating to feel like you have no handles on a problem, or that the tool you've been given, when you turn the handle the way you were told, at first seems to make it worse. Been there, done that. Tim. > I am sooo steamed right now. BG still out of control, although it does seem > to have come down a bit. At least it's not in the 400's. The nurse told me [quoted text clipped - 7 lines] > Increase by 2 units every 3-4 days. At this rate, it will take me next to > forever to get in control, if I ever will on this Lantus. Grrr... http://HeartMDPhD.com/Convicts/PrayForJulie <>< http://HeartMDPhD.com/HolySpirit/Love |
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