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Medical Forum / Diseases and Disorders / Diabetes / April 2008

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Doctor appointment

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michiko - 09 Apr 2008 19:58 GMT
I had an appointment with the diabetes doctor today. I had been writing down
my test results and he was pleased. Thanks for telling me to do that. He
checked me from feet to eyes, didn't have to strip thou. He said I was lucky
to catch it so early because I showed no signs of bad effects. He wanted me
to go to a training seminar but we're not sure Tricare will pay for it and I
can't afford it.
Anyway he said I need to loose weight and if I get down to 125 pounds I
could probably get off all medications and control with diet and exercise
only. I weigh about 150 pounds now and am 5'3" tall. He wants me to exercise
more and suggested brisk walking for 30 minutes 3-4 times a week.
I am to continue taking metformin twice a day and start taking Januvia in
the morning. I have to test my blood before breakfast, 2 hours after each
meal and at bedtime. I need to portion my carbohydrates to keep the 2 hour
tests under 160. He said the Januvia would help a lot with that. Rice is ok
but only in portions that don't raise my test over 160. The most important
thing is to loose 25 pounds. I need to see him again in 3 months. I have to
keep record of all my tests and a record of my exercise sessions and weight.
Loosing 25 pounds should be no problem now that I can't eat as much rice.
I'm going walking tonight and will start on the Januvia tomorrow.
John Williamson - 09 Apr 2008 21:38 GMT
> I had an appointment with the diabetes doctor today. I had been writing down
> my test results and he was pleased. Thanks for telling me to do that. He
[quoted text clipped - 15 lines]
> Loosing 25 pounds should be no problem now that I can't eat as much rice.
> I'm going walking tonight and will start on the Januvia tomorrow.

Excellent news. :-)

I had the same "coming off medication" thing for a few months after
diagnosis & going onto metformin for a month or two. I was taken off the
metformin for a while as my levels were too low, until the weight crept
back on..... :-/

Keep up the good work. As others have said, try different sorts of rice,
too. I quite like what's called brown rice in the UK, which seems to be
a sort of rice equivalent for wholemeal flour. It's got a nice nutty
taste, & may help your numbers.

Signature

Tciao for Now!

John.

michiko - 10 Apr 2008 01:06 GMT
>> I had an appointment with the diabetes doctor today. I had been writing
>> down my test results and he was pleased. Thanks for telling me to do
[quoted text clipped - 28 lines]
> sort of rice equivalent for wholemeal flour. It's got a nice nutty taste,
> & may help your numbers.

We have brown rich in Japan. It's ok but I like white rice much better. Our
stable rice is short grain white rice and that is what I was raised on. It
is hard to imagine living without it.

Mitchiko
Tiger_Lily - 10 Apr 2008 03:29 GMT
>>> I had an appointment with the diabetes doctor today. I had been writing
>>> down my test results and he was pleased. Thanks for telling me to do
[quoted text clipped - 34 lines]
>
> Mitchiko

basmati rice had a different starch chain to it........ this makes it
easier on our bg levels

it's a very nice rice with a slightly nutty flavour to it

i'm sure you would find the change easy to make (i did after 40 yrs of
sticky rice)

good luck
kate
John Williamson - 10 Apr 2008 09:01 GMT
>>> I had an appointment with the diabetes doctor today. I had been writing
>>> down my test results and he was pleased. Thanks for telling me to do
[quoted text clipped - 32 lines]
> stable rice is short grain white rice and that is what I was raised on. It
> is hard to imagine living without it.

That's now. If you start eating brown rice, wild rice & basmati rice,
after a few weeks, you'll probably wonder why you ever put up with the
insipid lack of taste of the short grain white rice. ;-)

You'll also find your portion sizes go down, as they're more filling.

It's a comfort thing, you're like everyone else, you don't want to
change, but I'm willing to bet that with the determination you're
showing so far, you'll manage fine. :-)

I see elsewhere that someone was asking if you've been referred for a
digital eye photo to check for retinopathy. Did your doctor use eyedrops
to dilate your pupils when he checked your eyes, & then do a full
examination? (The one where he shines an annoyingly bright light into
your eye, not the one checking for short sight & so on, but actually
looking into your eye). If so, then he was obviously happy with the
results, if he didn't, then ask him about being checked for eye problems
next time you see him.

The UK standard is to go to the optician for a (free under our system)
diabetic eye test every year, & they take a series of pictures of both
retinas, which are kept by your doctor to keep track of any deterioration.

If you wear glasses, next time you go to the optician for a checkup,
mention you're diabetic, & he should do the full check automatically.
Diabetes can also make you slightly more short sighted if your BG levels
are high, so he needs to know. Often, here, if you buy a pair of
glasses, they waive the charge for the eye check.
DaveT - 09 Apr 2008 21:39 GMT
> I had an appointment with the diabetes doctor today. I had been writing
> down my test results and he was pleased. Thanks for telling me to do
> that. He checked me from feet to eyes, didn't have to strip thou. He
> said I was lucky to catch it so early because I showed no signs of bad
> effects. He wanted me to go to a training seminar but we're not sure
> Tricare will pay for it and I can't afford it.

This is were would probably help you to keep the asd group available
because as Brits we have no or very little information on insurance and
the US health care system. You would be able to post those sort of
questions there.

> Anyway he said I need to loose weight and if I get down to 125 pounds I
> could probably get off all medications and control with diet and
[quoted text clipped - 10 lines]
> now that I can't eat as much rice. I'm going walking tonight and will
> start on the Januvia tomorrow.

As a T1 I can not comment on either T2 medication or be fully competent
about the diet (we have it much easier by injecting insulin but still
have to be realistic about what we eat) but exercise is important for all
of us. The way to get the effect of a meal is to test before (to know
just were you BG level is before you eat the meal) an hour after to see
if you have *spiked* on that meal and again 2 hrs after the meal to see
if it has pushed your BG up too far. If it does push it up too high do
not panic but think of what you have had (helps to write it down) and
adjust the carb. carrying content of the meal to stop the rise next time.
3 strips for one meal may seem a lot but you should be able to just judge
what a meal will do to you quickly by doing that if you can. If you spike
on anything try to avoid it if possible. A spike is were that reading one
hour after the meal is very high but goes down quickly by the 2 hour test.
Sorry I was not here when you first posted but welcome.

Signature

DaveT T1 Dx 1955 (aged 9)
Basal Hypurin Beef Lente
Bolus Lispro

michiko - 10 Apr 2008 01:13 GMT
>> I had an appointment with the diabetes doctor today. I had been writing
>> down my test results and he was pleased. Thanks for telling me to do
[quoted text clipped - 37 lines]
> hour after the meal is very high but goes down quickly by the 2 hour test.
> Sorry I was not here when you first posted but welcome.

Thank you for the welcome. I'm going to do what the doctor told me for a
while and keep records. That way I can decide what will be best in the
future.
The first doctor I went to gave me a prescription for 200 strips as a one
month supply.I'll have to renew it soon. I found these strips are $90 for
100 at Walmart. They only charged me $9 for 200, a lot for me but still a
good deal.

Michiko
DaveT - 10 Apr 2008 11:33 GMT
snip

> Thank you for the welcome. I'm going to do what the doctor told me for a
> while and keep records. That way I can decide what will be best in the
[quoted text clipped - 5 lines]
>
> Michiko

Later as you get to know how different foods react to your diabetes you
will be able to cut back on your testing so it will be cheaper. It is
money well spent though.

Signature

DaveT T1 Dx 1955 (aged 9)
Basal Hypurin Beef Lente
Bolus Lispro

Nicky - 09 Apr 2008 22:28 GMT
>He said I was lucky
>to catch it so early because I showed no signs of bad effects.

Excellent! Has he referred you for a digital photo & retinopathy
check? That's important, and should be done soon to provide a
baseline. Then you can repeat it annually.

>I have to test my blood before breakfast, 2 hours after each
>meal and at bedtime. I need to portion my carbohydrates to keep the 2 hour
>tests under 160.

I hate to say it, but 2 hour tests under 160 will guarantee that you
will continue to do damage.

http://www.phlaunt.com/diabetes/14045621.php

http://www.alt-support-diabetes.org/Newly%20Diagnosed.htm

Aiming for 160 initially might be OK, but if I were you, I'd adjust
your targets downwards as soon as you can. Weight loss and regular
exercise will indeed help a great deal - especially if you walk an
hour after lunch and the evening meal.

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6%  BMI 25
michiko - 10 Apr 2008 00:59 GMT
>>He said I was lucky
>>to catch it so early because I showed no signs of bad effects.
[quoted text clipped - 23 lines]
> D&E, 100ug thyroxine
> Last A1c 5.6%  BMI 25

He didn't mention anything about a retinopathy check. Does he do that or do
I need to go to another doctor? This diabetes is getting expensive with the
doctors and medications.
Do you know anything about Januvia? Does it take a few weeks to work like
Metformin? I will start taking it tomorrow morning. He said it would help
with my 2 hour after eating tests. I can compare my 2 hour tests before and
after taking it.
I don't know about walking after the evening meal, it's getting dark then
and I don't feel safe walking in this neighborhood after dark. After lunch
is ok when I'm not working.
I've looked at both those web sites. It is hard to decide what to do. Until
I find out how the Junuvia works, it might not be a problem.

Mitchiko
Robert Miles - 10 Apr 2008 01:05 GMT
>>>He said I was lucky
>>>to catch it so early because I showed no signs of bad effects.
[quoted text clipped - 39 lines]
>
> Mitchiko
http://www.januvia.com
Nicky - 10 Apr 2008 08:51 GMT
>He didn't mention anything about a retinopathy check. Does he do that or do
>I need to go to another doctor?

It needs an ophthalmologist.

>Do you know anything about Januvia? Does it take a few weeks to work like
>Metformin?

No idea, actually! How it works is to delay the body's breakdown of a
hormone in your gut that controls your insulin response to carby
foods. I guess it might actually help a fair bit on the rice front. So
I also guess it might work immediately, as its action is in the same
place as the drug enters your body.

>I don't know about walking after the evening meal, it's getting dark then
>and I don't feel safe walking in this neighborhood after dark.

If you have a spike, marching on the spot will do - or climbing the
stairs, or doing squat thrusts, anything that uses the large muscles.
Walking is just nicer : ) Dancing is good too...

>I've looked at both those web sites. It is hard to decide what to do. Until
>I find out how the Junuvia works, it might not be a problem.

It'll be interesting to hear about your Januvia experiences. It's not
a common drug over here.

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6%  BMI 25
Flying Rat - 11 Apr 2008 15:52 GMT
> He didn't mention anything about a retinopathy check. Does he do that or do
> I need to go to another doctor? This diabetes is getting expensive with the
[quoted text clipped - 10 lines]
>
> Mitchiko

I did a bit of Googling and found this

http://www.diabetesmine.com/2007/08/januvia-smackdo.html

Have a read of the page but dont get all worked up over it. Januvia does
have some side-effects, just like almost every single drug on the
market. This page will give you an idea of what to watch for.

On the positive side there is a strong indication that januvia is
actually well tolerated in the majority of people compared to some other
similar treatments. So it seems like a sensible choice for you in that
respect.

Firstly you need to get your diet tweaked whilst ramping up the full
benefit of the medication, and that is dealt with in other posts. Good
luck as ever, and you may indeed find diabetes to be a positive life
change as you get fitter and slimmer.

Ratty
michiko - 11 Apr 2008 18:14 GMT
>> He didn't mention anything about a retinopathy check. Does he do that or
>> do
[quoted text clipped - 35 lines]
>
> Ratty

So far the Januvia is working good for me. Yesterday it lowered all my 2
hour tests for all 3 meals. One thing I really noticed was no hunger. I have
been hungry almost all the time since I have lowered my carbohydrates to get
my 2 hour tests down. Yesterday for dinner, I didn't even feel like eating
at all. This morning before breakfast test was 87 and 2 hour test was 128. I
realize that 1 day is not a fair test but it is a good start.
Mitchiko
Nick Cramer - 10 Apr 2008 05:43 GMT
> I had an appointment with the diabetes doctor today. I had been writing
> down my test results and he was pleased. Thanks for telling me to do
[quoted text clipped - 16 lines]
> now that I can't eat as much rice. I'm going walking tonight and will
> start on the Januvia tomorrow.

That's great, Michiko. Nothing like taking control of your own life, eh?

I would still urge you to also test at one hour after you start eating a
meal, and at one hour intervals as long as your test result is higher than
the previous hour (thanks, Wendy), and striving to keep your spikes at or
below 140.

Have a nice walk!

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