Sunday, July 21, 2013

Diabetes Management: Why DIY?

Answer: because probably, nobody else will.

Awhile back, my mother's new primary care doctor saw her for a checkup. According to Mom, the doctor took her blood sugar and wrote "diabetes out of control" on her chart and prescribed Metformin and Lantus (insulin). The doctor didn't look at the blood sugar records Mom brought.

Maybe it's the new medication, maybe because an infection cleared up, or maybe Mom has gotten more insulin sensitive, but she's been getting hypos in the morning. It's dangerous to have blood sugar get too low during the night. The doctor is hard to reach, and who knows how good she is at dosing insulin.

Mom had been fiddling around with her evening insulin dose, but without checking her blood sugar first. So today, after she got her blood sugar up from this morning's level of 55 (70-100 is normal), I suggested she check her blood sugar before taking her evening insulin. When she checked it tonight, it was 70. After doing some reading from Dr. Bernstein's Diabetes Solution, the Wheat Belly blog the Diabetes Update Blog, I said, no insulin, and finish your Quest protein bar. (Most readers know that the liver can make glucose from protein, and does so slowly.) All three sources say that insulin can cause hypos, but Metformin alone doesn't.

I hate to think what might have happened if Mom had taken an insulin shot with her blood sugar already at the bottom of normal. And I hate the fact that the only thing that stood between her and a potential disaster was blogs, a book, and someone with no medical background.

13 comments:

tess said...

we HAVE TO take care of ourselves, as you observe! whether a lot of doctors are overscheduled or just don't care enough -- doesn't matter, people are just NOT being served! those who have the interest, independence and savvy can do a lot to help themselves, but between bad advice and pathetically-poor doctoring, it's no wonder "western" populations are in such bad shape.

Lori Miller said...

+1

Good news--my mom's blood sugar was 124 this morning. High for a fasting blood sugar, but not dangerous.

tess said...

It must be tricky to get the right balance of the right foods and meds....

Lori Miller said...

It is, but Bernstein gives some straightforward formulas in his book. I can tell he used to be an engineer.

Larcana said...

Thanks for this. I just attended (this weekend) a family practice update seminar in Orlando, FL. There again i had to sit through statin BS and diabetes disinformation. These were funded by Pharma. That is why doctors give bad advice. It's the Pharma influence. It irks me no end.
Plus I <3 dr. Bernstein!! Hang in there till you find one of us that thinks outside the ADA guidelines.

Lori Miller said...

Larcana, thanks for reminding me of finding doctors. From reading the book "Why isn't my Brain Working," I see there's a Shane Steadman, DC in Englewood and a David Arthur, DC in Denver. However, I don't think DCs can prescribe drugs, which my mom needs.

Does continuing education for doctors include reviewing fundamentals? For example, I was just reading that glucagon works to prevent hypos only when circulating insulin isn't too high. Based on this, it seems the prudent thing to do is check blood sugar levels every time before an insulin shot, especially at night, then calculate the dose. Yet that method doesn't seem to be standard operating procedure.

Lowcarb team member said...

Lori, you are doing so well with your mom and her diabetes. I am not a medical person but as you are probably aware Eddie is a Type 2 non insulin user diabetic. He says that an insulin using diabetic MUST check blood glucose regularly and at the correct times otherwise you are playing 'russian roulette'. BTW Eddie thinks Dr Richard Bernstein is probably the most knowledgeable medical professional in the world regarding blood glucose control.Did you know he was the first person ever to test bg at home?

All the best Jan

Lori Miller said...

Very true about the Russian roulette. My mom's sister plays it all the time with blood sugars between 40 and 400--no exaggeration. Someday she's going to drive her car into the Pacific Ocean.

Dr. Bernstein is going to be my new best friend for the next few weeks while I read his book cover to cover. I read about his home testing on a machine designed to discern between drunks and hypoglycemics. His wife had to order it for him since she was a physician and at the time, he was not.

Galina L. said...

The earlier we realize that doctors do not have all answers, the better. Diabetes 2 is just one of examples, there are plenty of conditions that could be managed mostly by the life-style choices , and doctors mostly rely on medications to treat symptoms , so it is the straggling patient or his relatives to feel the gap. Dr.Bernstein is the shining example how to approach health issues - help yourself first, then try to help others if they want you to do it.

Lori Miller said...

Some doctors scoff at Dr. Google, but he's done me a lot of good.

Lori Miller said...

Galina, BTW, Mom thought our battle of the moms was funny (see previous post).

JanKnitz said...

It's a shame that there is such poor care for people with Diabetes II in particular. I think it's a combination of things--doctors have little time and little reimbursement, they follow the conventional wisdom and don't even think their patients are capable of lifestyle changes to help control diabetes, AND they tend to blame Type II's for getting diabetes in the first place since the conventional wisdom is that Type II is a result of poor lifestyle choices (but see Peter Attia's TED talk for a different perspective).

Self-advocacy, dietary changes (low carb, NOT low fat) and treatment is the best way to get diabetes II under control and prevent its progression. Unfortunately, a lot of people who are diagnosed with it are elderly, they aren't as likely to be internet savvy, and our parent's generation was raised to give doctors more respect than some of them deserve. Your mom is lucky to have a daughter who can do the research for her AND a good enough relationship with you to follow what you recommend instead of blindly following her doctor's instructions to the letter.

If you can, urge your mother to look for a better doctor. They are hard to find, but they are out there. Great podcast here might be helpful: http://www.askbryan.com/thepodcast/61

Lori Miller said...

Thanks for the reply, Jan, and I'll show the podcast to my mother.

In my mom's case, it was overcoming a lifetime of eating habits that was the challenge. That was like moving a mountain. Living with my father, who pushes carbage at her, doesn't help, either. She didn't get any guidance from her doctors, and isn't in awe of doctors. (She was born without a doctor--he was too drunk to get there; her second child died of a medical mistake; and a botched sugery almost killed her. Antifragility FTW?)

I've urged her to find an endo who takes her insurance; it may be time to revisit the matter.