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.
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.
Comments
Good news--my mom's blood sugar was 124 this morning. High for a fasting blood sugar, but not dangerous.
Plus I <3 dr. Bernstein!! Hang in there till you find one of us that thinks outside the ADA guidelines.
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.
All the best Jan
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.
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
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.