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[Type-2-Diabetes] Digest Number 3858

A group for individuals with, or caretakers of individuals with, Type 2 Diabetes.

Messages In This Digest (19 Messages)

1a.
Re: New member meal question From: Holly Shaltz
2a.
Re: New HgbA1C Result From: Holly Shaltz
3a.
Re: HELP! confused about it all.. From: Holly Shaltz
3b.
Re: HELP! confused about it all.. From: Dorothy Wurth
3c.
Re: HELP! confused about it all.. From: [email protected]
3d.
Re: HELP! confused about it all.. From: [email protected]
4a.
Metformin Overdose (Rx error) From: brian cooper
4b.
Re: Metformin Overdose (Rx error) From: ron42nm
4c.
Re: Metformin Overdose (Rx error) From: Holly Shaltz
4d.
Holly, A1c thoughts From: Jude
4e.
Re: Metformin Overdose (Rx error) From: Faye Ridpath
4f.
Re: Holly, A1c thoughts From: Holly Shaltz
4g.
Re: Metformin Overdose (Rx error) From: ron42nm
4h.
Re: Metformin Overdose (Rx error) From: Holly Shaltz
4i.
Holly, role of exercise in A1c levels, etc. From: Jude
4j.
Re: Holly, A1c thoughts From: Amal
5a.
Re: Dex4 Glucose Bits From: Wee K Chew
5b.
Re: Dex4 Glucose Bits From: Michael
6a.
Re: New member meal question - for Jude & Holly From: benzo4321
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Messages

1a.

Re: New member meal question

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 6:15 am (PST)



Tricia writes:

<< I don't know how to feed myself enough. I am
now eating only half of the food I used to eat. I
take a whole afternoon eating a small salad and
entire night eating a tiny small meal. I am hungry
but afraid to eat more. >>

One of the most nefarious things about our health
care system is how we are diagnosed as diabetic
then DUMPED for who knows how long without any
decent information about what to eat, when this is
the ONE disease *everyone* knows you have to
modify your eating for!

But you shouldn't be starving yourself :)

Are you on any medications for diabetes? I would
guess not, if you're thin and just "barely"
diabetic (though there are many opinions on
*that*, as you can imagine :) If you *are* on any
meds for diabetes, that can impact what you eat
and the timing of your food.

If you're not on medications, then until your
doctor tells you otherwise, just eat what you
normally eat, but as soon as you get your meter,
test your BG before, then at *least* at 1 hour and
2 hours afterwards. This will tell you the impact
of what you ate on your BGs. Also, write down
everything you eat, plus your exercise - even, if
you are just more active than normal, like washing
windows or scrubbing floors or shopping for an
afternoon - anything that has you moving a lot
more, or more vigorously than normal for a while
can impact your BGs.

Put each day's info on a form. I have one I can
email in .doc, .pdf, or .odt format (let me know
which) if you're interested. It's designed to be
filled out by hand, one page printed per day.
It's pretty comprehensive, based on my first year
of experimentation and research of what I needed
to test.

The "traitor" <g> food group is carbs - things
that are sweet or starchy. Most of us know sweets
are "bad" when we're dx'd, but what we don't
realize is flour, potatoes, fruits, corn, etc, can
raise BGs just as fast.

Protein, if you eat too much, can also
*eventually* raise your BGs, because our bodies
can slowly break about 1/3 of the protein we eat
into glucose if there's not much, or no, carb in
our food.

You will need to experiment to find what works
with *your* body. What I eat is lower-carb than
most, as my BG goals are lower than what most
people adopt, and I was diabetic for probably 30
years before diagnosis, which led my pancreas to
be mostly burned out. But it doesn't involve
starvation - in fact, I hardly ever get hungry
until 30 minutes before a regular meal, and then
just mildly :) A quick summary:

I eat 3 ounces of protein for breakfast, 4 ounces
protein and usually a couple cups of salad or 4
ounces raw veg for lunch, and 3 ounces protein
plus around 1 cup of cooked veg, or a salad like
the lunch salad, for supper.

*Your* body can probably handle more carb than
mine can, so you needn't limit yourself in the
carb department as I have unless some day you find
you want to in order to achieve near-normal BGs
and you can't do it with more carb. But it sounds
like you were caught pretty early, so you can
probably handle lots more carb than I can, with no
ill effects.

There are certainly very few people diagnosed as
T2 who aren't significantly overweight at
diagnosis - in fact, to be honest, the vast
majority of us are obese (I was 204, and that was
after getting so far along with the diabetes that
I was losing weight from it). However, unless
your BGs shoot up very high on minimal amounts of
carb, you are not very likely to be T1.

You can ask your doctor for a C-Peptide test to
know more about how your pancreas is doing. This
test measures a by-product of insulin production
to know how much insulin you're still making
(insulin itself dissipates rapidly so is difficult
to measure directly). The lab's range of normal
will give you a frame of reference. Most T2s are
on the high end, or well over the high end, as the
pancreas can usually, sometimes for years, crank
out more insulin than normal to accommodate
increasing insulin resistance (IR). T1s, OTOH,
make little-to-no insulin, and so are 0 to very
very low in the lab's reference range. As long as
you're still making a reasonable amount of
insulin, you should be able to treat your diabetes
as a T2, working with your doctor.

For solid, basic-to-advanced info on managing T2
diabetes, try Gretchen Becker's _Type 2 Diabetes:
The First Year_. It's a GREAT book, very
readable, starts out non-technically, but every
topic is covered in more depth later on in the
book. I still frequently refer to mine for all
sorts of info. She reviews various typical food
plans in a balanced way, talks about typical
diabetes medications, discusses the basics of
using insulin, even breaks down every type of
sugar substitute and explains the aspects of each!
I read it twice in my first couple months of
diagnosis, though I could hardly see due to
rapidly-dropping BGs that made my eyes blurry :)

I was worried about needing insulin right off the
bat, too, but it's not likely you need it. So
relax, start documenting your activity and food
(buy yourself a cheap kitchen scale and make sure
you've got a set of measuring cups :), and when
you get your meter, tell your doctor you want a
prescription for at *least* 6 tests a day - I
found 10 to be invaluable for about 4 months - and
start testing around what you eat and your
exercise. That will provide you with the
information you need to manage your food for the
best possible outcome: long life and glowing health!

Holly in MI

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Messages in this topic (6)
2a.

Re: New HgbA1C Result

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 6:20 am (PST)



Tricia writes:

<<My A1C result is down even more. It is 5.1%. >>

WHOOO HOOOO!!!! Wow, way to go, Tricia! That
*IS* great, especially considering the holiday
season!!!

Since we've had lots of new people on the list
lately, maybe you could share the bones of how you
manage doing that - and why you aim for a low A1C?
I'm sure some would like to hear it from someone
other than moi <g>

Holly in MI

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Messages in this topic (2)
3a.

Re: HELP! confused about it all..

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 7:05 am (PST)



Christie (thanks for the name - it's the same as
my DIL's! :) writes:

<<Every doctor I seem to get, although they have
very little knowledge of thyroid issues think they
could handle my thyroid issues without an
endocrinologist. >>

Umm, you've had severe thyroid disease for over 15
years and you're not under the care of an endo? I
don't know much about these things, but that seems
odd to me. Are you in an area where there aren't
many endos? There's only 4 that I've been able to
learn of, in the northern third of the lower
peninsula of Michigan, where I live, with 3 of
those 4 being 70+ miles away, but I've still
gotten an appointment with one.

There is absolutely nothing wrong with *telling*
your regular doctor that you want a referral to an
endo, and not taking no for an answer! Many
doctors are perfectly able to handle a "normal" T2
diabetic, but with your thyroid issues, seems like
you're anything but "normal" :)

<<I understand taking care of myself is taking
care of them it is just hard to remember me
sometimes being so busy with them. >>

Not to be too blunt about it, but.... you *do*
want to be around when that youngest baby grows
up, don't you? Diabetes is a killer. It can kill
quickly, by sudden heart attack, or by bits and
pieces, but it *will* kill if it's not controlled,
and maybe worse still, it will sap your energy,
your self-esteem, your ability to cope, all of
which can lead to severe depression. My father
died at the ripe old age of 47 of a heart attack,
his mother at 50, also a heart attack, of
uncontrolled diabetes. I was often suicidal until
my diabetes was well-controlled. Neither is a
good thing when you've got young kids around!

Back then (for my father, 30 years ago today, as a
matter of fact; his mother died about 50 years
ago) there weren't either the diagnostic or
management tools that we are lucky enough to have
today. *Today* we can manage this bugger of a
disease for a much better outcome - longer, much
healthier and happier lives. Don't you want to
not only nurture your youngest to adulthood, but
see him become a parent himself, someday? My
father never saw his first grandchild....my sister
was only 18, I was 21 when he died.

Not all the ramifications of the disease are quite
that stark, but they're still scary. Blindness,
for one. Amputation, for another. Kidney
failure. I hate to practice scare tactics, but,
Christie, you need to take care of yourself
appropriately! And if that's hard for you to do,
enlist help from others! Can your DH take you to
appointments and help advocate for better care?
Can your oldest child help you remember meds? Do
you have a friend you can walk with?

Money is tough, I understand that part - we've
been on a very tight budget most of our 31 years
of marriage. Do you have a bulk grocery store in
your area? If you can buy in bulk, you will save
a LOT of money over the cost of a regular grocery
store, though the up-front cost is higher. Do you
have a yard? You can grow an amazing amount of
terrific veggies in a very small area - look up
square foot gardening online for information. Not
only that, but any kids who get involved will be
much the healthier for helping!

Is there a farmer's market in your area? You can
talk to the farmers and maybe find one to work
with you, to buy bulk meat, or harvest the veggies
you buy from them to save money. We raise feeder
pigs, chickens, lamb, and eggs for sale. If
someone with limited income were to approach us,
asking for a way to make a payment plan, we would
work with that person gladly - seems like we
always have a pig that didn't sell or a lamb we
end up having to butcher for ourselves. It
doesn't hurt to ask :) Or maybe you can get some
friends to go in with you to buy a pig, or even a
steer, for meat, or other bulk foods.

<<My parents actually told me they are prescribed
way too many strips and could pass some down to me
if they are the correct kind for the monitor I
have...so hopefully they are.>>

Well, that would be handy - but makes me worry
whether they're managing their diabetes
effectively! :)

<<He just mentions I am overweight and should lose
weight he does not realize that with my thyroid
function so low it is probably impossible to lose
weight. >>

What I know about low thyroid is zilch, but
there's information on the net about losing weight
in spite of that problem. It's also *possible*
you've been insulin resistant for a long time
before your official diagnosis as diabetic. If
so, the excess insulin your pancreas has had to
crank out to cope could have been the culprit for
some of your weight - insulin is also a
fat-storage hormone. Cutting back on the carbs
you eat *might* help you lose weight.

I quickly googled "hypothyroid weight loss" and
the very first hit was this page:
<http://thyroid.about.com/cs/dietweightloss/a/losingweight.htm>
which mentions a possible connection with insulin
resistance! So, if you can control your BGs by
reducing your carb intake somewhat, you might find
weight loss as a very welcome side effect :)

<<I do think it is time for a new doctor...I'll be
looking into one tomorrow ;o) I just get
worried I will end up with worse than what I have. >>

I'm glad you've decided to take that positive step
toward better health! I suppose we all worry
about changes in our health management. I get
frustrated with my own PA's adherence to the ADA's
party line, and her unwillingness to treat me as a
unique person - but I still see her, partly
because I've been able to make the changes I
needed without her help or support, and I'm not
convinced anyone else would be any more understanding.

Do report back as to what you can do about getting
seen by an endo. I'm going to be seeing one next
month, and one of the things I'm going to be
asking for is a full workup of my thyroid, and a
full assessment of my diabetes complications.
Need to add those items to my list before I forget
- although I'm not often particularly fogged these
days, unfortunately the last 10 years have seen a
marked decrease in my short-term memory and
thinking ability, yet another side-effect of
uncontrolled diabetes <sigh>

Holly in MI

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3b.

Re: HELP! confused about it all..

Posted by: "Dorothy Wurth" [email protected]   dottie.wurth

Tue Jan 5, 2010 9:26 am (PST)



Christy wrote discussing her problems with the combination of diabetes and hypothyroidism.
Hi Christy,
I've been thinking a lot about you and wanted to welcome you to the group.  I went to a conference on aging 3 years ago.  There was a presenter (Gerontologist) who discussed the great difficulties involved in prescribing for thyroid problems.  He stated that doses of medication have to be titrated very very carefully and monitored continually because it doesn't take much to be over or under medicated.  I know that you are still a young woman, but it sounds like you have had a lot of stress on your thyroid, so maybe this would apply to you too.  Since you are planning on seeking another doctor anyway, consider going to someone who will really understand your thyroid problems (Endocrinologist).  I am a retired clinical social worker.  In that capacity, I worked with a lot of people with mood disorders secondary to thyroid problems.  One thing I noticed is that it is a slippery slope when people discover that they feel better when they forget
their thyroid medication.  At first they forget, then they think I have a lot I need to get done today, I'll skip today's dose, so I will feel better.  Soon things start going downhill. You have a lot on your plate.  It must be extremely difficult to manage it all especially if you are not feeling good.  I'm glad your parents are willing to help out with test strips.  I hope they fit  your meter.  Even if you don't have enough strips to test often enough to know what foods are increasing glucose level, you will at least be able to test when you are feeling bad to tell if you are high or low.  Short term, highs aren't going to kill you unless they are really extreme, but lows can happen very suddenly and be serious.  Others here are much better with answering questions about your diabetes, so I won't attempt that, but I wanted you to know that I am thinking about you and wish you well.  Please continue to post your progress.
Dottie
--- On Tue, 1/5/10, [email protected]rocketmail.com <[email protected]gmail.com> wrote:

 

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3c.

Re: HELP! confused about it all..

Posted by: "[email protected]" [email protected]   [email protected]

Tue Jan 5, 2010 8:13 pm (PST)




Dottie,

You know, I wondered if I have some type of mood disorder but more and more I notice my moods and brain fog seem to be directly related to my thyroid and/or blood sugar. It is so hard for me to get to the doctors since my husband has to take off work to watch the kids. Without much money that is really hard but now he is on a 4 day work week so I am going to set it up for Friday and just do it. When I forget my meds it is a spiral down hill until I am depressed, and a little off as far as my thinking. My husband has bipolar disorder, my mom, brother, sister, aunt and I think my father have depression so I know mental illness. Sometimes I think I could also have something like anxiety (not terrible) or at least social anxiety (also not severe) but I am not quite ready to dive into that until I have my medical stuff under control. The anxiety is controllable for me and the social anxiety is just really prefering to communicate via email rather than talking with someone on the phone, not liking to go out much and stuff like that so it could take the back burner for now...I have to pick my battles around here.

Christie

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3d.

Re: HELP! confused about it all..

Posted by: "[email protected]" [email protected]   [email protected]

Tue Jan 5, 2010 8:13 pm (PST)




Thank you for all of the great information Holly.

I have been under the care of an endocrinologist a few times but moved away from some and other things have happened like changes in insurance. I am not sure why they don't want to refer me now but I sure will ask. I am in Southern California, I am Inland so there is less care out this way as far as specialists but I am sure there are some of them.

As far is the garden, we live on a ranch so we have a lot of room for a garden, the problem again , as always, is extra money for what is needed for a garden. Where we live there is a lot of rabbits, gophers and squirrels and I don't think veggies would have a fighting chance here. I also would probably have to purchase enough soil to cover the area and break up the rock hard dirt we have here. My almost 14 year old, 10 year old, almost 7 year old and almost 6 year old (the "almosts" are for some my February Birthday's) go to school. During the day I am home with an almost 2 year old and almost 4 year old (yeah, also February Birthday's). It is hard enough to catch up on household chores indoors, I am not sure when I would have time outdoors to work on a garden but I have been planning on one for almost 2 years now. I guess I should get serious about finding what I need to build a raised garden or something like that.

My mother is managing her diabetes very well, my father, who is 55 years old sadly never has. He is on dialysis, is blind in one eye and has numb hands and feet. He also has a lot of pain. I see him and know I do not want to be like that and know how much he has put his body through still eating a lot of ice cream and drinking some thick sweet citrus drink called Tampico (similar to Sunny Delight). I think his was giving up die to frustration, I do get a little depressed when I feel like what I am doing is not working and almost go into that mode until I realize how much my kids do need me.

Thank you for the support, I really just learning and my doctor does not seem to take my diabetes seriously enough since I do not need medication yet.

Christie

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Messages in this topic (8)
4a.

Metformin Overdose (Rx error)

Posted by: "brian cooper" [email protected]   brianevans_99

Tue Jan 5, 2010 9:21 am (PST)




Donna,

Thanks for your suggestions. It may be that the Walmart pharmacy I'm using here in NC has to keep records, but I think that would vary by state. The FDA (theoretically) regulate drugs/etc, but state pharmacy boards license pharmacists, and may, as far as we know, also set standards and requirements for operation of pharmacies. (I may call our state board in Raleigh.)

I am about to call the doctor's office (the endo dept at the local med school) to see if a nurse will check my records to see what my latest dosage is supposed to be. Then, one way or the other, I'll be writing the doctor.

Incidentally, when I first discovered this apparent screw-up in the dosage, I went down to 2000mg/day on my own, since it was Christmas week and the doctor wasn't available.

>Brian Cooper

P.S.--Someone on the list advised me to get another endo. I don't know where they live, but there is a nationwide shortage of endos--and at a time when diabetes, thyroid problems, etc are epidemic and growing. Even in a city of 70,000 with a large university and med school, we have only about 6-7 endos here. One died, and another left for Atlanta, in the last year, and they're trying to replace a PA who also left (at the med school). I've already been through 2-3 of the lot, whom I found unsatis-factory. Most endos these days, at least here, seem to concentrate on diabetes, and I have thyroid and other hormonal issues as well (which most endos are still treating with the outdated knowledge they got in med school).
__________________________________________________________
>

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4b.

Re: Metformin Overdose (Rx error)

Posted by: "ron42nm" [email protected]   ron42nm

Tue Jan 5, 2010 10:06 am (PST)



Brian, I don't know where you get this idea. Endos concentrate on diabetes because it is far and away the most common endocrinological disease by at least 10 to 1. However, virtually all endocrinologists stay up to date on other aspects of endocrinology. This is especially true in a university teaching hospital setting like you use for your care. In all states that I know of, physicians must complete many hours of continuing medical education in their specialty every year. In my state we have to do 100 hours a year. Almost everyone does much more than that. It's impossible to be totally up to date on every aspect of your field, but you should be competent and know what you don't know. For example, I don't see a huge amount of hypercoagulability problems but I can diagnose and treat the common ones. When the studies don't fit those I call a coagulation specialist for help. Just because an endocrinologist doesn't know every aspect of a rare disease doesn't mean he's "treating with the outdated information they got in med school." He may need to research it and/or call someone who concentrates in that area. No one knows everything about everything, even in their field. I can't count the times I've been on the phone with a prestigious academic physician and have told him something he didn't know. Of course, more commonly he's told me things I didn't know. If you expect omniscience, you're never going to find a doctor (or lawyer or accountant or dance teacher or anything) that you're happy with. Find one you can work with, who will try to fill in the gaps in his knowledge when needed, and will listen to you.

Ron

--- In [email protected]yahoogroups.com, brian cooper <brianevans_[email protected]> wrote:
>
Most endos these days, at least here, seem to concentrate on diabetes, and I have thyroid and other hormonal issues as well (which most endos are still treating with the outdated knowledge they got in med school).

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4c.

Re: Metformin Overdose (Rx error)

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 12:26 pm (PST)



Thanks, Ron, for sharing your perspective as an
endo. Any chance you'll share how *you* react
when a patient is referred to you for abnormally
low A1Cs? Who is *not* following ADA guidelines
for food? Seriously?

Holly in MI

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4d.

Holly, A1c thoughts

Posted by: "Jude" [email protected]   peridotjude

Tue Jan 5, 2010 12:42 pm (PST)



--- In [email protected]yahoogroups.com, Holly Shaltz <[email protected]> wrote:
Thanks, Ron, for sharing your perspective as an endo. Any chance you'll share how *you* react when a patient is referred to you for abnormally low A1Cs? Who is *not* following ADA guidelines for food? Seriously? Holly in MI>

Holly, I'm just wondering what you mean by an abnormally low A1c. Less than 4.5? IMO, unless someone is a true hypoglycemic or is abusing insulin, I'm not sure how they'd get lower than that and still have any quality of life. 4.0 is a glucose average of 65-- eek.

And lastly, just my two cents-- you're very concerned that your new endo and his staff will disapprove of your WOE, but IMO again, your new, normalized A1c is just as much a result of an hour (!) of exercise a day, and a 60+ pound weight loss. I hope against hope that your new caregivers won't lose sight of the forest for the trees, and that they'll consider your entire self-care regime, not just your food choices.

Won't you be glad when that initial consult is over? Poor thing, you've been waiting for a long time.

Judy D.

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4e.

Re: Metformin Overdose (Rx error)

Posted by: "Faye Ridpath" [email protected]   mommy2marcella

Tue Jan 5, 2010 2:14 pm (PST)



Brian,

I can relate. My doctor isn't an endo but he seems to love diabetes because
once we found out I had that, that is all he talks about! I can mention any
other health issue I have at the time and he responds with "So, how is your
diabetes?"

Although he did prescribe me some kick butt stuff when I had a sinus
infection, and he also sent his assistant in to hold my hand at my first
appointment because he wanted to draw blood and I do not do well with
needles (ironic considering I'm an insulin dependant diabetic.)

~~~Faye~~~

On Tue, Jan 5, 2010 at 11:26 AM, brian cooper <[email protected]yahoo.com>wrote:

>
> Donna,
>
> Thanks for your suggestions. It may be that the Walmart pharmacy I'm using
> here in NC has to keep records, but I think that would vary by state. The
> FDA (theoretically) regulate drugs/etc, but state pharmacy boards license
> pharmacists, and may, as far as we know, also set standards and requirements
> for operation of pharmacies. (I may call our state board in Raleigh.)
>
> I am about to call the doctor's office (the endo dept at the local med
> school) to see if a nurse will check my records to see what my latest dosage
> is supposed to be. Then, one way or the other, I'll be writing the doctor.
>
> Incidentally, when I first discovered this apparent screw-up in the dosage,
> I went down to 2000mg/day on my own, since it was Christmas week and the
> doctor wasn't available.
>
> >Brian Cooper
>
> P.S.--Someone on the list advised me to get another endo. I don't know
> where they live, but there is a nationwide shortage of endos--and at a time
> when diabetes, thyroid problems, etc are epidemic and growing. Even in a
> city of 70,000 with a large university and med school, we have only about
> 6-7 endos here. One died, and another left for Atlanta, in the last year,
> and they're trying to replace a PA who also left (at the med school). I've
> already been through 2-3 of the lot, whom I found unsatis-factory. Most
> endos these days, at least here, seem to concentrate on diabetes, and I have
> thyroid and other hormonal issues as well (which most endos are still
> treating with the outdated knowledge they got in med school).
>

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4f.

Re: Holly, A1c thoughts

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 2:19 pm (PST)



Judy writes:

<<Holly, I'm just wondering what you mean by an
abnormally low A1c.>>

By ADA standards, of course :) Since they define
through 6.0 as part of the "non-diabetic", I
figure under 5 will be waaaay abnormal :) I have
no way of knowing at this time what this
particular endo's perspective is on ADA standards.

<<you're very concerned that your new endo and his
staff will disapprove of your WOE>>

Yes and no :) I do still hope I can build a
problem-solving relationship. Having read her
brochure, this seems less likely to me, as it
states usually diabetics will only have one
"consult" with the endo. Seems like one office
visit, no matter how thorough the prep, can only
result in a sort of snap judgment: either she'll
approve of what I'm doing and tell me to keep on
keepin' on, or she'll disapprove and tell me to go
back to the ADA standard of treatment. How would
there be time, with just one visit, and me
apparently being shoehorned into her schedule, for
anything more in-depth? Unless I'm lucky (?) to
be considered a "complex" T2, which her brochure
says might be accepted as a regular patient.

Of course, an approving response would be better
from my perspective than disapproving. But it has
its drawbacks, too. To be told everything is
great, keep on doing what I'm doing, doesn't
address those issues I still have - like diabetic
complications. I guess she could order whatever
testing will identify those, and then send me back
to my PA with a list of follow-up treatments. And
maybe, just maybe, having been a patient of the
endo's one time, I could call the office if I ran
into problems I couldn't figure out? I dunno, but
I can hope (note to self - add that to list of
questions)!

A "go back to the way of the ADA" response would
be disappointing, but not surprising. Needless to
say, I won't be changing my self-management, since
it's working :)

<<your new, normalized A1c is just as much a
result of an hour (!) of exercise a day, and a 60+
pound weight loss. >>

Interesting perspective, thanks for sharing it :)
I hadn't thought of it that way before. To me,
it's all the result of getting my BGs down to the
non-diabetic level. Weight loss results because
there's no excess glucose in my system to be
stored as fat. The exercise does help keep my BG
down a bit, but it's more important to me as a
means of feeling physically and emotionally
better, especially its role in reducing cravings.
I *know* I couldn't keep up with the exercise if
my BG wasn't under tight control. Just today,
doing my T'ai Chi, which I usually enjoy
enormously, my BG was fluctuating more than
normal, and it was hard to stay motivated to keep
going my usual time - wooziness and tiredness from
the fluctuations interfere with my motivation.

<<Won't you be glad when that initial consult is
over?>>

I'm looking forward to the appointments. One way
or another, they'll be interesting! I do hope Ron
(and are there any other endos on this list?) will
be willing to share some thoughts on how he'd
react to someone like me. Forewarned is forearmed
<g> And no, that doesn't mean I'll go in with a
chip on my shoulder. I would just like to
understand or appreciate where she might be coming
from. More chance of a meeting of the minds that way.

<< Poor thing, you've been waiting for a long time.>>

Good grief, I practically expect your hand to come
out of the monitor and pat me on my widdle head!
<VBG> This particular referral dropped out of the
sky quite unexpectedly. I *chose* not to ask for
a referral. I had the power to tell my PA I
wanted one (and I knew how long I'd have to wait
to actually get the appointment), but I chose to
not ask.

When she offered the referral totally out of the
blue, I considered for a couple minutes before
saying yes. By the time it was offered, I was
feeling on a pretty even keel. I said yes only
because I thought, at the time, I'd be getting
that resource for problem-solving the next time a
problem pops up. And maybe, just maybe, a chance
at starting insulin sooner, so that I can eat more
carbs!!! Doesn't look like that will happen, and
who knows, if I did go on insulin and ate more
carbs, I'd probably gain weight from it, now that
I know how that works. Sour grapes, you say? :)
Maybe - but if it keeps me focused on the prize of
good health, so be it!

Holly in MI

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4g.

Re: Metformin Overdose (Rx error)

Posted by: "ron42nm" [email protected]   ron42nm

Tue Jan 5, 2010 3:24 pm (PST)



Holly, I'm not an endocrinologist. I'm an internist and hematologist. I really can't answer your question. I've never seen a patient with a truly low Hba1c, for example, under 4. I doubt you could get that low with diet alone so I'd refer the patient to an endocrinologist for evaluation for hyperinsulinemia.

If you mean a diabetic following a very low carb diet and who has an a1c of 4.5, I'd ask to see their blood sugar logs. If they are not having lows and not having symptoms of hypoglycemia, I'd tell them to keep up the good work (with a couple of exceptions).

As an aside, none of the endocrinologists I know subscribes to the ADA high carb, low fat diet. They all recommend moderate to low carb diets.

Ron

--- In [email protected]yahoogroups.com, Holly Shaltz <[email protected]> wrote:
>
> Thanks, Ron, for sharing your perspective as an
> endo. Any chance you'll share how *you* react
> when a patient is referred to you for abnormally
> low A1Cs? Who is *not* following ADA guidelines
> for food? Seriously?
>
> Holly in MI
>

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4h.

Re: Metformin Overdose (Rx error)

Posted by: "Holly Shaltz" [email protected]   hollyshaltz

Tue Jan 5, 2010 3:48 pm (PST)



Sorry, Ron, I gathered from context that you were
an endo. My mistake! Thanks for the feedback,
though, every little bit helps! :)

Holly in MI

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4i.

Holly, role of exercise in A1c levels, etc.

Posted by: "Jude" [email protected]   peridotjude

Tue Jan 5, 2010 7:13 pm (PST)



--- In [email protected]yahoogroups.com, Holly Shaltz <[email protected]> wrote:<snip> <<your new, normalized A1c is just as much a result of an hour (!) of exercise a day, and a 60+ pound weight loss. >>
<<Interesting perspective, thanks for sharing it :)I hadn't thought of it that way before. To me, it's all the result of getting my BGs down to the non-diabetic level. Weight loss results because there's no excess glucose in my syst


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