Diabetes update

[ghostjmf]

I'm just gonna pretend this is my blog, cause I'm too lazy/whatever to set one up.


Anyway:


Finally saw the nutritionist; had to delay that appointment last month because of something more pressing in life matters. I had already told my nurse-practitioner that they weren't going to tell me anything I, as a long-time (but long ago) carb-limiting dieter didn't know, but they insisted I go anyway.


The clinic put the fear-of-payment into me by telling me I'd better be sure my insurance covered this, else it was $512.00 for a 15 minute visit. So I went around the bushes on that one, but am told the insurance does cover. Sure hope so.


Nutritionist talked to me for close to an hour, so I sure hope I am not paying by the 15-minute batch, but came out with very little for me to change except.....to eat more carbs! I am not fooling. Said I do not want to starve my brain of glucose, which can happen if the carbs are so low as I've gotten them to.


They're respecting my intelligence (after closely examining my food choices after this diabetes diagnosis) & not giving me the "you can trade this food for that food" charts, as they see I already know that stuff.


I was expecting the very condescending lecture my Mom got on her diabetes diagnosis (when most of her problems turned out to be due to lungs full of blood clots, not the diabetes, anyway) so was very pleasantly surprised.


I did get to look at some very funny rubber models of food & describe whether my usual portions are that size or some other size. I guess the rubber food toys come with the territory. Boy, if anything would put you off any food, those would. The "berries" model was especially awful.


Next appt was with the nurse-practitioner, who revealed that their plan was, in a month, if my blood sugar stays down (high 90s, low 100s) to slowly wean me off the Lantus insulin (yay!) & slowly put me on a pancreas-kicking drug. To see if my beta cells have recovered enough to put out on their own again. With some chemical prompting.


They've also got me on omega 3 fish oil pills, to lower my already-very-low (112) bad cholesterol even lower. Its that or statins. So 1st I go with the fish oil.


I again broached the question about not really knowing what is wrong in my case; is it pooped beta cells? Is it a problem with the hormone that's supposed to tell the liver to stop turning stuff into glucose, which hormone Metformin reportedly replaces? Is it insulin-resistance of my muscle cells, so the sugar just can't get in? Is it some combo of 2 or all these factors?


The nurse-practitioner said I could have a ref to endocrinology if I really wanted one, but we're both not so sure they'd order all these tests even though I want them. For the present I'm staying with the "this worked, now we'll try this next & see if it works even better" approach, but I'd rather have a clearer diagnosis based on tests. I like the nurse-pract a lot though, & they're putting up with me, & that counts for a lot with me in medical personnel.

[a1mamacat]

Lord I'm exhausted from all the testing and clinics, and I only read it.

Hugs to you ghostie, you seem to be on the right track, and kudos for putting your proverbial foot down about things you know work for you.

continued better news is my wish.

[thguy65]

I again broached the question about not really knowing what is wrong in my case; is it pooped beta cells? Is it a problem with the hormone that's supposed to tell the liver to stop turning stuff into glucose, which hormone Metformin reportedly replaces? Is it insulin-resistance of my muscle cells, so the sugar just can't get in? Is it some combo of 2 or all these factors?

In a nutshell, the answer usually is you have a combination of all of those things.
Just for clarification, it is insulin that tells the liver to stop releasing glucose into your system, and metformin helps your liver respond better to whatever insulin is present (whether it is your own insulin or the injected insulin).

I'm happy to hear that you are getting to the point where they can try using less insulin, but I suggest you consider the newer drugs with a cautious eye as well. There can always be concerns of undiscovered side effect issues, while insulin is tried-and-true.

[Bob Juch]

Strange that your doctor would say, "your insurance had better cover this," as most just call the insurance company and check themselves.

[ghostjmf]

BJ says:

Strange that your doctor would say, "your insurance had better cover this," as most just call the insurance company and check themselves.

My doctor didn't say that; the scheduler-person at the nutrition clinic did. I had a go-around about whether it would be covered with the person at the contact # at the insurance. One problem is that the nutritionist is not a doctor (or a nurse-practitioner). My nurse-practitioner thought the insurance would cover it, "because we referred you", but I've found out in the past the hard way that while a referral from your doctor (or nurse/pract) is essential to get coverage at all, it doesn't guarantee that the insurance will cover something.

Turns out that while the nutritionist is not listed by name in the insurance company's list of "local referrals we will cover", because they're not a doctor/nurse, the clinic actually is listed. By some special # the insurance listed which the clinic nicely gave me. Not by their name, that would be too easy.

[ghostjmf]

Thank you for checking back in, theguy. Can I ask if you would be doing tests, or also assuming "all 3 are true", at least to start out with? The nurse-pract is this practice's diabetes expert, but of course they are not an endocrinologist, because they haven't had the full medical training. They do run all their plans for their patients by the doctors in the practice 1st, but all of those are general-practitioners.


They want me to do more exercise, of course. Its axiomatic that however much exercise a type II diabetic is doing, since they still have high blood sugar without drugs to bring it down, they're not doing enough. My problem with this is that even if I were to embark on a serious exercise routine, & it really worked, I'd be in real danger on days when for whatever reason I couldn't get the routine in. Whereas I can cut down carbs all days. And I can take these darn drugs all days.


I'm very wary of side effects from new drugs. I hate being on drugs, period. The appetite-suppressant effect of the Metformin does me good, but the slight, & sometimes not-so-slight nausea from it only does me good in that when you're nauseous, you don't want to eat. I don't, anyway.


I was really afraid I would have some bad side effects from the Lantus (for the rest of you; this is recombinant-DNA insulin formulated to be longer-lasting than regular human insulin), but so far have not.

[thguy65]

Thank you for checking back in, theguy. Can I ask if you would be doing tests, or also assuming "all 3 are true", at least to start out with? The nurse-pract is this practice's diabetes expert, but of course they are not an endocrinologist, because they haven't had the full medical training. They do run all their plans for their patients by the doctors in the practice 1st, but all of those are general-practitioners.

I don't bother to do the tests since the information rarely would alter my treatment plan.
Typically, if you are doing well with metformin and insulin then I keep my patients on it. if you can get by with minimal insulin, then that's great, but I don't try to switch patients from insulin to the newer drugs unless the patient has special issues (such as a truck driver that can't keep his commercial driver's license if using insulin) that truly make the new oral medications advantageous.

- Tim H

[ghostjmf]

http://www.diabetesincontrol.com/index. ... le&id=6740


thguy corrected my ambiguous comment about "the hormone that tells the liver to stop putting glucose into the blood stream" by say that the hormone was insulin.


The reason I was being ambiguous, though, is that I had read an article like the article above; finally found one again.


I am sure thguy knows this stuff, but for the rest of us:


When you're fasting, such as while you sleep, the liver puts glucose into the blood.


When you eat carbs, signals of them get to the pancreas, which then puts out insulin. Insulin then signals the liver that it can stop putting glucose into the blood, as you've got enough from what you ate.


Insulin, as many hormones, in the case of telling the liver to "stop putting glucose into the blood", acts through agents in the body instead of directly, say by fitting into a particular slot for it on liver cells. In the case cited above the agent is a chemical called CPB.

Insulin is supposed to cause production of CPB, & its the CPB that actually fits into slots on liver cells (or some method like that) to turn off the the production of glucose by the liver. But with people with insulin resistance, this signal isn't working.


The study cited says that Metformin actually acts like CPB, doing the job of telling the liver to stop producing glucose.

Why the bodies of Type II diabetics do not produce enough functional CPB is still not known.

[ghostjmf]

http://www.sciencedaily.com/releases/20 ... 145741.htm

Another article, here saying the pancreas normally secretes the hormone glucagon to get the liver to secrete glucose, & that Meformin suppresses glucagon.

How this ties in to the previous article I cited, &/or whether some of these chemicals are the same ones under diff names (yes, that happens in the World of Science)) I have to look up.