Just Par for the course. (Long read...Sorry)

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Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/16/2009 6:00 AM (GMT -7)   
Between "insurance" companies and the medical profession as a whole it is really a shock that 90% of the population doesn't die of complications from diseases by the time they are 25.

(Yes I am on a bit of a rant after my latest round of walking through Wonderland)

I have been using the One Touch Meter for a long time. It was the meter my old insurance sent me when they finally got around to approving paying for my testing supplies. I have had a few upgrades over the years, but they have always been to newer One Touches.

Back about the time there was the recall on certain One Touch meters I lost mine so I simply sent in a request to the makers of One Touch for a free meter. Not knowing about it my wife did the same thing and they arrived a day apart. Cool. Now I have two meters. Nice to have a backup just in case. A week later the insurance company sends me a new one because of the recall. Really cool now I have 3. I ended up giving one away though to a single parent in town whose child is type 1 after hearing that her old meter was ruined and it was going to take a week before they could get a new one. Anyway 2 meters is plenty.

I was using one of my meters up until a couple of weeks ago when it crashed. No big deal. I just pulled out the backup and started using it. I was running low on test strips (only had about 10 days left) so I went and reordered them from the pharmacy. When I went to pick them I was informed that my "insurance" (I have a premium based medicaid type insurance) would no longer pay for One Touch. They had contacted my "doctor" to get authorization for a new brand of meter and test strips. The insurance company also decided to no longer pay for Novolog and Levemier insulins so a request was also sent in to switch me to Humalog and Lantus.

As it turns out my "doctor" was an vacation so it took almost 2 weeks to get new scripts written. In the meantime I ran out of test strips (I kept 3 in reserve just in case I felt like I had a low sugar episode) though fortunately I am on a slightly different schedule with insulin scripts so I still was able to take my insulin though with they way I yo-yo with the effects of that I did temp reduce it to try to avoid any low issues.

So anyway I finally got my new testing supplies yesterday. I also had an appointment with the Nurse educator again and ended up picking up my meter on the way to my appointment. When I got there I told her first off about everything that has happened in the last 2 months. Might as well saved my breath because the first words out of mouth when she downloaded were "Why are there only about 2 weeks worth of readings". Errrrrrr. So we discuss everything that has happened AGAIN and this time she says: "Why didn't you call me. I could have given you a new meter. I have boxes of all of them."

So I asked her: "Until today did you know which meter the state insurance would pay for? Answer: No.
Next question from me: Do you have test strips for the meters you could have given me? Answer: No. You have to have a script to get strips unless you pay for them out of pocket.
Final Question: Can you write scripts for test strips, meters, insulin? Answer: No I am just an RN not a nurse practitioner.

Ok, so what good would it have done to give me a new meter. I had/have a working meter. I just don't, nor could I afford to buy test strips.

So anyway I had been thinking about splitting my long acting insulin into 2 equal shots taken 12 hour apart since I have read that for some people Lantus/Levemere works less than 24 hours and tried to discuss this with her. Her response was basically: "Well it isn't going to hurt anything but is not needed since those are 24 hour insulins."

I asked her the following: Wouldn't splitting the long acting help determine if I am maybe metabolizing it faster than 24 hours as well as help determine if I need an adjustment in the dose of the long acting as well as potentially stabilizing my sugars somewhat if I am using it up faster than advertised or if maybe as a result of using it up faster than 24 hours I am taking too much fast acting and my body is having a bit of a war with the insulins causing or at least contributing to the roller coaster ride. Her answer was "Well yes, that is possible."

Generally speaking I try to be a good patient. If I agree to let any given medical pro treat me I do try to follow their advice and instructions and after my latest round of doctor troubles I am a bit gun shy about "bucking the system" and pissing off anyone, but I am running out patience with all of this double talk and every medical pro I come into contact to using a totally different play book in regards how to "beat" this diabetes demon team I am up against. I really think after 10 years of playing it "their way" it is time for me take a more "active" approach to this and try doing things my way a bit.

After 10 years of following all the "expert" advice all I have to show for it is severe nueropathy in my legs and feet, entry level Chronic Kidney Disease, and I think it is starting to mess with my eyes a bit now too as sometimes I can't focus (something totally new that just started in the last week or so, and yes I am heading to the eye doctor as soon as a check comes in we are expecting).

As several some one's have said, sometimes it is better to ask for forgiveness afterwards than permission before, and I have come to the conclusion that time is a bit overdue.

Sorry for the long read, and thanks for letting me rant and vent.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 9/16/2009 6:22 AM (GMT -7)   
I can imagine how frustrated you are.  This is so stupid.  Any chance of explaining this to the doctor?  And a question I have is why you couldn't get a prescription even if the doctor is on vacation.  There should have been another one in his place and if need be your doctor could have been contacted wherever he was.  Life doesn't stop because a doctor isn't in the office.  What you describe is a disservice to the patient.  Sorry you had to go through that.  mad
Lanie
forum moderator - diabetes
diabetes controlled so far by low/no carb diet and exercise; no meds
                                                                 


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 9/16/2009 7:34 AM (GMT -7)   
Jim - I replied to your last 2 posts with a whack of info that I thought might point you in the right direction (to better manage your insulin & diet regimen). Did you read them? Find any of the info valuable? I ask because you didn't respond to them :-)

Still don't know if you're type 1 or 2 (I assumed Type 1, which is why I gave you the "how to use insulin" links). Is your doctor an Endo or GP? That can make a big difference. Do you use Rapid with an I:C ratio?

You've had the 'D' a bit longer than I have but, one thing I learned very quickly.....
"I am the most important person in managing my diabetes".

I consider myself like the CEO of my own company and my Endo, GP, eye doctor, and diabetic nurse are like my VPs and executives. I rely on the information they can provide and value their suggestions and recommendations but, ultimately, I run the company and I make all the decisions. It's a tough job, especially to to well but, there is no one better suited to the position. I live in my company (body) 24/7 and my executive team provides updates on a quarterly basis. It's the day-to-day operations that determine success (which is why I continue to keep a daily log).

If you don't have a good team that works with you - find a new one. If you HAVE to work with the one you got - take the CEO's position and start making them work for you. It is unfortunate but true... most medical professionals (for various reasons) do not and will not know more about your diabetes situation than you can, especially if you take an active role in learning all you can about how diabetes works. Example: You're switching to Lantus from Levemir. Learn about Lantus' action profile and match it to your personal rhythm - i.e. dose at night or morning or split? Most switchers find they need about 20% more Levemir than Lantus so, be aware that your basal dose will change.

Insurance can be tricky depending where you live. In Canada, ours differs from province to province plus whatever private insurance one has. One province may cover strips and insulin and another only needles and meters. Shop around is the name of the game here.

Most pharmacies often have an "unadvertised" continuous promotion that sees the meter given free with the purchase of 100-strips box. I've been using the One Touch for years and was told this by a Wal-M*rt pharmacist. Whichever meter strips your insurance allows, just make sure you go in with a script for the strips, get the 100 box, ask about the "meter free with purchase" and often it's free. This is a program that the meter manufacturers have with the pharmacies. It's in their best interests to give you the tool for free 'cause the money is in the strips :-)

With the switch in insulin regimen you're about to make, you may want to start a log to record the BGLs, insulin doses, and carbs consumed (if you're not already). It will help you and whomever it is you work on this with, to find the best regimen to suit you. Again, your basal dose and timing will be the first place to start with the new insulin. The link I posted in past replies will be helpful for that.

Keep us posted; let us know how you're making out.
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/16/2009 11:48 AM (GMT -7)   
Well folks, for starters you have to kind of remember I am currently in something of a doctor limbo.

Back about March I was shown the curb by my last doctor.
Took until end of June to find a new medical pro (Nurse Practioner turns out) who would see me.
She then passed me off to an actual MD in the same clinic due to my chronic pain issues, but was writing scripts for my diabetes supplies and cholesterol meds.
I don't see the MD until next month.

I do agree someone else should have been handling script needs for the NP while she was on vacation. I have no idea if there was I just fell through the cracks or what. I also feel the state should have sent out a letter about all the medication changes a month or two ago to both those with the medicaid insurance and to all the doctors in the state so they could be prepared. In my opinion a lot of people dropped the ball on this one and I sort of ended up under a rock thanks to it. Then again it is nothing I aint used to.

As far as an Endo goes, nope don't have one. Last one I seen was a jerk with a capitol J-E-R-K. That was when I had my old insurance and under the care of my former GP. He was also the only endo at the time within 3 hours drive who was taking my old insurance and new patients.

Far too many medicos have God complexes going on in that they want their patients to do what they tell them to do and get very mad when they don't regardless of the reason. Since doctors can drop a patient for any or no reason at all it is something of a fine line when it comes to "self treatment".

I have just over a month to go before I see that MD and two months before seeing that nurse educator. So I have a little time to sort of experiment and see what I can do. Hopefully I can show some positive results to that MD. At least enough she will say "Keep doing what you are doing."

The two things, in case you haven't noticed yet, that really tick me off about all of this are: Everyone operating from a different book and being treated either like I was diagnosed yesterday or I am a complete idiot. I may not be a genius but I think my 127+ (lowest IQ score I ever got) is good enough to comprehend most things. tongue
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 9/17/2009 8:42 AM (GMT -7)   
Jim,
Did you read Phishbowl's post? Ranting is fine but we can't help you if you don't fill in the blanks. Are you a Type1 or Type2? Are you keeping a food diary along with your meter readings? Readings alone do not give the doc the full picture of sugar management. Do you exercise?

And finally, please thank your lucky stars that you have some type of insurance. I've had none for over six years. I purchased a Prestige IQ meter online with 300 test strips for about $100 when I started. This meter has been good to me and the strips are very inexpensive.

Please give us some answers so we can help.
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
I know God will not give me anything I can't handle. I just wish that He didn't trust me so much. ~Mother Teresa

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/18/2009 9:15 AM (GMT -7)   
My official diagnosis is that I am an insulin dependent Type 2.

I do not currently keep a food diary. I have done so twice in the past. Once for 3 months and once for 6 months....and my "food" diary was more than just food. It was a complete diary that included blood sugar readings, every food and drink I had through out the day, carb count per day, any medication changes, and how I was feeling. Both time I have kept one I did it on my own and gave copies of it to my doctors as well as any Nurse Educator and/or dietitian that I may have seen.

At best I get some kind of runaround speech about how it can take time or how this, that or the other can effect things. At worst I am basically called a liar.

In the past 10 years I have also read enough literature from so called experts from all over the world about diabetes to fill a full set of encyclopedias.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5408
   Posted 9/18/2009 9:37 AM (GMT -7)   
Ok, Jim, I think you need to stop dwelling on the past.  Pull yourself up and take control of your diet yourself.  Go out and buy the Bernstein book.  No whining because whining never changes anything. nono
Lanie
forum moderator - diabetes
diabetes controlled so far by low/no carb diet and exercise; no meds
                                                                 


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 9/18/2009 9:45 AM (GMT -7)   
I'm confused... I really thought that insulin dependent meant Type 1. I am type 2 and was on insulin but I changed my food plan and removed most everything white from it. No wheat, corn, rice, barley or potato products. I dropped about 45 lbs and had to go off of my insulin because I was getting too many lows.

I pretty much maintain this food plan and have kept my sugars in line with my metformin. I also swim for exercise and walk when I can. Exercise has a huge impact on your sugars and how your body handles insulin resistance. Is this something you can add to your regimen?
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
I know God will not give me anything I can't handle. I just wish that He didn't trust me so much. ~Mother Teresa

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/18/2009 11:23 AM (GMT -7)   
Type 1 means that your body is not producing insulin or very, very little.

Type 2 means you are still producing insulin but either not enough or that your body is losing its ability to properly use what it does make.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 9/18/2009 11:27 AM (GMT -7)   
And it is not that I am dwelling on the past. I am in the same "rut" with these health care idiots that I have always been in.

As far as "taking charge" there is a fine line you have to walk with these doctors. If you have never run head long into the "good old boy club" these quacks have great. Once you do and see what they can do with immunity you tend to be cautious.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 9/18/2009 12:07 PM (GMT -7)   
Type 1 & 2 really differ mainly in one way: diabetic ketoacidosis.

Idiopathic diabetes is divided into two main types; insulin dependent and non-insulin-dependent. Insulin-dependent diabetes mellitus, IDDM (more commonly referred to as type 1 diabetes) is defined by the development of ketoacidosis in the absence of insulin therapy.

Type 2 diabetes is characterized by a lack of the need for insulin to prevent ketoacidosis. (Unlike patients with type 1 diabetes, those with type 2 diabetes have detectable levels of circulating insulin).

Insulin therapy is and can be used for both Type 1 & 2 Diabetes. Insulin usage does not determine the type; it's just the method (therapy) used to treat the condition.

Not sure where I can help you, Jim, or even if you're looking for that?? (Maybe just want to rant - that's OK, too. Just let us know that so we don't think you're looking for advice if you're not).
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Linty
New Member


Date Joined Oct 2009
Total Posts : 1
   Posted 10/4/2009 12:41 PM (GMT -7)   
Hello Jim, This maybe long as well. I am not sure if you are T1 or T2, if you are T2, this is what I did. I started with fasting glucose 267 and A1C 11%. It was a shock. I am obese (now I am only ovewight) Lost 20lbs in 3 month. I walk 30 min./day, a do 30 min. weight resistance at the gym almost daily. (oh how I hate it..LOL) I refused any kind of medication until I find out if I can deal with this just by diet, excersize and good sleep. I bought my own glocometer (Aviva from Roche) and bought the software that is available from Roche to monitor progress and defeats. I started immediately on a very low to zero carb. diet. That's the only thing that works for me. Again, I am T2, T1 would be very different. I eat skinless chicken, lots of fish, sardines, even tuna, 1x/week a small piece of either pork or beef, vegetables, especially dandilion salads, kale salads, spinich and asparagus. Tomatos are ok too. No yougyrt for me, 1tbs of cottage cheese at the time only. I eat a lot of whey protein (in skakes with almond or soy milk) I put cinnamon in my decaf coffee or on anything it can be put on. I use Flax seed as crunchies on anything, I do eat small portion of nuts, mainly brazil nuts and walnuts. I use for snacks roasted pumpkin seeds. I stick my fingers at least 10x/day, fasting in am, then before any food, as well as 30min. after, and 2 hours after. That tells me about the food reaction as well as portion size. Downloading results with notes of what I ate and how much, gives me a running curve of my progress. I do take a lot of suplements. Dandelion,Mormodica (bitter melon) Nepal cactus,Gymnema sylvestre, Thiamine (actually Benfotiamine, much vetter absorption,)Vit.B6 in addition to a B compex, extra vot E and C and manganese. L-Carnatine, Alpha Lipoic Acid, Vit.K and 2000Iu of Vid.D, For the eys, I take Lutein, Zink, Billbery and Eyebroght.
Results so far: Fasting between 90-105. Before breakfast usually arould 120, after breakfast briefly up to 140-145, back down to 120 in 1 hr. After lunch (my largest meal) I spike to 150 - 155, but back down in 1 - 1 1/2hr to 120-125. Lipids normal, cholesterol normal,renal functions normal.
Obviously, not completely out of the danger zone which I consider any time reading over 140, but I am making huge progress in just over 2 month. I am hoping that loosing more weight will also help. I will run another A1c in December, will let you know.
Lucy
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