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6 Responses

  1. AngelaC
    AngelaC August 12, 2013 at 7:33 am | | Reply

    Vis-a-vis the “over-basaled” issue: I’m not a professional, but I have personal experience with it with both myself and my mother.

    Before I was properly diagnosed, I’ve had doctors who’ve insisted that where the fastings go, the post-meal bgs will follow. When I was put on Metformin ER, it brought my fasting bgs down, but if I ate anything, even a salad without croutons or any heavy starches, my bgs would remain high (mostly over 200) for 3-4 hours after (or more). When I showed my doctor these readings, I was either dismissed and told that those between meal readings were unimportant or called “neurotic” and “non-compliant” for over-testing and obviously not taking the Metformin as prescribed. The doc’s response? Double the dose, yell at me some more, and tell me to stop testing between meals since all it was doing was upsetting me. I didn’t stop the testing, and 3 months later, still taking double the Metformin, I still was having post-meal bgs in the sky-high range. So, then we added Lantus and you know what? All that did was make my fasting bgs even lower, so I was having overnight lows and between meal highs. When I asked what the logic behind this treatment was, these doctors truly and honestly believed that if we could force the fasting down low enough, we could keep the bgs from rising so high after eating. This was even after I found out my c-peptide levels were in the type 1 range and should have signaled that I was in desperate need of insulin at meals as well as a long acting.

    Now, my mother (a definite type 2) is going through the same thing. She’s been on Metformin ER for about a decade (or more), and when it began to fail, she was placed on a series of drugs (Glipizide XL, Avandia (off now), and Januvia) in addition to the Metformin. All of these drugs are long-acting (“basal” drugs, so to speak) and of the four, only Januvia really does anything “more” when the person is eating. Despite all these drugs that are supposed to get her bgs down, her last two A1cs were 7.6% — way too high. So, what did the doctor do? He added yet another treatment — Levemir — that acts on the basal end of the problem! He didn’t even bother to look at any bg readings to see where the problem is so he could decide how best to attack it! Instead of helping her, she ended up having lows in the middle of the night if she didn’t eat a relatively substantial snack before going to bed and her fasting bgs never rose above 85. Because of the number of lows, she ended up discontinuing the Levemir before she even finished her first 5 pens. Yet, her A1c remained high because no one has bothered to look at her post meal bgs and do something to attack them instead!

    IMO, I believe this is part and parcel of the culture of doctors who believe that patients are more compliant with instructions if they have to take fewer pills, fewer shots, etc per day. Frankly, I disagree. I’m far more compliant with my insulin regimen and more likely to remember it than I am my once-a-week Fosamax pill! I also think it’s part of the left-over thinking from before the DCCT, from before the spread of home bg meters, from before strips were nearly universally covered by health insurance plans. It’s thinking from the time when too many people only knew what their blood sugars were when they went to the doctor’s office and that was the most important measure of a diabetic’s control. If you ask me, it’s beyond time that way of thinking got changed.

  2. Mary Dexter
    Mary Dexter August 12, 2013 at 9:19 am | | Reply

    In Jenny Ruhl’s book, Blood Sugar 101, she explains that fasting blood sugar’s measure how well the body maintains its basal insulin. However, when the body can’t produce enough insulin, it borrows from what’s stored for the first attempt to cover food to make up for the amount missing from basal (heart and brain take priority), leaving less to cover meals. The body then tries to make up for this deficiency by covering the meal with the second surge. Thus, the first thing to go is not fasting, but post-meal.

  3. Andrew Bell
    Andrew Bell August 12, 2013 at 11:38 am | | Reply

    Thanks for the recap, Amy. Very informative.
    As always, it’s nice seeing familiar social media faces at in person events.

  4. Bennet
    Bennet August 12, 2013 at 1:54 pm | | Reply

    Great to see you. Loved being a part of the social media session. Most inspiring to see that day attendees who took it to heart and engaging on Twitter.

    Best

  5. Kate Gilbert
    Kate Gilbert August 21, 2013 at 3:07 am | | Reply

    Hi Amy, Thanks for the rundown from the conference – brilliant insights and updates.

    I wish you every success with broadening the content on those AADE tablets.

    I published some research last year in the ADA’s Diabetes Spectrum journal which showed that health professionals (mostly DEs participated) hugely underestimated the breadth and depth of support that people with diabetes get from participating in online communities. They may acknowledge that people find it helpful to connect with others, but when you ask people with diabetes similar questions (we ran online focus groups), they describe much more than just connecting, things like staying motivated, staying sane, and even learning how to live with diabetes and problem solving skills. We know this of course but some people need things formally researched and published which I managed to do at last. Might be some more ammunition for you in that!

    I’ll be writing about the research some more on my new blog soon or the Diabetes Spectrum article is online and full of quotes from the focus groups that could be useful.

    Good luck, I look forward to hearing your progress, Kate

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