Diabetes Management

[Guest guest]

Shirley,

You wrote, " The first endo I went to when I found out that I was a mild

diabetic was very good at his job but he was very rude. "

Just to encourage you to keep the training to the professionals and then tell

the doctor what to order. After my visit with the CDE program, I left with

videotapes and manuals, books, and more. Everything I could imagine on pumps. I

find CDE's much more understanding of treating with the most appropriate means

to avoid getting any worse. An insulin pump is more likely to mimic the

healthy pancreas.

Indiana has recently done a joint venture with the Federal Health care

Agency's to fight Chronic Disease. They now offer a free twenty hour Diabetes

Management Course to anyone.

Dr. Sutherland, however, can't seem why everyone with Diabetes doesn't get a

pancreatic transplant. He says the anti rejection drugs don't contain steroids

and the success rates for full pancreas transplants are highly successful.

That is still the route I ultimately want to pursue.

On the flip side, Dr. Sutherland told me that there are islet cells through

out the body, and he has seen remarkable things occur when the diseased

pancreas is removed and patients are off narcotics. I believe in Quantum Healing

and

really believe that in the right circumstance we could all be free of disease.

Karyn E. , RN

Executive Director, PAI

http://www.pancassociation.org

Pancreatitis Association International

[Guest guest]

My Gi prescribes me my pain meds all the time and when one doesnt work he

tries another ntil something works. He is now thinking about sending me to an

anathesiologist(sp?) for a nerve block. My suggestion is fined a new pcp, find

a good GI and go to the pain clinic they can help too

[Guest guest]

>

> Dear All,

> I am becoming very disappointed in my PCP as ever few

> times I have been to see her she hurries me in and

> out.

> When she started me in insulin, she pretty much gave

> me the monitor, needles and all that goes with it-and

> said " go for it " No instructions, no counseling or

> anything. So I am pretty much on my own.

Hi Donna,

Wow, this is a lot to be given to " figure out on your own " ! In

general, most hospitals/large medical centers have separate " Diabetes

Management Training " departments to do this sort of thing ... but

your PCP should at least have pointed you in their direction. You

might make some phone calls to some of your area hospitals and find

out if they have such a program/department. It's a pretty common

thing, especially since diabetes is so prevalent. Most of the

programs are staffed by RNs with a special " CDE " (Certified Diabetic

Educator) certification.

At this year's Symposium, one of our speakers was Shirley Howell,

RN/CDE, who gave a talk about diabetes management in pancreatitis

patients. You can download the handouts/lecture notes from her

presentation from the following url:

http://www.pancassociation.org/symposium_2003_handouts.html

This gives a general overview, but you really do need to have the

individualized direction of an endocrinologist and/or diabetic

educator. Diabetes is the #1 complication from this disease, and

keeping that under control is extremely important to your health.

Cheers,

--Tull

[Guest guest]

Dear Donna,

Boy, can I understand why you're disappointed! Diabetes management has a

pretty severe learning curve, and having instruction by a certified diabetes

educator is essential to get you started, and then to help guide you through

any adjustments you may need to make to your insulin and dosages to get

your BG under good control. I can't believe your PCP hung you out and left

you to dry like that! I'm not surprised, though, my internist did just about

the

same thing. The problem was that she just didn't understand that much

about the different insulins available, or how to figure out dosing for carbs,

etc. It turns out she had me taking my insulin on a sliding scale AFTER I did

my post pradial check, which is totally wrong, and I was forever trying to

" catch up " with sky high glucose levels.

Fortunately I was able to get in with an Endocrinologist within a month after

my diagnosis. He changed my baseline insulin to Lantus, and put me on a

fast acting insulin (Humalog) to take BEFORE my meals. The amount I take

is based on the carb values of each meal, as it should be, not on a

predestined sliding scale. The sliding scale makes no sense if your carb

intake adjusts with each meal. And this type of dosing is perfect for someone

like me who doesn't always eat three meals a day, or eats at different times a

day, or eats different amounts of carbs at each meal. Once I met with the

Endocrinologist, he set me up with an appointment with the CDNE Certified

Diabetic Nurse Educator) that he has in his office. She interviewed me at

length, to find out what my habits were, what I liked to eat, and when, and

how much. Then she devised a schedule to get me started. Ever since then

I've had excellent control, except for those odd days when my brittleness

decides to throw me a curve. When that happens, nothing works the way it's

supposed to, my levels can jump from 90 to 280 within an hour for no

explicable reason, etc. I've learned not to stress out about those days, and

just concentrate on the regular days.

I love the Lantus, because it does cover me accurately enough that I can go

all day without food (like when I was NPO in the hospital), and my BG levels

will remain constant and steady. I don't have to eat meals at any prescribed

time, and I don't have to eat a set amount at each meal. With most other

insulins, you're programed into having to eat within a certain time, and also to

eat a controlled amount each time. You don't have to do that with Lantus,

and if you skip breakfast, or have to skip lunch, it will still remain constant.

For meals or snacks, the amount of fast acting Humalog I use is based on the

number of carbs I plan to eat at that meal. I also take an additional dosage of

Humalog about 2 1/2 - 3 hours after a large lunch and every dinner to cover

the protein from that meal. It takes protein longer to digest than fats and

carbs, and we found out that my protein intake wasn't even starting to digest

until about 2 1/2 hours after I ate. This is called dual digestion, and seems

to

be a problem with a lot of diabetics.

Once I got good instruction at how to figure all of this out, it's made life so

much easier and it's given me great control. I never could have done it

without help, though, and my CDNE and an insulin instructor are the ones

who helped make it happen.

Tull's advice about diabetes management classes at the local hospital is on

target. Each of the hospitals in my area offers those, and you should look

into this. I'd also recommend that your diabetes care be managed by an

Endocrinologist, instead of your PCP, anyway. Most Endo's have a CDNE, or

can refer you to one.

As for your pain med situation, if your GI won't prescribe, then yes, I guess

you need to find help from a Pain Management Clinic. Fortunately, my GI

wants to have full control of my pain mangement issues, and has so far been

great about prescribing the medication I need, and also about increasing the

dosages as needed, too. I'm guess I'm lucky in this respect, after listening to

so many other's complain about problems with their own.

What insulin are you taking, and what kind of dosing schedule are you on?

What is your target BG level? Have you had an HB1c test done, and what

was your score? If there's any way I can assist you with any of this, I'd be

glad to help, or I can direct you to some online support groups that could

help, too.

Handling your diabetes management is defintely something anyone needs

some thorough instruction with when they're a newbie. It's not a

one-size-fits-all type of disease, and YMMV (your milage may vary). If you

want to discuss this more, and there's anything you think I could help with,

please feel free to email me: hhessgriffeth@... anytime.

With hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep.

PAI, Intl.

Note: All comments and advice are personal opinion only, and should

not be

should be substituted for a professional medical consultation.

Donna wrote:

> I am becoming very disappointed in my PCP as ever few times I have been

to see her she hurries me in and out. When she started me in insulin, she

pretty much gave me the monitor, needles and all that goes with it-and said

" go for it " No instructions, no counseling or anything.

I asked her for pain meds, and she said her hands were tied.... GI's purpose

is not to prescribe pain meds.

[Guest guest]

Heidi,

Thank you for sharing your diabetic experiences. I am interested in

seeing if my PCP will set me up with a diabetic educator as well as

an endocrinologist because I am using NPH plus a sliding scale and I

do always seem to be playing catch up when things aren't just so

with my schedule. (wow what a run-on sentence)

My wife and I are in the middle of moving to a nicer place and my

schedule is all on its head right now. I have been mostly ok but I

have had two sub 70s and two plus200 hundreds during this move time.

Its because I am on absolutely no kind of schedule right now.

thanks again,

Bert

> > I am becoming very disappointed in my PCP as ever few times I

have been

> to see her she hurries me in and out. When she started me in

insulin, she

> pretty much gave me the monitor, needles and all that goes with it-

and said

> " go for it " No instructions, no counseling or anything.

>

> I asked her for pain meds, and she said her hands were tied....

GI's purpose

> is not to prescribe pain meds.

[Guest guest]

Bert,

I'm glad that my comments were of interest to you. As you can see, I'm really

sold on this insulin, Lantus, because of the fliexibility it allows me. It

makes

me feel like I'm in control of it, instead of it controling me. I can chose

what I

want to eat, and when, and as long as I'm sensible about my choices and

cautious with my carb intake, most times I can get the results I need to keep

my BG levels under good control.

I don't know much about the other insulins, as I took Regular and Novalin on

a sliding scale for a very short time and had horrible numbers the whole time I

took them. I never had any control whatsoever and found the whole process

frustrating.

If I'm able to eat what I want, in reasonable quantities, and when I want,

without extreme variation, it makes it so much easier and less of a situation

where everyone else is having to adjust to my schedules. There's no

hardship for anyone else around me with my using the Lantus and Humalog.

I understand it is more expensive than some of the others, but insurance

covers it all but my copay, and in this regard, like the hair coloring

commercial, I feel " I'm worth it " . I'm definetly all in favor of anything that

can

help make life living with two chronic illnesses easier. The complications of

diabetes as a result of poor glucose control are terrifying to me, and I'll do

whatever I need to to avoid them.

Let me know if you have any more questions or if there's any way I can help

you with this.

With hope and prayers,

Heidi

Heidi H. Griffeth

South Carolina

SC & SE Regional Rep.

PAI, Intl.

Note: All comments and advice are personal opinion only, and should

not be

should be substituted for a professional medical consultation.

Bert wrote:

> Thank you for sharing your diabetic experiences. I am interested in seeing if

my PCP will set me up with a diabetic educator as well as an endocrinologist

because I am using NPH plus a sliding scale and I do always seem to be

playing catch up when things aren't just so with my schedule.