The Endo Encounter

Posted by on Jul 21, 2015 in Diabetes & Emotions, General, Management & Care, Treatment & Medication |

(Originally posted at My Diabetic Heart.)

So, last week I had my first appointment with an endocrinologist.  For the last six and a half years, my diabetes care has been overseen by my primary care doctor, but due to some struggles I’ve had and changes that I wanted to make, we agreed it was time for a referral to an Endo.  Initially, I was excited about the change, but as the appointment grew nearer, my nerves got the better of me and panic set in.  I was Expecting the Inquisition.

Well, I survived that appointment.  In fact, it went much better than I feared it might.  I do have some reservations about it, but I’ll get to those in a bit.  First, the good parts.

Doc D. is a young guy, maybe 34 years old at most.  I’m 31, so we’re close in age.  He was attentive, listened, and took the time to get to know me and my situation.  He asked a lot of questions and documented my responses as we went along.  I appreciated how thorough he was, and the fact that he took the time to process my information and put his recommendations in writing before he tried to explain his thinking behind them.

He revised my meal time insulin regimen, giving me a coverage plan that is more logical and better suited to my needs.  That should help a lot.  He left my Lantus and Victoza doses alone.   He also prescribed the oral type 2 drug Jardiance for me to try, and suggested that I add a coenzyme Q10 supplement to help strengthen my heart and increase my energy levels.

Doc D. also said he wants to check my pancreas output with a c-peptide test.  He was a bit surprised that I’d never had one.  And since he was ordering tests, I requested that he order GAD65, IA-2, and insulin auto-antibody tests while he was at it.  I practically begged my PCP to run those tests, but they were never done.  Now, they will be.  So, I have that bloodwork to look forward in two months.

He took his time and didn’t rush through the appointment.  That was huge in my mind.

And…. AND…. There was no mention of my weight at all.  Let that sink in for a second… The doctor did NOT focus on my weight at all.  I’m really not use to that.  I was honestly kind of shocked.

His focus was more on nutrition.  Eat better, the benefits will follow.  Hey, I agree with that logic.  I know it works.  But the means of getting there are where some of my reservations begin.

Doc D. is something of a paleo diet evangelist and strongly “encouraged” me to adopt that diet and to severely restrict my carb intake.  He wants me to give up a lot of things that I’m just not sure I’m willing to ditch completely.  I have a real problem with having to deprive myself of the things I love, and I have no desire to go back to starving myself like I did for months after I was diagnosed.  While the results at that point may have been beneficial for a while, it ultimately lead to a major crash and burnout.  I don’t need that again.  I’m willing and wanting to make some changes, but I’m not sure the paleo diet bible is one that I’m willing to thump.  And I’m certainly not going to be beaten over the head with it.

The other major reservation that I have concerns the drug Jardiance that I mentioned above.  I had never heard of it, but through some research I’ve learned that it’s basically Lilly’s version of Invokana.  It’s an oral type 2 drug that is supposed to help my body dump excess sugar when I take a leak.   I’ve heard mixed things about that class of drugs and I’m incredibly leery about starting it.

I have two issues with this.  One, yeast infections are listed as common side effect of this medication.  If you’ve read my story, you know that’s what lead to my diagnosis in December 2008.  It’s understandable that I wouldn’t want to venture down that road again.  Secondly, do I really need another medication on top of what I’m already taking to treat my diabetes?  I’m already taking Victoza, Humalog and Lantus.   I think that’s enough. And I’ll spare you a rant about the additional monthly cost of that medication and the CoQ10 supplement.

So overall, the appointment went well.  I have some strong reservations about some things, but there were some really positive things that came out of it.  I’ve got some clearly defined goals to work on as far as my A1C goes, a better insulin regimen, a new supplement that seems to be helping to boost my energy, and hopefully a doctor who will be the same at the next visit as he was at the first.  He listened, he was thorough, and didn’t leave me feeling judged.  I see him again in September.

Time will tell.

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The Flawed One-Size-Fits-All Approach to Type 2 Diabetes

Posted by on Jun 28, 2014 in Management & Care, Treatment & Medication |

The more I observe the general approach being employed by many in the medical and diabetes health communities to address the ‘diabetes epidemic,’ the more I wince.

At the heart of the matter, there seems to be a general undercurrent of belief regarding the condition: diabetes type 2 is a straightforward situation, so just exercise more, and eat less. I get that vibe a lot when I watch TV, read the news, or read the blogs of many a well-meaning health professional and health advocacy organization. While this is generally true in principle and the advice and ideas of many of these folks are helpful, one comes away with the impression that they consider diabetes to be a one-size-fits-all situation, where people are simply undisciplined. This is a nearsighted perspective that is unhelpful for the patient – it fails to truly address the multi-dimensional psychological aspects of a person living with the condition, and thus, their ability to truly embrace the challenge.

What do I mean by this?

What I mean is that diabetes is simply a symptom of a problem. Let’s think about this situation for a moment. Would we tell an anorexic or bulimic patient who has developed heart disease to simply start eating more, or to simply stop throwing up? No. We understand that these behaviors are symptoms of a larger problem – that there are psychological challenges at work, creating disordered eating in this person’s life. We can tell a person with anorexia how undereating will kill them, or a bulimic how throwing up will damage the enamel of their teeth – but no amount of information is going to stop the disordered behavior. There needs to be intense psychological intervention in order to address the warped perceptions in the patient’s life.

This is just one example of how a chain of events can lead to chronic condition in someone’s life. Every ‘someone’ ought to be treated in ways which are tailored to their life experience. Now, while not all persons with diabetes are obese, the fact of the matter is that the majority of persons with type 2 diabetes have some disordered eating, are overweight, or are obese, and the reasons for this need to be addressed.

  • There are some folks who may have gained some weight simply because they are very busy — be it busy parents with families, or busy professionals – and they might just need some help tweaking their habits. These types of folks could benefit from just a bit of guidance on how to readjust, and minimize just reaching for the convenient meal or junk food snack;
  • There are folks who’ve gained weight due to illness, medications, or immobility, and could use some help juggling the situations; and
  • There are some folks who genuinely have disordered eating, and have gained massive amounts of weight: folks who use food as a form of comfort, as a form of treating pain or depression, as a form of coping with life much in the same ways a person might use drugs or alcohol, etc.

Whatever that person’s reason to struggle with disordered eating which has lead to weight gain – it needs to be addressed first. We recognize that disorders like anorexia and bulimia are dangerous, and not just a matter of ‘eating more,’ and stopping the dangerous habits. So why don’t we recognize that a large number of people who are obese also have a deadly eating disorder and are in need of psychological attention? Would we throw an eating plan at folks with anorexia, or bulimia, and expect them to fix themselves? Or would we give them much needed psychotherapy, and coaching, to help them succeed?

We need to understand that type 2 diabetes can affect a large variety of people who are in many different walks of life, and with many different social challenges. Assessing the patient in a wholistic way – addressing the level of psychosocial support and therapy that a patient might need in order to overcome their health challenges will be ESSENTIAL to managing the diabetes epidemic. There is no amount of healthy foods, exercise facilities, and information that can fix a person whose mind is warped by the thoughts and cycles of disordered eating. Therapy is needed, and it must not be ignored.

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Guest Post: When Metformin Can’t Do It Alone Anymore

Posted by on Jul 20, 2013 in Guest Posts, Treatment & Medication | 3 comments

Our first guest post has been supplied by my cousin Christy, who writes hare about a recent medication change. — Bob

I’ve been T2 diabetic for a long, long time. I’m sure I was “pre-diabetic” for several years before an appendectomy and subsequent post-operative infection threw me over the edge into full blown Type 2 diabetes. I was sent to diabetes education classes and put on metformin. That was around 12 years ago. Metformin did a fine job taking care of my diabetes for me with very little effort on my part. My A1C was always in the 6.0 range, fasting sugars were in the 120-130 range, blood pressure, cholesterol, triglycerides all near normal (with applicable medications doing their job).

A few months ago, my blood pressure began creeping up, and my blood sugars, fasting or not, began to creep higher and higher, and I began to gain weight. My A1C jumped to 7.1 in less than 6 months. Exercise didn’t help. I felt so sad, knowing that I have not done everything I could do to control my diabetes (let’s be honest – not much at all), instead, depending on the metformin to do it all for me. I met with my doctor, and he advised that not only is diabetes progressive, but that metformin eventually loses its effectiveness. He said most people get 2-3 years before they have to add another medication to their metformin regimen. He started me on Victoza along with the metformin. I am amazed how fast Victoza has brought down my fasting sugars, and I can’t wait to see what my next A1C is. If I overdo it on the carbs, the next morning glucose numbers are noticeably higher, but not like they were before.

The lesson? Even though Victoza seems to be the new answer for me, I don’t want to take it for granted like I did metformin. I’m extremely grateful for the number of years metformin worked well. I’m hoping with the addition of Victoza, better diet control, exercise and going to the monthly diabetes support group, I won’t have to go through this kind of frustrating scare again.

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