December 3, 2012

Type 2 and Insulin Use

Carla Cox, PhD, RD, CSSD, CDE starts off her blog on the American Association of Diabetes Educators (AADE) website with something that truly surprises me. All I can say is thank you Carla. I have been fortunate never to have a provider (doctor) say what makes her want to scream. Believe it or not, it was a certified diabetes educator that said, “If you cannot control your diabetes better, you will have to be put on insulin.” This was in the month following my diagnosis and I was still figuring out what I could eat and my numbers were still generally above 250 mg/dl. When this was said, I got up, and said that may be necessary, but your way of stating this sounds like a threat from someone that does not understand diabetes as I went out the door. I did not understand then how correct I was, but I found out over the next few months that this person did not really understand diabetes and was terminated for her attitude.

I did call my insurance company when I got home and explained what had happened and how long I was in the room with her. I was told that I was not the first to complain and payment would reflect the short time and lack of education. October 2003 was the month of diagnosis and this was about mid-November. I did see my doctor mid-December and he was concerned that I had not reduced my blood-glucose readings more. He had me rescheduled for late January. He suggested that I do some research on insulin. No, there was not order, just a very polite suggestion.

I knew by the middle of January that I would be better on insulin and had read two books and done a lot of Internet reading. I had the blood draw and the doctor was ready to see me. I said the test results would probably be late and he said yes. I said he was welcome to look at my recorded results for blood glucose readings and that I should be using insulin. My readings were still generally over 150 mg/dl. He said he still was not sure, but that he would talk to the person and get me started with some education while waiting the test results. I said I would not meet with the person I had before and he said she is no longer part of the office and he felt that the RN would be able to gain my confidence.

I must admit he was right. The first question she asked me was what I knew about insulin. I opened my briefcase and showed her the two books and said there were many types of insulin and I wanted to stay away from any mixed insulins. I would probably need a 24-hour insulin and a fast or rapid acting insulin. At that point, the doctor entered the office and had the test results. My A1c was 7.1% and my lipid panel was within range. The doctor said I should probably stay on oral medications for a little longer. I said I am tired of being overly hungry and fighting to bring my blood glucose levels down and being even hungrier. The RN spoke up and said that with the knowledge I had already that I should be on insulin. We talked for a few minutes longer and he pulled out his prescription pad and wrote several prescriptions. He instructed the RN to give me one of the better meters and for me to stop using the one I had.

The next 45 minutes with the RN were intense and rewarding at the same time. She gave me the starting dosage for Lantus and Novolog after doing some calculations. She anticipated my questions and showed me how to calculate and refine adjustments over several weeks as needed to get me to the levels I had expressed wanting to reach. Then we covered the correction ratio for correcting readings that were higher that desired before a meal. She carefully wrote out all the calculations and what to do to adjust the dosage to get near the readings I wanted. Then she had me walk through several calculations. This was a great learning experience for me and I still have the calculations. This fit my learning style – observe and then do – and I remember how to do this today.

Then she said it was time to scare the dickens out of me and I said like hypoglycemia. She did a double take and asked where I had read this. I pulled out the book (the second in my list here) and showed her the tabs I had created on post-it paper. She looked at the area I had marked and stated, “You do know then.” I said she had not read far enough to read some of the tips to correct hypoglycemia and what not to do. She said if you know that now, I don't need to cover this. She did take time to look at many of the tabs I had marked and then she went to the copier and copied the cover of the book. I told her where I had purchased both books (including the first on the list) and she said she had not seen either of them and wanted to read both now that she knew of them.

Next, she wanted to talk about reading labels and I hauled out my third book and a cookbook. She asked what I had learned. So I showed her the labels I had put in the book from different foods and explained that I had a scale to weigh things if necessary. Next, I opened the cookbook (Betty Crocker's Cookbook, ninth edition – ring binder)) with the nutrition information with each recipe and said I look at the number of servings in the recipe and multiply the carbohydrates by the number of servings and divide by the number of servings I would be using. She said I understood better than most and I thanked her. She did suggest a carb counting book that I had not heard about and we covered a few other pointers she wanted to cover.

She commented how much she wished others would work to understand diabetes and investigate insulin like I had. I said that not everyone has an interest and many do not want to talk about diabetes. I said I had gone to several bookstores and several places on the Internet looking for books, especially after the doctor had politely asked me to learn about insulin. She made sure I had the telephone numbers for my doctor and how to contract her or her associate if I was having problems. We did exchange emails a few times and she would give me new book titles that she thought I might be interested in.

About a year later, I lost contact. I have met a few CDEs outside of an office setting and had enjoyable experiences. In an office setting, I have not had an experience I wish to repeat. I am very surprised and appreciative that I had such a pleasant experience with a registered nurse.

I have to wonder as most of the cookbooks since then no longer have the nutritional information included especially the hardbound editions. In looking through the bookstore a week ago, all of the hardbound and paperback cookbooks do not have the nutritional information included. This store does not carry any of the ring binder versions.

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