August 8, 2013

Problems with A1c and Obtaining Insulin

Before starting this blog, I must state that it is for people with type 2 diabetes only.  What was your latest HbA1c result? If it is like many of the people with type 2, it was probably 8.0% or higher. There are only a few reasons to have an A1c this high and actually an A1c higher that 6.5% should concern you. The only (in my humble opinion) reason to have an A1c this high is if you are very elderly, in poor health, and having difficulty taking your medications when you should.

Unless you have trypanophobia (a fear of injections) or aichmophobia (an intense or morbid fear of sharp or pointed objects), you need to learn about insulin and what it can do for your diabetes management. If you have these fears, consider reading this.

There may be other reasons, like having hypoglycemia too often which may be a good reason to have a higher HbA1c. Other reasons I don't consider as valid for letting your A1c reading become this high. They are:

#1. You have a doctor that will not prescribe insulin. If this happening to you, seriously consider finding another doctor. Your health is worth this. You will need to consider if there are other doctors available in your area. You will need to ask your doctor why he will not prescribe insulin very politely. If your doctor won't talk to you about insulin, then the decision will be difficult if there are no other doctors near you. I have had one person tell me that he had to question the doctor about why he would not prescribe insulin. He explained that he wanted to be on insulin and wanted a doctor that would prescribe insulin. When the doctor would not talk about this, he suggested that they could learn together. The doctor started to answer, but stopped. At that point, he knew he was going to need to drive about 75 miles one way to another doctor, but he asked the doctor for a referral and the doctor did give him a referral for the doctor he had thought he would be seeing.

#2. Your doctor has not given you any education. Most doctors do not have the time except for minimal education. Most doctors do not have access to certified diabetes educators (CDEs) or even registered dietitians (RDs) so this would not be a surprise. Self-education is often the only avenue open to you. This is part of the reason I have been writing blogs about sources for you to read. No. 1 and No. 2.

#3. Your doctor is stacking oral medications and they are not working. You started on one oral medication and then when your A1c did not come down enough or when it started to rise, your doctor added a second medication. When those results deteriorated, a third medication was added. With the side effects of each medication, this could have become intolerable. But you wanted to get your A1c level down. You may have even asked for a stronger medication, but the doctor refused.

#4. Are you not managing your diabetes? I don't like to use accusations, so I will ask some questions. Have you reduced your carbohydrate consumption? Have you been able to test enough to know what the different foods do to your blood glucose levels?

#5. Are you not taking your medications? Do you take them when directed or do you forget occasionally? Do you have a schedule for taking your medications? Have you talked to your pharmacist about what to do if you remember you forgot the previous dose? How often do you forget? For help you might want to read this blog.

#6. Are you able to exercise and what is your routine? When your blood glucose levels are higher than they should be, are your able to exercise for a longer time? What exercises do you do or are you limited in what you can do?

I could continue to list reasons, but this could only serve to discourage you and cause you to stop your self-education. What you need to do is have an honest discussion with your doctor. Do this after you have given a lot of thought whether you wish to stop the complications and manage your diabetes. Unfortunately, only you can make this decision. Yes, you may ask for help if you have someone that can and will assist you, but you will need to ask.

If possible, you need to honestly assess your situation and decide what you are capable of doing, how you can better manage your diabetes, and whether insulin is the medication you need. Some of my blogs that may be of assistance for using insulin include – blog 1, blog 2, blog 3, blog 4, blog 5, and blog 6

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