April 3, 2013

Diabetes Questions to Ask Your Doctor – Part 1

Part 1 of 3 Parts

Are you ready for your doctor appointment? The following is some of the questions to ask your doctor if you have recently received a diagnosis of diabetes, type 2. Some questions just lead to more questions and can make it difficult to follow what is and what is not important to know immediately. I have tried to stay with what is important at the start and good to learn at the beginning of your journey. Each question tells you which of my blogs contain an applicable discussion if you wish to read more or I will refer you to a blog by another writer.

I have tried to sprinkle in the acronyms that you will learn and see very often. I will also try to point out terms that you will need to learn. Why? Because you will see them used by most people that have had diabetes for several years and once you learn the language, you can learn to read without a dictionary. You may still want one handy, and there are several online. I prefer this medical dictionary, but I will also use this medical dictionary. There are others and you may search for them and see if you like them.

An example is blood sugar (BS), which I do not like, but most writers insist on using this term. Correctly, both scientifically and medically, the term should be blood glucose (BG). I would urge people new to diabetes to read this by David Mendosa. One example that I see all too often is the use of the word glucometer. This is correct only if you are referring to the meter registered to Bayer as a trademark. Correctly, your meter is just that, a meter. Also, be careful as most people refer to a meter and test strip as a unit even though you must change test strips.

The 10 questions are really 14 questions and I have divided them accordingly.
1. Should I check my blood sugar levels at home with a glucose monitor? How often should I check them?
2. What are my goals regarding blood sugar levels?
3. What are the warning signs or symptoms that my blood sugars are too high? What do I do if my blood sugars are too high?
4. What are the warning signs or symptoms that my blood sugars are too low? What do I do if my blood sugars are too low?
5. How can I change my lifestyle and diet in a way that will be healthy?
6. What are the side effects of my medications/insulin?
7. Will I always need medications/insulin? How will you evaluate whether these medications are the best treatment for me?
8. What are the long-term complications of diabetes, and how can I avoid them?
9. How do other factors such as high cholesterol and high blood pressure affect me if I have diabetes?
10. How often should I be seeing my doctor to optimize my diabetes management?

I will list each question and give my response as a patient to them. They are still questions worth considering for asking your doctor, but you will not see them answered this way.

Should I check my blood sugar levels at home with a glucose meter? Yes, you definitely should check (test) your blood glucose at home, at work, or where ever you are when testing is needed or desired. Many doctors discourage this for various reasons and this is wrong. Many doctors do not want you to know what they are or do not want you to be depressed with the high readings. If your doctor does not have a meter to give you one and a prescription for more strips, then insist (even demand) on a prescription for a meter, lancet device, lancets, and test strips before you let the doctor leave the exam room. If your doctor remains uncooperative, then you have a decision to make about possible change in doctors. For your diabetes health, the sooner you make this decision, the healthier you can be.

Testing is the only way you have for determining how different foods and food quantities affect your blood glucose (BG – is the acronym). A term you will see in blood glucose management is self-monitoring of blood glucose (SMBG – is the acronym). You will also need to test more frequently in the beginning to learn how long before you reach the high level of your BG. Many suggest one hour after first bite and for some people this can be too early. If you are a speedy eater (gobble down your food), this may work; however, studies have shown that you should eat slower for greater blood glucose management. Some writers do use the word control for the same meaning. Some will suggest testing more often until you are comfortable with when your high level of BG happens. I suggest starting at the one-hour mark and testing every half hour the first few times. When the reading is lower than the previous reading, then you may stop.  Your high point has occurred between these two readings.

Having said this, I must warn you that most, if not all, insurance companies will limit the number of test strips they will reimburse for your use. Therefore, your budget may not allow for the testing you should attempt. And, these vital test strips are expensive.

How often should I check my blood glucose? This is not an easy question to answer, even for new people with type 2 diabetes. This will depend to a great extent on your medication(s), what your insurance will cover, your budget, and your comfort zone. Many people with type 2 do purchase extra test strips out of their own pocket because they can afford this. Those people with a limited budget that are on oral medications probably will need to use what the insurance will reimburse. People on sulfonylureas that have had problems with hypoglycemia should encourage their doctor to write a letter explaining this and asking for additional test strips. There are other combinations that may cause use of extra test strips and your doctor should make you aware of them and request extra test strips. Please read my blog here for some of the oral medications that can create troublesome hypoglycemia.

How often you test will depend on your desire to bring diabetes under good management and your budget. You will also need to find out how willing your doctor is to go to bat for you with the insurance company for additional testing supplies. Some companies will allow some extra test strips in the first few months, but then want to restrict you thereafter. Other insurance companies will only allow a set number of test strips per day. I recommend that you talk with your insurance company to find out what they are willing to allow. You may need to bargain with them and attempt to convince them of the need for allowing more test strips for the first three to five months. Don't be surprised if you are denied, but it is still worth the effort.

What are my goals regarding blood glucose levels? This will depend on what you are willing to tolerate. I suggest reading this for an excellent guide. Some people set lower goals and do not like being over 125 mg/dl (milligrams per deciliter) at the high point in BG. For a person just getting started, my link is a good goal. Try not to have fasting BG under 80 mg/dl, especially at first. Gain some confidence in what you are doing before letting the numbers become overly important. Yes, learn first, and then work toward them. Do not become discouraged when you cannot achieve them the first few weeks. Remember you did not develop diabetes overnight, and it can take time to set goals and achieve them. These are goals you are working to achieve and you have a lot to learn at first. I have been at this for over nine years, and there are times when I have difficulty in maintaining the range of numbers I want to achieve.

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