Living With Diabetes

 This is one of the reasons why I choose insulin over an oral drug.  Also the oral medication wasn't working fast enough for me. 

More than 6 million people around the world have taken the drug Avandia (rosiglitazone) to treat Type II diabetes. But a new study published this week in The New England Journal of Medicine suggests that the drug is linked to a higher risk of heart attack and death.

Source: Diabetes Drug Linked to Heart Attacks - Newsweek Health - MSNBC.com

Posted by at 8:49 AM | Permalink

Medco has been jerking me around, yet again, over Protonix.  During spring break, I went to see the primary care doctor to see if there was something different we should about my GERD, since I was almost out of Protonix and to let him know we were playing the Medco game.

He is fed up with, decided I needed to be scoped anyway since it had been a while, so he sent me to a gastric doctor (I think I've posted about this, sorry for the repeat).

So I saw the gastric doctor.  She decided I also needed a gall bladder ultrasound since gall bladder stones can cause a backup of bile, looking like GERD.  She also gave me a medication, Carafate which is supposed to help if it is bile reflux.

It doesn't seem to help.

She also prescribed Reglan which set off all sorts of red flags because it counteracts Symlin.  I tried it for a few days, it doesn't seem to help.

Then the Endo said to back off on the Symlin -- so I went to 10 units.  Amazingly enough it didn't seem to affect my blood sugar.

I have had to make another change to the Symlin, unrelated -- I've been having trouble with crashing in the evening during my new workouts, so I've changed my evening meal, so that I take no insulin and no Symlin.  I can't decide if that is helping or now, and I'm still low at night.  That means I still need to eat something before I got to bed which DOES affect the reflux.

Anyway, back to the Medco games.  Gastric doctor prescribed Protonix, 2 x time which is the only thing that helps.  Most of the time.  I still get break through depending on how much I have to eat to fix the nightly low.

So Medco needs an authorization for Protonix, because it isn't Nexium.  Then they need a second authorization for the amount of Protonix, because it's an extra amount.

So the gastric doctor had to fill out both authorizations -- and I think that is where everything got screwed up at the primary care physicians.  The good news is that I'm authorized for the extra dosage until October and I'm authorized for the medication until April.

I had the sonogram on Friday and am supposed to get the results back tomorrow.  I'm getting scoped tomorrow, early in the morning.

All this, because Medco has to play games on GERD medications.

Posted by at 6:29 AM | Permalink | Comments (1)

The Charlie Weiss case and the warnings they give is one of the many reasons I've not gone for the weight loss surgery thing.  I've been looking at the articles on his case, and I'm not sure he has a malpractice case and I am not sure he should be suing.  You are warned going in that things can go wrong. 

Link to Close Concerns Weblog: A Godsend or A Scare: Results Can Vary Widely with Weightloss Surgery

Posted by at 7:41 AM | Permalink

It will be interesting to see what happens -- I just injected my first dose of Depo Prevera. I don't like the needle, it's thicker than a diabetic needle but not bad.

This is a lower dosage so it will be interested to see what happens with blood sugar, periods (right now, I don't have any), break through bleeding (don't have it), and acne -- occasional breakouts near time to inject, though didn't this round.

Posted by at 5:10 PM | Permalink

Grab A Cuppa Grand Rounds! // Emergiblog

Posted by at 6:46 PM | Permalink

Get on the scale daily to keep lost pounds off - CNN.com

Losing excess weight is often easier than keeping it off. A new study shows that stepping on a scale every day, and adjusting eating and exercise habits accordingly, can go a long way in helping dieters maintain a weight loss.

Every time I've been successful I weighed pretty close to daily. Though I can get obsessed and it does sometimes bad fire.

Posted by at 9:13 PM | Permalink | Comments (1)

Tundra Medicine Dreams: Grand Rounds, Vol. 2 No. 52

I contributed this round. I addresed the "hope for a cure" issue.

Posted by at 2:04 PM | Permalink

And there is at least one Type 2 diabetic who believes that oral medications are for the birds and that insulin is the only way to fly.

Very Old, Very Healthy Diabetic

Posted by at 8:44 PM | Permalink | Comments (1)

Diabetes Mine: Who Needs Patient Studies When You've Got PCs?

This is right up my alley literally. Since I teach computer science, I do keep up with the field.

I certainly don't think that simulated clinical trials will replace real ones, but they will help rule out bad treatments early. Remember the clinical trial that has ruined the health of the healthy volunteers in Great Britian? If a simulated clinical trial could eliminate such problems, you'd see more people participating in the real ones.

Posted by at 12:56 PM | Permalink

Diabetes In Control Newsletter - Study Compares Gastric Bypass and Gastric Banding Surgeries

This is what I was told by a surgion.

Study Compares Gastric Bypass and Gastric Banding Surgeries

Posted by at 7:40 PM | Permalink

But not for another 12 weeks.

I finally got my gynocologist to let me self inject depot by switching to Depo Sub-Q.

I've been on Depo Prevera for over 15 years. I went on it before I went into teaching. I've never had any complications except for the lack of period and PMS (and I don't see that as an adverse side effect).

Both the doctor and I are concerned about bleeding and he wants me to let him know if that is an issue.

Since it is non-formulary and there is a generic version (but intra-muscular), it is actually going to be cheaper to get it at the retail pharmacy than it will from mail-order, we think -- we being from my looking at the Medco site and my talking to a customer service representative.

So I have a script and it's on my list of things to do in 4 weeks.

Posted by at 6:25 PM | Permalink

The Diabetes OC is astir right now over the current Congressional votes on embryonic stem cell research.

I'm personally against the federal government supporting embryonic stem cell research.

I believe that other stem cell research shows much more promise and needs to be researched long before we go so far as embryonic stem cell research.

Already, embryonic stem cell research has crossed ethical boundaries -- results have been falsied, etc. and I think its just something to completely stay away from until all other research has been exhausted.

I also don't think you are going to get very far with transplants, or other replacements of the pancreas until you find out why the body is destroying beta cells in the first place.

Posted by at 8:23 AM | Permalink | Comments (1)

Imperfect, Imprecise but Useful: Your Race - New York Times

It always seems like a no brainer to me, but maybe that's because we know there are genetic diseases that run in our family.

Posted by at 8:24 PM | Permalink

I've been watching every episode of Miracle Workers since it started on ABC and I was actually happy to see one of their procedures fail.

So far, it has just been TOO positive, without getting into the true ordeals the patients have had to go through to get their miracle. I will say, that everyone so far, has eventually turned out in a better shape than they started with, including the poor woman who died after the show was filmed tonight.

I was especially interested because they were putting an articial heart in her. I'll be honest -- and my mom and I was just talking about this -- I figure I'll be suffering from cardio vascular complications at some point in the future, since I have heart problem history on both sides of my family. In fact, I've been seeing a cardiologist every year for the last 3 years, and was seeing one every 5 years before that.

Back to the show. Poor woman had gone through breast cancer and then was diagnosed with heart failure. They put a Jarvik pump in her, and after 3, yes, 3 open heart surgeries she was doing better. They sent her home and she finally died of a massive infection.

I personally think they went too far with the second surgery, though I do think she was aware enough to participate in decisions.

I just know I don't want to go that far.

Posted by at 9:59 PM | Permalink

Here's the story behind grapefruit.

Experts Reveal the Secret Powers of Grapefruit Juice - New York Times

In 1989, a group of Canadian researchers studying a blood pressure drug were astonished to discover that drinking a glass of grapefruit juice dangerously increased the drug's potency.

I haven't touched grapefruit in years.

Posted by at 11:03 PM | Permalink | Comments (2)

Can you tell I really like the Diabetes in Control newsletter? Very factual and rarely judgemental.

Diabetes In Control - High Drop Out Rate for Rimonabant Diet

High Drop Out Rate for Rimonabant Diet

Posted by at 9:51 PM | Permalink

Mostly I've been going through physical therapy.  I have been getting home from school around 5:00 pm on Monday and Friday, eating, and then going to physical therapy and then getting back home between 7:30 - 8:00.  On Wednesday's I tutor, eat and go to physical therapy
and get home between 8:00 and 8:30.  On Thursday's I train dogs all evening.  Also, every other weekend has been a major agility trial.

Plus I'm now responsible for planning 6 preps and teaching 5 of them. 

There hasn't been ANY free time, especially for writing.

Life has just been very difficult.

The knee was better until Friday.  I don't know if it was the physical therapy session, the lack of anti-inflammatory, or the horrible cold front, but I've been aching since Friday evening.  A few times to the point I didn't want to walk at all.  In fact, it's throbbing now. 

Posted by at 8:10 PM | Permalink | Comments (1)

My insurance plan uses Medco (which I've blogged about in the past), to manage our prescriptions and their costs.  I've also blogged some about my problems with gastric reflux disease.

Basically, my gastric reflux is out of control, and the only medication that comes close to solving the problem is Protonix.  In December, I got a letter telling me that Protonix was no longer in our formulary.  Well, Friday I got a letter telling me that they would no longer cover Protonix AT all, and that they would only covered omeprazole or Nexxium. 

How do I go about fighting this?  Right now, I'm double dosing on Protonix and last night I was up with GERD.  I've tried double dosing Nexxium and it almost but not quite does the job.

I know I need to control my food better in the evenings, but it is flat out difficult between the diabetes and the stress I keep going though.

I'm hoping someone reading this can give some help.

Posted by at 8:05 PM | Permalink | Comments (3)

My aboslute favorite commercial of all time is the Joe Green Pepsi commercial. It's great because you remember the product.

Well, I just saw a remake of the commercial, with some important changes. It's a young football player who gets to meet Bettis (sp), another football player who has asthma. It's for GSK Asthma Control program. The cool part is how it ends, the young player tosses HIS jersey to the pro.

I like the focus -- living with asthma and being successful. I get SO tired of the "looking for the cure diabetes" commercial, probably mostly because I don't think it's happening soon. I personally focus on getting through the day with the tools I have.

If you want to see the ad, it's on the Asthma Control Test website.

Posted by at 8:04 PM | Permalink

If you need a physical therapist, I can't recommend him enough.

http://www.metrocrestchamber.com/html/members_alpha.cfm?Company=T

Closest thing I can find to a website.

My doctor's office likes him too.

Posted by at 11:25 PM | Permalink

Shorter Dinner-To-Bed Time Linked to GERD

In addition to diabetes, I do have GERD (Gastric Reflux Disease). Before my diabetes diagnosis, I was careful not to eat after 6:00 pm and I found that my sympthoms were significanly reduced.

However, now if diabetes, the nuitrionist had me eating before I went to bed and yes, I saw an increase in GERD. In fact, just about everything they want you to do to manage your blood sugar makes GERD worse.

My GERD is best if I only eat three meals a day. Of course, that causes spikes.

I am working hard to avoid eating at night, but these higher blood sugar levels make it harder.

Posted by at 6:09 PM | Permalink

Certain Drugs May Be as Effective as Surgical Management for...

Certain Drugs May Be as Effective as Surgical Management for GERD

So maybe I did make the right decision by not doing the surgery thing this Xmas. Of course, I can always change my mind, but the GERD does seem better lately.

Posted by at 10:46 PM | Permalink | Comments (1)

Diabetes In Control - Daily Weighing Helps People Lose Weight, Prevents Gain

Whenever I have successfully lost weight, I have been obsessive about weighing. I often weigh twice a day. I'm very realistic about it, and use it as a tool -- if I am up a little, I think about what I did and how I could do differently. If I am down, I celebrate.

In order to lose weight, I have to actively think about it all the time, or I end up gainning weight.

Daily Weighing Helps People Lose Weight, Prevents Gain

Posted by at 8:20 PM | Permalink

at least if I am at home.

The Haversian Canal: Call an Ambulance, in the US

I live in Farmers Branch, and recently ourfire department won an award for having one of the fastest response times in the country. Also the fire station is so close, that it probably takes them longer to turn on the unit than it does to drive here.

Posted by at 11:25 PM | Permalink | Comments (1)

I've had at least two doctors try to pressure me to have weight loss surgery. My endo has left it to my choice.

Dallas Morning News | News for Dallas, Texas | Latest News

After reading this, I know I have been right to delay the surgery. Right now, things are working okay, but if they stop, I'll consider it again.

Posted by at 7:53 PM | Permalink

National Sleep Foundation

Effective September 1, 2005, Missouri Medicaid will no longer cover many kinds of durable medical equipment (DME), including positive airway pressure (PAP or CPAP) devices which are the mainstay of treatment for obstructive sleep apnea

Posted by at 10:38 PM | Permalink

Obesity: Pain and Prejudice

Over the past 4.5 years, as Psychologist for the Bridges Surgical Weight Loss Program at St. Luke's Medical Center in Phoenix, Arizona, I have been privileged to personally interview more than 2000 patients seeking bariatric surgery. This experience has obliged me to reflect on the treatment that many have received at the hands of the very people who these vulnerable individuals contact for help with this traumatic condition. It is not a secret that the base rate of abuse (physical, emotional, and sexual) in the obese population is higher than in the nonobese population.[2] The stories that have been shared with me about how these people have been treated by friends, family members, and yes, even medical professionals have revealed the cruel and inhumane conduct to which the obese patient is regularly exposed.[3,4] Why those trained under the principle of primum non nocere would engage in emotionally harming those who have come to them for help is a mystery and speaks more to the issues of the professional than to the physical status of the patient.

This is a really powerful article. I can't tell you how many times a health care professional has made being overweight worse that it is.

Posted by at 8:53 PM | Permalink | TrackBacks (0)

I've been giving this a lot of thought and watching all the people who are cheering over the Atkins Nutritionals Bankruptcy.

One thing that people aren't getting, is that the Atkins diet ISN'T Atkin Nutritionals. It's the products with an "A" on them. Yes, the books are probably also a product of the company. But the biggest problem was the food. It really didn't taste very good, I know I've tried it. Lots of companies who are good at making good tasting food have managed to come out with lower carb food and I think that's why Atkins Nutritional is in trouble.

Plus they had a hard time getting shelf space. For example, Kraft is making South Beach diet stuff. The Kraft brand already owns shelf space in almost every grocery store -- they can just tell the grocers to change their shelf space. Also, South Beach Diet foods are MUCH better tasting.

What really gets me, is that are a few Bernstein advocates cheering the Atkins demise and that REALLY doesn't make sense. The difference between Bernstein and Atkins is that Bernstein limits ALL food components, not just carbs. Bernstein just limits carbs a lot more.

I know a lot of non-diabetics who have lost weight and kept it off with Atkins. I have personally tried Atkins. I don't lose weight if I do Atkins, but I don't gain it either.

In fact, the only way I do lose weight is if I count carbs AND calories AND exercise. And it is REAL slow.

Posted by at 9:06 PM | Permalink | Comments (2)

The Well-Timed Period: Bone Density and Depo-Provera

Bone Density and Depo-Provera

Posted by at 11:14 AM | Permalink

Okay, now this is just weird.

If I get Depo-SubQ mail order, it costs $65.84 each fill, but if I get it at the local pharmacy, after the first 2, it's $55.00. On the first two fills it is $40.00. That's weird. Now I need to look up Depo again.

I'm glad I checked. They must have changed the prices because it's $25 for the first two, and then $35.00 at retail and $45 by Mail.

I'm going retail.

I wish I had checked this before I ordered the last one.

Posted by at 12:25 AM | Permalink

The Diabetes Blog

I've already commented on this post, but I want to expand upon it further.

One of the huge misconceptions is that sugar leads to diabetes. It doesn't.

Type 1 diabetes is known to be an autoimmune problem. Ingesting sugar has nothing to do with getting diabetes, or even preventing complications. What you have to control is the amount of sugar that is in the blood stream. While sugar itself metabolises to sugar in the blood stream so does any other carbohydrate, and so does protein, but at a much slower and lesser rate.

Type 2 is believed to be linked to obesity, but that again doesn't mean that consuming sugar leads to diabetes. It doesn't mean that all obese people are going to become diabetes, and it does not mean that non-obese people will not become diabetes.

I believe that any press in the news that ignores the cause and effect factors, or exagerates cause and effect factors is doing harm. I've blogged on this in the past, and so have the other diabetes bloggers.

There are many ways in which the popular press is harming diabetics. First, the more that an obese person is pushed to lose weight, the harder it can be for them to do it. It becomes even harder when that person has uncontrolled blood sugar, because uncontrolled blood sugar causes them. It's a weird mechanism, but what is happening, when the body doesn't get enough insulin, the body isn't getting enough fuel, and as a result, the body is literally starving. In fact, sudden, rapid weight loss is a sympthom of diabetes.

Anything that can get in the way of good glycemic control, and that includes mental attitudes is harmful to the diabetic, no matter the cause.

Posted by at 1:44 PM | Permalink | TrackBacks (1)

APP.COM - Problems with sleep apnea resound in waking hours

Problems with sleep apnea resound in waking hours

Posted by at 10:04 PM | Permalink | TrackBacks (0)

Diabetes Health - Where Do We Stand With the Noninvasive Dream?

Posted by at 5:35 PM | Permalink | TrackBacks (0)

CNN.com - Hospital sued over wrong surgeries - Feb 10, 2005

A doctor may have performed the wrong type of gastric bypass surgery on more than 50 patients at a Wilmington hospital, officials said.

Posted by at 5:24 PM | Permalink | TrackBacks (0)

Here's someone that gets the Catch 20/20

The Health Care Blog

There is general agreement that -- at least 15 years since everyone has understood the problem -- the health care system suffers from a lack of transparency, information systems, rational incentives, and care quality. Diabetes care is a microcosm of that.

Posted by at 1:26 PM | Permalink

Kevin, M.D. - Medical Weblog: Vytorin and the license to eat

As a patient who is on Zetia and Zocor ... and who struggles with controlling blood sugar, lipid levels, etc. and who will soon be on Vytorin...

I don't take any of the advertising too seriously, even though I seem to be on every medication with a serious ad compaign.

For me, the combo has been the end of a long time of frustration. I couldn't, even with high doses of Zocor, control blood sugar AND lipid levels. It was the addition of Zetia that finally brought it down.

Vytorin is great, because it reduces a copay.

Posted by at 8:34 AM | Permalink

I come home and find a HUGE box on my door step. I open it to find a cooler with 3 gel packs inside and one dose of depo (yes, that's right, I ordered one dose).

First thing wrong with the picture -- it's supposed to be stored at controlled room tempature.

Second thing wrong? Well the last shipment of insulin came in an insulated bag with one gel pack and it's supposed to be stored refrigerated.

Oh well.

Posted by at 12:16 PM | Permalink

I got the "bill" off the internet today and they charged non-formulary price, so now I'm getting two drugs for the price of one formulary copay ($62.50) -- NOT bad. But I wonder why they didn't tell me that. Weird....

And the depo arrived today -- at least it's on the doorstep -- husband will have to bring it in. Apparenlty the generic isn't available yet, but it was $42.00 instead of $56 which is what the regular pharmacy charges. Since it is cheaper than a copay, I pay for the cost.

Posted by at 9:32 AM | Permalink

It's almost the end of the year, and we STILL don't have a continuous blood glucose monitor for patient use. Right now, Minimed has one that doctors can order and you wear for 3 days, but there is no real time readout.

Both Therasense -- now owned by Abbott and Minimed were supposed to have one out by the end of the year.

Well, we have a couple of weeks yet, but I'm not holding my breath.

Posted by at 2:05 PM | Permalink

Medco makes me wonder some times... I decided to stick with Depo, and I've being charged full price for Depo. If I go with the new generic, it is still is pretty costly, but if I use the mail order portion, the price drops substantially.

So I called the ob/gyn office and requested a script and sent it out, and now I'm waiting for the Depo. The really good news, is that I don't need it until around the 10th of January.

Posted by at 7:12 PM | Permalink

Of course, I'm always interested in anything like this.

I'm STILL not sure I want to do gastric surgery, though if I do, I need to start getting things together now, if I want to do it, as I would want to do it sometime after the AP Computer Science test.

Bariatric Surgery use in Type 2 Diabetes

Non-randomised observational studies show that bariatric surgery has a highly beneficial impact on diabetes. Bariatric surgery leads to remission of diabetes in at least two thirds of patients, and reductions in drug therapy for many others. Those with more recent onset diabetes, fewer treatment requirements, and able to achieve most weight loss are more likely to achieve remission. Therefore, bariatric surgery is an attractive treatment option to consider for selected more severely obese patients with favourable characteristics. Although data on bariatric surgery in subjects with diabetes are provocative, all recent clinical studies have been uncontrolled or otherwise flawed. Moreover, bariatric surgery has yet to be compared either with medical treatment for weight loss, or against standard medical treatment for diabetes in any randomised controlled trial with diabetes-specific end points. There remains a need for long-term randomised controlled trials before bariatric surgery is used more widely as a first-line treatment for obese patients with type 2 diabetes.

Posted by at 6:15 PM | Permalink

Review of Insulin Therapy -- Daugherty 17 (1): 10 -- Journal of Pharmacy Practice

Posted by at 3:05 PM | Permalink

I am still looking for Type 2 diabetes to participate in a research study.

This is the information from the researcher:

Several months ago we had exchanged email concerning this research
project that I am doing with diabetes. We have evaluated 4 groups of
physicians - housestaff, internal medicine faculty, endocrinologists,
and private primary care physicians. They each performed a series of
pairwise comparisons assessing the relative importance of 4 indicators
of diabetes management.

While we hope to make the task a bit more complex in the near future, we
would first like to compare our physician results with a group of
patients. We are looking for type II diabetics who have computer
literacy. If you could assemble a group of 10 or so, we would be very
grateful. We believe that patients may have different priorities than
physicians, and want to test that hypothesis.

Posted by at 6:14 PM | Permalink

I'm looking for 8 diabetics who are Type 2 and are computer savvy for a study for a doctor.

If you would like to participate, please send me your email address. Send it to kathleenw at gmail . com (spaces inserted on purpose) with the subject line: Diabetic Study and I'll add you to the list.

Posted by at 5:50 PM | Permalink

Bearing the Olympic Torch for Diabetes Awareness

Our patients often teach us more than we could ever teach them. Gary Hall, Jr, an 8-time Olympic medal winner, is one such patient (Figure 1). I was with him when he won 4 of those medals, and I am heading to Athens to see if he can win more. This is the first in a series of reports as I start my journey to the birthplace of the modern Olympics; in this report I will recount my past 6 years as the physician on the team of an elite athlete.

Posted by at 7:16 PM | Permalink

Posted by at 2:41 AM | Permalink

The Health Care Blog

If you don't care to go back to the archives, a short recap ....

My doctor and I decided that I should go on the pump because I was gaining weight on MDI and had what I felt was inadequate control with shots.

It was the right decision, but the idiot HMO said, NO, you have to throw all the diabetes meds in the world at her in combination before we'll approve it.

I'd had my full of diabetes drugs after the first one, and besides, insulin really is better and the pump is the most efficient way to deliver it.

And by the way, I've been steadily losing weight again.

Posted by at 4:58 AM | Permalink

Family Medicine Notes: Psychiatry Archives

Any time I get frustrated with my doctor or insurance I'm going to go back and read this.

Posted by at 4:55 AM | Permalink

This year is the first year I opted to go for a flexible spending account. It works out really well. The money for it is deducted pre-tax dollars, and put in an account. When I have a medical expense (actually I usually do 4 at a time), I fill out a form, send it in, and get the money back.

Actually, it works out even easier. I scan the receipts, and file them on my hard drive. I fill out the form online, print it, sign it, and scan it. Then I take that form, the 4 receipts and fax them to the administrating company. Less than a week later, I get a check back, which I put straight into my charge account.

Oh, that's the other key -- I charge everything -- especially mail order prescriptions, since I do that all online too. That's one reason I always put the reimbursement checks on the charge card.

Here's the cool part -- they go ahead and give you the money, even if you haven't deposited yet. Right now, I only have $30 in the account, but they are still giving me the money. They pay up to the projected amount.

"Next year" starting in August, the state will be putting some money is a savings account. I have to pay out of the flexible account before I can go to the savings account, but one neat thing about that one, is that it has a debit card. I wish this one had that option, and maybe it will. That would make life a bit easier all around.

Posted by at 6:34 AM | Permalink

I was afraid of this ... Yesterday my Freestyle Flash meter failed. Switching batteries worked temporarily....

But I called and was on hold for over 15 minutes -- I know, because my Treo told me. Didn't get a satisfactorily answer but did get the meter working.

But today it was dead. I called Therasense again, and was on hold for 15 minutes AGAIN, I know, I recorded the time I called. The rep was not friendly, was not very helpful and resisted replacing the meter. Wouldn't believe me at all, because yesterday's rep did NOT record the battery problem.

I was afraid of this. I am afraid I'll be switching to One Touch Ultra because

a) Animas has parterned with them and is planning having their pump talk with their meter.

b) The copay will be $60 instead of $112 starting in August.

My CDE really doesn't want me to switch or I would have already. She claims the Hb1AC is correlarates to the reports better than any other meter.

Posted by at 4:43 AM | Permalink

DB's Medical Rants

As a patient, I know that there is a raging debate among endos as to whether or not tight control is a good thing or bad thing.

Some of that is up to the individual patient, few patients are as sensitive to insulin and or blood sugar as I am. Most diabetics and most doctors (my own included), tend to think I'm nuts. My doctor at least humors me.

However, I have trouble with my vision when my blood sugar is over 160 ... this is a problem. I'm dizzy at 90-110, especially if I have come down from a higher number. This is a problem too. And those are just the beginning sympthoms.

But who knows if the tigher control I tend to prefer is better for me in the long run? I do run the risk of hypoglycemia. Look at the last week. If I lose my awareness, I could get into real trouble.

At least now I can point back to some research and maybe more is coming. It's only in the past few years we could even achieve tight control.

Posted by at 4:34 AM | Permalink

I have stopped wearing my medical ID because it is UGLY. I did find someone at http://www.beadin-beagle.com who makes pretty medical jewerly and ordered some.

By the way, you go to a different company to order the engraved medical parts, they ship to Beadin Beagle, and she makes them. Mine are all detachable, because I will probably order other styles.

The bracelet is here:

and the necklace is here:

Posted by at 5:47 AM | Permalink

Medrants asked if a good death is important.

I think so. My father had a good death. He was diagnosed with congestive heart failure (this was 20 years ago), sent home, and was given some home nursing and equipment and basically left to die. It did take 3 years, and some of it was painful, but he did adjust well. We had plenty of time to talk and resolve issues. The only invasive procedure was a catherization, but that was his choice, he wanted to make sure why he had congestive heart failure. Most was congenital.

My mother-in-law had a good death too. She and my father-in-law were in a car accident and she was killed instantly. They had just been visiting their grandchildren and were on their way to a card show. They were in good health and she just went.

Even my father-in-law went relatively easily for him because he never regain consciousness. However, my husband and his sister had to deal with decisions. They did put him in hospice care and died a few weeks later without gaining consciousness.

However, my grandmothers didn't fair as well. For different reasons, they were put in nursing homes and had all the care needed to keep them alive. One is still living, and has been reduced to the mental age of about 1 1/2 years. It's very sad, and I wish she could die.

I've had friends deal with parents with lingering illnesses.

If I had my choice, I'd go the way the inlaws did, especially mother-in-law. I certainly don't want to spend my last days in a hospital poked and prodded, especially by strangers.

Posted by at 11:57 AM | Permalink

"I just want a diet that works!" That's the plea from confused people who feel overwhelmed by today's many diet options, or frustrated that their diets seldom bring long-term results. The diet that works for you, however, will be the one that removes or reduces the foods you overeat in a way that you can live with permanently. There are plenty of options to consider.

I've been doing iShapes, logging everything, and concentrating on eating 600 less calories than I've burned and it's working out well.

Posted by at 7:49 AM | Permalink

See ... a doctor said it! It has to be true.

It's the only time it works for me.

Though I wonder about her calorie level, any thing under 1500 after exercise for me puts me in starvation mode.

Posted by at 10:05 AM | Permalink

I DO hope they do what they are claiming they are going to do. I don't much trust Minimed though, because of their customer service track record and other issues, for example the water tight issue.

BUT, they have taken their CGMS Gold system -- available from doctor's office, and made it a tad smaller -- though it is still big. They have come up with a device that they claim will alarm when blood sugar is too low or too high.

They are marketing it to the kid market, BUT it can't be worn in the pool -- though they claim you can shower with it (you can't with the CGMS Gold system). They also claim that it is going to be upgraded in the same type of program as the Paradigm system is.

However, they don't have a launch date and they don't have a price.

I will probably still hold out for the Therasense system, I have been SO impressed by their customer support, but it is interesting.

And you still need to test 4 times a day.

Oh, and I can't figure out how you are going to get their sensor + pump on a 5 year old. But that's not my problem

Posted by at 11:25 AM | Permalink

It's a VERY good thing I knew the allergy medication game was coming. Here's the latest in the saga...

The doctor's office didn't get the precertification back quick enough for Medco. On Feb 26, Medco sent the script back to me. The precertification came through on Feb 27.

So now I have to wait until the script is returned to me, and then send it back to Medco to be filled. So far, we're talking about the following:

I went to the doctor on February 16, and got the prescriptions.
I dropped them off at the mailbox on the way home -- but it was a postal holiday so it didn't get mailed until February 17th.

The rest of the order arrived on February 27th -- a 10 day turn around.

SO, if the script arrives in the mail today, I'm looking at March 12 to get my Zyrtec.

NEVER NEVER put off filling medications. In fact, I'd be totally screwed (though I didn't let onto this), if I had not built up a 60 day cushion on my meds.

ALWAYS make sure you have a full month's supply at all time otherwise you'll have to pay a 30 day copay rather than a 90.

Posted by at 12:59 PM | Permalink | Comments (2)

Medco is still showing the order cancelled, but I am figured they didn't get it until late in the day and won't hollar at humans until the end of the day on Monday.

A hint: any medication you REALLY REALLY need, and you are mail ordering? Make sure you have at least a month overlap. They tell you that in the documentation. They say always get a 1 month script and a 90 day script at the same time. You don't want to run out! And they don't seem to care if you might.

Posted by at 12:59 PM | Permalink

code: theWebSocket; - A weblog of Al Hawkins, RN

A year-long intensive glucose management protocol using a blood glucose goal of less than 140 mg/dL at a mixed medical-surgical intensive care unit (ICU) resulted in a 6% absolute reduction in in-hospital mortality — a 29% relative risk reduction, according to results reported here at the 33rd Critical Care Congress, the annual meeting of the Society of Critical Care Medicine.

One of the more common things to discuss on the insulin pumper logs is how to manage blood sugar during surgical procedures. This article is definately worth registrating, printing and keeping if you have to go to the hospital.

Posted by at 8:47 AM | Permalink

Managed Care SUCKS!

About a week ago, I sent off a set of prescriptions to Medco Health plan. If you look at my insurance plans fine print, they manage care some medications, in particular, allergy medications.

By the way, Zyrtec is $50 for 90 days with my plan. Claritin is $20.99 for 30 days from drugstore.com. Guess what I want to do?

The doctor has to fill out an additional form, and if they don't fill it out right you don't get it.

They claim they haven't heard from the doctor yet.

They gave me an 1-800 and a case number to check on it.

Well, I tried the case number and the computer is claiming it has been denied.

Don't worry, we're not done yet.

Posted by at 4:21 AM | Permalink

Got a call from the doctor's office -- please send an email documenting why you are on Zrytec.

ARGH!

I know they are managing care this, but I'm a teacher. Sinus headache last night because I spent the day in another room's dust testing. Which reminds me, I'm going to request highly that I test my few 11th graders in my room for the next round rather than TAAS testing in the library. We had over 40 students test and that test died two years ago. So sad, but that's a different blog.

I could try the Claritin thing, but why should I pay $20.99 from Drugstore.com for 30 days, when I am paying for insurance benefits that allow for $50.00 for a 90 day supply. And I AM paying $200.00 in insurance. Yeah, I use it too

Posted by at 8:20 AM | Permalink

reviewjournal.com -- News: Friend says girl died after complaints mishandled

Who missed this? Hope mom goes to jail.

Posted by at 5:45 AM | Permalink

DB's Medical Rants

A thread started on the insulin pumper's list about how some doctors don't prescribe pumps ... and I decided to go to the best source I knew.

Posted by at 11:39 AM | Permalink

DB's Medical Rants

Posted by at 8:12 AM | Permalink

When Treating Diabetes, Physicians Told to "Separate The Disease From the Person".

Posted by at 8:52 AM | Permalink

DallasNews.com | Dallas-Fort Worth | Business

This is interesting -- I already pay more for the "brand name" drugs. For example, if I go with Humalog insulin (which makes me itch by the way), I have a $20.00 copay (for a month's supply). If I go with Novolog, it's a $30.00 copay.

Same thing goes with test strips -- if I go with their choice of meter, it's $40.00 copay for 3 months or $60.00 copay for the brand I like.

I do wish, however, that the doctor's office would cooperate with me, rather than them. I was recently switched to a cheaper statin -- Pravachol.

Now, my doctor hasn't bothered to tell me -- I guess I'll email him and ask -- why he agreed with the pharmacy and switched me.

Posted by at 6:26 AM | Permalink | Comments (3)

How Sleep Affects Cancer-Trustworthy, Physician-Reviewed Information from WebMD

Since I have so many sleep related problems, this is something I keep an eye on.

It's pretty interesting.

Posted by at 11:49 AM | Permalink

Type 2 Diabetes Randomized, Parallel-Group, 24-Week Study

I think this is a free but registration required site. I signed up for it years ago, and often find things of interest.

Basically they found that intensive therapy was acceptable to Type 2's. That they had equal results with MDI (injections) and CSII (pump). Frankly, I think the pump is easier, but your milage may vary.

Of course, this is a small sample.

Posted by at 9:58 AM | Permalink

DB's Medical Rants

I'm somewhere in the middle. I certainly don't accept my size, and am desperately trying to do something about it.

However, I'm getting sick and tired of seeing doctors who see fat, and not the other medical problems that are causing the fat to be more difficult to deal with.

Posted by at 8:50 AM | Permalink | Comments (3)

DB's Medical Rants

I still don't think he is getting it Though he is working on it.

I'm not cinvinced its genetics either. I think the problems behind morbid obesity are STILL undiagnosed or untreated medical issues that the doctors are missing due to their prejudices.

I've been going through a period of stress, worried about my husband, and I've stopped sleeping. As a result of the not sleeping, I'm finding it almost impossible to go to the gym and am eating more because I'm trying to stay awake.

Now that I am feeling better about his situation, I'm sleeping better, and feel the other issues will resolve again.

Posted by at 7:22 AM | Permalink

Dia Care -- Table of Contents (January 2003, 26 [90001])

Standard in Diabetes Care.

Posted by at 2:46 AM | Permalink

Bariatric Surgery

This is an excellent article on the side effects of weight loss surgery.

I don't know about the rest of the world, but I want to get well some day and be normal.

If I'm still "here" in 10 years, maybe.

I still think fixing the insulin delivery system and sleeping will help.

Posted by at 2:47 AM | Permalink

DB's Medical Rants

I've got a really good friend who is morbidly obese and desperately wants weight loss surgery.

She hasn't been able to get it.

She needs a new knee joint too but the surgeon won't touch it because she's too overweight.

She can't exercise because she has too much knee pain.

She's in this huge catch 20/20 situation because of insurance and because of the doctors.

I worry about her a lot.

I'm not sure what should be done for her.

Posted by at 2:41 AM | Permalink

DB's Medical Rants

I'm really glad that DB brought up the morbidly obese thing. Yeah, I am morbidly obese.

Yes, I have had a horrible time with my weight loss struggles.

Here's the deal. When my medical issues are taken care of, I lose weight. When my medical issues aren't taken care of, I gain weight. I also never seem to have weight stay the same.

Maybe DB and other doctors would have more success with the morbidly obese patients, if they would stop assuming the problem is patient behavior and look further into the patient's health and lifestyle.

The hard part is getting help. Especially with doctors that don't know me and don't try to find out more about me.

As those who have been keeping up with this know, I got a new doctor this year.

He means well, but he really makes some irritating statements sometimes. One included -- "maybe you should work out". That got him the teacher look, as I have been going to the gym pretty close to every day since before January 1. The correct way to handle that, is, what kind of work out are you doing, maybe you need to change it. In my case, the problem was how we were delivering insulin, and he DID get that one right.

When a patient IS doing the right things, then maybe there is an underlieing medical problem. My primary care doctors have NEVER asked me how much I sleep. The allergists have, and tried and tried to send me to a sleep study, but for 5 years, I went to a primary care physician who was doing everything he could to save money, and I have no idea why I didn't insist.

Fixing the sleep would have probably kept me from becoming morbidly obese.

Even when the patient is having some eating issues, maybe fixing some of the medical issues will stop the eating issues. Changing the insulin delivery method did that.

Believe me, I'll be ranting more on this, because I'm a very frustrated patient!

Posted by at 1:56 AM | Permalink

Memory Lane

I've been sensing and feeling connections between my cognitive ability and my memory retrieval ability in relationship with the level of blood sugar in my blood stream. So this type of article fascinates me.

One of the reasons I strive for as normal blood sugar as possible, is that I just plain have trouble thinking when it's high. The higher, the worse it is.

Posted by at 7:58 AM | Permalink

FDA Announces Labeling Changes on Heart Benefit Associated With Cholesterol Drug Zocor

I really hope it does help better than the others.

Posted by at 2:08 AM | Permalink

Thought more on this today.