Tuesday, April 8, 2008

The importance of diabetes self-management

Before I move on, I want to say one last thing about my first endocrinologist.

I mentioned in my post about finding my old medical records that my first endocrinologist used to berate me for adjusting my own insulin dosage.

Here are his notes in my records:


Overall control is much more variable. I have asked Katharine not to very [sic] her Lantus dose. If she is having difficulty she is to let us know.


She has been adjusting her Lantus dose by herself. Her blood sugars have been very irregular since her last visit as a result...

A hemoglobin A1c is significantly improved, however, her blood sugars remain very erratic. I have asked Katharine to not change her Lantus dose. Her Lantus dose should remain relatively stable.

I'm missing the paperwork for the visit that would have fallen between these two, but I'm sure you get the idea. By the time I switched to the Barbara Davis Center, I had come to dread my appointments with my endocrinologist, because I knew I would be harassed and blamed for attempting to control my diabetes on my own.

The thing is, my erratic turned out not to be because I was trying to adjust my own Lantus dose, as my doctor claimed, but because he had failed to tell me Lantus expires 28 days after being opened. I was using the bottle until it was empty, which took about two months — so every other month, my sugars were off the charts.

It was his nutritionist who realized what was going on, and it was she who gave me the subtle encouragement I needed to switch doctors. She saw that I was not happy with my current endocrinologist, and gently suggested that a good doctor-patient personality match is important.

Thanks to that advice, I now have a doctor who is much more supportive of me and my diabetes. He has never criticized me for adjusting my own dosages, and although he has made suggestions in the past, it also seems like he usually agrees with the changes I make to my dosages.

The thing is that being able to adjust one's own insulin dosages is imperative for good control of type 1 diabetes. Despite my doctor's claim that my "Lantus dose should remain relatively stable," my insulin needs are in constant flux, and I need to be able to keep up with them if I want to avoid periods of persistent highs or lows.

For instance, during my menstrual period I almost always require about four units less Lantus, compared with the rest of the month, when I'm on the pill. Stressful periods (such as finals week when I was in school) almost always make my insulin needs go up, and periods when I am more active or eating less than usual almost always make my insulin needs go down.

If I didn't feel confident adjusting my own insulin dosages, I would suffer chronic high sugars or dangerous hypoglycemic episodes every time my metabolism adjusts up or down. This shows that in order to have the best possible control over your diabetes, you literally have to know your body better than your doctor — and be comfortable making executive decisions based on what, in your experience, works or doesn't work. Treating diabetes is a daily thing, not just something your doctor deals with every few months!

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