dr's driving me bonkers

[megan]

well saw the psyc nurse today.....not sure what to say really....

he was mainly writing info about me....he asked how many blood tests i do a day and when i said 4 - 6...he wanted to see my fingers. he then said that he works with drug addicts and if i did that many tests it would show more on my fingers!


mmmmmmmm

we didn't really get anywhere and he left it with i'll be in touch.....oh and as it was 1.30pm and i last ate at 10.30....i'd left it a long time and so with that and the anxiety...would i be ok to drive...

that was not a big gap not to eat....quite normal in fact....if one was not so patient one may decide to pull ones own hair out in frustration!!!

oh and the i got to see my old diabetes dr. took my husband for support. the nurse poo poo'd the whole analogue versus animal thing....then the dr looked at my carb counting, blood results sheet and asked where i got it from then gave me his own and said when i've filled it in to send it to them and then we can have a lunch time session of checking how i count my carbs!!!! argh!!! for the love of god!!! (sorry).............we left in total shock and disbelief......my husband said he didn't speak up as there was nothing he could say...

and so.......i have no idea what to do next....hubby says that we'll go else where and put in a complaint here....but there is no where else.....if there was it would all be private and cost a fortune....the reason why i had to stop in the first place...

i think i should actually give myself a pat on the back for holding my sanity through all these years of cr*p from medics who act like they really don't like their job or maybe its just people :roll:

 

[donnellysdogs]

Hi Megan

I don't understand why you are annoyed that your doctor wants a different format record or why you should be annoyed that he wants to check the carb counting....

I personally thought it was fantastic when I used to email my GP every week with my log records that included all my carb counting, insulin intake, hypo's etc, as it gave him chance to have a really good look at what I was doing and how everything was including my carb ratio's and levels after food etc...I really miss this fantastic rapport that I had with my old GP.

Perhaps the positive that may come from this, is that your old diabetic doctor may agree to some changes that will help.

With the psych nurse as well, were you asked to make another appointment or was it totally left open, or will he be writing to your GP? If the psych nurse was writing a lot down, then there must have been notes that he would have been writing about to talk about..possibly at further appointments or with notes say to go back to GP...I think you are taking quite a negative outlook to the appointments today and don't reaally appreciate why you want to complain to be quite honest.....from your post I don't see why you feel so disapponted with the treatment that you received today.

Going back to the psych nurse, when the nurse said, 'i'll be in touch' didn't you ask what the next step was, what happens now, what did they think? etc etc...I personally would never leave an appointment without knowing what the next step was....

 

[janabelle]

Hi Megan,
I'm so sorry you've had such a disappointing time today I'd like to say I'm surprised but I went through the same load of cr*p for the best part of 4 yrs, and still come accross the disbelieving attitude regarding the analogue/ animal insulin issue. Like you, it was considerd a phsychiatric problem and my diabetes consultant's answer was anti-depressants :evil:
I can't remember if you've already contacted the IDDT, but if you haven't please give them a ring tomorrow while you're still fired up. I bet none of your diabetes team are taking insulin themselves, which begs the question why would they "poo poo" what other insulin users have experienced and know to be the truth. There is enough to read on the internet about it and medical professionals have access to far more info than we do. Unfortunately they don't always have our best interests at heart.
When my son who was 11 at the time, relapsed with Ewing's Sarcoma in 2003, we were told categorically that there would be no further treatment and he would die within the year. My husband, who's a clinical scientist, had access to info and discovered a chemo regime had been tested in the USA and been successful with some patients. However we saw 2 pediatric cancer specialist in London who claimed there was no treatment option. When my husband presented the information he'd discovered to my son's onconlogist, we got the impression she was already aware of it :evil: We pushed for him to undergo the harsh treatment, which meant he was in hospital for over 4 weeks and tube fed for 3 months. We knew that the toxicity of the treatment might kill him, and had a limited chance of curing him, but at that point we felt it was worth a chance.

Thank god for my husband's knowledge, if we'd left it up to the doctors Matt would not be here now. He turned 19 in February, and is in surprisingly good health. It left a bitter taste in our mouths regarding the doctor who'd treated him since diagnosis, but was ready to give up on him.

I'm sorry I've veered off track a bit, but my point applies to both your case and my son- doctors are not God, they don't always make the best or right choices. If you feel strongly enough about something suchas changing your insulin and your reasons for it, your doctor and diabetes team should have the decency to offer you the choice. They certainly have no right to refuse you on financial grounds, their "poo poo-ing" is simply down to ignorance.
You definately deserve a HUGE pat on the back for having to put up with such cr*p, and don't be beaten!

Speak to Jenny at the IDDT, then print of as much info to present to your doctor. Make another appointment asap, and present your case to him clearly and concisely. Make it clear you want to try another insulin and if he refuses ask him for a reason why. Stick to your guns and with any luck he'll take you seriously.

Wish I could offer more help Megan, you must be well pxxxed off
Jus x

ps as for psychiatric care!!!- my son was referred to our local "care" team and I use the term loosely. They forgot about him for 6 months despite promising a referral to a psychologist. They NEVER answer their phone, and don't reply to ansaphone messages unless a threat to complain to my GP is included. If my son was left to deal with them, which as a 19 yr old adult, he should be expected to do, he'd have probably given up. Fortunately it is me who is left tearing my hair out and saddened that someone as vulnerable as my son should be treated so shoddily. :evil:

 

[megan]

oh wow janabelle...i am so sorry for all that you have had to go through and your son and husband.....fantastic that you kept on and on until you got the help that was needed.....

i think you understand all this very well and i appreciate your support enormously!

donnellysdogs....i guess on first looking i can understand your confusion at my reaction....believe me it was not the strongest reaction at the time....i have stayed very quiet....my husband was with me and was fuming..

i would never have a problem with a dr if i never had to see them or had had the experiences i have had....i have remained patient for years and years
i only went back to this diabetic dr because i had no choice, and i had to still have some hope and optimism. he is known well for his awful bedside manner. i can accept that. but his flippant way of not paying any attention to my results and notes and not giving any opportunity for me to talk or for him to listen. he was 'box ticking' ..no more than that...which in mine and my families opinion is simply not good enough.
so what happens next is that i fill in his book with the information i went in with yesterday and post it to the diabetes nurse and then they call me in for a chat about how i am counting my carbs.
i can't even tell you how many times this has happened over the years...there is no other help for coming, i simple get sent home and told to live with it as it is.
that is not good enough.
they talk about keeping good levels to try to avoid the complications that can come later and yet offer me no other tools with which to do this.
the psych nurse said yesterday that my sugars should not be so poorly as the team should be helping me...so whats the problem.
the problem is that they put you on the meds and tell you what to do with it...i did the DAFNE years ago.....i have seen more than my fair share of dieticians.....i have been through this routine so many times.

its taking the 'mick' through ignorance and lack of knowledge...or is it simple because thats what everyone does (majority) and so therefore we will not be looking else where for answers.

i did manage to briefly speak up for myself before i went into the dr when the diabetes nurse came to talk to me. i mentioned that i might like to try swapping the novo for an animal alternative (i have spoken several times to the very helpful and supportive IDDT).....she screwed up her face and said that that was really only people who keep going seaching for a miracle and its not that....and where are these people....i said that they are all round the world and not just based in this one small area.....

i wish i had added that what is wrong with wanting to find help...to help improve your health to make you feel better.....but it would have fallen on deaf ears.

i have put up with their seriously cr*p attitudes and generalisations for years...thats why i stopped going there in the first place. i saw a team in bournemouth twice and they were far more approachable and willing to listen and discuss. unfortunatley because of where i live i cannot afford to go there as it costs £500 a time!....and although they want to help me with a pump..i do not live there and they cannot help with that.

so i have to go back to my old team and have a lot of hope and the usual half tonne of patience.

its seems simple enough to me....health issues..not controlled make you feel lousy...no hope for getting it better and such little support makes it even harder...what the furture then holds?

end up at a psych nurse for help with meds change when i was meant to be going back to a dr i knew and who knew me....but the system has changed and so i had to see the nurse first....i didn't ask him what came next i guess because he hadn't seem to believe some of what i said and kept asking me questions about how i got there in the first place which i thought i'd answered several times. it was all very confusing and i was just told to wait..

and so......if i speak up to ask questions i am just told i am anxious and thats my problem according to the diabetic dr....have i heard of CBT....yes i have a yes i did it for 18 months....its all there in my notes.

he didn't pay any attention to my blood sugar results.....or my CARB counting....dismissed me....i waited a long time for that appointment......and i am to reschedule with him in 3 months......

i am in my 30's, i need to be working but am unable at the moment....i want to feel well but am still banging my head against that same wall..... :shock:

 

[Snodger]

megan, I don't have any useful advice but I just wanted to say how sorry I am you are having such a struggle and I think you are perfectly right to be frustrated and angry at what you've had to put up with.
The stuff the psych nurse said just makes me soooo angry... basically calling you a liar based on entirely irrelevant experience. You are very patient, I would have walked out at that point I think.

 

[donnellysdogs]

Sorry Megan to hear your full story.

Is there nothing that can be done to change practices, hospitals or anything at all?

I too have had cr*p time with GP, and I only get treated well by him, if my husband attends-even if my husband says nothing at ll, the GP has a completely different attitiude to me!!! I know you have had your husband there, but there has to be a way around the problems that you are expereincing with your health professionals. I don't know what they could be tho'!!

 

[iHs]

Megan

If you are using the bolus/basal regime, how are you going about calculating your insulin for the carb that you eat?

 

[Snodger]

(also megan, this thread reminded me of how useful your experiences are going to be on my advisory group for my study... I sent you a PM about it but I don't think you've PM'd back with your email. Would be great to have you on board if you are still interested. Am thinking of sending some stuff round to the group soon.

Snodger)

 

[Sid Bonkers]

well saw the psyc nurse today.....not sure what to say really....

he was mainly writing info about me....he asked how many blood tests i do a day and when i said 4 - 6...he wanted to see my fingers. he then said that he works with drug addicts and if i did that many tests it would show more on my fingers!

Your psyc nurse might benefit from a course in physiology so he is able to tell the difference between a simple finger prick test and injecting heroin into a vein, what an idiot.

 

[megan]

oh thanks guys....hearing from you puts a smile on my face...

the bolus/basal regime i use is

24 basal morning and 24 at night

1.5u/10g cho for all 3 meals and if needed then the same or 1u/10g for a snack depending on what it is...

saw my new gp today.....with my husband so i had back up to confirm the prat that is my diabetes dr and his side kick the diabetes nurse and the psyc nurse....she did have a smile and a chuckle with us and was looking forward to the psyc's report and indeed to setting him straight if necessary.

as for the diabetes team...well we all understand i have to tread water there and do as instructed....and then if in time they still don't help or change as they have never really been able to do before then i may have some footing and support with the gp to formulate a letter and maybe intime get a referral to the uk....but that is me summising...and hoping i guess....the dr wandered if the diabetes dr may be up for retirement soon....not a hope! :cry:

but she has increased my new antidepressent as i am tolerating it ok.....if it helps with the anxiety....which seems to have a mind of its own...then perhaps that will help with the blood levels....but i also think its a case of what came first..the chicken or the egg

the diabetic dr and uncontrolled sugars or the anxiety......i know which way round i think it came!

 

[megan]

(also megan, this thread reminded me of how useful your experiences are going to be on my advisory group for my study... I sent you a PM about it but I don't think you've PM'd back with your email. Would be great to have you on board if you are still interested. Am thinking of sending some stuff round to the group soon.

Snodger)

hi so sorry i didn't get back to this sooner...have PM you now and look forward to hearing from you

 

[iHs]

oh thanks guys....hearing from you puts a smile on my face...

the bolus/basal regime i use is

24 basal morning and 24 at night

1.5u/10g cho for all 3 meals and if needed then the same or 1u/10g for a snack depending on what it is...

Megan

You appear to be using the same insulin to carb ratio for all your meals. If you have done DAFNE hasn't anyone explained to you about adjusting the ratios up or down according to what your bg levels are and on how much carb you eat? Testing your bg levels 4-6 times a day is not going to give you wonderfully good control. The testing needs to be done 6 times a day, writing all your bg results down, how much carb you eat and adjusting your ratios up or down so that when you test your bg levels they will be somewhere between 5-7mmol before you eat a main meal, then 7-10mmol 2 hours later. If bg level is about 7mmol 2hrs after eating you will probably need to eat a small snack but if it is on 8-10mmol you can leave yourself go for another 2hrs without eating although you will need to be on the lookout just in case you find yourself going low 30mins before you are due to eat a main meal. Unfortunately no one can actually tell you what your exact ratios need to be, you've got to work them out for yourself by testing etc

 

[Snodger]

hi so sorry i didn't get back to this sooner...have PM you now and look forward to hearing from you

I can't see your PM.... ?? :?
Is there something wrong with the PM system? It seems to be doing odd things.

 

[cugila]

hi so sorry i didn't get back to this sooner...have PM you now and look forward to hearing from you

I can't see your PM.... ?? :?
Is there something wrong with the PM system? It seems to be doing odd things.

The pm system is under the control of individual Members, as far as we are aware it is working fine. It does however, depend on what setting you put in to start with.......Member's can choose to not allow pm's if they wish. You will always get pm's from Monitor's or Admin.

Anybody who appears to have a problem can pm myself or Sue and we will try and help sort things out. If your pm system isn't working put a message on the board and we will respond.

 

[megan]

oh thanks guys....hearing from you puts a smile on my face...

the bolus/basal regime i use is

24 basal morning and 24 at night

1.5u/10g cho for all 3 meals and if needed then the same or 1u/10g for a snack depending on what it is...

Megan

You appear to be using the same insulin to carb ratio for all your meals. If you have done DAFNE hasn't anyone explained to you about adjusting the ratios up or down according to what your bg levels are and on how much carb you eat? Testing your bg levels 4-6 times a day is not going to give you wonderfully good control. The testing needs to be done 6 times a day, writing all your bg results down, how much carb you eat and adjusting your ratios up or down so that when you test your bg levels they will be somewhere between 5-7mmol before you eat a main meal, then 7-10mmol 2 hours later. If bg level is about 7mmol 2hrs after eating you will probably need to eat a small snack but if it is on 8-10mmol you can leave yourself go for another 2hrs without eating although you will need to be on the lookout just in case you find yourself going low 30mins before you are due to eat a main meal. Unfortunately no one can actually tell you what your exact ratios need to be, you've got to work them out for yourself by testing etc

most of the time....occasionally i uses 1 unit for 10g of a lunch time dependent on what i am eating...but yes i have tried and tested it over the last 8 years and it sometimes changes...sometimes has been more than 1.5 units for 10 g.....i do assess the whole situation before taking doses......at the moment the sugars are just high accross the board and then this last day they have dropped a little.....all sorts of things effect it as you know :?

 

[megan]

oh and do you have any idea about how many times i have been told i do too many blood tests!!!

either by the very dr who taught me the DAFNE or by the gp that has got his advice from the before mentioned diabetes dr!!!!........a few years back i even got advised to not do any tests for 3 days so i could relax about it all!!!!

 

[moonstone]

Hello Megan,

Yes you have had some bad attitude from some medical professionals. I think I remember you saying once before that you're in one of the British isles and don't have the right to free health care, so you're stuck with them.

I see three paths to sorting this situation out. And all of them entail you stopping putting your life into the hands of others, no matter where or who they are, and taking control of the situation by yourself.

1. You are a DAFNE graduate, hence you are entitled to use the DAFNE website. Get in touch with your DAFNE coordinator, get your login details, sign up immediately, join the forum and get advice from the healthcare specialists in that part of the forum. Bypassing the locals and going straight to the experts.

2. You say your levels are high across the board. Thus, you are quite simply not injecting enough insulin. You have 3 main choices: increase basal, or increase bolus, or increase both. The way it looks to me, is you are already taking a lot of basal and the basal/bolus ratio is meant to be around 50/50 when you add up your total daily dose. Therefore, it seems to me, you're probably not injecting enough rapid acting insulin. As you know, from DAFNE, you change only one thing at a time, and when changing ratios you only go up half a unit at a time. So you leave the basal where it is and increase all 3 mealtime ratios by 0.5 for several days and see if the numbers start getting better. If yes, but you're still high across the board, well you go up another 0.5. Gradually you may find nuances in the times of day and you may find you need more in the morning, like many diabetics (I don't, so it's not everyone).

3. Factor in your hormonal fluctuations. You can't help it, but you have to be aware of it before you can deal with it. I had no idea about it but was advised strongly to note my periods in my DAFNE diary and there it was, clear as day: I needed more insulin in the week before, and I could have a big hypo on the first day. The last 2 months have seen me spend 3-4 days going into hypoland before righting myself again. OK, so I'll make plans for next month, simple. One lady at a DAFNE follow-up said she had to change everything every week due to her hormones. So that's the deal, you need to assess it all for 2-3 months then make appropriate adjustments the next time it's due. I now note when my period's due in the food diary so that I am ahead of the game and prepared for what's coming.

I'm no angel and haven't got a perfect hba1c but I can't fathom why you let yourself be dictated to by these people, which only increases your sense of anxiety, frustration and powerlessness. You need to take control.

Testing? The DAFNE rules are: test on waking, test before each insulin shot, test before bed, and test if you feel you might be hypo. If that's 4 times a day cos you only ate twice, then it's 4 times a day. if it's 10 times a day because you've eaten lots of times and thought you might be hypo, then it's 10 times a day. Maybe you can try to do one month with no snacks to cut out what I call the 'chaos factor' and try to leave a gap of 5-6hrs between each meal so that you get true readings before meals and can more clearly see what's happening.

Get out your DAFNE course manual and re-read absolutely everything. If you've lost it, you will get a copy on the website. You can also download the DAFNE food diaries there. You will be able to get direct answers from experts in the field on the forum, you can upload all your results to the site and get answers and essentially, you will be able to start taking more control for yourself whilst taking advice that you feel, crucially, you can trust.

Jeez, no wonder you're anxious and depressed with all those people telling you what to do with yourself!! So - it's time to dust off the cobwebs and start again, with you in charge. What do you want them to say or do for you - unless you think they're going to follow you round counting all your carbs and working out your insulin! (Well, I've offered my hand in marriage to anyone that will do that but it turns out it's my job.) Since they're obviously not helping - you help yourself. You can do it, of course you can. And yes, constantly high sugars lead to a higher chance of depression, I was demented at diagnosis and slipping back to an hba1c of 9% last year started affecting me again in that way; it took a few months of better control to shake it off. So you have to keep reminding yourself - you only feel like that until you get your sugars under control. And the person counting those carbs, and injecting that insulin, is not the doctors, it's not the psychiatric nurse, nor is it your husband - it's you, and you will gain control of your own sugar levels.

I hope you get somewhere - and just remember there's no point banging your head against that same brick wall, especially not when you could take more of the initiative. I hope I haven't sounded high-horsey because I'm trying to be encouraging. First thing tomorrow, get your DAFNE login details and find that manual - that's where it's all going to start going right for you! And force yourself to stop winding yourself up into knots about who said what about this that or the other - who cares, certainly not you, right? All it's doing is dragging you down. Next time you start thinking about that psych nurse or that Dr you just have to say - oh who cares. You know, they're well-meaning, and that's what you have to take away from it.

Take care of yourself,
Moonstone

 

[megan]

thank you moon stone for your response....its encouraging and heartfelt.

i work very hard at being proactive in my own health care. through trolling the internet and reading and gaining as much information as i can i have been looking after myself with no diabetes team for the past 4 years. i did go to the uk twice and although they were very supportive...they could not actually be my diabetes team as such.

i have counted my own carbs and adjusted my own meds for so many years i certainly don't expect anyone else to do that. its an automatic calculation as you will know.

i have changed insulin, split doses, gone onto metformin requested thyroxine increase when it was needed, keep stock of antibiotics and testers for recurrant UIT's......i look after myself....i have got critisised numerous times for testing too much for trying too much.....
one thing i find concerning is that when i did the DAFNE course i was told by the diabetes dr and nurse that their method would either be praised or thrown to the wolves when they took it to the uk.....they never told me the out come....i never had a manual....i've never heard of the login.

thank you for that and i shall do that straight away

as for the hormonal fluctuations....because of the coil i have, i have no periods and haven't for 5 years.

i have tried to look for patterns each month and continue to do so.

this year i joined the gym and pilates in jan.....caused pain and had to stop.....went to dr for help...got none....feb pains continued...went to dr for help another two times....eventually as it was dragging me down the dr referred me back to psych dr.....then promptly forgot about my referral for 3 weeks until i had reminded them 2 times.

inbetween times i felt so awful and my sugars were geting higher that i changed my gp. new gp great and reduced my antidepressents......diagnosed fibromyalgia.
within 3 weeks i wasn't coping very well with this. sugars getting higher.
went back to new gp and she immediatly changed my antidepressent to a new one.

week later new gp increased dose of new medicine.
saw psych nurse and diabetic dr and wished i hadn't.

blood sugars starting to improve. rather than 14 - 20

now 8 - 13

more often 12 -13 but an improvement no less.
i have tested my basal insulin before to see that i am on the right amount....i this does get periodically changed.....i am interested to see what the uk DAFNE site is like

thanks

 

[moonstone]

Hi Megan,

I'm sure all the pills you're on aren't helping your sugar levels - when I was about to be diagnosed and it was really obvious what was wrong and I was really ill, I wanted to take painkillers and my type 1 manager - had it 30-odd yrs - told me that he reckons only paracetomol has no effect. So it will be good when you can come off the antidepressants. From what you've said I reckon your hba1c has to be about 9ish, which is where I started to feel depressed again.

As for the coil, I don't think it stops hormonal fluctuations as-is, despite stopping periods, unless you've got the merina coil which gives out hormones, and once again I understand they will affect blood sugars (in fact I won't have one because of that). Same for the pill. I should imagine it's still a factor, so keep a note anyway.

If you did DAFNE outside the UK I'm not sure they give you an automatic login but you can still sign up, so head over to dafneonline.co.uk and get in! And the sugars you're reporting are absolutely not the worst in the world, ok they're not the best, but they're not the worst either so once you get it down a touch for a couple of months you will in fact feel a lot better, I'm sure of it. I just wonder if you only need to increase your ratios by 0.5 for each meal to achieve much better results most of the time - you're really not that high. It might be worth injecting the same ratio for snacks for a while too, and as I say it might be a good idea while changing ratios to even skip snacks altogether for a few weeks. I did it, when I kept going too low - no snacks, and all my meals 6hrs apart. It gave me a much clearer picture. Eventually it became a routine. I think the solution to the issue is probably simpler than you think, and the Dr, diabetes nurse, psychiatric nurse et al can only give your the best advice they can manage, and I think they're confusing you just by being there. Well I know they are, because it's clear from your posts (you might not realise it). Smile sweetly at them, say yes Doctor, you're right, and go off and do what you need to do.

As for the animal insulin, it's obvious you're going to get nowhere until you can show you're in control of it all so when you get lower, get off the antidepressants, feel better, then go in armed with the right info from the IDDT and get the insulin change you want. Whatever reasons they're giving you for not having it, they're basing that on what they're seeing now and obviously trying to put you off, so although it seems counter-intuitive to you they clearly think they're doing the right thing and it's pointless trying to have that argument with them at the moment. Once you've turned a corner, they'll probably take you much more seriously. We're only diabetics, not salesmen, but sell yourself. Look at me, I've improved x, y and z; I've taken control of it and got my target hba1c three times in a row; I take advice from specialists such as professors on the DAFNE forum; I know what I'm talking about and doing and my next step is I want to try animal insulin and I accept that if it doesn't work for me I will go back to the other stuff but I want minimum 6 months on it in which to give it a good trial.

If they still won't be nice to you after that then God knows!!

Have a lovely day,
Moonstone.

 

[donnellysdogs]

I have fibromyalgia, and for me every single antidepressant or antidepressant/painkiller has actually lowered my need for insulin quite dramatically.

Fibromalgia sufferers rarely actually manage to get off antidepressants, as like mine (duloxitine)-it is antidepressant and pain killer.

Pain is known to have an effect on the needs of insulin.

Personally, I don't think that coming off all the antidepressants and medicines is a choice when you have fibromyalgia. Fibro is when your brain gives wrong signals due to an imbalance ot things like serotonin.

I am not a fibro expert, as I am still suffering with it, but now I actually have got a number of drugs that keep me good-ish, I am sticking with them, and working my way around them with the type 1 diabetes and the insulin pump.

Giving figures of 9-ish for feeling depression is a buit misleading, as depression is a big part of fibromyalgia and the way our brains operate. I have had hba1c of 6.7 and still feeling depressed- I could have a level of 5 and be far more depressed if I wasn't on my fibro medicines.

Finding the right medication for fibro is hard. GP's will try out cheaper drugs before the more expensive ones. I tried practically everything before my GP put me on duloxitine and ampitryptalene and my brain is now functioning, and my pain is improving.

Your diabetes is manageable, I would far rather give myself enough insulin to bring down my levels than worry about the amount I am having to give.....and what I am having to take etc.