<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />Patti- I am a simple orthopaedic surgeon so I knew naf all about the real day to day management of diabetes. If I had a patient in DKA or severe hypo- then I would have sorted it out properly.
At the moment I have an osteomyelitic bone infection in my foot- I have to push the system to get what I need (about to start hyperbaric oxygen therapy at my local NHS supported decompression diving chamber). Luckily I can give myself my own intravenous antibiotics at home. <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">
I am sorry to hear about your foot, it must be both extremely painful and very frightening too. I do hope the new therapy does the trick. Naturally you will need more insulin, since your body is under stress and producing cortisol which will push your BGs way up!
<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote">It is well accepted that patients only recall about one third of a consultation. The new members here have a hell of a job getting to grips with it. I am not a good example as it is a lot easier for me to absorb all the new skills. I can't carb count as my glucose profile has not been static since diagosis one year ago. I usually dose adjust appropriately- mind you I have had mild hypos over the last three evenings. My last HBA1C was 6.5% (I don't know what this weeks one was yet). You have a fab HBA1C- you sound like my paediatrician neighbour who ranges 4.9%-5.6%. You have a lot to teach insulin users. <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">
Not only do they have difficulties getting to grips with it, a lot of people rely on the medical profession to educate them how to manage it, and frankly from my own experience (and that of several diabetics I know in the real world, who just ignore their condition and rely on "the pills") I would say that is highly unlikely to happen. Since we need to be <b>at least</b> 60% of our own healthcare team I think people must be made to realise that if the NHS isn't going to educate them, they need to educate themselves.
<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote">We all have differnet profiles. I have to keep my HBA1C low as I have neuropathy. I also need to closely monitor my post prandial BG which is a different ball game in type 2 compared to type 1. In type 2, the liver produces 3 times more glucose (gluconeogenesis) than normal subjects. It is not just an insulin resistance/underproduction issue. I use my basal/bolus regime in a differnt way to my type 1 neighbour although we both use a n a loque insulins.<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">
Martin we <b>all</b> need to keep our Hba1c low in order to survive with as few complications as possible. I do know the differences in the types and how each is a different ball game. I must be the saddest person, since I spend ages reading NICE guidelines and getting into professional sites to read the latest papers I can find on anything to do with diabetes...but there you go, it is at least a fascinating hobby if nothing else!
<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote">Most diabetics are type 2 and most of them are not young. I suppose this forum will be biased towards type 2 users. Also, most type 2s are not unwell at diagnosis or in childhood. So a lot of new forum users will be diagnosed by GPs and treated in surgeries rather than in hospital specialised clinics. <hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">
For what it's worth, I am 61. I was diagnosed diabetic at age 57. My BG was 35 (in other words off the normal meter scale). I had rapidly lost weight and looked like something from another planet. I was immediately labelled T2 and put on Gliclazide and subsequently Metformin, which didn't do anything to lower my levels. I felt so ill I begged to be put on insulin a month later. I was put on Novomix 30 (dreadful stuff) and told to eat lots of starchy carbs by the dietitian I saw. The metformin and gliclazide were dropped. I had an Hba1c of 7.8 and a ticking off from the practice nurse who is the ONLY medical professional I have ever seen regarding diabetes. She was convinced I was stuffing sweets, whereas I was following the dietitians advice to the letter.
After a particularly nasty hypo in a department store where the assistants sneered at me and sniggered about "the drunk"... I decided that I needed an education and where better to get one than somewhere I'd been at home in since the very early 90s - in other words the internet. I found a newsgroup with a bunch of deadly serious folks (deadly serious about control that is) no huggy stuff and no feeling sorry for themselves. I learnt tons very quickly.
I kicked up a fuss until I got put on Lantus and Novo (subsequently changed to Levemir). I went my own dietary way... next Hba1c was 5.4 - once again I got ticked off by the nurse. She's given up now I think.
However, I am still labelled T2 because of my age when diagnosed and only minor ketones (but hey, LADA don't produce ketones to start with) I have asked for and been refused tests. I doubt I am T2, I am probably LADA and so yes, I've been through the honeymoon period where I never knew how much insulin I was producing and every day was a different juggling act, I still managed Hba1cs under 5.7. It all seems to have settled over the last 2 years and I have consistently been on the same dose of basal insulin (more or less, up a unit when sick, down a couple of units when it's hot). The bolus I adjust according to what I eat and the time of day.... I'm not on the sort of doses T2s typically use... go figure...
I was denied a DAFNE course "because you are T2". "Oh really, who says I am?" The very practice nurse I was talking to, at least she had the grace to blush and say "well maybe T1.5" I have never seen a diabetic Specialist and never will "because I am labelled T2" and only once seen a proper DSN (when I changed to MDI) and then only for 15 minutes. I will never be able to get a pump, or any education that I don't get for myself.
Cynical... you bet! But, I have never let diabetes get me down. It doesn't stop me doing anything. I will do all I can to help those who want to help themselves, and have even campaigned very hard (including a petition to No.10) to try to ensure that T2s not on insulin don't get denied test strips. On the same subject the BMJ printed my letter.... in response to that idiot who conducted a completely flawed "study" and concluded that allowing T2s to SMBG did not improve their Hba1cs. OF COURSE it didn't, they weren't educated in what to do with the results of the testing, and they were encouraged to "maintain the same regime".... yes????? Oh how very odd that their Hba1c's didn't improve.
Patti
On Levemir/Novorapid. Last hba1c 5.3
