through the hoops
Question:
I just got a call from my new doctor. She got my blood tests back from the lab. My HbA1c test was 7.4, which she said was very good. My Chem 24 panel test was apparently also very good. She didn’t sound as resistant to my Regular-insulin-only therapy this time. Hopefully the insurance company will also give me the thumbs up. Mark M
Response:
Doug, it’s been a real education for me. I haven’t had much to do with the medical profession for the past several years, and I just sort of expected them to be more than they were. That their behavior was robotic wasn’t especially surprising to me, but that they had an almost complete lack of sensitivity and openess to actually relating to me as a fellow human was really shocking. They seem to feel that they’re not dealing with humans but with mechanical objects. Hell, I know car mechanics who have a more feeling relationship with cars than the doctor I saw had with me. I feel sorry for her when she herself has to go to a doctor. Mark
The last time I put up with the condescension of a doctor was when my pediatrician suggested that I stop eating so much instead of properly diagnosing me with a hypothyroid condition. That was 30 years ago. I would not tolerate that ever again. Randy
Response:
Mark been there, done that, and I HATE IT when they treat me like a six year old moron that doesn’t even know what diabetes is. Fortunately, when my son became diabetic, the staff at children’s hospital tested me and my wife and after 24 hours, released him to our care since we obviously knew what we were doing. That was such an unexpected result that I still have trouble believing it happened. He’s doing fine too. As for the labs, they almost always require a fast THEREFORE you must have needed one too because that’s the way it was with the last 1524 patients. You really can’t expect them to think now can you???? Doug
Doug, it’s been a real education for me. I haven’t had much to do with the medical profession for the past several years, and I just sort of expected them to be more than they were. That their behavior was robotic wasn’t especially surprising to me, but that they had an almost complete lack of sensitivity and openess to actually relating to me as a fellow human was really shocking. They seem to feel that they’re not dealing with humans but with mechanical objects. Hell, I know car mechanics who have a more feeling relationship with cars than the doctor I saw had with me. I feel sorry for her when she herself has to go to a doctor. Mark
Response:
I went to an endocrinologist today for the the first time in several years.
Mark been there, done that, and I HATE IT when they treat me like a six year old moron that doesn’t even know what diabetes is. Fortunately, when my son became diabetic, the staff at children’s hospital tested me and my wife and after 24 hours, released him to our care since we obviously knew what we were doing. That was such an unexpected result that I still have trouble believing it happened. He’s doing fine too. As for the labs, they almost always require a fast THEREFORE you must have needed one too because that’s the way it was with the last 1524 patients. You really can’t expect them to think now can you???? Doug
Response:
Some type 2’s can produce enough insulin to handle their basal. R with a bit of a tail may work better at this than H. Art Schor – Hide quoted text — Show quoted text – Just how do you handle MDI using Regular only? At what times do you test/inject? And how about sleeping? I inject R about 30 minutes before each meal, the number of units depending on the composition of the meal. I test first thing in the AM (FBS) and 2 hours after every meal. When I first switched to this therapy, I did overnight BG testing on 2 separate nights, to make sure that the R I had injected before dinner was still covering me properly (which, of course, is the biggest question mark with this type of therapy). Occasionally I test intensively for a couple of days to make sure nothing has changed. I use Humalog during a meal if I decide to eat an extra helping or a sweet desert, as well as to cover snacks. I also use Humalog to bring down my BG in the event (very rare) that my 2-hour post-prandial BG is higher than 140mg/dl. I sleep only 5-6 hours a night, typically from midnight to between 5-6am. Although I set my alarm clock for 6:30am, I can’t remember the last time when I didn’t automatically wake up by 6am. When I was younger, however, I required 7-8 hours’ sleep and felt rotten if I got less. I think that this schedule, combined with a high sensitivity to insulin and a low basal need, are what have enabled me to thrive on this rather unusual type of therapy. From what I’ve read in this newsgroup, though, it appears that most Type Ones have a much higher basal need and therefore could not rely simply on R for overnight coverage; typically they would need to add some N or U. dkc David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/media.htm [To reply by e-mail, delete "removeme." -- including the extra "."]
Response:
Then she asked me all the standard diabetic questions and was of course surprised that I hadn’t seen a doctor in a while. She also seemed very perturbed that I was treating myself with multiple daily injections of only regular insulin. I asked her if she had many patients my age who’d been diabetic as long I had who were as healthy as me. She got kind of flustered and said, "Well, I have a whole range of different patients."
Just how do you handle MDI using Regular only? At what times do you test/inject? And how about sleeping? TIA Ned — Ned Kelly Computer Innovations, Inc (732)345-1250
Response:
(…) Then she asked me all the standard diabetic questions and was of course surprised that I hadn’t seen a doctor in a while. She also seemed very perturbed that I was treating myself with multiple daily injections of only regular insulin. I asked her if she had many patients my age who’d been diabetic as long I had who were as healthy as me. She got kind of flustered and said, "Well, I have a whole range of different patients."
(…) Thanks for taking the time to post the details. When I first told my doc I’d switched to MDI using only Regular insulin, he raised his eyebrows, heard me out, examined my BG log, and said, "This is an unusual therapy, but since it works well for you, by all means continue with it." But I’d bet just about anyone on MDI had a flash or two of recognition in reading of that doctor’s reactions. It’s taking a VERY long time for some MDs to update themselves on the DCCT results. BTW, Did you get accepted for the policy? dkc David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/media.htm [To reply by e-mail, delete "removeme." -- including the extra "."]
Response:
BTW, Did you get accepted for the policy?
I’ll get the blood tests taken tomorrow, and I’m sure I’ll then have to wait a bit for both the medical and insurance company bureaucracies to do their things, but I’ll let you know when the final decision comes in. I’m keeping my poked fingers crossed. Mark M
Response:
Just how do you handle MDI using Regular only? At what times do you test/inject? And how about sleeping?
I inject R about 30 minutes before each meal, the number of units depending on the composition of the meal. I test first thing in the AM (FBS) and 2 hours after every meal. When I first switched to this therapy, I did overnight BG testing on 2 separate nights, to make sure that the R I had injected before dinner was still covering me properly (which, of course, is the biggest question mark with this type of therapy). Occasionally I test intensively for a couple of days to make sure nothing has changed. I use Humalog during a meal if I decide to eat an extra helping or a sweet desert, as well as to cover snacks. I also use Humalog to bring down my BG in the event (very rare) that my 2-hour post-prandial BG is higher than 140mg/dl. I sleep only 5-6 hours a night, typically from midnight to between 5-6am. Although I set my alarm clock for 6:30am, I can’t remember the last time when I didn’t automatically wake up by 6am. When I was younger, however, I required 7-8 hours’ sleep and felt rotten if I got less. I think that this schedule, combined with a high sensitivity to insulin and a low basal need, are what have enabled me to thrive on this rather unusual type of therapy. From what I’ve read in this newsgroup, though, it appears that most Type Ones have a much higher basal need and therefore could not rely simply on R for overnight coverage; typically they would need to add some N or U. dkc David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/media.htm [To reply by e-mail, delete "removeme." -- including the extra "."]
Response:
- Hide quoted text — Show quoted text – I went to an endocrinologist today for the the first time in several years. The main reason I went was that I just applied for insurance, and the insurance company requires that I be examined and a couple of blood tests be taken. So I made an appointment at one of the endocrinologists that the insurance company will cover once I’m approved. Since I’m not approved yet, of course, I have to pay for the office visit and the blood tests. The doctor weighed me, checked my height, took my blood pressure, shined a bright light in my eyes to check for retinopathy problems, touched the bottom of my feet with a broken-in-half tongue depressor, asking me if I felt it. I’m happy to say that I’ve passed everything so far: I have a weight, I have a height, no retinopathy, and yes, my feet are at least as sensitive as "a normal person’s" and I even have hair growing on them and strong pulses in them. Imagine that. My blood pressure was kind of elevated, 150/80, I believe. Shining bright lights in my eyes and hearing a doctor expound pedantically about my impending bodily degradation had nothing to do with that, I’m sure. Then she asked me all the standard diabetic questions and was of course surprised that I hadn’t seen a doctor in a while. She also seemed very perturbed that I was treating myself with multiple daily injections of only regular insulin. I asked her if she had many patients my age who’d been diabetic as long I had who were as healthy as me. She got kind of flustered and said, "Well, I have a whole range of different patients." It felt like she was talking to me as if I was a retarded robot that she needed to scold, repair, and warn of the looming inescapable dangers of my condition. She was constantly saying things like, "Of course we will have to do some checks on your kidneys, because the kidneys of diabetics are very much at risk." Or, "As a diabetic ages, his feet begin to lose sensation." She seemed appalled that I didn’t wear shoes in my house and that I had some calluses and told me that the next step was that my calluses would split open and then I’d be in real trouble. I’d lose sensation in my feet; I could step on a nail and not know it; and the next thing I’d know I’d be in the hospital for an X-ray and they’d discover a nail embedded in my foot. She literally told me this. I *tried* just to nod my head and say, "Yes, doctor," knowing that I have to go through all the requisite hoops if I’m to have any chance of actually obtaining insurance. But, after a while, I couldn’t take it anymore. I told her that the ONLY reason I was there was to qualify for insurance so that it would help pay for my insulin and test strips. I told her that if she happened to be a doctor who was open to working with me in my particular exploration of my treatment of my diabetes, including all the alternative things I’ve done that have obviously kept me more than regularly healthy, then I would be very glad to have her as a doctor. She just looked dazed after I said this. I think it went right over her head. So I started doing the "Yes, doctor" behavior, with a very serious and contemplative look on me face as I considered and agreed with her oh so wise counsel, and she seemed to instantly become more at ease. They didn’t have a lab at her office, so I have to get the tests done elsewhere. I thanked her profusely (thinking Obi Wan Konobi-like-thoughts in her direction: "You will let the insurance company know that there are no problems with this one…") and went and waited for them to tally up my bill. $220. For at most 20 minutes. I couldn’t believe it. And then I still have to pay for the blood tests. Thinking I could get them done next, I drove to the lab, sat in a waiting room for a few minutes, and then was called up to the receptionist. She asked to see my paperwork. "Have you had anything to eat or drink today?" "Yes." "You have to fast for this test." "The doctor didn’t say anything about that." "Well, you can take it if you want. It’s up to you." "But I’m supposed to have fasted before taking this test?" "Yes. For at least 8 hours." "OK. I’ll come back tomorrow." When I got home, I called the doctor’s office to find out why they hadn’t warned me, and they told me that I DIDN’T need to fast before the test. That certainly raised my confidence in the competence of these medical people. I hope they don’t infect me with mad cow disease or something while they’re drawing blood. Just thought I’d share my joyful experience of the medical world here. Mark M
Mark, When we outlive all expectations, they don’t know what to do with us (AIDS and breast cancer patients probably have the same problems we do when dealing with the medical profession). You’re almost expecting them to say, "Why aren’t you dead yet???" Even though I don’t mind my current MD, I so wish I could find a Marcus Welby-type who REALLY cared. But they don’t exist. Keep doing well, Mark. Good luck to you. Jennifer "Never go to a doctor whose office plants have died." –Erma Bombeck
Response:
I hate doctors. Well, most of them, anyway. Mark, take heart. There really are good ones out there. I’ve got one (I had to go through a few to find him, but I found him). Someone really ought to clue doctors into the fact that gloom and doom counsel is only minimally useful. Wendy
Response:
– Hide quoted text — Show quoted text -I went to an endocrinologist today for the the first time in several years. The main reason I went was that I just applied for insurance, and the insurance company requires that I be examined and a couple of blood tests be taken. So I made an appointment at one of the endocrinologists that the insurance company will cover once I’m approved. Since I’m not approved yet, of course, I have to pay for the office visit and the blood tests. The doctor weighed me, checked my height, took my blood pressure, shined a bright light in my eyes to check for retinopathy problems, touched the bottom of my feet with a broken-in-half tongue depressor, asking me if I felt it. I’m happy to say that I’ve passed everything so far: I have a weight, I have a height, no retinopathy, and yes, my feet are at least as sensitive as "a normal person’s" and I even have hair growing on them and strong pulses in them. Imagine that. My blood pressure was kind of elevated, 150/80, I believe. Shining bright lights in my eyes and hearing a doctor expound pedantically about my impending bodily degradation had nothing to do with that, I’m sure. Then she asked me all the standard diabetic questions and was of course surprised that I hadn’t seen a doctor in a while. She also seemed very perturbed that I was treating myself with multiple daily injections of only regular insulin. I asked her if she had many patients my age who’d been diabetic as long I had who were as healthy as me. She got kind of flustered and said, "Well, I have a whole range of different patients." It felt like she was talking to me as if I was a retarded robot that she needed to scold, repair, and warn of the looming inescapable dangers of my condition. She was constantly saying things like, "Of course we will have to do some checks on your kidneys, because the kidneys of diabetics are very much at risk." Or, "As a diabetic ages, his feet begin to lose sensation." She seemed appalled that I didn’t wear shoes in my house and that I had some calluses and told me that the next step was that my calluses would split open and then I’d be in real trouble. I’d lose sensation in my feet; I could step on a nail and not know it; and the next thing I’d know I’d be in the hospital for an X-ray and they’d discover a nail embedded in my foot. She literally told me this. I *tried* just to nod my head and say, "Yes, doctor," knowing that I have to go through all the requisite hoops if I’m to have any chance of actually obtaining insurance. But, after a while, I couldn’t take it anymore. I told her that the ONLY reason I was there was to qualify for insurance so that it would help pay for my insulin and test strips. I told her that if she happened to be a doctor who was open to working with me in my particular exploration of my treatment of my diabetes, including all the alternative things I’ve done that have obviously kept me more than regularly healthy, then I would be very glad to have her as a doctor. She just looked dazed after I said this. I think it went right over her head. So I started doing the "Yes, doctor" behavior, with a very serious and contemplative look on me face as I considered and agreed with her oh so wise counsel, and she seemed to instantly become more at ease. They didn’t have a lab at her office, so I have to get the tests done elsewhere. I thanked her profusely (thinking Obi Wan Konobi-like-thoughts in her direction: "You will let the insurance company know that there are no problems with this one…") and went and waited for them to tally up my bill. $220. For at most 20 minutes. I couldn’t believe it. And then I still have to pay for the blood tests. Thinking I could get them done next, I drove to the lab, sat in a waiting room for a few minutes, and then was called up to the receptionist. She asked to see my paperwork. "Have you had anything to eat or drink today?" "Yes." "You have to fast for this test." "The doctor didn’t say anything about that." "Well, you can take it if you want. It’s up to you." "But I’m supposed to have fasted before taking this test?" "Yes. For at least 8 hours." "OK. I’ll come back tomorrow." When I got home, I called the doctor’s office to find out why they hadn’t warned me, and they told me that I DIDN’T need to fast before the test. That certainly raised my confidence in the competence of these medical people. I hope they don’t infect me with mad cow disease or something while they’re drawing blood. Just thought I’d share my joyful experience of the medical world here. Mark M
Wonderful Mark. I enjoyed ever word. Don’t you just love it when you KNOW you’re surrounded by professionals who REALLY knw their jobs? I bet you slept soundly THAT night:-) Best of luck with the insurance (Kow-towing works well in these circumstances I should imagine:-) Beav — Email me (if you want to) at the usual place: Beavis at nachos dot demon dot co dot uk You can even visit my web-page at http://www.nachos.demon.co.uk
Response:
I went to an endocrinologist today for the the first time in several years. The main reason I went was that I just applied for insurance, and the insurance company requires that I be examined and a couple of blood tests be taken. So I made an appointment at one of the endocrinologists that the insurance company will cover once I’m approved. Since I’m not approved yet, of course, I have to pay for the office visit and the blood tests. The doctor weighed me, checked my height, took my blood pressure, shined a bright light in my eyes to check for retinopathy problems, touched the bottom of my feet with a broken-in-half tongue depressor, asking me if I felt it. I’m happy to say that I’ve passed everything so far: I have a weight, I have a height, no retinopathy, and yes, my feet are at least as sensitive as "a normal person’s" and I even have hair growing on them and strong pulses in them. Imagine that. My blood pressure was kind of elevated, 150/80, I believe. Shining bright lights in my eyes and hearing a doctor expound pedantically about my impending bodily degradation had nothing to do with that, I’m sure. Then she asked me all the standard diabetic questions and was of course surprised that I hadn’t seen a doctor in a while. She also seemed very perturbed that I was treating myself with multiple daily injections of only regular insulin. I asked her if she had many patients my age who’d been diabetic as long I had who were as healthy as me. She got kind of flustered and said, "Well, I have a whole range of different patients." It felt like she was talking to me as if I was a retarded robot that she needed to scold, repair, and warn of the looming inescapable dangers of my condition. She was constantly saying things like, "Of course we will have to do some checks on your kidneys, because the kidneys of diabetics are very much at risk." Or, "As a diabetic ages, his feet begin to lose sensation." She seemed appalled that I didn’t wear shoes in my house and that I had some calluses and told me that the next step was that my calluses would split open and then I’d be in real trouble. I’d lose sensation in my feet; I could step on a nail and not know it; and the next thing I’d know I’d be in the hospital for an X-ray and they’d discover a nail embedded in my foot. She literally told me this. I *tried* just to nod my head and say, "Yes, doctor," knowing that I have to go through all the requisite hoops if I’m to have any chance of actually obtaining insurance. But, after a while, I couldn’t take it anymore. I told her that the ONLY reason I was there was to qualify for insurance so that it would help pay for my insulin and test strips. I told her that if she happened to be a doctor who was open to working with me in my particular exploration of my treatment of my diabetes, including all the alternative things I’ve done that have obviously kept me more than regularly healthy, then I would be very glad to have her as a doctor. She just looked dazed after I said this. I think it went right over her head. So I started doing the "Yes, doctor" behavior, with a very serious and contemplative look on me face as I considered and agreed with her oh so wise counsel, and she seemed to instantly become more at ease. They didn’t have a lab at her office, so I have to get the tests done elsewhere. I thanked her profusely (thinking Obi Wan Konobi-like-thoughts in her direction: "You will let the insurance company know that there are no problems with this one…") and went and waited for them to tally up my bill. $220. For at most 20 minutes. I couldn’t believe it. And then I still have to pay for the blood tests. Thinking I could get them done next, I drove to the lab, sat in a waiting room for a few minutes, and then was called up to the receptionist. She asked to see my paperwork. "Have you had anything to eat or drink today?" "Yes." "You have to fast for this test." "The doctor didn’t say anything about that." "Well, you can take it if you want. It’s up to you." "But I’m supposed to have fasted before taking this test?" "Yes. For at least 8 hours." "OK. I’ll come back tomorrow." When I got home, I called the doctor’s office to find out why they hadn’t warned me, and they told me that I DIDN’T need to fast before the test. That certainly raised my confidence in the competence of these medical people. I hope they don’t infect me with mad cow disease or something while they’re drawing blood. Just thought I’d share my joyful experience of the medical world here. Mark M
