It’s unfortunate, but our healthcare is primarily controlled by insurance companies. If the insurance companies are acting nice, then it can be our medical team. What about the rights of the patient?
I live with Type 1 Diabetes. This means that I live with a disease that does not go away. It takes zero breaks. It is working on me 24/7/365, so the only way to combat it is to fight back 24/7/365.
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Tomorrow night is my sleep study. This sleep study was initiated way back in August when I saw my endo and we talked about my loud snoring and waking up to gasping for air in the middle of the night.
The sleep study referral was sent out and the office made contact with me to schedule an appointment. The day of the appointment for the over night study (which at that time, I had no idea if it was overnight, at my own house, or any general information about what goes on during a sleep study).
That was not very good customer service and patient management if you ask me.
That appointment ended up being cancelled by me because I didn’t know if there was a deductible, co-pay, what it entailed, nothing, so, I cancelled.
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At my last endo appointment, I already knew that my A1C was going to be high. How did I know this? My Dexcom Clarity report told me what my 90 day average was.
Knowing this information going into the appointment, I knew it was going to be a topic of discussion, so instead of trying to delay that discussion or hide it, I started the appointment off with it. I simply said, “just a heads up, my A1C is going to come in as the highest since my diagnosis and here’s why..”
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I have struggled with weight problems and insulin resistance for a long time. It’s one of the reasons that my insulin to carb ratio is outrageous. It’s almost 1 unit of insulin for every 2-3 carbs.
So for me, it’s been a viscous cycle. I take a lot of insulin which makes it more difficult for me to lose weight. I don’t care what the happy go lucky people try to tell you, if you take a lot of insulin, you will gain weight
Now, the large amounts of insulin are also due to eating high carb foods and unhealthy foods and not exercising, so that is also tied into it.
When I exercise consistently, my insulin ratio jumps to about 1 unit of insulin for every 5-7 grams of carbs. A big, big difference.
Unfortunately, I’ve never exercised or ate healthy consistently.
So, I think I need some help.
One of the things that my endo recommended to me on my last visit a few months ago was to start on Jardiance. This would help with all of the issues that I stated above.
I know that Jardiance will help me lower my insulin needs by increasing my insulin sensitivity.
Jardiance would help me lose weight. I don’t like the way that Jardiance would help me lose weight, which was described to me as having a smaller appetite and potentially feeling nauseas. I don’t want a chemical in my body affecting my appetite. I’d much rather control it on my own, which has obviously not worked for the last 10 years.
I know that Jardiance will also help prevent and lower heart disease. I am already on blood pressure medication, cholesterol medications and also triglyceride medication.
I am always afraid to add another pill into the mix.
But, I tried to stay off of BP and cholesterol meds as long as possible as well until I realized that my body just needed them. I was at a disadvantage living with Type 1, so I had to level the playing field some how.
Now, of course there isn’t just the positives when it comes to adding another medication into the mix.
The first and biggest side effect is DKA. You could go into DKA without any notice. Your blood sugars could be perfect, but still be going into DKA, so it is important to constantly be checking for ketones.
I don’t know if that’s something that I would be willing to do, because I know that I won’t remember to check frequently.
Another side effect of Jardiance that I don’t even like the name of, is higher risk of yeast infections. Another thing that I don’t know if I’m willing to deal with.
So, as of now, I am torn. I don’t know if I should give it a shot or not.
Ultimately, the final decision will come down to me. My doctor can prescribe it, but I have to be the one who takes it.
So, I’m asking anyone in the community, have you taken Jardiance as a Type 1 before?
If so, what has your experience been?
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Something that I haven’t really talked about on the blog or on social media is that my wife and I have moved recently. A pretty far move in fact. This post is not going to be about that.
I am writing this today because I now have to choose a new endo for the first time in 15 years.
When I first moved to Florida to go to college, I met with an endo, which was in Boca Raton – the senior capital of the world, and within 5 minutes he said the first thing he would do is take me off an insulin pump and I walked out before he could finish the visit. I paid my co-pay and left.
I was then put in touch with an awesome Type 1 endo and loved my time with her, which was for 2 years, but stayed at her office because they had someone new coming in that I heard of before. At the time, I was interning at a diabetes supply company and I had attended a CDE accreditation course and this lady was the teacher who was teaching CDEs!!
So, I knew that I wanted her to be my doctor.
The weird part, at first, for me was that she was not an endo. In fact, I have not seen an actual endo in over 10 years.
She is an ARNP, which took me forever to remember what that stood for. ARNP stands for Advanced Registered Nurse Practitioner. She was also a CDE and the most knowledgeable person on diabetes that I have ever met.
I had the greatest doctor – patient relationship with her. She listened to me. She let me lead appointments. She drew charts of insulin activity on the white paper that is pulled over the patient seat. She was absolutely incredible.
She let me sample everything. She told me about new studies, new books, things from ADA and AADE, she even provided me with a lot of resources when I was stressing about having a kid.
At the same time, she also let me make a lot of excuses. She would cut my excuses down and put me in place when need be. For example, when I kept fighting her on going on blood pressure medication and she spent an extra 30 minutes during her lunch break to explain to me why I needed to be on the meds, no one else would have done that.
So now, I’m back to having to find someone new and start a whole new relationship. I feel like I’m breaking up a relationship of over 10 years and starting fresh.
How do I walk into an appointment and say, listen, I have a lot of knowledge, I’m not your typical patient who is just going to say how high when you say jump. We need to have a relationship, not a dictatorship.
I am back living in the same area I was when I was first diagnosed, so I could possibly see the same endo I saw when I was first diagnosed. I’m 80 pounds heavier and A1C is not so great and I haven’t exercised in over a month now since the move, but hey, I probably do need a serious reality check.
I will definitely miss the “celebrity” treatment I received in the other office.
This is also a time for me to put into work all of the tips that I have given over the years of how to become an empowered patient and creating a relationship with your doctor that is healthy.
I’ll keep you all updated.
A couple of weeks ago entailed a lot of doctor appointments. I have new insurance this year, which is a lot better than the insurance that I had in 2017. I will be posting about my horrible experiences with them and my on-going issues with them. Anyway, all of my doctors now accept my new insurance. But I had not seen a primary care physician in over 2-3 years for multiple reasons. Primary reason was because I just didn’t care to go see one.
With new insurance and a new year comes new reasons to make sure that I am healthy. It just so happened that both of these appointments were back to back with each other.
First up was the Primary Care appointment. This was a new doctor, so of course I had to sit in the waiting room for 20 minutes filling out information. Apparently this place is a doctor’s office for a much older crowd. The average was probably about mid to late 70s. I was by far the youngest person and they were looking at me weird. It’s probably why the office staff was so nice to me, it was nice to see a younger person who isn’t so angry.
I really was happy with this doctor. The nurse was friendly and had a conversation with me. Asked me what I do for a living, where I was from (she knew my PA accent), where I went to college, kids, wife, etc. The doctor asked a lot of questions. A lot. But the main part, and the most important part to me, he allowed me to talk.
I handle my doctor appointments pretty much the same way that Eminem handled the final rap battle in 8 Mile. If you never saw the movie, he basically made fun of himself. He put everything out on the table about himself, so that when the other battle rapper was about to go, he would have nothing to say about Eminem.
That’s exactly how I handle my appointments.
I told the doctor that I know I am overweight. I know I need to lose about 60 pounds. That I don’t eat healthy all the time. I haven’t been to the gym in like 3-4 months. I don’t check my sugar as often as I should. I don’t rotate my shots as often as I should. I don’t go to the dentist or get my eyes checked regularly.
After I was done with all that, there wasn’t a lecture. In fact he said, “I’m not going to lecture you. You’re a grown man, you know what you need to do, you just need to do it.”
I think when it really sunk in was when he spent the next 5-7 minutes dictating it all into the computer. So, hearing him basically repeat everything that I just said was pretty surreal and an eye-opening experience. But I liked it, because I heard the doctor’s notes. I never know what is being put into those notes, but this time I did.
After that part of the appointment, they draw some labs right there and then it was off to my next appointment.
This one was my endo. Now, when I say endo, she’s not an endo, she’s a ARNP, CDE and something else (sorry I forget all the titles).
I didn’t have labs to review, but I had an agenda coming into the appointment.
The morning of the appointment, I received an email with a press release from Novo Nordisk about Fiasp. So, I wanted to talk Fiasp with her. She didn’t have samples at the time, but I picked up a few from her the other day, so I will be using it soon.
My other agenda item was to discuss with her my decision to go off of the pump and move to MDI and an insulin pump. I want to stress what I said here….. MY decision to do this. She is a huge proponent of insulin pump therapy. So, when I said what I wanted to do, she just asked me to justify the decision. I explained to her exactly why I wanted to and why I felt like it would be better for me.
5 minutes later, she was writing new prescriptions.
That appointment was primarily based on those discussions and also me admitting to her that I was in a bit of a funk towards the end of 2017. I wasn’t really myself. There were some personal issues holding me back, but I’ve been able to work through them.
I left the appointment feeling refreshed and motivated to move forward.
Both doctors recommended to me that I start a baby Aspirin and both said that they hope they see less of me next time.
Here’s to the journey.
Last Monday was my endo appointment. Unfortunately, I didn’t realize it was my endo appointment, so I didn’t get any blood work done before hand. This would usually be a waste of an appointment, but I’m thankful for the 630G and a lot of great data that we could discuss anyway.
First, we started with an in-office A1C, for whatever that’s worth. 8.1. Not very good. I knew it was going to be high because I spent 45 days without going to the gym and visiting my family in PA, which I tend to eat pretty bad while up there. My weight was down, but only about a pound, not too happy about that.
We couldn’t go over any labs, which I was curious to know where my triglyceride numbers had gone to. Previously, they were amazing, 6 months after being at “heart attack” levels. I’m going to get my blood work done this week, so I am lucky to have an endo that is willing to review my reports after an appointment and send me an email with any recommendations or updates after viewing that.
I had two main concerns going into the appointment, which is how we start out, her asking me, what’s been going on? Morning and after meal spikes. In the morning, as soon as I wake up, my blood sugar just starts to shoot up. Without eating, without drinking anything, just as soon as I wake up, it just shoots up. I do drink coffee pretty soon after I wake up, but I’ve purposely held off on the coffee for a little while and the same thing happened.
What I’ve done in the past is just take a 5-7 unit bolus as soon as I wake up. No real rhyme or reason behind it, just give a little extra insulin to combat that spike that I know is coming. Then, I need to cut out all carbs during breakfast, well as many as I can. I typically eat a 3 egg omelette with cheese or ham in it. When I do this, it definitely helps stabilize my blood sugars until lunch.
But, then that’s when the next issue happens (depending on what’s for lunch). If I eat what I’m supposed to which is a salad with no croutons and a vineagar based dressing, then it doesn’t spike that bad. I can usually control this lunch spike.
On a good, normal day, I will then hit the gym. This brings down any high that I had and usually drops me pretty low. This is where I see a fun amusement park looking slide on my CGM. This is followed up with a nice, cold Gatorade that also puts back into my body 120 calories that I just burned off.
Dinner is my biggest problem and my biggest spike. Dinner is where I tend to slip up. When I am on my healthy eating habits, none of this happens. So, that is the root cause of the problem. Eating healthier. Unfortunately, I eat unhealthy way too often. When I do, I eat a lot of carbs. Those carbs then cause a spike. I have tried all of the different times to take insulin before eating my meal. I’ve taken insulin 15 minutes before and pre-bolused… same thing. I’ve taken it 30 minutes before, same thing. I’ve taken it the same time I eat, 10 minutes after…. it doesn’t matter.
We discussed that it seems like an insulin sensitivity issue. Where I place my infusion sites is the same areas I’ve been doing it for 11 years. I also use a lot of insulin, so within 2 days there’s nearly 250 units of insulin that has been delivered through that cannula. This is where the problem exists… too much insulin.
We felt that all of these spikes can be resolved with less insulin. So, like I try and do with any problem, we reverse engineered it. I’m using a lot of insulin because of lack of exercise and poor eating habits. So, if we change these two items, I will need less insulin, which will have an effect on my insulin sensitivity. Less insulin being delivered in a short period of time, will allow my body to absorb this insulin and allow the insulin to do what it needs to do.
We also discussed several other things. The use of Metformin as an additional treatment to people with type 1. Invokana being used as an additional med used also.
She knows that I do not like adding additional medications to my list of ones that I’m already using. This is why she will make a recommendation, tell me to do my own homework, talk with people in the DOC and then come back with a decision. So, for now, the goal is to accomplish this all naturally with better eating habits.
There is also the idea of quitting pumping all together and just doing MDI again, but I don’t know if I’m ready for that.
I haven’t been to the endo in 7 months. I had 3 different appointments all get cancelled and rescheduled for multiple different reasons. I was flying back to south Florida from the north on Sunday and was hoping that the winter up there wasn’t going to delay me and make me cancel my appointment again on Monday. My endo office made it clear that I needed to be at this appointment or there would be no more prescriptions written, which is completely understandable in my eyes.
I got my blood work done up in PA while I was up there, but I wasn’t sure it was going to be completed in time for the appointment, but luckily it was.
But, just like I thought, the blood work was not good.
I was previously on a statin and something for my triglycerides because they were extremely high. I had ran out of refills and my primary doctor would not call in any refills, I had to set an appointment. Well, I should say, my FORMER primary doctor, because he no longer is because of that. Since I could not get refills (they were prescribed by PCP, not my endo), I stopped taking the pills. For this reason, I knew my cholesterol and triglycerides were going to be off the charts. And they were.
I also hit my highest weight I have ever reached. I’m actually quite embarrassed by it, and I don’t get embarrassed easily.
We had a very nice heart to heart conversation about your 30’s being different than your 20’s. I’m now married, with a kid, own a home, own a business and have a shit load of other stressful items, so life is a bit different.
We also talked about how my body is already at a disadvantage by having diabetes, so we have to try and level the playing field. Also, in order to get my labs back at a normal level, I really needed to make changes. I am now back on a generic Lipitor, triglyceride meds, blood pressure and Vitamin D. My pill collection is growing.
I used to be anti-medication because once you start, it’s tough to stop. But I am at a point in my life that I just want to be healthy, and if taking a pill is necessary to reach that goal, then so be it.
I also needed to lose weight. My insulin usage is out of control, my basals are so damn high, and I get it, as long as my levels are under control, it doesn’t matter how much insulin I use. However, I need to cut that back by cutting out my diet a bit.
So, she put me on a diet that I have been doing for 2 days now and I feel confident in sticking to this diet. Basically, this is the diet:
Breakfast – 3 egg omelette. One day with cheese, the next day with ham. Alternating back and forth.
Lunch – As big of a salad as I want. Vinegar based dressing. No croutons
Dinner – 6 oz of meat ( 8 oz of fish). Non-starchy veggies.
Snacks – Mixed nuts. I have set aside a certain amount for the day and I have been eating it throughout the day.
So far, it has been great. My blood sugar levels have been nearly perfect (perfect to me).
I am excited to continue on with these changes and losing the weight and becoming a better person.
Follow me on Snapchat to follow my journey on this new diet and new changes. Just screenshot the image below and follow the steps:
When things go wrong, excuses usually begin to fly. This is not only true with diabetes, but also with anything in life. So, this morning when it was time to review my latest blood work, I was going to hold myself accountable for whatever the numbers told us. I was not going to blame it on the diabetes, but my choices.
I knew going into reviewing the labs that my A1C was going to be higher and that there may be some issues with the lipid panel because of the horrible diet and forgetting what the inside of my gym looks like.
A1C was a little higher than last time, but lower than what I thought. I honestly felt that my A1C was going to be between 8.0 – 8.5 because I’ve seen the numbers on my meter and they have been bad, probably my worst 3 months in the past 5-6 years. Which is also why I knew it was time to go back onto the pump and get off of MDI. The A1C was 7.5. Not good, but better than I expected. It was 7.1 six months ago, so I obviously wanted to improve on that, but didn’t.
Everything else in the lab results was good, except for one big issue. Triglycerides.
I’ve never had an issue with my triglycerides being high because I always had some form of exercise, not intense, but would get at least an average of 15 minutes per day. My triglycerides were 455. If you know about triglycerides, then you know that’s pretty damn high. The doc was concerned about this number obviously, but as I’ve written before, we have a great relationship and she does not scold me, but provides me with the information I need to make better decisions and make improvements.
There was a side of her that wanted to put me on medication, but she knows that by giving me a warning and doing labs again in 90 days, that it will motivate me to improve that number that she feels I won’t need medication.
So, here is to holding myself accountable. No more bolusing 40-50 units for one meal. Yes, you read that right, 40-50 units for just one meal! No more just sitting on the couch watching horrible reality tv shows (my wife loves that shit!) and more of getting back to the gym, walking around the neighborhood, ANYTHING.
Here’s to lowering triglycerides
Yesterday I posted about the excitement that I had about ordering and receiving my first 90 day supply order since having insurance for the first time in 15 months. However, I also had to add an update because after coming home and opening the box, there was 3 vials of Humulin in this box.
Ut-oh!
I started thinking about why their would be Humulin N in this box and not Humalog, so right away I called the insurance company. They told me that the RX they had on file that the doctor faxed over was for Humulin N, 10 units a day, which meant 3 vials for a 90 day supply. What is this? I’ve never used Humulin N in my life. In fact, I didn’t even know what Humulin N is!
So I asked OptumRX what the process was to return this insulin and to get my $25 back for this 90 day supply because I will never use this insulin and it’s just going to go to waste. Well, since they shipped the insulin that the doctor faxed over, they cannot refund the money and they cannot accept the insulin back as a return. I mentioned that it was a doctor mistake and I’m not even using Humulin so it’s not an actual doctor’s order because I don’t use this stuff, never have.
Their answer, “Sorry, sir, we apologize for the inconvenience, but we cannot refund the $25 or accept the insulin back as a return”
One day back with an insurance company and already the hoops, loops, obstacles, and BS has started. I also mentioned yesterday that I will never complain about insurance or pharmacies again because I have lived without having them, so I am completely grateful for this and the $25 loss is well worth it, as long as the correct insulin is ordered and shipped.
I called the doctors office this morning and explained the situation. The doctor’s assistant is the one who faxed over the RX and there was a bit of confusion….so, let me explain.
During my last visit, we discussed ways to try and cut out these highs in the morning. Here’s an example of one, I woke up this morning at 124 @6:30 a.m. I fell back asleep until 9:30 and my blood sugar was 325. That’s it, no food, no coffee, nothing, just simply waking up increases my blood sugars crazy high. So, my doctor recommended taking 10 units of Humulin N at night before bed to try and stop those lows.
There was the confusion, I guess.
Doctor’s assistant saw the visit notes and saw Humulin and did not see anything about Humalog, because I was on Apidra, but it’s too expensive right now and went with Humalog. Even though I told the receptionist Humalog, and I know she didn’t get it wrong because she’s probably the best doctor’s receptionist I’ve ever had before.
Bottom line is that the issue is fixed….I hope. My credit card was charged another $25, so I’m assuming I should be getting an email later tonight about the order shipping and hopefully will get it tomorrow. If not, it’s back to the doctor for a sample vial of insulin to get me through the weekend.
