Pardon Me, Doctor
Severe hypoglycemic episodes often happen without warning, but new tools can provide the warning we need.
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
September 2009 — Dear Husband's Endocrinologist,
Please allow me to introduce myself. I am the wife of one of your type 1 patients. I also happen to have type 2. For the past few years, I have been blogging and writing about our respective experiences with diabetes alongside many other type 1 and type 2 patients. I'm not sure if you are aware, but the online diabetes community has become quite influential when it comes to advocacy and education.
That being said, I must say that I was quite disappointed when my husband came home from his recent appointment and told me that you were not encouraging the use of a continuous glucose monitoring system (CGMS). You said something about it not being worth fighting with insurance, though perhaps that might have been lost in translation for all I know.
You weren't the one who had to answer the phone when the paramedics called to let me know that Greg had experienced a severe hypoglycemic seizure in the middle of a grocery store near work. You weren't the one with his parents in the emergency room while they ran tests to make sure there wasn't a concussion involved. You weren't the one trying to help him through the back pain that ensued for several months afterwards, caused by the fall to the ground and the seizing itself. I don't ever want to live through that again.
You're not the one who has had to watch while Greg has feared letting his blood sugar go low or becoming hypoglycemic unaware again. You're not the one who encourages him to exercise; only to see him over treat the resulting hypoglycemia in the rare instances he joins me for a walk. You're not the one who sees half a package of Oreos gone in one evening of constant lows or listens to the multiple trips to the bathroom once his blood sugar hits the roof after such consumption. No, that's me – his wife.
Please review Greg's A1C levels both before and after November 2004. I think you will see that he was consistently below 7.0% beforehand and has been consistently above 7.0% since. It's been better recently, that I can admit. He's begun to accept blood sugars of 100 mg/dl and lowered his upper threshold to treat hyperglycemia as well. That is, as long as there are no signs he's dropping fast (in the case of 100 mg/dl) or if he knows he will be exercising (in the case of mild hyperglycemia).
This is where I believe that CGMS could come in handy. Those times where he drops towards severe hypoglycemic episodes happens so fast that he can't tell until the symptoms show – until that point where he feels the need to consume more fast acting carbohydrates than may be necessary. That doesn't help his weight and it doesn't help keep the extremes of hyperglycemia at bay. And this device could help him maintain a good range of blood glucose levels during exercise, not too low and not too high, while making sure to keep his body healthy in spite of diabetes.
If you don't believe me, believe the dozens of people with type 1 with whom I am acquainted who have used CGMS – either as a trial or as covered by insurance. Most of them would tell you they have achieved better, even tighter, control while catching hypoglycemia before the blood sugar dips to levels that lead to seizures or fainting. Most of them would tell you that this device helps keep A1C levels to acceptable levels, something that may avoid complications down the road.
All we're asking for is a trial of this device. Once we see the kind of data that could be given to us, then we would make the decision whether to fight for insurance coverage. I don't want to receive another phone call from a paramedic (or goodness forbid, ever have to call 911 myself) and I don't ever want my husband to experience the physical and emotional pain of such a horrible result of severe hypoglycemia.
I think as his doctor, you should want this for your patient, too.
Thank you for reading,
Your Patient's Wife
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dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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