My Doctor Isn't Giving Me Answers - Can You
Several dLife members asked how to handle situations left unresolved by their physicians. This column will address a few of the issues raised.
Q. I feel so lost with my type 2 diabetes. I have doctors, but to be honest, they are very hard to talk to and get answers. I have seen an endocrinologist, dentist, ophthalmologist, and general practitioner. No one wants to deal with my neuropathy. I really have no support system. Please help me. Who should I see?
A. How about starting with a certified diabetes educator (CDE) that works in an American Diabetes Association recognized program? CDEs are typically nurses, dietitians, pharmacists, and social workers whose role is to partner with you and your doctor to find what will work best given your situation. And they have the time to answer your questions. The national standards of diabetes self-care management include 10 hours of initial education. Physicians usually spend less than 15 minutes with patients. In terms of your neuropathy, the first place to start is to ask for a referral to a good neurologist. They would perform a complete diagnostic work-up and provide you with your treatment options. Check out resources from the Hope for Neuropathy article (the Dellon Institute has skilled plastic surgeons who can also diagnose neuropathy). If the diagnosis is not clear, you may need to see an orthopedist (to be sure your symptoms are not related to nerve compression).
In terms of not having support, dLife is a great resource in addition to your CDE. You have a virtual support system here. Have you checked out the popular dLife Blogabetes or Support Forum? Some topics are so hot, they have over 20,000 posts! You can find local support groups as well. You are not alone in fighting diabetes. How willing are you to get connected?
Q. When I received a fasting glucose of 295 in July, I weighed 210 pounds. My doctor allowed me to try diet and exercise for 3 months. Now my A1C is 7.8% (first one ever, so I don't know what it was originally). I lost 33 pounds. My doctor does not have me checking my sugar (never even mentioned it), and now she wants to start me on medication. I'd rather continue with diet and exercise than mask damage and experience side effects from medication, which always happens when I take any medication. Is it dangerous for me to not start?
A. Yes, according to several studies. Damage may already be occurring as a result of high glucose levels.
Congratulations on your tremendous work and improvement in your numbers. Exercise improves your body's ability to use insulin, so keep it up. The "let's wait and see" approach is dangerous because of beta cell destruction and high probability of failure (the cells that make insulin). The sooner your A1C is below 7%, the better, yet it is difficult to stay less than 7% for more than a year. Diet and exercise are cornerstone to diabetes management, and medications are more often than not needed. Because of the side effect issue, some people are opting to go natural by taking the hormone insulin itself in low doses. It's all about risk-to-benefit ratio. Self-monitoring of blood glucose is the best way to learn from food choices and to know if you are safe. Ask to see a nurse or pharmacist CDE and learn how.
Q. I was so glad to finally find an article about seizures/hypoglycemia. I had a gran mal seizure, bit my tongue, lost hours of memory, spent time in the ER, etc. The MRI and CAT scan were normal. My neurologist and endocrinologist seem to think the seizure was caused by hypoglycemia. Now I am paranoid of going low. I check my glucose 6 times a day and am afraid to leave the house without glucose tablets. I hate this disease. Can you advise/help?
A. Have a continuous glucose monitor study (like with DexCom) and to learn more about the lows. Your endocrinologist can analyze the data. You also mentioned being on Lantus and Novolog. What about an insulin pump that can alarm when your glucose is starting to fall so then you can take action to prevent a problem before it starts? What about Symlin to help reduce the glucose fluctuations, and therefore, reduce the lows? It's time to go back to the drawing table to come up with another approach so you can get your life back and minimize the risk of going low. Start with the endocrinologist and work with your CDE. It's normal to hate diabetes.
Q. My doctor says I have carpal tunnel. I quit using the wrist brace he gave me because it only made my elbow hurt more. It is extremely sensitive. By day, I install network cabling and by night, I play bass guitar for hours in a band. Where and how do I get a definitive diagnosis for neuropathy?
A. A neurologist or talented plastic surgeon (as in those specially trained with Dellon Institute) can diagnose neuropathy. The best way to tell nerve function is with the Pressure Specified Sensory Device (PSSD) as it is more sensitive and a lot less painful than the needle conduction study. Let your doctor know that the brace only made things worse. Request to see a specialist as it is interfering with your work and passion. Once you get a diagnosis, then you can weigh the pros and cons of treatment options.
Readers, I encourage you to share your concerns with your doctors much like the way you write in with questions. If something isn't right, let it be known. If you are not getting the answer, say as much. It's the only way your healthcare team can take action. And if that doesn't work, maybe it's time to shop around for someone more suitable.
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NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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