New & Testing Question (Sort of Long)

Hi,

I am new to this board and a newly diagnosed Type 2 - 1/26/06.   At the time of diagnosis I was warned by my doctor of all the complications that I could get if I don't take this seriously, and was given a meter (which I was told not to use until I met with the dietician), a referral for the dietician, and a prescription for Metformin 850 2x day.  Nothing else, not what to eat, what not to eat, nothing.  Of course, I didn't wait to use the meter - especially since I was not able to get into the dietician for two weeks.  In the meantime I went out and bought a couple of great books.  The dietician told me to test 7-10 times a day, which I have been doing.  She said this was especially useful since this is new to me and I can see how my body reacts to different types of foods and in what amounts.

Today I had my first follow-up doctor's appt. and asked him to prescribe more strips than just 2 per day (I have been paying out of pocket for the others I use).  I told him I had contacted my insurance company and they would pay for as many as he prescribed.  He told me I was obsessively testing and accused me of wanting to test that much so that I could eat a ton of sweets.  I haven't had one single sweet thing since I was diagnosed.  He said I only needed to test 4 times per day.  I can deal with that, so I asked him to up the prescription to 4 per day and he flat out refused, and then said I really only need to test once per day - first thing in the morning, and occasionally if I felt low.  I asked him if he was doing this because of the insurance and I could understand if he told me his hands were tied, but he said no, that testing once a day was more than enough, even though he had just gotten through telling me to test 4 times a day.  Does that make sense?  Could you share how many times a day you test?  We ended up basically fighting over this and neither one of us was happy when I left.  I asked to see an endocrinologist and he refused to give me a referral. 

Also, the dietician told me that my fasting numbers should be between 65-99.  My doctor says my fasting level in the morning should be 126 or under.  Does this sound right?  Nothing I've read says that is right.

Thanks,

Sandi

Hi Sanmarie,

Well, first off, what are your readings?  7-10 times a day is what a type one diabetic would have to do to control their insulin dosages and maybe even not that many.  It is overzealous to say the least and oh my, your poor fingers.  As a type II I test 4 times a day which is a lot but I do it mainly to establish a profile for the medicine I use which dramatically effects my after meal blood sugars, so I test before and after meals to see what the effects are. 

Right now as a newly diagnosed diabetic, your most important number is right after you get out of bed in the morning.  If you can keep it at 100 or less great.  Thats pretty much where a normal person would be.  The ACCEPTED range for a diabetic is 120 or less.  Im assuming that the medical establishment assumes that we still won't be doing damage at that level and that we run less risks of hypoglycemia by trying to push our blood sugar low enough to achieve morning numbers in the 90's. (that happens with me....I'll suffer numbers in the 50' and 60's at night to get to 90 in the morning and that is not good at all). 

Metformin is a first line diabetes drug.  It is universally prescribed to new diabetics and pre-diabetics as their first medication.  There are two basic classes of meds for a type II.  One class of meds fights your body's resistence to insulin; making you more sensitive to the insulin you are already producing.  This is the class that metformin (the generic name for "glucophage") falls into.  The other broad class of medications works on  your body to stimulate the temporary production of MORE insulin.  Typically these are taken right before a meal to help ameliorate a spike in your blood sugar caused by eating and help keep your BS constantly in a normal range.  These are typically NOT prescribed for new diabetics unless your intital numbers are really high.

Now, about the attitude of your doctor.  That is the attitude of a typical internist or GP and not an endocrinologist.  He wanted you to see the dietician because diet is important for keeping you normal but the 7-10 times of testing is really excessive.  HOWEVER, I would think that he would encourage you to test when you wake up and maybe 2 hours after dinner just to see how your body deals with a meal.  I think you would be better off with a doctor, either internist or endocrinologist that is more willing to explain things to you than to just take an intractable attitude of "Im the doctor and what I say is right".  I don't know what your numbers are so I can't advise you, but I sure would want a doc that would give me a bit more of an explanation as to "why".

Hope this helps