Need Some Diabetes Direction

My 19 year old DIL (to be) has gone to the emergency room several times in the last month for feeling "out of it" and having intense stomach pain. They always discharged her saying that it was nothing and made her feel it was all in her head. The last time she was there they finally managed to do bloodwork and she had a fasting sugar level of 372.

She was instructed to follow up with her PCP. She had no doctor currently so it took her a week to find somebody that would take her as soon as possible. This doctor gave her a glucose meter and instructed her to test in the morning first thing. If her number was above 400 she was to go to the emergency room. During the last week her fasting morning Bloodsugars have been between 310 and 389, testing 2-4 hours after meals was much much higher.

So this week she returned to the doctor to review her blood work and the numbers from the week. Her A1C was 6.5 and the dr said she doesn't need any treatment as of now and sent her on her way. He said that insurance will not pay for anything unless she is over 425/6.8.

I am particularly irritated with the lack of guidance this dr provided her, maybe she is not to the official point of requiring medication of any sorts, and that's ok. I am just not ok with ignoring an issue and waiting for it to "get worse" so she can get help. There are tons of things she should be starting to do but this dr didn't even make suggestions.

We have a local physicians assistant that only sees diabetics (her specialty for the last 15 years) but she isn't seeing patients till February due to a change in locations. I encouraged her to call and make an appointment with her ASAP. She is on medical assistance so she can't just have a consultation with a specialist or I would suggest an endocrinologist. I actually sent the PA a FB message too, I am just not comfortable with the Drs lack of concern and guidance.

Just really looking for some input, is this first Drs "plan of action" is realistic? Have others started treatment with similar numbers or have you waited? Thank you for any suggestions!

Thank you Lanie!

She is about 110lbs but hasn't really had any unexplained recent weight changes. She had a baby about 4 months ago and is just a little bit above pre pregnacy weight. While pregnant there were no issues noted when she did that sugar cola test. Not sure if having a baby is enough to kick in full force diabetes or not. Although I do know things like rheumatoid arthritis can go into remission while pregnant so is that a possibility? Her grandmother has a history of Type 1, but isn't very compliant. My DIL's diet and eating habits are not great to say the least. It's a lot of junk food and soda, stuff like that, I guess living off of assistance it is difficult to not eat a lot of potatoes, pasta and bread unfortunately.

I am not experienced with diabetes meal planning but did have gastric bypass 5 years ago so I do eat a very similar diet. I have told her the types of things to avoid in general. As you suggested, I also told her to keep track of food/readings/activitity so the Drs can understand more of what is going on. The dr would only prescribe 30 strips (to test once in the AM), so I may need to buy her strips to test frequently for the next few weeks. I was looking at some A1C General conversion charts and can't understand how she is at 6.5 with the high readings that she is getting. I guess at some point during the day she is going so low that the averages are being brought down. I had that test about a year after weight loss surgery because I was bottoming out occasionally but the A1C tested fine, I have a little understanding of how that test works. .

The PA I was referring to messaged me last night around 10PM and was pretty much freaking out about this Drs lack of concern. She wants her to call the new office and explain that the PA was contacted by me directly and aware of the situation and she needs to be on the schedule right away when she starts. She did mention a 48 hour test that needs to be done right away as well. I am glad she will take this seriously!

I really don't understand how this other PCP is not at all concerned. Of course I wasn't there so I may not be getting all the info, just what is shared or responses to what I ask.

Thank you so much for the info Lanie, I will pass that website along as well.

Post Edited (Angeleyes13) : 1/20/2016 4:15:36 AM (GMT-7)

NIH.gov (Diabetes area) said...

What is continuous glucose monitoring?

Continuous glucose monitoring (CGM) systems use a tiny sensor inserted under the skin to check glucose levels in tissue fluid. The sensor stays in place for several days to a week and then must be replaced. A transmitter sends information about glucose levels via radio waves from the sensor to a pagerlike wireless monitor. The user must check blood samples with a glucose meter to program the devices. Because currently approved CGM devices are not as accurate and reliable as standard blood glucose meters, users should confirm glucose levels with a meter before making a change in treatment.

CGM systems provide glucose measurements as often as once per minute. The measurements are transmitted to a wireless monitor.

CGM systems are more expensive than conventional glucose monitoring, but they may enable better glucose control. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the U.S. Food and Drug Administration (FDA) and are available by prescription. These devices provide real-time measurements of glucose levels, with glucose levels displayed at 5-minute or 1-minute intervals. Users can set alarms to alert them when glucose levels are too low or too high. Special software is available to download data from the devices to a computer for tracking and analysis of patterns and trends, and the systems can display trend graphs on the monitor screen.

Seems like it is just like the monitoring portion of a pump. I may need to set her up with instructions for meals, testing and monitoring, it's a lot of a 19 year old new mother to deal with. I know she has little support from her family for anything.

I think she probably eats only one meal per day, plus a bit of junk here and there. Definitely not OK!!!!

Since I had gastric bypass I cringe when I see people doing that sort of thing. I stick to under 25 grams of carbs per meal, that's my tolerance. When I see people eating 300-400 grams at a time I just can't believe it!