Type 2 and Insulin Use

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Carla Cox, PhD, RD, CSSD, CDE startsoff her blog on the American Association of Diabetes Educators (AADE)website with something that truly surprises me. All I can say isthank you Carla. I have been fortunate never to have a provider(doctor) say what makes her want to scream. Believe it or not, itwas a certified diabetes educator that said, “If you cannot control your diabetes better, you will have to be put on insulin.” This was inthe month following my diagnosis and I was still figuring out what Icould eat and my numbers were still generally above 250 mg/dl. Whenthis was said, I got up, and said that may be necessary, but your wayof stating this sounds like a threat from someone that does notunderstand diabetes as I went out the door. I did not understandthen how correct I was, but I found out over the next few months thatthis person did not really understand diabetes and was terminated forher attitude.
I did call my insurance company when Igot home and explained what had happened and how long I was in theroom with her. I was told that I was not the first to complain andpayment would reflect the short time and lack of education. October 2003was the month of diagnosis and this was about mid-November. I didsee my doctor mid-December and he was concerned that I had notreduced my blood-glucose readings more. He had me rescheduled forlate January. He suggested that I do some research on insulin. No,there was not order, just a very polite suggestion.
I knew by the middle of January that Iwould be better on insulin and had read two books and done a lot ofInternet reading. I had the blood draw and the doctor was ready tosee me. I said the test results would probably be late and he saidyes. I said he was welcome to look at my recorded results for bloodglucose readings and that I should be using insulin. My readingswere still generally over 150 mg/dl. He said he still was not sure,but that he would talk to the person and get me started with someeducation while waiting the test results. I said I would not meetwith the person I had before and he said she is no longer part of theoffice and he felt that the RN would be able to gain my confidence.
I must admit he was right. The firstquestion she asked me was what I knew about insulin. I opened mybriefcase and showed her the two books and said there were many typesof insulin and I wanted to stay away from any mixed insulins. Iwould probably need a 24-hour insulin and a fast or rapid actinginsulin. At that point, the doctor entered the office and had thetest results. My A1c was 7.1% and my lipid panel was within range. The doctor said I should probably stay on oral medications for alittle longer. I said I am tired of being overly hungry and fightingto bring my blood glucose levels down and being even hungrier. TheRN spoke up and said that with the knowledge I had already that Ishould be on insulin. We talked for a few minutes longer and hepulled out his prescription pad and wrote several prescriptions. Heinstructed the RN to give me one of the better meters and for me tostop using the one I had.
The next 45 minutes with the RN wereintense and rewarding at the same time. She gave me the startingdosage for Lantus and Novolog after doing some calculations. Sheanticipated my questions and showed me how to calculate and refineadjustments over several weeks as needed to get me to the levels Ihad expressed wanting to reach. Then we covered the correction ratiofor correcting readings that were higher that desired before a meal. She carefully wrote out all the calculations and what to do toadjust the dosage to get near the readings I wanted. Then she had mewalk through several calculations. This was a great learningexperience for me and I still have the calculations. This fit mylearning style – observe and then do – and I remember how to dothis today.
Then she said it was time to scare thedickens out of me and I said like hypoglycemia. She did a doubletake and asked where I had read this. I pulled out the book (thesecond in my list here) and showed her the tabs I had created onpost-it paper. She looked at the area I had marked and stated, “Youdo know then.” I said she had not read far enough to read some ofthe tips to correct hypoglycemia and what not to do. She said if youknow that now, I don't need to cover this. She did take time to lookat many of the tabs I had marked and then she went to the copier andcopied the cover of the book. I told her where I had purchased bothbooks (including the first on the list) and she said she had notseen either of them and wanted to read both now that she knew ofthem.
Next, she wanted to talk about readinglabels and I hauled out my third book and a cookbook. She asked whatI had learned. So I showed her the labels I had put in the book fromdifferent foods and explained that I had a scale to weigh things ifnecessary. Next, I opened the cookbook (Betty Crocker's Cookbook,ninth edition – ring binder)) with the nutrition information witheach recipe and said I look at the number of servings in the recipeand multiply the carbohydrates by the number of servings and divideby the number of servings I would be using. She said I understoodbetter than most and I thanked her. She did suggest a carb countingbook that I had not heard about and we covered a few other pointersshe wanted to cover.
She commented how much she wishedothers would work to understand diabetes and investigate insulin likeI had. I said that not everyone has an interest and many do not wantto talk about diabetes. I said I had gone to several bookstores andseveral places on the Internet looking for books, especially afterthe doctor had politely asked me to learn about insulin. She madesure I had the telephone numbers for my doctor and how to contracther or her associate if I was having problems. We did exchangeemails a few times and she would give me new book titles that shethought I might be interested in.
About a year later, I lost contact. Ihave met a few CDEs outside of an office setting and had enjoyableexperiences. In an office setting, I have not had an experience Iwish to repeat. I am very surprised and appreciative that I had sucha pleasant experience with a registered nurse.
I have to wonder as most of thecookbooks since then no longer have the nutritional informationincluded especially the hardbound editions. In looking through thebookstore a week ago, all of the hardbound and paperback cookbooks donot have the nutritional information included. This store does notcarry any of the ring binder versions.