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Adults with Type 1 a question

Discussion in 'General Discussion' started by mom24grlz, Nov 7, 2010.

  1. mom24grlz

    mom24grlz Approved members

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    My T1 daughter is 11, so I'm not sure what is normal with T1 adults. Here's the general background. My husband's younger sister is 24 and a T1. She was diagnosed 4-5 years ago. Earlier this week she went to her endocrinologist appointment. She left feeling not so great about herself.

    First what is a good AIC for a 24 year old female? SIL's was 7% and the doctor yelled at her and told her it was to high. SIL has also been having a snack and bolusing for it before bed. The endocrinologist told her she needs to stop eating before going to bed. Is eating before bed not encouraged? We let Ashleigh have a snack before bed. She is 11, so maybe that's the difference? He also said that if she wants to get her numbers under control she needs to stop or really limit breads and pasta. SIL is hardly eating anything now, she afraid that her AIC will go up more and the doctor will yell some more:mad:

    To me he sounds old school=diabetes equals no sugar allowed. Is this what most adult endocrinologists are like? Do you think she should seek out a new one.

    She and her husband want to start TTC their first baby, but she was to upset to even ask him about that.
     
  2. emm142

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    Ugh! If my endo was like that, I'd be shopping for a new one.

    I've been treated by an adult D team since I started self-managing my D entirely (so for 3 years now). They have exactly the same attitude to eating as my pediatric D-team did (eat what you would do without D, and bolus for it). They do like my a1C to be around 6.5, though. Not too much lower, and not much over 7%.
     
  3. BrendaK

    BrendaK Neonatal Diabetes Registry

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    Sounds like a crappy endo who is educated in the "old-school" way of diabetes management. He's definitely not in the 21st century.
     
  4. Flutterby

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    Sounds like this Endo is use to dealing with a patient that has type 2.. your SIL should eat like everyone else, a balanced, healthy diet, and take insulin as needed. If she wants a snack before bed, she should have it, as long as she takes the needed amount of insulin.

    Honestly, she should search out another endo, one that is in tune with type 1s and not so caught up in type 2s misconceptions.
     
  5. sarahspins

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    I agree... 7% is not that horrible. She could do better, sure (couldn't we all?), but to be made to feel horrible about a 7% is definitely not a good thing. Yes, it's too high to TTC right now, but it's VERY CLOSE to where she needs to be.. and she can get there within a few months. There are plenty of adult T1's who start off in the 10%+ range and have to reign things in before pregnancy. She's already doing a million times better than that.

    My endo prefers me to hang out in the low to mid-6's (if I were pregnant or TTC she'd want me in the low 6's), but she's not hugely upset with me if I am higher. My endo actually cares though.. anything in the 7's (or higher) usually earns me a series of questions to help figure out if I've just gotten lazy or burnt out, or if I'm actually having some kind of problem that we can fix together. I've never been lectured by her about having a high A1C (and I even hit 9.9% last January, after weeks of not being able to get under 200 for anything, and hanging out mostly in the close to 400 range, but that's a long story and trust me it wasn't for lack of trying to get those #'s down).. but I have been lectured in the past, and I *hate* it. Seriously nothing upsets me more, or demotivates me more than being lectured about doing better when I am trying my hardest already. She needs encouragement.

    I snack before bed if I am hungry - it is NOT a problem at all as long as it's covered correctly. Really the biggest problem of eating when you don't "need" to is weight gain. If her fasting #'s are fine and she's not gaining weight from it, then it's not a problem for her.

    I definitely think if she is planning on TTC, that she needs to find another endo (and D team) that she gets along with better, because she'll be dealing with them a LOT... if they're not working well together before she's TTC, things won't improve once she is pregnant.. trust me, as I have BTDT, and ended up firing an endo mid-way through a pregnancy.
     
  6. MHoskins2179

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    Her endo would hate me, then, for hanging out in the mid and high 7 range.

    Of course, if my endo acted like that to me, I'd kick the fool to the curb. And then I'd get a refund for my latest appointment and the headaches.

    It does vary much between endos, with many being "old school." But there's many good ones out there. Yes, 7% could be much better. But it ain't bad.

    For TTC and even the whole female D-perspective, I'd suggest you read Kerri Sparling's blog at sixuntilme.com for some great insight. There are others, too, but many consider her's to the best. Good luck to your SIL, and of course to your 11-year-old!
     
  7. funnygrl

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    I generally tend to try and stay under 6.5, but I don't think 7 is that bad. I have never been yelled at for eating as long as I bolus.
     
  8. TheFormerLantusFiend

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    An A1c below 6.5% is recommended but my endo would not yell at me for a 7%, which is still better than the adult T1 national average of 7.9%.

    However, when a woman with diabetes is planning to get pregnant (and the woman who runs the support group I go to is planning that and I've been hearing about it ad nauseum) it becomes much more important to have a lower A1c, and often a doctor will have a set A1c- 7% or 6.5% - that the patient has to get under before he or she will OK getting pregnant. During pregnancy, the higher numbers may affect the baby; in addition, more than a third of women with type 1 diabetes will see a progression in eye complications during pregnancy or the three months immediately afterwards.

    Eating low carb is not recommended across the board but it may be that she's seeing a lot of spikes with the pasta and bread. Many doctors think that eating low carb is key to controlling all diabetes. My endo does not follow that school of thought.

    I personally find that a bedtime snack is an absolutely terrible idea because who knows if I'll go high or low from it, and I won't be awake to check. Keep in mind that most adults do not get up in the night to check their blood sugar.
     
  9. MHoskins2179

    MHoskins2179 Approved members

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    As far as bedtime snacks:

    Some of that goes back to the "old school" days, something that most on these forums really wouldn't be experts on as a majority are "newly" diagnosed within the past several years. This isn't as mainstream a thought anymore. And many appear to be on pump therapy these days. But prior to pumping and MDI, a common train of thought was for us to have a snack like crackers and cheese before going to be - some carbs to boost you up and the protein to bad the foundation so you didn't drop low while sleeping. Nowadays, that practice isn't needed as much as you can carb count or adjust basals - as well as get up to test regularly or have a CGM to watch the levels.

    When I'm under 80 at bedtime, I typically still will have a piece of toast with peanut butter. That then allows me to get through the night. As an adult, I do get up regularly and test at 2-3:30a, as I don't have a CGM.
     
  10. deafmack

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    Well, it would be interesting to know what the doctor thought her a1c should be. If he says 6.5% then that is in line with the American Asociation of Endroncrinologists. My one question is how does this doctor know that eating at night is contributing to her a1c of 7. He has no idea and I think she is doing fine although if she want to start thinking about having children most endos will want her to have a lower a1c before trying to have children. Kerri Sparling talked about it in her blog
    "Six Until Me"
     
  11. miss_behave

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    I would fire that Endo on the spot.
     
  12. denise3099

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    Don't have T1 myself but wanted to chime in. Anybody yells at me is gettin' a punch in the nose! Nobody who works for me is allowed to scold me for anything. You doc should be trying to help. Trying to find out why what is happening is happening and how to help you fix it, not make you feel like a failure. I'd be looking for a new doc asap. You should walk out of the doc's office with a plan you feel confident enacting, not feeling like you're in trouble.
     
  13. mom24grlz

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    Thanks everyone for your replies. I'll let SIL know what you said. From what i've heard her endocrinologist is normally not like this. He has never yelled at her before. I wonder if he was just having a bad day? She goes back in 4 months for another appointment.
     
  14. Ali

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    Ugh. This is just plain awful. i have had T1 for many a year. It used to be that there was not an A1c. Then they had one but no Docs commented on it. I had 10's and the only comment was to try an get it a bit lower before having kids.:cwds: Then 8 was the gold standard,then seven without anyone telling me this was the "new" standard". The Endo who assumed I knew "7 was the new standard" I should be aiming for, which I did not!!, and thus assumed I just was not taking care of myself was soon an ex Endo. I would suggest your family member change Endos and just go in and tell the new Endo she needs current info about dealing with her illness.It never occured to me that the current standard was 6.5 and lower, I run in (lower actually) that range but I have tons of experience,wear a CGMS, limit my carb intake, use Apidra!:eek: The idea that the average T1 person with limited knowledge could do this floors me. Ali
     
  15. Nightowl

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    Does the Advice Work?

    Here are my thoughts on your sister in law and her endo. The "yelling" issue aside, I think the advice the endo asked your sister in law to try is very conservative and very effective. Your sister in law has an elevated A1c. Her endo is advising that she try to gain better control of her blood glucose and I am assuming she has the same goal. Apparently, after scanning your sister in law's data and talking to her about how she has been eating, he is recommending that she try two "new" techniques: (1) don't eat and inject insulin late at night, and (2) cut down on bread and pasta. We can only assume this endo has had success with patients who try these methods. My advice is that your sister in law should try these techniques for a period of time and judge for herself whether the advice works or it doesn't. If the new techniques help her gain better control of her blood glucose levels, then she can decide for herself if she thinks the better control is worth the sacrifice. Ultimately, every diabetic must decide what level of control they want and what they are willing to sacrifice for it. Would your sister in law have preferred that her endo said, "well, your A1c is elevated but just keep doing what you are doing."? I think it is bad advice to tell your sister in law she should leave her current endo because he doesn't support the "new school" treatment philosophy that type 1 diabetics should eat whatever they want whenever they want to. He has no doubt learned that advice is no more effective in adults than it is in children. I would rather have an endo who evaluates my numbers and tries to make constructive suggestions about how to improve them (which I am then free to accept or reject) as opposed to an endo who sees mediocre (or worse) numbers but offers no specific advice on how to improve. No advice given in good faith should be rejected and ridiculed without first making one very simple determination: does it work?
     
    Last edited: Nov 13, 2010
  16. Connie(BC)Type 1

    Connie(BC)Type 1 Approved members

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    I had an endo who told me I was non compliant for wanting a pump in 1998, fired her , found a new one, he retired (he was a god to me), and went to who he said may work, she didn't , but did find one who respected my knowlege while imparting hers, and we've always worked together, and discussed changes, about the only thing we butt heads on is the flu shot, she's brainwashed to want it done, I won't have it! BUT, she never yells about it, just writes in her reports that I don't wish to have one! Love her to death!
    I ran into the bag who said I was non compliant last week at a fund raiser, she still looks nasty to me :)
     

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