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Sending Logs To Doctor's Office?

Discussion in 'Parents of Children with Type 1' started by MamaBear, Dec 18, 2010.

  1. MamaBear

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    Ok I have another question. I horned in on the thread where someone else asked about when you decided to/felt comfortable making your own adjustments instead of leaning on the endo's office to do it. Now I want to know if there comes a point when you stop sending in the daily logs with carb counts,insulin doses,etc. ? Do you get to stop doing it? Is that allowed? If so when did you just stop doing it?

    My endo's office is MOSTLY great. I love the doctors, I love the nurses, I CANNOT stand the nutritionist. I think that there have been some personnel changes going on because a few people I used to love are no longer there, and she seems to be the only person who calls me about the logs I send in, IF she bothers to get around to it. And it seems when he is having consistent lows, she doesn't call in a timely manner, and when she does, it's "I'm not gonna make any changes right now"... I had to wait until a day when he almost passed out in class. He slumped over in his desk, (per the district nurse's orders at care meeting) teacher gave sugar without checking blood first. He had a juice box,still wonky,another juice box,still not doing well,then she got him to eat skittles,then another pack of skittles..after all that tested and he was up to 92, of course don't know how low before. Picked him up and by the time I got him home (3 minute drive) he was 73. I called after hours purposely to avoid her and talked to endo on call who changed his ratios. He DID think all the lows were an issue.
    The past few weeks we have been on the other side of the meter, consistant highs. EVERY BG check between 11 am and 4 am for about 2 weeks, was over 250. Some overnights went into 300s. He has had corrections daily at school, after school,at dinner,at bedtime,and every 2hours right up until 3 or 4am. To me, this IS a problem that requires adjusting. She didn't want to because she was afraid those 1 or 2 normal numbers would go away. I finally had to throw a fit at someone else over the phone to get the numbers changed. And since the ratios were changed his numbers this week have been good.
    So I faxed the logs a few days ago. This time, when there are no problems, she gets back to me immediately..oh sure of course when NOTHING needs doing she's right on it. She starts with "I don't mean to nitpick"...anyone who starts with that DOES mean to nitpick. She proceeds to pick at me because on one day ONE DAY he was 97 and I gave him carbs with no insulin. I say "uh huh was it bedtime?" she said "I dont' know". Not sure how she does't know since the top of the logs they provide read from left to right "Breakfast,snack,lunch,dinner,BED TIME,night. Anyway I ask the date so I can look at it along with her. Yep. It's right under the heading "Bed time" time listed is 9pm. She says again she doesn't mean to nitpick but I shouldn't give him carbs without insulin unless he's low. and 97 is not low." I remind her AGAIN (because this was not the first time we have had this very talk) that I was told by his doctors and nurses that he needs to be,has to be over 100 for bedtime. "Oh well I didnt realize"..UGH! Idiot! Not only is she so super out of touch with D and the difference between consistant numbers and random numbers, but she is one of those people who interrupts so you only get to ask half of your question. Then she goes out of her way to make you feel dumb for asking. But of course in front of docs at appoinments she's nice and sweet.
    I feel like if she is the only one who is going to view these logs anymore, and she has no interest or ability to be helpful, why bother spending my dollar every few days to fax them? Do you guys still fax logs? Am I wasting my time and money?
     
  2. Nancy in VA

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    I don't think I ever sent daily - I think it was every 2-3 days but as soon as I had 2-3 days that weren't introducing a question for me, I didn't send them. Within 4 months, we were only sending them when there was a problem I needed their help with. We started sending them more frequently when we started on the pump, but after about 6 weeks on that, we were back to only with a problem to address. There is no need to send #s every day
     
  3. mandapanda1980

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    I'm sorry you're so frustrated with this lady. I know how you feel. Not with our endo but with other people.

    As for the logs, when dd was first dx'd it was every day or two. Then every week. After a while I slowed down to every 2 or 3 weeks unless I had a problem. When we started pumping it was back to daily and a call at bedtime to the on call endo. Now were at weekly, although I'm feeling much more comfortable with things and don't stress if it doesn't get to them for a week and a half or so...

    Luckily our educator is awesome and works really well with us. If I feel that something needs attention usually she agrees and says to try it..and if things start to be off we will go back to before.

    I hope you figure things out :)
     
  4. Rcj176

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    I always sent in the first 2 sets one each week. And that was it. I don't call the endo for adjustments, I do them all myself. The only time I call them is if the kids are really sick with ketones or if I need doctor orders for the school.
     
  5. swellman

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    Never did it.
     
  6. Caleb's*mom

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    I only fax logs in when I'm concerned about BG. I am also able to keep contact with our endo through email
     
  7. hawkeyegirl

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    We never did it either. If it's not helping you, stop. What are they going to do to you? Send you to bed without supper? ;)
     
  8. frizzyrazzy

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    how long as he been dx? I'm sorry.

    And...the nutritionist has no business making dosing suggestions anyway. If they're not responding to you then they're telling you they don't want these. However, if you feel you still need guidance then I would ask the endo how he wants it handled.

    I know for a while I would fax to our CDE when we were having a problem - not every day - but just when we had some issue I needed her to look at and then I'd tell her specifically what was causing us trouble and she'd call and we'd talk about what I thought should happen and either she'd say "yes" or she'd say "maybe this instead". It was a process by which we learned to think about changes on our own but had 'training wheels"
     
  9. Amy C.

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    If the office isn't offering any information, I would stop sending in the logs and venture out on making changes myself. It sounds like his Lantus needs to be adjusted to be halfway to what the endo suggested.

    Pumping Insulin offers suggestions on how to make the basal/bolus regime work. I was much better at regulating the shots after reading that book.

    I never sent in the records. For a couple of months, I would call when there was a problem, but soon ventured out on my own.
     
  10. stevecu

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    Another excellent book is "Think Like a Pancreas".

    It's really up to you when you feel comfortable making your own decisions, but I wouldn't do so unless you know how to test your basals and carb ratios and make informed decisions on your own.

    We sent daily logs for a few weeks after dx, then if we had problems. We stopped altogether when we started pumping and using Carelink. The reports from Carelink may be the best thing about MM.

    Now we upload before seeing the endo. I run a handful of reports to bring in and if they want anything more than that they run their own reports from our data.

    You're in charge!! Use their help if it helps.
     
  11. MamaBear

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    LOL so needed that laugh.

    I've been thinking this is what I will do from now on. I just don't see a need in spending gas money to drive to a fax place,then pay for a fax,that they are going to ignore..unless of course they need to griped that I give him carbs at bedtime when I'm supposed to. :rolleyes:

    Firstly, he was DX July 17. Secondly, THANK YOU! I understand she does serve a purpose for SOME people (no I don't need her I grew up with a nutritionist in the family) BUT, she needs to be educating on which foods are best for a D child, NOT adjusting insulin. ESPECIALLY when she doesn't know differences between consistant highs/lows and random highs/lows. She needs to stick to nutrition and stop being rude to patients. Hm maybe I should suggest that if she changed her own diet it might improve her mood?;)

    Thank you. And Thank ALL of you for your responses. I think this site has been MUCH more helpful and supportive than this ninny. If I need help with numbers I'll try posting here instead of dealing with her.
     
  12. momtoirishtwins

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    Ummm we have never sent in logs. We called maybe once or twice right after diagnosis for help with changes, then that was it. I preferred to do it on my own.
    Our endo doesnt even ask to see his log book just goes off his meter readings.
     
  13. MrsBadshoe

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    2 kids never sent in any logs. We have never spoke to a nutritionist.
     
  14. swellman

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    The skeptic in me is wondering if they can charge for "evaluating" the logs and they are a source of revenue.
     
  15. MamaBear

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    Hmmm I don't know. Maybe. I'm not sending the logs tomorrow so if that's the case, no revenue for them. I am looking over his numbers though and thinking he needs adjustments again. They said at the office when they made the meal time changes, that if I started seeing highs again I would need to up his lantus, which is currently 4 units per 24 hours. I'm afraid to do that though because he is fine after breakfast and during the afternoons,except the other day we saw a random 64, but at dinner check and from then into the middle of the nights he is in 200s and having corrections. So I was thinking of taking his lunch dose from 1;25 to 1;23 and his dinner dose from 1;22 to 1;20. This would be the first adjustment I've done on my own and I'm a little scared. But I guess I have to try sometime.
     
  16. swellman

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    Don't do it if you're scared - that's my advice. That's why they get paid and why they're there. However, I do think you need to get to the point that you understand why decisions are made because you, and eventually, your child, will have to make them all on their own. Don't rush it - let them help. Tell them what you think and let them advise you. For what it's worth your adjustments seem fairly small - around a 10% change. I suggest you wait until you think you KNOW what to do before you change the status quo.

    $0.02
     
  17. MamaBear

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    The problem is that while they are getting paid to help, they don't.
     
  18. joan

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    They charge you every day for reviewing daily logs? Maybe i'm out of touch but I have never heard of that. No wonder they want you to send in daily logs. I agree with swellman that if you are afraid to adjust insulin you might not be ready but I would be afraid of what the dietician told me to do. Is there someone else there that can go over the logs with you? Usually when changes are made in insulin doses a few days are needed before changes are made again. Again, as swellman said, don't rush. Your confidence in insulin adjustments will come. When my son was young I never had a problem decreasing his insulin if he was running low. It was the increasing I felt uncomfortable with.
     
  19. MamaBear

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    I have no idea if I get billed for reviewing daily logs. That was Swellman's thinking. I have to pay to send them by fax though.

    As my initial post stated, noone else seems to be available to help anymore. They have gone through personell changes and this nutritionist is the only one who reviews the logs and makes adjustments anymore. And since she is willing to let him either run low till the point where he almost passes out in school, or go so high he's feeling sick and neither of us is sleeping for weeks at a time, then who else is there to make the adjustments other than myself?
     
  20. 5kids4me

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    The first two weeks after dx, I called in his numbers to the nurse, after that, we were told to stop.

    One week after he started using the omnipod, I emailed his logs to the dr. Got a two word reply. "Looks Great!" :rolleyes: he had had some highs but we Made all changes on our own. Guess we did ok...
     

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