- advertisement -

Treatment Priorities

Discussion in 'Parents of Children with Type 1' started by RomeoEcho, Apr 1, 2009.

  1. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    I know that the more immediate dangers of diabetes are in the lows and we should be targeting to avoid severe lows. However, we have proof that long term, the goal is reducing A1c. I have also noticed that I feel much healthier and much more "human" with blood sugars and A1cs in the normal-ish range. It's not a feeling that I noticed until I was able to do it fairly reliably with the help of my CGM, but I do notice a difference. I used to feel that my endo and I were on the same page with treatment goals and process, but this week, I found that to be opposite. I was very excited about my 6.9% A1c, and my much more stable numbers. My hypo awareness has actually increased, and my CGM works well. I was expecting him to also be happy about my success and instead, he said nothing positive about my A1c, decreased my correction insulin, increased my DIA, and raised my night time target back to 140.

    He said that he thought my corrections were to radical, even though I recently tested my ratio and found it to be very accurate and it confirmed my DIA of 3 hours. He said he wanted to increase the DIA to 4 hours to reduce the risk of stacking, which I rarely see a problem with unless I intentionally override the pump suggestion. I am also questioning the overnight target. Especially since getting the CGM, I have seen the overnights as a place to really get a jump. It's a long period of time to effect the A1c, it means not starting the day on a rollercoaster, and it means feeling better and having an easier time getting up in the morning. I do have regular "lows" below 70, but they aren't severe. I have always just accepted that some amount of lows are unavoidable, but the endo insists that the goal is to avoid all lows at all cost.

    I know that every individual is different, but am I completely out of line here? Am I being overly ambitious in my goals, or is he just afraid to let me try?
     
  2. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

    Joined:
    Sep 10, 2006
    Messages:
    4,925
    How old are you (or is this your child's stuff)?
    In any case, you should tell the doctor what YOUR goals are. Diabetes more than any other medical condition out there requires that you be involved.

    You are not out of line to want to aim for what
    a) makes you feel good
    b) hits YOUR treatment goals
    c) looks like it stacks up with general medical advice.

    It's your body. While I think that what you've been doing diabetes wise sounds good (and congratulations on lowering your A1c!), even if I didn't think that, I still think you have the right to the lion's share of the say in what your treatment is.

    You are not out of line to disagree with your doctor, and your doctor might be.
     
  3. sariana

    sariana Approved members

    Joined:
    Dec 28, 2007
    Messages:
    422
    My dad has been diabetic for 20+ years. He has always said that he FEELS better when he is just a bit on the higher side. Not super high, just a tad higher then what they say that he should be.

    I would think that it should be between you and your endo... Did you tell them this? explain why you think otherwise?
     
  4. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    I am 24, and I am pretty used to being very independent with my diabetes. But I am also used to this doctor agreeing with me. He's been the one doc who trusted me, who I didn't need to justify myself to. So I was caught off guard this time. But this is also the first time I have felt this confident with targeting so low. I don't remember the last time I had an A1c under 7 before this.
     
  5. Nightowl

    Nightowl Approved members

    Joined:
    May 6, 2008
    Messages:
    168
    I agree with you. My son feels best at 85. If you can keep your range very narrow then you quickly acclimate to a narrow, normal range and you become very hypo and hyper aware. In order to keep a stable and narrow range we realized quickly that we had to make dietary adjustments. Not only is my son now able to keep a narrow range but avoiding lows is easier (he feels the tiniest shift in glucose levels). The best part of it is the "feeling great all the time" aspect. So yes, don't let your doctor discourage you from normalizing your blood sugars. Like you mentioned, it's critical for long term health plus you feel better every day in the short term. There is only upside.
     
  6. mom of four

    mom of four Approved members

    Joined:
    Oct 23, 2008
    Messages:
    215
    It sounds to me like you're doing a great job. We have quite a few lows which our endo. obviously wants us to try to avoid, but at the same time she tells us that lows are going to happen when you have great control. At your age I personally believe you should be targeting an A1c of under 7. I don't know why your doctor would be resistant to this..:confused:
     
  7. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    I think many endos tend to be on the conservative side - that's why they tell people that a1Cs in the 8s are acceptable. They know that many patients and parents just aren't vigilant enough to catch lows when the target is lower, so instead of helping people do that, they just lower their standards.

    We have a CGM, and we try to run Jack between 90 and 120 at night. Sometimes that's not possible when there's a growth spurt or something else going on, but it's what we aim for. I see no reason why a motivated adult with a CGM should be required to set their target at 140 at night. When you can get a solid 8 hours of really good BG, why wouldn't you???
     
  8. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    Nightowl: When you say lowcarb diet, how low do you mean. And how on earth do you manage to convince a 15 year old boy to stay on a low carb diet? I am just thinking of the teenage boys I usually see who will eat a whole pizza, a loaf of bread, and a box of twinkies for an afternoon snack....

    I am also curious, if you are targeting 83 and maintaining an A1c under 5, what do you consider to be a treatable hypo? And how often does he have lows?
     
  9. RomeoEcho

    RomeoEcho Approved members

    Joined:
    Dec 22, 2008
    Messages:
    483
    Thank you guys for confirming that I am not entirely crazy. I thought I was supposed to be targeting under 7, and it isn't really fair, especially when dealing with my health, that I should lower my standards for other people's failures. I think I am going to continue to try and minimize lows, both for dangers associated with lows and the highs that often follow. But I don't think I can agree with the avoid all lows at all cost mindset. And to give the doctor the benefit of the doubt, he has always been very good to me in the past and there were several things off this appointment, maybe he was having a bad day.
     
  10. Nightowl

    Nightowl Approved members

    Joined:
    May 6, 2008
    Messages:
    168
    Basically, the vast majority of my son's carbs are complex vegetables. I also do baked items with flaxseed meal and almond flour and other low carb items. His motivation is feeling great. He hates how he feels when his glucose levels are swinging. He is a great student and always has been and he says he feels fuzzy when he is high. He has become so self motivated that on mornings when he has a big test he won't have any carbs for breakfast. He corrects anything 90 and above, and he treats anything below 75. With a pump it's easy do to very tiny corrections.
     
  11. Nightowl

    Nightowl Approved members

    Joined:
    May 6, 2008
    Messages:
    168
    My son never goes low. Of course it could happen, so we don't take it for granted, but when my son's Endo downloaded his meter at his last appointment, it showed 0 lows - by Endo's standard. When my son does drop to say 70 it isn't a profound fast drop its always very manageable. My son doesn't shoot huge quantities of insulin so everything becomes more predictable.
     
  12. ecs1516

    ecs1516 Approved members

    Joined:
    Dec 11, 2007
    Messages:
    7,028


    How about during sports etc.? My son using his 'Ripstick'(skateboard like) always shoots him low.

    My other question is I thought on a growing child you were not supposed to do a low carb diet because it can stunt growth?
     
  13. Nightowl

    Nightowl Approved members

    Joined:
    May 6, 2008
    Messages:
    168
    Sports are a lot easier for my son on a low carb diet because he is shooting significantly less insulin. Absorption is much more predictable. We just got back from a ski trip where my son skied all day without going low. Swimming is more difficult. He plays water polo in the fall and those practices are tough. He has to take glucose tabs throughout the practice to avoid lows.

    My son is now 6 ft 1 in. He grew 1 inch on this diet. The only studies I can find about stunted growth and diabetes relate to hyperglycemia. The only thing we have done is replace refined carbs with lots of vegetables. We basically follow a paleolithic diet. Frankly, I have noticed a very positive change in my son since we gave up the gluten. There seems to be an added sharpness or spark to him. Anyway, our experience has been extremely positive.
     
  14. KRenee

    KRenee Approved members

    Joined:
    Jul 23, 2008
    Messages:
    322
    I wouldn't do a low carb diet with a very young child, but I think it's fine for a teenager. And it makes it so much easier to mangage every aspect of diabetes.
     
  15. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    At 24 I think you should be able to keep doing the great job your doing..As a mom, the only thing that might make me nervous is if you lived alone. Do you have people around you? My son is 13 and I'm fine with his bg as long as it is over 100 at 3 hours after his last fastacting... What DO you want your night time target to be? If it's over 100, I'm sure it's fine:cwds:
     
  16. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    I'm not trying to fight with you, I don't know how long he's been on this diet, for all I know he grew that inch in the last 3 months..I just wanted to let you know that kids are supposed to grow 2 inches a year. I know this because of Jake's growth issues...
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice