[Nejeda]

So I went to see my doctor today and he informs me that my A1C is the highest it has been since I was first diagnosed... it's 10.6! And I can't explain it, my blood sugar has been all over the place, I've been stressed which is the reason for the blood sugar being all over the place.

On top of this he told me that he is very happy with my weight loss, and that after me being on Humalog for 10 years, he's going to switch me to an insulin that will help me lose more weight!

I'm sixteen, I'm fix foot two and a half... and I weigh about one sixty six... My BMI according to the doctor is 29... which he says is fine...

But he seemed more intent on getting me to lose weight then getting my A1C down... is it just me or is there something not right there?

[spike]

Originally Posted by Nejeda

So I went to see my doctor today and he informs me that my A1C is the highest it has been since I was first diagnosed... it's 10.6! And I can't explain it, my blood sugar has been all over the place, I've been stressed which is the reason for the blood sugar being all over the place.

On top of this he told me that he is very happy with my weight loss, and that after me being on Humalog for 10 years, he's going to switch me to an insulin that will help me lose more weight!

I'm sixteen, I'm fix foot two and a half... and I weigh about one sixty six... My BMI according to the doctor is 29... which he says is fine...

But he seemed more intent on getting me to lose weight then getting my A1C down... is it just me or is there something not right there?

An insulin to help you lose weight??? Are you sure he didn't mean a MEDICATION to help you lose weight.

Yes, something is wrong with the picture if the doc isn't upset with such a high A1c. That's the sort of numbers I used to run when I first became diabetic. Get it down! If you need assistance from a doctor, and he won't help, go see another endo.

[duck]

Um, yeah.

First things first...Relax, I don't know if I know of any teens who can say they are in "tight control" or who have consistently good A1c's...You have a first-hand view of how hard it is to manage one hormone, and you also have a good view on what happens when a group of them go raging through your body. I'm not trying to give you a blanket-excuse to stop taking care of yourself or disregard bad readings, but I hope you don't beat yourself up about this either. To me, it says "need to work a little harder..." and that's all.

Second, IMHO your doc is nuts. If you are not comfortable with a new insulin, don't let him switch you (which one, btw?). But what has me more concerned if his "lose weight" attitude. You certainly are not obese...I weight 175 and I am only 5'7", and NO ONE has ever told me to lose any weight. Also, being that you are a teen, I worry more about starving your growth needs than you being overweight, in light of the evidence. Your doc may be caught in a rut where he tells every diabetic to lose weight, cut the sugar and keep an eye on your blood sugars...If worse comes to worse, tell him you want a re-evaluation or a second opinion. I also worry a little when doctors advise teen females to lose weight, that is such a loaded thing to advise--It MAY be true, but looking at the stats you posted, I dunno...

You are right that he should be more concerned about the A1c...maybe that's why he wants to switch your insulin? I forget, are you a pumper?

[Nejeda]

Nope, he specifically said an insulin that would help me lose weight, it is brand new. He said he was going to battle my insurance company to get them to approve it.

And I definetly am working on the A1C. I even got a shiny new monitor... the new One Touch Ultra 2... it's spiffy...

[JediSkipdogg]

You're 6' 2.5" and you weight 136 and he thinks you are overweight? Where the heck is he getting the BMI info from anyweights? I am 5' 11.5" and weight 193 and am only overweight by about 10-15 lbs. If anything, you are underweight in my opinion.

Secondly, my guess is he either wants to add Symlin to your mix (which is not not a replacement for Humalog, but another injection) or to something called Aphidra (some help with the spelling) and even then I'm not sure on the weight loss principals of it yet. What other insulin are you on in addition to Humalog?

Your weight loss is not caused by your insulan in my opinion and should not even be a concern for your doctor. RIght now, he should care less about that and more about your A1C. Lowering your weight will not bring your A1C down.

Now, to the important factor and the title of your question. How often are you checking your BG and what makes you check it? How are you calculating how much insulin to give when running how? How about when eating?

It seems to me your problem is in your checking your BG and your calculating what you eat. Are you carb counting? I think answering these questions will greatly help us understand how you are controlling diabetes and from there we can better explain to you how to control it better.

[Nejeda]

Originally Posted by duck

Um, yeah.

First things first...Relax, I don't know if I know of any teens who can say they are in "tight control" or who have consistently good A1c's...You have a first-hand view of how hard it is to manage one hormone, and you also have a good view on what happens when a group of them go raging through your body. I'm not trying to give you a blanket-excuse to stop taking care of yourself or disregard bad readings, but I hope you don't beat yourself up about this either. To me, it says "need to work a little harder..." and that's all.

Second, IMHO your doc is nuts. If you are not comfortable with a new insulin, don't let him switch you (which one, btw?). But what has me more concerned if his "lose weight" attitude. You certainly are not obese...I weight 175 and I am only 5'7", and NO ONE has ever told me to lose any weight. Also, being that you are a teen, I worry more about starving your growth needs than you being overweight, in light of the evidence. Your doc may be caught in a rut where he tells every diabetic to lose weight, cut the sugar and keep an eye on your blood sugars...If worse comes to worse, tell him you want a re-evaluation or a second opinion. I also worry a little when doctors advise teen females to lose weight, that is such a loaded thing to advise--It MAY be true, but looking at the stats you posted, I dunno...

You are right that he should be more concerned about the A1c...maybe that's why he wants to switch your insulin? I forget, are you a pumper?

I've never been considered in "tight control" I've been getting closer in the past year or so... up until lately that is.

The other doctor in the office in which my doctor practices (I've seen) has the same attitude towards me losing weight as well. And I kind of thought it was odd that a doctor would want a teenager to lose weight.

I then thought that maybe it was because I was a diabetic?

[Nejeda]

Originally Posted by JediSkipdogg

You're 6' 2.5" and you weight 136 and he thinks you are overweight? Where the heck is he getting the BMI info from anyweights? I am 5' 11.5" and weight 193 and am only overweight by about 10-15 lbs. If anything, you are underweight in my opinion.

Secondly, my guess is he either wants to add Symlin to your mix (which is not not a replacement for Humalog, but another injection) or to something called Aphidra (some help with the spelling) and even then I'm not sure on the weight loss principals of it yet. What other insulin are you on in addition to Humalog?

Your weight loss is not caused by your insulan in my opinion and should not even be a concern for your doctor. RIght now, he should care less about that and more about your A1C. Lowering your weight will not bring your A1C down.

Now, to the important factor and the title of your question. How often are you checking your BG and what makes you check it? How are you calculating how much insulin to give when running how? How about when eating?

It seems to me your problem is in your checking your BG and your calculating what you eat. Are you carb counting? I think answering these questions will greatly help us understand how you are controlling diabetes and from there we can better explain to you how to control it better.

The Aphidra... I think that's what he was talking about...
I check my blood sugar before and after I eat (when I eat, if I eat... I have a bad habit of not eating like a should) But usually around six times a day. My doctor has a scale he gave me to inject insulin based on what my sugar readings are. I used to carb count, but I don't anymore, I'm on a sliding scale, and it works better for me.

(Side note... I'm 5'2.5... I think you misread that part... I wish I were taller)

[spike]

Originally Posted by Nejeda

Nope, he specifically said an insulin that would help me lose weight, it is brand new. He said he was going to battle my insurance company to get them to approve it.

And I definetly am working on the A1C. I even got a shiny new monitor... the new One Touch Ultra 2... it's spiffy...

Good! You got an excellent monitor and the right attitude about working on your A1c. Please let us know more about the insulin when you speak with him again.

[duck]

Apidra's website says nothing about helping to lose weight. However, Symlin is known to help lose weight:

http://www.apidra.com/Default.aspx

http://www.symlin.com/

The Benefits of SYMLIN

SYMLIN provides several benefits that can lead to better overall diabetes control.

Less extreme and less frequent blood glucose (sugar) peaks

SYMLIN reduces your blood sugar fluctuations by smoothing out the peaks in blood sugar that happen after eating and throughout the day.

Reduces A1C levels

One measure of how well you are managing your diabetes is to look at your A1C level. A1C measures the amount of sugar attached to red blood cells. SYMLIN lowers the A1C levels of most patients beyond what insulin alone can achieve, giving you better overall control of your diabetes.

Potential weight loss

Because SYMLIN works like the natural hormone amylin, it can reduce your appetite, which leads to eating less and to possible weight loss.

Less mealtime insulin is needed

Because SYMLIN works with insulin to control blood sugar, you may actually need less insulin to achieve your optimal blood sugar targets after meals.

Nausea is the most common side effect with SYMLIN. Mild nausea is more likely during the first weeks after starting SYMLIN and usually does not last long. It is very important to start SYMLIN at a low dose and increase it as directed by your healthcare professional. If nausea continues or bothers you, call your healthcare professional right away.

Tell your healthcare professional if you have any side effects that bother you or that do not go away.

[spike]

Originally Posted by Nejeda

The Aphidra... I think that's what he was talking about...

Apidra...
----

[duck]

Originally Posted by Nejeda

The Aphidra... I think that's what he was talking about...
I check my blood sugar before and after I eat (when I eat, if I eat... I have a bad habit of not eating like a should) But usually around six times a day. My doctor has a scale he gave me to inject insulin based on what my sugar readings are. I used to carb count, but I don't anymore, I'm on a sliding scale, and it works better for me.

(Side note... I'm 5'2.5... I think you misread that part... I wish I were taller)

I'm going to pick on you a "little". Tell me to get lost, and I will:

If you say the "sliding scale" is working for you, you need to explain how if your A1c came back at 10. I hate the sliding scale, it worked like poop for me, yet for years that's all my doctors ever talked about. "Use the sliding scale, use the sliding scale". Carb counting saved my life, literally.

I wish I were taller too.

[JediSkipdogg]

Originally Posted by Nejeda

The Aphidra... I think that's what he was talking about...
I check my blood sugar before and after I eat (when I eat, if I eat... I have a bad habit of not eating like a should) But usually around six times a day. My doctor has a scale he gave me to inject insulin based on what my sugar readings are. I used to carb count, but I don't anymore, I'm on a sliding scale, and it works better for me.

(Side note... I'm 5'2.5... I think you misread that part... I wish I were taller)

You mistyped it and I wasn't sure which way to take it... (I'm sixteen, I'm fix foot two and a half...) Not sure what a fix two is, lol.

But anyways, that insulin won't help you use weight. At your weight you should have about a BMI of 25. It's slightly overweight, but only by about 5 lbs max.

Carb counting is the easiest way to go if you have accurate numbers. What made you give up carb counting? I think something that would be helpful is if one day you put your mind too it and kept a journal of what you eat in the day and what insulin you give and when. Then we can see what you are doing and maybe give you advice on where to improve.

[spike]

Originally Posted by duck

I'm going to pick on you a "little". Tell me to get lost, and I will:

If you say the "sliding scale" is working for you, you need to explain how if your A1c came back at 10. I hate the sliding scale, it worked like poop for me, yet for years that's all my doctors ever talked about. "Use the sliding scale, use the sliding scale". Carb counting saved my life, literally.

I wish I were taller too.

I found this online:
"
Sliding scale

In intensive regimens, the most common way to adjust your insulin dose is by using a sliding scale, also called an "algorithm." A sliding scale, which is calculated by your doctor or a diabetes nurse educator, shows you how much insulin to add or subtract to your dose depending on your current blood sugar level. Some people who do not count carbohydrates may use the sliding scale to adjust their insulin doses."

Can you BELIEVE they consider the SS to be a form of "intensive regimen"???

I agree, Duck, counting carbs should be the rule. I adjust my bolus based on current bg's (like the Bolus Wizard does on pumps), but I'd never JUST adjust my insulin based on the SS w/o regards to what I'm about eat.

[duck]

Originally Posted by spike

I found this online:
"
Sliding scale

In intensive regimens, the most common way to adjust your insulin dose is by using a sliding scale, also called an "algorithm." A sliding scale, which is calculated by your doctor or a diabetes nurse educator, shows you how much insulin to add or subtract to your dose depending on your current blood sugar level. Some people who do not count carbohydrates may use the sliding scale to adjust their insulin doses."

Can you BELIEVE they consider the SS to be a form of "intensive regimen"???

I agree, Duck, counting carbs should be the rule. I adjust my bolus based on current bg's (like the Bolus Wizard does on pumps), but I'd never JUST adjust my insulin based on the SS w/o regards to what I'm about eat.

The more I think about it, when I was "using" the sliding scale, I never felt worse. Maybe it works for someone, but man-oh-mighty it just made me frustrated, and corresponds with the "dark ages" of my diabetes treatment, LOL.

Nejeda, if it works for you, that's great. You come across as smart enough to understand it and use it. I'm just not a believer in the technique.

[spike]

Originally Posted by duck

The more I think about it, when I was "using" the sliding scale, I never felt worse. Maybe it works for someone, but man-oh-mighty it just made me frustrated, and corresponds with the "dark ages" of my diabetes treatment, LOL.

Nejeda, if it works for you, that's great. You come across as smart enough to understand it and use it. I'm just not a believer in the technique.

Yes, I agree that whatever works for someone is "good enough", by definition. Never mess with success. (10+ A1c is hardly success, though...)