1. Returned study pump...impression, not worth a plugged nickel. Assuming it was the polypeptide medication. Study doc and researcher are now in a quandary over whether or not that part of the study needs to be repeated,(because of strep) if in four weeks my insulin requirements vary greatly from what they have this week I will have to repeat it. That's two more Boost tests, and another gallon of blood leached. The blood leaching might conceivably improve my a1c, if it weren't for the over 500 for two more days factor. Can't see how that is going to improve anything. I hate being over 500,it feels so yucky and icky and horrible. Apparently, I'm not alone in the "over 500" category, one guy actually went up to 650. (their meters read up to 850) I also think I'd like more compensation if I'm going to have to do this again.(there's the cost of gas, and the $4 tunnel toll) I don't want to mess up their study and they have to find someone else but I also hope they'll be understanding of the inconvenience of putting oneself through two more times of utter D-heck for this.
2. New Niece! hopefully it works out for bro and girlfriend, both the mom & infant are doing fine... my parents went down and saw them Sat.afternoon.(baby was born on Friday)
3. Other then that, and the never-ending abysmal rain, I really need to get back to the gym, seeing the depressing average on my meter makes me think it will take some pretty major watching the preprandials,postprandials,and everything else to even do damage control on my next a1c. Team Type 1 will be rolling into MD at the end of the week,and that will be marginally exciting. Hopefully inspire me toward more exercise.
Showing posts with label blood glucose control. Show all posts
Showing posts with label blood glucose control. Show all posts
Sunday, June 21, 2009
Monday, November 24, 2008
The Line Between the Two
I've been thinking about the concept of using CGM's in the hospital and have come to the conclusion that that there is just no way it could EVER work.
Patient "M" is extremely sick, in the ICU. Patient M's blood sugar is going up and down like a pregnant women on steroids. Patient M could really benefit from stabler bgs and fewer hypos. Patient M, however, is being pumped full of acetaminophen/narcotics and that pretty much voids out the usefulness of a CGM.(acetaminophen makes the moniter read HI) Throw in the occasional (or not so much,if they are in the ICU they might have a few of those) MRI and the staff had better remember to remove the sensor or the patient will be dead. (due to the metal in the sensor) You think about the lawsuits waiting to happen, it's rare for staff to be acquainted with pumps, let alone CGM's. (I have a question for anyone who has ever been
in the hospital, with a pump...assuming they even permitted you to continue using it, did they even ask if you were changing the site every 2-3 days? I don't, so it doesn't disturb me,but many people are prone to infection + that needs to be addressed. Breeding ground to further issues, is the pump site infection.)
And for infection prone patients, it is something else for the staff to forget. (changing it occasionally) In its current form, CGM's would be a headache for use in the hospital setting. I'd far rather have frequent bg checks then rely entirely on the CGM it is a good thing that there are many more type 2's then type 1's in the hospital or even more staff would be required.(so I think) There are so many D's in the hospital, they make up like 2/3 of the patient population.(according to Diabetes Forecast) The CGM is a very valuable tool, but someone has to be following it, tweaking, looking at patterns and another characteristic of non-endocrinologists is they are REACTIVE,(aka the "sliding scale") rather then proactive. I realize I'm lumping all of them into one generic group but its a case of guilty until proven innocent. Until someone demonstrates their D-savvyness, I do not assume that they've got it. And I would not use a CGM without meter confirmation. A CGM, does not replace the need for meter monitoring.
I think the answer lies in being more proactive with management, rather then the highly unpractical, time-consuming, expensive CGM. How about an insulin pump or IV insulin drip rather then then NPH/Regular shots?(for starters) Or how about not serving juice, jello, and various other high glycemic foods to skyrocket the patient's blood glucose even more? The goal is to prevent complications, not encourage them. I'm not sure things will ever improve, to where they should be, even in the enlightened hospitals. I wish I could tell this to a few hospital CEO's, better blood sugars translate into money(and lives) saved.
Patient "M" is extremely sick, in the ICU. Patient M's blood sugar is going up and down like a pregnant women on steroids. Patient M could really benefit from stabler bgs and fewer hypos. Patient M, however, is being pumped full of acetaminophen/narcotics and that pretty much voids out the usefulness of a CGM.(acetaminophen makes the moniter read HI) Throw in the occasional (or not so much,if they are in the ICU they might have a few of those) MRI and the staff had better remember to remove the sensor or the patient will be dead. (due to the metal in the sensor) You think about the lawsuits waiting to happen, it's rare for staff to be acquainted with pumps, let alone CGM's. (I have a question for anyone who has ever been
in the hospital, with a pump...assuming they even permitted you to continue using it, did they even ask if you were changing the site every 2-3 days? I don't, so it doesn't disturb me,but many people are prone to infection + that needs to be addressed. Breeding ground to further issues, is the pump site infection.)
And for infection prone patients, it is something else for the staff to forget. (changing it occasionally) In its current form, CGM's would be a headache for use in the hospital setting. I'd far rather have frequent bg checks then rely entirely on the CGM it is a good thing that there are many more type 2's then type 1's in the hospital or even more staff would be required.(so I think) There are so many D's in the hospital, they make up like 2/3 of the patient population.(according to Diabetes Forecast) The CGM is a very valuable tool, but someone has to be following it, tweaking, looking at patterns and another characteristic of non-endocrinologists is they are REACTIVE,(aka the "sliding scale") rather then proactive. I realize I'm lumping all of them into one generic group but its a case of guilty until proven innocent. Until someone demonstrates their D-savvyness, I do not assume that they've got it. And I would not use a CGM without meter confirmation. A CGM, does not replace the need for meter monitoring.
I think the answer lies in being more proactive with management, rather then the highly unpractical, time-consuming, expensive CGM. How about an insulin pump or IV insulin drip rather then then NPH/Regular shots?(for starters) Or how about not serving juice, jello, and various other high glycemic foods to skyrocket the patient's blood glucose even more? The goal is to prevent complications, not encourage them. I'm not sure things will ever improve, to where they should be, even in the enlightened hospitals. I wish I could tell this to a few hospital CEO's, better blood sugars translate into money(and lives) saved.
Wednesday, November 12, 2008
Notes from a Spinning Planet: Progress Notes
I sit, waiting, for the doctor to appear-shoes squelched tightly against tile, toes curled, sweaty hands gripping chair arms in death grip...
"Hello."
"Hi."
"Your labs look great, with the exception of your blood sugar, which is high, the last one was 185."
He fixes me with the all-knowing look.
(Not again...)
"It's very important to keep your diabetes under control."
Great. How to put this is diplomatic, physician-approved, terms. Deep breath, going off the deep end never helped one's case.
"I understand, and I do try, but I'm not your typical type 2 patient and type 1 diabetes is impossible to prevent post-meal spikes. My kidneys aren't going anywhere." (the regular function of them is perfectly fine)
He does not look convinced.
"Proper management is ESSENTIAL, you don't want those problems too."
He's a nephrologist, and I'm his type 1 diabetic patient- I guess he has the right to rag some. How many patients has he seen die because they neglected their D? probably quite a few.
I wish he would stop it though. I get that I'm at prime risk for everything under the sun. I take my health(and D) seriously, and I'm trying to manage it. Unfortunately, Doctor-Patient Communication 101 must not have been a class taught in medical school some 44 years ago and I get the feeling he thinks I'm just spouting off excuses.
"Why is it so hard for you?"
Check yes on that theory. It's not that it's consistently "hard", it's more like D has a freakin' mind of it's own and even when it's easy the insulin peaks at odd times, the hormones surge whensoever they wish and the effects of exercise hit at 4 AM, leaving the total deal somewhat of a crap shoot. And I can't explain all that, the million factors of managing bgs. I respect his expert opinion on the management of my electrolytes, but the nagging guilt parade over my bgs has got to stop. I've got to find a way to communicate that to him, because he is a very hard-nosed, do-it-my-way kind of doctor who stopped learning new info a long time ago. Finding another doctor isn't possible, the wait list for nephrologists is 1-2 months and I still have to get infusions. I need him, to manage it. It is doing much better,and I will soon only have to have it 1x/week.(on the good news front)
"Hello."
"Hi."
"Your labs look great, with the exception of your blood sugar, which is high, the last one was 185."
He fixes me with the all-knowing look.
(Not again...)
"It's very important to keep your diabetes under control."
Great. How to put this is diplomatic, physician-approved, terms. Deep breath, going off the deep end never helped one's case.
"I understand, and I do try, but I'm not your typical type 2 patient and type 1 diabetes is impossible to prevent post-meal spikes. My kidneys aren't going anywhere." (the regular function of them is perfectly fine)
He does not look convinced.
"Proper management is ESSENTIAL, you don't want those problems too."
He's a nephrologist, and I'm his type 1 diabetic patient- I guess he has the right to rag some. How many patients has he seen die because they neglected their D? probably quite a few.
I wish he would stop it though. I get that I'm at prime risk for everything under the sun. I take my health(and D) seriously, and I'm trying to manage it. Unfortunately, Doctor-Patient Communication 101 must not have been a class taught in medical school some 44 years ago and I get the feeling he thinks I'm just spouting off excuses.
"Why is it so hard for you?"
Check yes on that theory. It's not that it's consistently "hard", it's more like D has a freakin' mind of it's own and even when it's easy the insulin peaks at odd times, the hormones surge whensoever they wish and the effects of exercise hit at 4 AM, leaving the total deal somewhat of a crap shoot. And I can't explain all that, the million factors of managing bgs. I respect his expert opinion on the management of my electrolytes, but the nagging guilt parade over my bgs has got to stop. I've got to find a way to communicate that to him, because he is a very hard-nosed, do-it-my-way kind of doctor who stopped learning new info a long time ago. Finding another doctor isn't possible, the wait list for nephrologists is 1-2 months and I still have to get infusions. I need him, to manage it. It is doing much better,and I will soon only have to have it 1x/week.(on the good news front)
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