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First DSN appointment tomorrow.

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stackingcups

stackingcups

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Type 3c
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Is there anything I should be asking to get the most out of the telephone call?

Trying to note stuff down so I have back up for when it all falls out of my head.

Should I make a note of my recent BG numbers to tell him?
 
I would ask for his email address, so that after the phonecall, when you remember the thing you really should have asked, you can email and ask it ...

Yes, he may want to know recent BG numbers, to see if he can spot any patterns you might have missed. If so, that's another thing that would be easier to do by email though.

You are presumably going to be asking about starting bolus insulin (if I'm right in thinking you're just on basal at the moment)? If so I would explain about your high waking readings, because it would be easier to correct those with bolus.

Hope you get someone helpful who is understanding about type 3c.
 
Email address is a good shout!

I will ask about bolus insulin - though I feel awkward taking the lead there as I don't quite understand it all myself. Some days my readings 2 hours after lunch are very similar to before lunch. Whereas other days like today there was a jump from 7.8 to 11. Sometimes more of a jump. I'm very much struggling to see patterns.

The guy I'm going to be speaking to is the guy my DN has been calling to ask about the 3c, and seems to be the highest up of the DSN's at the hospital so I think he is going to be the one for the 3c stuff.
 
Let's hope he is! (the one with useful answers)

Do NOT be afraid to take the lead - if there were not other folk exactly like you - he would be out of a job, wouldn't he!!
 
Yes, try to get yourself on Balsa/Bolus regime. This is the standard for T1s who have little or no insulin production and you are in the same position. If you can, measure your blood pressure as this is one of the measures needed for your records.
 
Ooh good call, I'm being treated for high blood pressure at the moment. Will check whats going on with that in the morning.
 
From a fellow T3c i'm on basal/bolus regime. Find it to be the best regime for me,especially when i have a pancreatic flare up and can't eat. I find it gives you more control as i suspect you take creon also with food and milk. Best to write everything down, like fellow members have said dont be afraid to ask questions and don't be rushed. I've just done a weekly well it was 8 days recording blood pressure twice a day. I find that if you cross out or tick the things you've told him. Stops you repeating yourself.
 
Dutifully weighed myself (unexpectedly lost 4lbs) and did my blood pressure (meds appear to be working!)

Not on Creon as the GP says my fecal elastase levels are high. I'm only suffering with digestive issues on and off.

Off to go scribble down notes for myself!
 
Just want to say hope it goes well, and just to ask them to repeat if there is so,etching you don't understand.
 
Good luck today and I second/ third/ fourth about asking about a basal/ bolus regime. Your morning readings testify that something else is needed.
 
stackingcups said:
Thank you all. I feel like I've got a bunch of people in my corner here. Makes me feel a bit braver.
Click to expand...

Don’t be afraid to be a bit pushy @stackingcups We really do have to advocate for our own needs. Make sure you control the conversation and bring it back to what you want to ask and what you want. Having that written down in front of you helps a lot. Your aim is to get what you need not sit there and have someone talk at you.

Good luck 🙂
 
Had appointment. Was on the phone for over half hour. very thorough and lovely.

He's given me his extension number should I need him.

Wants me to carry on with the Lantus to get my morning readings down. and one they're settled he's warned me that adding in a rapid acting may be needed for meal times. but doesn't want to rush anything.

Has discovered my cholesterol is high looking at my last blood test, and is a bit annoyed that my doctors didn't flag it with me. Has asked them to start me on statins.

sending me to see a diabetic dietician, and is recommending I get referred for bariatric surgery which i'm a bit :/ about
 
Pleased you had a good appointment and feel somewhat reassured. I wonder if this is a new directive with regard to starting people off on just basal initially because it seems we have had quite a few new members who have experienced a similar scenario.

I hope you find the dietician appointment helpful. Personally I didn't but then I was following a low carb diet and she didn't approve. If you need to lose weight (since you mention bariatric surgery) then a low carb diet might benefit you too and since you aren't on a bolus insulin yet, eating low carb might help with your BG levels. It also reduced my cholesterol levels without the use of statins, but everyone is different.
With cholesterol, as with diabetes (Hba1c), it is useful to know the actual figures rather than just be told "it's high". There are conflicting schools of thought about cholesterol and statins. Some health care professionals hand them out like sweeties if your levels are borderline or above the diabetes guideline whilst others take a more individual approach and look at your risk factors and the individual elements of the lipid results and the ratios of them, which can make a significant difference. It may be that you have sufficient risk factors to warrant statins but it is helpful to have a knowledgeable discussion about the risks. It may be that your nurse did this and you just haven't mentioned it, but just want you to be aware.
Look forward to seeing your morning readings in the "Group 7-day waking average" thread come down a bit (assuming he has increased the Lantus dose??) and that should help you to feel much better.
 
cholesterol is 6.7 apparently.

he wants me to keep continuing to increase the Lantus by 2 units at a time until I hit 20. If theres still not much improvements on the morning numbers then I'm to increase by 4 units at a time until I get close.

He's contradicted the DN a few times, she suggested I could test less, happily doing just once a day, he wants me to test before every meal and before bed instead.

I've been lowering carbs gradually and increasing fibre. Will look into reducing more.
 
More testing is really important to see what is going on. Once a day gives you very little information, so it's good that he wants more testing. Are you going to continue with the waking reading? Hope so, so that we can see your levels reducing on the other thread.

Good to hear you have the "go ahead" to make slow steady increases to your Lantus and that he is giving you responsibility to do that rather than having to keep going back to him to increase it. Diabetes is all about self management and learning how to adjust your own doses. That will start to bring your morning levels down. Did he advise making a change and then waiting 3 days before you decide to increase it again? Hopefully so, as it takes about 3 days for the full impact of a change to take effect with Lantus I believe. When do you inject it?

6.7 is a bit high to argue against statins I guess. Is he prescribing them?

Slow steady reduction of carbs is the way to go if you decide that low carb is the way forward for you and fibre is a really important element. I use a home made fibre drink on a morning before breakfast with psyllium husk and chia seeds and Apple Cider Vinegar (ACV) in water, which really helps my digestive health and probably lots of other benefits (cholesterol and heart health) too.
 
Hmm yes, he said before breakfast which somedays is very different to waking for me. I've been doing the waking readings on my accu chek monitor I bought myself and left by my bed so I think I will continue to do those, and then use the prescribed strips and monitor for the before meals and bed readings.

He said to increase after 3-4 days, and then settled on 4 days so that I wasn't having to deliberate. DN initially said every 3-4 days and then when I told her I'd been doing exactly that she decided on 5 days instead. I'm injecting the Lantus around 8pm at night. I'm looking forward to seeing the numbers come down myself and keep getting a bit impatient.

For the statins, he asked how I felt about it. I know a lot of people seem to be against them but I don't know their reasoning. My Dad died of a sudden heart attack when he was only a little older than I am now, so anything that prevents me suddenly dropping dead is great in my opinion!
 
I like the sound of your DSN. Just the fact that he asked how you felt about statins is really good and shows he has the right approach. I am not against statins as such, but I do really dislike the way they are dished out willy nilly without taking into account an individual's circumstances. And not discussing the risks and options with patients. I think, in your circumstances, I would feel the same.
So pleased you will be continuing to post your waking reading and it will be quite exciting seeing your levels eventually start to come down.
You might find that taking your Lantus at bedtime (assuming you don't go to bed at 8pm) or possibly in the morning when you wake up is a better option. Lantus has a peak of activity about 5 hours after injecting I believe and most people need less insulin in the depths of their sleep (1-3am) but experience something called Dawn Phenomenon which can start to kick in about 4-5am or sometimes not before they actually set foot out of bed (Foot on the Floor syndrome). Most people also need much more insulin during the early part of the day than they do at night, so taking it early in the morning can be a better alternative for some people. These are just things to bear in mind if you start going low at night but high through the day.
 
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