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Monday, December 28, 2009

[Type-2-Diabetes] Digest Number 3842

Messages In This Digest (17 Messages)

Messages

1a.

Re: Diabetes Educators

Posted by: "Diane Moro" deemoro@gmail.com   signoradiana

Sun Dec 27, 2009 3:41 am (PST)



Based on this information, perhaps I should be seeing a DE instead of a
therapist.
~diane

On Sun, Dec 27, 2009 at 1:50 AM, Tiamat <tiamat99@comcast.net> wrote:

>
>
>
>
> AADE American Association of Diabetes Educators
>
>
>
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1b.

Re: Diabetes Educators

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 4:59 am (PST)





--- In Type-2-Diabetes@yahoogroups.com, Diane Moro <deemoro@...> wrote: Based on this information, perhaps I should be seeing a DE instead of a therapist>>

I imagine your insurance will pay for both.

One of the differences is that the CDE isn't going to see you every week for ten weeks or whatever. An initial consultation and maybe one or two follow-ups is usually all someone needs until maybe next year or until there's a change made in the patient's diabetes care. An exception to this is probably a new pumper, who may need multiple visits, but pumpers would have all the insurance coverage they need.

Also, the CDE isn't qualified to advise you on issues outside your diabetes care-- if you're depressed, angry, confused about your home life or relationships or stuff at work, a good CDE would always advise a therapist be consulted.

Judy D.

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2a.

Re: Metformin Overdosing

Posted by: "AnaLog Services, Inc." analog@logwell.com   sydlevine

Sun Dec 27, 2009 5:35 am (PST)



Call management at the Wal-Mart store in question. It will scare the heck out of the assistant manager or whoever they give you to. Say something like "I am not now considering legal action as long as I can get a satisfactory explanation on what has transpired" or words to that effect.

If you have a nice company letterhead, write them if you really want to see some fast footwork. If you do not have letterhead, I can send you a nice official looking letterhead (in M$ Word) for my old consultancy company that you can use. They will assume it is from your lawyer, and will fall all over themselves to find out what happened.

Syd

----- Original Message -----
From: brian cooper
To: Type-2-Diabetes@yahoogroups.com
Sent: Saturday, December 26, 2009 9:14 PM
Subject: [Type-2-Diabetes] Metformin Overdosing

Analog,

Thanks for your suggestion about Walmart. As a matter of fact, when I called them, I asked if they didn't have computerized or other safeguards, and got a less than meaningful or satisfactory answer. I think I'll follow up with them again, in person.

But even with their goof in the first place (possibly), or chance to rectify the doc's goof, I think the probability that the error originated with the doctor gives me serious pause about her. There are plenty of ways in which she might treat me in the future that might not lend themselves to being caught by a pharmacy system--and if she is so "spacey" or careless in this case, can I take the chance that this is a unique, isolated case?

Thanks again,

Brian Cooper
__________________________________________________________

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3a.

Re: what a CDE does

Posted by: "AnaLog Services, Inc." analog@logwell.com   sydlevine

Sun Dec 27, 2009 7:05 am (PST)



As I pointed out before, the mere passing on of information does not constitute the practice of medicine in any state in the union as far as I know (at least back when I studied law). Otherwise, what we do on this list would be illegal even with all the caveats that opinions on here must not be substituted for a doctor's sage advice.

These things are in flux anyway. Many states did not allow optometrists to use dilation drops (Tennessee for one) since the ophthalmologist / AMA lobby insisted they were not MDs but merely glorified opticians. Nowadays, every state or nearly every state allows Optometrists to use dilation preparations.

----- Original Message -----
From: Jude
To: Type-2-Diabetes@yahoogroups.com
Sent: Sunday, December 27, 2009 1:34 AM
Subject: [Type-2-Diabetes] Re: what a CDE does

The only thing I can think of is that the role of the CDE is legally defined differently in Kristy's state than it is in my own. This actually is possible.

For example, as a dental hygienist, I know that in some states, trained and certified RDHs are allowed to use local anesthesia (novocaine, etc) as part of the periodontal therapy they do with their patients. But not in my state. Maybe other paraprofessional roles are differently defined by different states; in fact, as I said, this is quite likely.

The things you say CDEs can and cannot do, Kristy, are absolutely not true about the CDEs I've seen in my endo's office.

Judy D.

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4a.

Mental Difficulties

Posted by: "Debbie Drechsler" deb@debdrex.com   debsudrex

Sun Dec 27, 2009 7:06 am (PST)



> I have not started any new meds since this started.
> These are the meds I take daily:

> Levothyroxine for decreased thyroid

Your symptoms could also be from a change in thyroid status. If your
doctor hasn't checked your TSH lately make sure to request that test.
To be really thorough check Free T4 and T3 as well.

Being hypothyroid or hyperthyroid can certainly cause a lack of mental
clarity and it's apparently not that uncommon for a person to be on
the same dose of thyroxine for years and suddenly it's too much or not
enough.

Good luck!

Debbie in Santa Rosa
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4b.

Re: Mental Difficulties

Posted by: "AnaLog Services, Inc." analog@logwell.com   sydlevine

Sun Dec 27, 2009 9:37 am (PST)



That is true, but Occam's razor would argue for the narcotics being at least a part of the problem. Load up those opiate receptor sites and you won't be feeling pain, but perhaps a little forgetful. Don't forget that methadone is used to wean junkies off heroin.

Methadone has an interesting history. It was developed during WWII by the Nazis because they feared a disruption in the supply of the opiates used for pain control. We expropriated the technology after the war. Junkies do not really like the stuff, but they just love oxycodone, so methadone is becoming more popular for pain control due to lower cost and less potential for abuse (junkies have been known to steal methadone, but they will go for something else if there is a choice).

----- Original Message -----
From: Debbie Drechsler
To: Type-2-Diabetes@yahoogroups.com
Sent: Sunday, December 27, 2009 9:08 AM
Subject: [Type-2-Diabetes] Re:Mental Difficulties

I have not started any new meds since this started.
These are the meds I take daily:

Levothyroxine for decreased thyroid

Your symptoms could also be from a change in thyroid status. If your doctor hasn't checked your TSH lately make sure to request that test. To be really thorough check Free T4 and T3 as well.

Being hypothyroid or hyperthyroid can certainly cause a lack of mental clarity and it's apparently not that uncommon for a person to be on the same dose of thyroxine for years and suddenly it's too much or not enough.

Good luck!

Debbie in Santa Rosa

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5a.

Metformin Overdose

Posted by: "brian cooper" brianevans_99@yahoo.com   brianevans_99

Sun Dec 27, 2009 9:41 am (PST)



Jude,

I realize that the doc herself may have had a technician phone in the drug order--or that it may have been received at Walmart by a tech--either of whom COULD have made the blunder.

But I believe accountability, in healthcare perhaps more than in most things--is a vital element we have too little of in our society. Someone who makes this kind of mistake should be monitored to make sure they don't make similar ones too often; and canned if they do. Initial hiring decisions are too often lax; and techs may be paid too little to get "decent" employees; not to mention that the employee pool in some areas is pretty dismal.

Is this a matter of state law, or does anyone know if records must be kept of who actually phoned in an Rx, and who received it at the pharmacy?? And, of course, what the drug and dosage were?

Thanks,

Brian Cooper
__________________________________________________________

--- On Sun, 12/27/09, Type-2-Diabetes@yahoogroups.com <Type-2-Diabetes@yahoogroups.com> wrote:

> From: Type-2-Diabetes@yahoogroups.com <Type-2-Diabetes@yahoogroups.com>
> Subject: [Type-2-Diabetes] Digest Number 3841
>

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5b.

Re: Metformin Overdose

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 3:04 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, brian cooper <brianevans_99@...> wrote: I realize that the doc herself may have had a technician phone in the drug order--or that it may have been received at Walmart by a tech--either of whom COULD have made the blunder>>

Definitely. A blunder is possible anywhere along the way, right from the get-go. I srsly doubt the doc would write an order for a dose that's twice the max normally given. But his handwriting is undoubtedly illegible, and all the front desk person (a business associate, not a "tech" of any kind, and usually no one with medical training per se) could very well have thought the order for 2000mg total, taken in two doses (1000 each) could have mean two doses of 2000 each-- as someone who is non-medical, she wouldn't have questioned it. The pharmacy assistant who took the call at WalMart might not have know the diff either. BUT the pharmacist himself definitely should have known the diff.

So from a malpractice standpoint, really, the only two culpable ones would be the doc and/or the pharmacist. And as I say, I srsly doubt the doc wrote the orders wrong (altho anything is possible, I know), so it might have been a miscommunication between poorly trained or untrained people, but the end point, the pharmacist-- he would know the difference, absolutely.

<snip> Initial hiring decisions are too often lax; and techs may be paid too little to get "decent" employees; not to mention that the employee pool in some areas is pretty dismal>>

There are plenty of good people available, but none of them want to work for $7.50 or $10 an hour, with no sick leave, health insurance, or vacation pay (this is de rigeur in dental offices, I assume it is in medical offices, too-- the front desk staff is abysmally underpaid, with practically non-existent bennies. Anyone who thinks the high fees paid for appointments goes into the non-medical staff's pockets can have another think.

> Is this a matter of state law, or does anyone know if records must be kept of who actually phoned in an Rx, and who received it at the pharmacy?? And, of course, what the drug and dosage were?>>

Strictly speaking, the notes in the doc office patient's chart should be initialed or actually signed by the caller.

I have no idea if the pharmacy tech has to say who received the call on their computer, but I wouldn't be a bit surprised if they did.

Judy D.

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6a.

how do you all manage to remember to check your BG?

Posted by: "Wee K Chew" wee@weekhiong.plus.com   wee_khiong

Sun Dec 27, 2009 10:28 am (PST)



Folks,

I was chatting to Holly previously on here but not able to continue due to
some weird code I am sending out via my email client, Pegasus.

I do not understand what the code means and the list owner emailed to give
the "heads-up" on the matter.

I am now using Outlook & I hope "no more problems".

I have a new problem.

I started metering BG on the 8th October 2009 and my Post Prandial(2hrs
after meal) is always >(126)7mmol/L.

Recently, I have been reducing & eating the correct amount of carb and
result was a series of "unpleasant" hypos L

The carb portion size was recommended by the Lead Dietician in the Diabetes
Day Unit.

This sorted the highs on the PP and I was able to manage & keep BG levels
between 4 - 7mmol/L(72 - 126mg/dl).

However, I am now seeing a lot of hypos purely because the BG is coming down
sooner than what I was used to.

I will ask my Doctor if my Metformin should be adjusted down on my next
visit.

It is not easy to adjust to this new lifestyle of metering sooner than
before.

The only thing I carry with me at all times is my Nokia Model: 6300 mobile
phone.

There is no automatic feature on the phone to set up the alarm to come on a
series of preset times.

How do you guys manage? J

Wee in Middlesex, UK J

Dx: August 2008

T2, aged 52,

Weight, 70Kg

Height, 1.72m

BMI: 23.7

1000mg Metformin(twice daily),

80mg Gliclazide(once daily).

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6b.

Re: how do you all manage to remember to check your BG?

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 3:18 pm (PST)



-- In Type-2-Diabetes@yahoogroups.com, "Wee K Chew" <wee@...> wrote:
some weird code I am sending out via my email client, Pegasus.I do not understand what the code means and the list owner emailed to give
> the "heads-up" on the matter. I am now using Outlook & I hope "no more problems".>

Use the group's home page to read the messages and reply to any you want to, and you'll completely bypass your home email program-- everything will just go through yahoo, and usually it works very well.
http://health.groups.yahoo.com/group/Type-2-Diabetes/

> I started metering BG on the 8th October 2009 and my Post Prandial(2hrs after meal) is always >(126)7mmol/L.Recently, I have been reducing & eating the correct amount of carb and result was a series of "unpleasant" hypos <snip> I am now seeing a lot of hypos purely because the BG is coming down sooner than what I was used to.I will ask my Doctor if my Metformin should be adjusted down on my next visit.>>

You said your glucose is running between 4.0 and 7.0 at all times (a range of 72-126). This is not hypo. A true low is 70 or under, and some people feel fine at 65ish or so. 70 and rapidly falling will feel *awful*, but as I said, a range of 70-125 sounds like good control to me, not going hypo.

If your glucose is deemed to be going too low, the culprit is probably the Gliclazide you're taking, not the metformin. Pick up the phone and ask the doc about this. You don't have to wait to actually see him.

> How do you guys manage? >>

The PP test doesn't have to be right on the nose at two hours. It could be 1.5 hours or 2.5 hours, anything in that time frame. It's not an exact science, after all. What you're trying to do is just get some idea what in heck's going on with you after you eat certain things.

Judy D.

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Messages in this topic (4)
6c.

how do you all manage to remember to check your BG? - Judy

Posted by: "ClaraNet" wee@weekhiong.plus.com   wee_khiong

Sun Dec 27, 2009 7:49 pm (PST)



Jude :)

"Use the group's home page to read the messages and reply to any you want
to, and you'll completely bypass your home email program-- everything will
just go through yahoo, and usually it works very well."

It will take too long to collect & reply to emails from every group's site,
I belong to :(

"You said your glucose is running between 4.0 and 7.0 at all times (a range
of 72-126). This is not hypo. A true low is 70 or under, and some people
feel fine at 65ish or so. 70 and rapidly falling will feel *awful*, but as I
said, a range of 70-125 sounds like good control to me, not going hypo."

I recently experience <4 mmol/L (it happened twice today, one was 2.6 &
other was 2.9 mmol/L).
These can be avoided if I was better at remembering to meter BG.
As we speak, my BG is 4.9mmol/L and I don't feel good :(
My last meal was 8pm, it is now 20 minutes gone midnight here in UK.
What if I have a hypo during sleep, is it possible to have a hypo during
sleep? :)

"If your glucose is deemed to be going too low, the culprit is probably the
Gliclazide you're taking, not the metformin. Pick up the phone and ask the
doc about this. You don't have to wait to actually see him."

Good point and I have a gut feeling, I don't need it but will seek Doctor's
approval.
It is a Public holiday here tomorrow(Monday) because Christmas falls on a
Friday this time.
The earliest I can ask the Doctor is on Tuesday which is the day I am seeing
him anyway.

"The PP test doesn't have to be right on the nose at two hours. It could be
1.5 hours or 2.5 hours, anything in that time frame. It's not an exact
science, after all. What you're trying to do is just get some idea what in
heck's going on with you after you eat certain things."

Pure ignorance on my part, only started metering BG 2 months ago but very
grateful for this confirmation.
I just have to be "more regimental" at recoding BGs to stop getting too many
hypos.

Wee in Middlesex, UK :)

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6d.

Re: how do you all manage to remember to check your BG? - Judy

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 10:36 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, "ClaraNet" <wee@...> wrote:
I recently experience <4 mmol/L (it happened twice today, one was 2.6 other was 2.9 mmol/L)>>

*gets calculator out to see what that means* OK, that's 49 and 52. Yes, those are true lows. How are you counteracting them? The fastest thing to use is a liquid carb, like 4 ounces of OJ or milk or real (not the diet stuff) soda (Coke, etc) You can also use glucose tablets,chewed up well with a drink of water. Whatever you use, wait 15 minutes and repeat the glucose test. If you're still below about 80 (4.4), repeat the food or glucose tablets, wait 15 more minutes, and retest. By then you should be up over 100 (5.5), but if not, do it all again. Do your best not to over-treat, eat too much, etc, to counteract a low, because doing that will just send you way up too high and make you feel even more awful.

<<These can be avoided if I was better at remembering to meter BG>>

It's possible you're not eating enough or that you're delaying your meal times too long. Are your meals complete, with some carbs, some protein, some fat? And are you remembering to snack about 3 hours or so after meals? The snack should be a small portion of carbs and a small portion of protein.

> As we speak, my BG is 4.9mmol/L and I don't feel good :(>> My last meal was 8pm, it is now 20 minutes gone midnight here in UK.

That's 88 in American. Too low for going to sleep, IMO, especially for someone who's been going too low all day already. You feel awful because you've been walking around hypoglycemic most of the day, and hypos make you feel like a washed-out dishrag-- no energy, can't think straight, sweaty, weak, shaky, sometimes sleepy.

I take insulin, so my personal go-to-sleep number is 100 (5.5). If I see anything lower than that, I snack before lying down, eating a bit of carbs and a bit of protein.

> What if I have a hypo during sleep, is it possible to have a hypo during sleep? :)>

Yes, of course. Your brain is busy functioning, keeping you breathing and your heart rate steady, digestion continues, sure... although you're resting and not moving around much, there's still a lot of stuff going on inside you during sleep. Metabolism continues.

Can you feel your lows? Do you sweat, for instance? If so, hopefully the symptoms will wake you up. Until you get this hypo problem resolved, I think you should a) always test before bedtime b) always have a small snack right at bedtime c) keep your meter and test strips right at your bedside for nighttime use and d) keep a bottle of spring water and a container of glucose tablets right there, too.

Please let us know how you're doing, Wee.

Judy D. in New Hampshire, USA!

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7a.

Obesity & Exercise (Was Re: Diabetes Causes Obesity)

Posted by: "questsky" questsky@yahoo.com   questsky

Sun Dec 27, 2009 11:56 am (PST)




--- In Type-2-Diabetes@yahoogroups.com, Holly Shaltz <holly@...> wrote:
>
> Karen writes:
>
> <<Has anybody else been able to crawl out of this
> type of hole, get moving again, and lose the
> excess weight? Any feedback will be appreciated.>>
>

Hi, everyone, I've been in weight watchers for 3 weeks and I've lost about 10 pounds. It doesn't sound like much but try lifting a 10 pound weight at home. At the weekly group meetings you get weighed (ulp). I've lost about 3 pounds a week. There is also an online meeting. I'd assume weight loss is essential and it feels great to have some small victory even if you can't make the diabetes go away completely.

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7b.

Obesity & Exercise (Was Re: Diabetes Causes Obesity)

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 3:18 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, "questsky" <questsky@...> wrote:
Hi, everyone, I've been in weight watchers for 3 weeks and I've lost about 10 pounds. It doesn't sound like much but try lifting a 10 pound weight at home. At the weekly group meetings you get weighed (ulp). I've lost about 3 pounds a week. There is also an online meeting. I'd assume weight loss is essential and it feels great to have some small victory even if you can't make the diabetes go away completely.>

WW is a proven program that works for a lot of people. Some chafe at the freedom it gives them-- these days, most any food is allowable on the points program, and some can't handle that. Others LIKE that freedom and thrive inside the framework of the points system.

Congrats on the 10 lbs. I think 3 lbs a week is terrific, and it's the healthy way to lose weight. Good work!

Judy D.

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7c.

Obesity & Exercise (Was Re: Diabetes Causes Obesity)

Posted by: "karenscribes" karenscribes@yahoo.com   karenscribes

Sun Dec 27, 2009 7:48 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, Holly Shaltz <holly@...> wrote:
> Yes, by eating to my meter as I've posted ad
> nauseum :) Like you, I hurt all over, all the

Holly: I'm glad to hear that. I'll look for your other posts.

> In the beginning I could hardly walk because in
> addition to the weight and pain I had an infection
> on the skin of my legs, covering a large portion
> of each. And I could hardly breathe, like you.
> So I started small - VERY small, a walk of maybe
> 300 feet! By the end of 3 months I was doing 3/4
> of a mile in 15 minutes, with hills involved, so
> it improved remarkably quickly overall.

This is very encouraging. I started walking again a few months ago, and, at that time, I could barely get to the mailbox and back. I can get about 1/10 of a mile before I give out, so I guess I'm making *some* progress. It just feels like a snail's crawl. It's encouraging to hear you were able to improve your distance that quickly.

> Can you get a referral to some sort of exercise
> specialist who can get you started with safe
> things you can do?

I don't know if I can or not. I'll have to talk with the doctor about this at my next check-up appt.

> Good luck!

Thanks! I appreciate it.

Karen C.

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8a.

Re: Newly diagnosed and looking for books

Posted by: "Cindi Marshall" cjmobxnc@embarqmail.com   cindimarshall196327909

Sun Dec 27, 2009 12:41 pm (PST)



Judy, have you actually had T2D for 33 years? Can I ask you how old you
were when you developed it?

Cindi

From: Type-2-Diabetes@yahoogroups.com
[mailto:Type-2-Diabetes@yahoogroups.com] On Behalf Of Jude
Sent: Friday, December 25, 2009 6:55 PM
To: Type-2-Diabetes@yahoogroups.com
Subject: [Type-2-Diabetes] Re: Newly diagnosed and looking for books

--- In Type-2-Diabetes@yahoogroups.com
<mailto:Type-2-Diabetes%40yahoogroups.com> , Holly Shaltz <holly@...> wrote:
The best first read on T2 diabetes IMO is Gretchen
> Becker's _Type 2 Diabetes: The First Year_.>>

I need one entitled, "Type 2 Diabetes, The Thirty-Third Year".

No, really, I'm not kidding! <G> I really do!

Judy D.

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8b.

Re: Newly diagnosed and looking for books

Posted by: "Jude" peridotjude@yahoo.com   peridotjude

Sun Dec 27, 2009 3:23 pm (PST)



--- In Type-2-Diabetes@yahoogroups.com, "Cindi Marshall" <cjmobxnc@...> wrote: Judy, have you actually had T2D for 33 years? Can I ask you how old you were when you developed it? Cindi>

Dx'ed one month shy of my 27th birthday, in 1976. No home glucose monitors, metformin, disposable insulin syringes, A1c tests, CDEs or local endocrinologists in those days. My family doc put me in the hospital for a week (I felt fine, admitted with a 380 fasting level, but in no danger of coma) so he could have them teach me how to take NPH insulin, how to do the urine tests, and for the lab to schlep to my room twice a day to do blood draws. Longest week of my life, and absolutely back in the dark ages.
Judy D.

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