Ask your doctor if…

Last week I wrote about how I don’t really consider my doctor as being part of my “team”. He’s not living in the diabetes trenches with me, day in and day out. However, he is a trusted adviser (advisor? which spelling is correct) and I value his input.

When I go to see him at the end of the month, I’ll have a list of questions that I plan to ask. I’ve never come prepared with a list before, but I think the time is appropriate. This is my life, and I need to understand what’s going on and make the best decisions for me.

Insulin-in-the-distance

Will Novolog be voted off the island?

1. A -log by any other name

I’d love to smooth out my postprandial BG spikes a bit, and I wonder if Humalog might be better for that than Novolog. I always thought that Huma- peaked slightly sooner than Novo-, and a previous endo of mine (with an surplus of caution and a deficit of data) switched me from Huma- to Novo- years ago because of a few isolated lows he saw right after meals. Keep in mind this was when I was using insulin pens — now that I pump and make extended use of the extended bolus options, this should no longer be an issue.

Though, as I scoured the interwebz trying to find a comparison of the two for the purpose of this post, I read on DiabetesNet that Novolog peaks 23 minutes sooner than Humalog, on average. I also read Kerri’s post on Six Until Me, including the comments, which seems to support the opposite (but also that Humalog stays in the system longer) and now I’m totally confused. People have also experienced more air bubbles with Novo-. I’ll admit that I’ve found lots more bubbles in my reservoir lately, which I’m tempted to attribute to the change in seasons/air-pressure. Of course, neither of these sites are medical advice and blah, blah, blah. That’s why I’ll ask my doctor if Humalog is right for me. Not that there is a definitively right answer.

I guess the best thing to do is to try it, right? Maybe he’ll give me a sample to try, because my fridge is fully-loaded with Novolog right now (my insurance plan changes in July, and the cost of insulin goes up, so I’ve decided to stock up now).

Besides, I like Lilly. They have blogger summits. They gave me a 25-Year-PWD medal. They sent Coco around the world (apparently, without any airport-security harassment). But then, Novo Nordisk’s US operations are based out of New Jersey, and I’d love to support my wonderful home state. What’s a guy to do?

2. Is it Neuropathy?

A few weeks ago, I felt a little twinge in my left thigh – kind of like a sunburn but a little below the surface. Several years ago, I used to feel this a lot in my thighs, and it was highly irritating. At the time, I had been injecting insulin in those spots all the time. The tissue below the skin was becoming lumpy and the body-hair on my legs was developing bald-spots. So I figured this was due to the repeated jabs of an insulin syringe and thought nothing of it. After ditching the syringes and pens and moving to a pump (never on my thighs), the problem vanished and I completely forgot about it for years.

Now that I’m a bit more educated, I think this might be a sign of neuropathy. I hope not, and it scares me to even bring it up, but I keep reminding myself that if I just ignore it, it won’t necessarily go away. These twinges now are rare, maybe a few seconds every few months, but if it is something that needs attention, the concern should be raised, right? Then again, if the “attention” means keeping the best control of blood sugars that I can, well, I’m already trying to do that, so nothing really changes.

3. Those damn Motor Errors

MotorError_Jan2013

Old photo – Recycled.

I know my doctor is a fan of Medtronic, as am I. But I just got off the phone with them, and they’re going to overnight me my SIXTH Paradigm Revel 523. The first was replaced because of a crack in the case, and the next five have Motor-Errored out. I won’t go into details — you’re probably as sick of hearing the stories as I am of living them.

What I want to know is — what does he see from his other patients? Is this common? Does it happen more with the newer-model Revel pumps? My old reliable 515 lasted for years, well past end-of-warranty. Is it a suspected manufacturing glitch? Does the phone rep’s claim that it could be due to an occlusion or a bad reservoir seem plausible (my reservoirs are old, but still non-expired, and after the first Motor Error, the second always follows soon after).

And more and more, I wonder — from the data guru who talk me the value of data guruism — is Carelink still worthy of  a Sinéad O’Connor serenade, or can one of the other data collection/aggregation tools compare? Is it time to start shopping around?

4. Guinea-pig syndrome?

At one time I felt I’d be “all in” if offered to become part of a clinical trial. Now, I stare at the paperwork and questionnaires and begin to wonder. Among other things, if I were to enroll in one, my doctor would need to be on-board with it. Would it be worth having the discussion with him now, in a completely hypothetical manner? Would my regular endocrinologist be actively involved, or would he relinquish all responsibility to the people conducting the trial? I’ve only been seeing him for about two years and that’s about all the historical data he has — is it enough for him to comfortably declare eligibility (or non-eligibility)?

5. Thyroid levels

At the last appointment, he looked at all my lab results, but we only discussed A1C (he doesn’t place a huge value on A1C if it means only a few tenths of a percent either way). But I feel I’ve been a bit more tired than usual lately. Could it be that my Synthroid level needs to be increased (again), or is it because my both my son and my CGM have an agenda of preventing me from getting a good night’s sleep?

6. Search for Enlite-nment

I know he’s not supposed to know anything, and even if he did, he couldn’t tell me. But…

Think I can fit all this in, given — oh — fifteen or twenty minutes?

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Posted on May 8, 2013, in Diabetes, Personal. Bookmark the permalink. 8 Comments.

  1. Great list of questions! Way to be proactive and come prepared. =)

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  2. I think it’s good to go with questions written down. I always feel frazzled if I don’t! My endo and her PA say they appreciate it – they love patients who are informed and really care about their health.

    Fingers crossed about the neuropathy. Keep your blog fans posted!

    I’ve been tired too lately. I’ve decided it’s allergies. And I took a 4 month break from the gym (injury and laziness on my part) but now that I’m back in the routine, I do feel a bit more energetic. Damn that exercise being good for us and stuff.

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  3. Phoebe's Dad

    Thank you for sharing. You address several issues that we (and I guess many others) have experienced.
    The Medtronic pump thing – we had similar. After 3 years trouble free pumping there was a problem with the battery/alarm and we got a ‘replacement’. Then that malfunctioned – so we got another. And so on. It was only when our insurance co said we were eligible for another ‘new’ pump that this cycle ended, because we got an actually NEW pump. It seems that replacement pumps are ‘refurbished’ (so ones that have been fixed??). Maybe economics dictates this, but would be good to know up front.

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    • I’ve wondered about the whole refurbished-versus-new thing, but I’ve been told that when pumps get returned, they are (during or after testing) cracked open and harvested for parts, But after hearing this, I’ll be sure to request a NEW one next time. Thank you.

      Meanwhile, I just opened up my new refurbished replacement….

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  4. I love questions! They are never a bad thing and your doctor should be more than willing to discuss any of your concerns. It is depressing when you are trying to do research and nothing seems to agree…medical things like that are funny. Usually I try to go to the source (what the manufacturer says), not people’s experiences — but everyone is affected differently even if it’s not what is “normal”. Good luck with the appointment and taking an even more active role in your care!

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  5. These are all great questions… I’ve been running in Humalog since 1999, so now you have got me wondering about peak times, too. And Lilly has a 25 year program? Totally getting on that… I’ve only ever used Lilly insulin!
    I’m on the Revel and got a motor error once recently. I assumed it was because my cartridge was almost done. Had no idea others were having this issue!

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