Re: [IP] Did My MD Insult Me?
Your "real" Pump Endocrinologist says, "you should stay on MDI just like
Well, This is TOTALLY IN CONFLICT with AACE recommended practices. The
established standard is 6.5 or better, you're MDI-based treatment isn't
achieving this. And I bet it's not YOUR fault, MDI just doesn't allow
you to match the timing of your insulin needs well enough. That's why
they invented pumps!
Is your post saying that you're putting Lantus in a pump (you're already
pumping), or that you're still MDI and visited a "real Pump
endocrinologist" to ask about pumping? Pumping Lantus makes no sense to
me: the whole idea behind pumping is to get better control of your
insulin delivery timing, and using a really long, slow-acting insulin in
it would defeat the whole purpose.
If you've got Dawn Effect, you need to be pumping a fast-acting analog,
not getting by with a basal rate created by two shots of slow,
smooth-acting Lantus. (You need a SHARP peak to match up your Dawn
Effect at the time it happens. No shot taken 8-12 hours before can
provide such an activity curve.)
He didn't insult your intelligence... he merely demonstrated that *HE*
is unqualified to treat *YOU*, or IMO, any other Diabetic: he's still
living in the days when 7.5 was acceptable, those days are LONG GONE. If
he's an Endo, he should either READ AND PRACTICE the AACE guidelines,
explain WHY he thinks they're wrong (in front of THEIR COMMITTEE and to
his pts.), or he should just fscking quit and stop killing pts. with his
"that's going to be complicated" laziness.
If you live in Chico and are willing to travel all the way to the Bay
Area, you can find an A+, BOARD CERTIFIED, and CARING Endo by going the
other way: Daniel R. Caruso, Reno NV, 775-348-1811. I think that he's
authorized to prescribe and train on BOTH the MiniMed Paradigm 772RT
(the Pump with CGMS which you're thinking of) and the Dexcom CGMS
(suitable for use in conjunction with other pumps, such as Animas).
Last time we met, he was wearing the Dexcom. Right now, I am too. He
also had a "loaner" Paradigm available for me if I had wanted to try
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