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RE: [IP] Re: basals and boluses/Relationship with one's doctor

Laura wrote, in part:
"And a CDE is a creature I've never once 
met. So you guys are spurring me on to look around for some detailed 
support. Asking for help when you need it, what a concept. Thanks for 
letting me think out loud. Anyone want to share details of what their 
endo/CDE does at the office visit?"

Currently, I see an internist with an interest in diabetes (so she keeps
up) and CDEs at the Crawford Diabetes Center, which is part of Mercy
hospital here in Cedar Rapids.  There might be a similar sub-group at a
hospital or clinic near you.  The CDEs are much more helpful to me in
terms of answering questions about pumping, fine-tuning blood sugars,
and they take lows seriously -- I've never had a doctor before
(including endocrinologists) who saw these as the kind of
life-interfering problems they are and gave much effort to evening out
the lows.  Usually, in my experience, doctors of all kinds tend to focus
on your A1c numbers, and concentrate on lowering highs, but the CDEs
have helped me to work on both ends of the scale.  It is also easier to
get hold of someone knowledgable when questions arise (my doctor has a
very busy practice, and it sometimes takes a couple of sessions of
telephone tag with the receptionist and nurse to get an answer to my

I don't mean that my internist is a bad doctor -- she referred me to the
clinic and has been supportive of my pumping -- but the CDEs have more
time for really analyzing my logs and helping me out with
diabetes-related questions.  They also had access to CGMS when I needed
to figure out general weirdness -- my doctor prescribed it, but the
clinic actually did the test and helped me interpret the results.  The
CDEs do focus on your diabetes, so they aren't the people to see for
actual illness (chicken pox, for example) but they are the place to go
to learn carb counting, finetune your basals and bolus ratios, etc.

Hope that gives you some idea.
Kathy Trondsen
Pumping 3.5 years with MM 508
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