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Jumping right in, say hello to your host, veteran type 1, diabetes author and community educator Wil Dubois:
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Julie from Colorado, type 3, writes: I could kill our endo. He told my 14-year-old boy that he could eat anything he wanted to so long as he bolused for it. Now my son is eating M&Ms and his blood sugar is a wreck! When I try to call him on it he just tells me the endo says it's OK. What should I do?
Wil @Ask D'Mine answers:
What? Oh! Sorry! I drifted off into fantasy there for a moment. I was picturing your endo leaning against a stained and pot-marked wall, smoking his last cigarette, contemplating blindfold or no blindfold, while a squad of infuriated mothers load their rifles.
All right, so first to the medicine side of this equation. Technically speaking, the endo is right: you can eat anything if you bolus correctly for it. Yeah, and technically speaking, you can swim in bloody water with great white sharks without using a shark cage — if you do it correctly. But that doesn't make it a good idea.
Even when using advanced pump features, super-bolus techniques, a Symlin pen, and perfect timing to make a marching band proud—many adults have trouble bolusing for some kinds of foods. Our fastest insulin is not nearly fast enough for many of the foods in our environment. On top of that, type 1 teens are smaller ecosystems, which are harder to control than larger ones. And teens often lack the...ummmm... focus... needed to make complex boli work. And don't even get me get me started on the whole hormone thing.
So does technically correct advice make for good advice? Uh, no. I think most of us would agree that telling a teenage kid that they can do anything they want, "just so long as..." is a really bad idea.
I'm sure you wanted to tear that endo apart, and I applaud your restraint in not doing so. You could try "talking" to the endo, but I think you'd probably be wasting your breath. Endos don't get continuing education credits talking to moms (although it would be a good idea). My experience with docs is that the more specialized they are, the less open to outside advice they are. And changing endos wouldn't remove the hall pass your kid just got. Worse, even if your endo changed his tune, the kid will still stick with the original statement because it validates behavior he wants.
So, at this point, the die is cast. The train has left the station. The ship has sailed. You get the idea...
The core problem here is that a Medical Authority—note capital letters—has given your son permission to do something against your rules/desires. And in the pediatric type 1 universe, Medical Authority can trump parental authority. After all, if mom and dad know it all, there's no reason to go to the doctor, now is there?
I think your only alternative here is to appeal to a higher authority than the endo: King Teststrip.
I propose you make a deal with your son: Fine. The endo is correct. You can eat anything, as long as you bolus. But the endo also gave you glucose targets you have to keep inside of. The latter rule trumps the former.
With apologies to sci-fi author Isaac Asimov, here are my Three Laws for employing this advice from the endo:
- You must first keep your blood sugar in target.
- You must take insulin when you eat.
- You may eat anything you want, so long as you don't break rule number one and rule number two.
Say to your son: if you can stay under your high target, fine, you can eat it. If you can't keep your numbers in target, sorry, you can't eat it. Now, let's test those M&Ms.
I'm guessing the M&Ms will have a hard time passing the test.
Good luck, and be sure to let us know how it all works out for you!
Robert from New York, type 2, writes: I'm 54 years old and my last A1C was in the high 8s. Lately I've been having some trouble in the bedroom. I'm wondering if my diabetes is the cause, and what I should do about it. Should I ask my doctor for the little blue pill? Will it work for me?
Wil @Ask D'Mine answers: I think you should ask your doctor if a prescription for five prostitutes is right for you. But seriously, now that I've offended half the readers with my off-color humor, erectile problems are common for middle-aged guys. They are also common for PWDs with elevated blood sugar. I won't bum out all of you guys with the statistical odds for middle-aged PWDs with high blood sugar, as it's much too nice a day out to go there. Let's just say your odds are long. On second thought, that's a really bad choice of words on my part. Moving on...
There are lots of causes of what we now like to call Erectile Dysfunction, or ED. Some are physiological—body stuff. Some are psychological—emotional stuff. But, yeah, I'd be willing to bet that your diabetes has a part to play in your bedroom problems.
The first thing you should do is get your damn blood sugar down where it belongs. High blood sugar can cause ED, and getting your diabetes in control might be all it takes to get you up and running again (if you know what I mean).
Also, beyond the bedroom, an A1C in the high 8s puts you on the doorstep of kidney damage, which will make your bedroom problems look pretty small by comparison. So a lot of good things will come from getting your blood sugar better controlled.
I think that should be your first step. If you continue to have trouble in the bedroom after your BG is in control, then one of the several prescription meds for ED is very, very likely to work for you. The clinical track record for these meds is excellent.
Not long ago I asked a patient if the Cialis that one of our docs had prescribed for him had done the trick. "Works great," he told me with an ear-to-ear grin.
"Too well!" spat his wife.
It's at times like this that I actually don't know what to say.
And, of course, in keeping with the perverse nature of the heathcare universe, ED meds are usually better covered by insurance than diabetes meds and supplies. But that's a subject for another day...
One last note for the guys only: Don't be selfish bums. If you are having some ED issues, please remember that there are other ways to make your partner happy and satisfied until you are up and running again. Be creative about it. Be open about it. Be a man about it.
Don't forget to ask YOUR questions. Go ahead. You know you want to...
This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.