Wil Dubois

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by our snarky diabetes expert Wil Dubois, a veteran type 1 and diabetes author.

This week, Wil helps out a struggling woman who wants to know if maybe a change in insulin delivery might be warranted. She isn't happy with her healthcare provider and is in search of advice... so Wil does what he can.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

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Jessica, type 1 from California, writes: Hi, I’ve been a type 1 diabetic for 38 years. I am 60 years old. I’ve been on an insulin pump for 26 years. My problem is that if I do not change my pump site everyday I end up getting sick. Since 2013, I have been going down hill with my health. My sites are getting fewer due to changing every day. I have stomach bloating, ischemia developing in my brain, sinusitis, urinary issues that have me going to bathroom 2-3 times a night, and Epstein Barr so I get tired easily.

Okay, my question: I feel like my body is not getting enough insulin with my pump and I wonder if I need to change to shots for better control and coverage?? I wish I could find a specialist endocrinologist to help me in the area where I live. Right now my endocrinologist sees me in just 5 minutes, looks at numbers, and says I am fine. My last A1C was 7.6. But I feel the worst I’ve ever felt. I have good insurance and just traveled 2-1/2 hours to see a diabetes educator whom I found. It did help and I have some hope, but I need a doctor to help me make some changes and run tests on me and really take their time with me to figure things out. I am scheduled to see a stomach doctor, and a neurological doctor next week. I am getting tired of not feeling well and struggling with my body and health. Any suggestions?


Wil@Ask D’Mine answers: I’m sorry to hear you’re facing so many congruent health challenges. If you ask me, type 1 diabetes is plenty to deal with on its own, and we should be immune from all else, including the common cold and mosquito bites. But, of course, that’s not the way the universe works, and it seems that both flavors of diabetes are magnets for other health issues instead.

I’m in no way qualified to offer any advice whatsoever on the cerebral ischemia, the Epstein Barr, the sinusitis, the polyuria (which doesn’t seem likely to be from high blood sugar, given your A1C), or the stomach stuff; so I’m relieved to learn that you have good insurance, that you have lined up specialist visits, and that you are motivated to follow through on all of those issues. Hopefully the specialists can make headway on those problems and get you to feeling better. But as to the diabetes, you’ve come to the right place!

First, let’s tackle that pump and the insulin issue.

Based on your A1C, which is in the sweet spot for your age, it seems to me like the pump is delivering close to the right amount of insulin—unless of course you’re having absolutely crazy highs and crazy lows that only average to a good number. Still, needing to change sites every day suggests there’s more going on here than just blood sugar control. It sounds like your tissues are having absorption problems with the pump sites after a day or so. If that’s the case, the pump probably does a better job earlier in the site’s “life” than it does toward the end of its life.

Have you noticed worse coverage, or the need for a more aggressive IC ratio in the hours leading up to the site change? If so, switching to pens or syringes might make your life easier in that regard, with more predictable results, but remember that shots are more work than you are used to.

You’ll need at least one basal shot a day, possibly two. Then you’ll need to take a shot with every meal and snack. After 26 years of button-pushing, I suspect you’ll find the workload of shots a shock. You’ll also have to work the math on the insulin-to-carb ratios yourself, which you are used to having your pump do for you, although there are some helpful apps for that.

Of course, on the flip side, changing sites daily is a hassle, too.

But here’s the thing that I think most people tend to forget: This isn’t like joining the Marine Corps. There’s no commitment. Instead of thinking about this issue as “switching” or “changing,” you should view it more as a vacation. Take a break from the pump. Try out the shots and see how they work for you. Get with that new educator you found and see if she can line you up with a few weeks of samples so that you don’t have to make a mess of your pump supply orders while you try shots out. The educator should also be able to help you convert your pump’s basal rate back into an injected dose, which is likely to be about 20% more. She can also see how many insulin-to-carb ratios you have on the pump (in case you’ve forgotten), what there numbers are, and what kind of correction factor you’ll need to use. She can give you a refresher on how all of that works, along with good injection technique, and the rest of it.

Now, despite what I just said about commitment, you do need to give this a fair shake, because the odds are you won’t like it at first, even if it proves to be the best for you in the long run. This is a big change, and you’ve been “doing” diabetes one way for more than two and a half decades! I think three weeks would be enough to acclimate and see if shots are (A) right for you, and (B) better for you.

Now, you also told me that you need a doctor to “help me make some changes and run tests on me and really take their time with me to figure things out.”

I can only agree with part of that. Yes, you do need to find a doc who will take the time you feel you need, although that’s getting harder and harder with the economic pressures doctors find themselves under, so you may have to compromise some. The first thing you can do is when the doc says, “Come back and see me in three months,” is reply: “No. I’m not happy with where I’m at. I’d like you to see me next month.” In other words, you need to stand up and advocate for yourself.

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Source: www.unstuck.com
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Here’s another tip for the short office visit ecosystem we find ourselves swimming in: Come armed with one question or issue that you want to deal with in the visit, and one only, and insist it be taken care of. Time is limited. If you come with a long grocery list of issues, none will be addressed well. Limit yourself to one concern per visit and you’ll get better quality care. Book as many visits as are necessary to get all your concerns covered.

OK, on to your comment about finding a doc who will run tests on you. Any specialist should be willing to either run whatever tests you want or need, or give you a clear explanation as to why, in his or her expertise, there would be nothing to be learned by running the test. So I’m not sure you need to find a new doc for this, you may just need to work on your communication skills with the doc you have now.

Lastly, help you make changes? Hmmm…. That’s not really the doc’s job. That’s your job. Well, your job with the assistance of your educator. It’s your diabetes, and only you can remain firmly in control of it. The buck starts and stops with you. All these other people are only there to help guide you, but changes need to come from within.

I hope that helps. I was saddened when I read that you feel you’ve been going downhill, and that you are tired of struggling with your body and health. But given all that’s on your plate, I can see how you feel that way. Still, I can see that you’ve taken major steps to change the direction of your health. You’ve got a new educator, you’ve got visits with specialists lined up, you’re thinking about whether you need to change endos, and you are asking questions.

To me that sounds like a recipe for going back uphill.

 

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.
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.