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Tue Sep 8, 2015, 05:54 PM

My brother was diagnosed last week with type 2 Diabetes...........

the doctor gave him two medications (I'm waiting to be told what they are) and the doc said they would control his diabetes and also to watch his carbs.

He was not given a glucose meter, told what was too high or too low, no information on diet, etc. Brother came over today I took his blood and the glucometer read 290, way too high. My brother didn't understand it was high, because the doctor never gave him any instructions.

I'm pissed at the doctor. This is all new for my brother, he's flying blind with no support from the doctor. My brother does have me (also Type 2) to come to, but I can't hold his hand.

A doc just can't hand out meds and say that will take care of it, there's more to handling diabetes than watch your carbs and take 2 kinds of pills a day.

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Arrow 10 replies Author Time Post
Reply My brother was diagnosed last week with type 2 Diabetes........... (Original post)
mrmpa Sep 2015 OP
Warpy Sep 2015 #1
mrmpa Sep 2015 #2
Warpy Sep 2015 #3
Name removed Nov 2015 #5
nadinbrzezinski Dec 2015 #7
HeiressofBickworth Sep 2015 #4
nadinbrzezinski Dec 2015 #6
Useless in FL Apr 2017 #8
mrmpa Apr 2017 #9
oppressedproletarian Sep 2017 #10

Response to mrmpa (Original post)

Tue Sep 8, 2015, 07:40 PM

1. Tell him to go to Wal Mart (they're usually cheaper) and buy himself a glucose monitor

The pharmacist can help him choose one, along with a bottle of test strips and a finger poker, if that doesn't come with the meter.

He needs to check his sugar every morning when he wakes up, before he's had anything to eat or drink. He needs to check his level if he starts to feel dizzy, hungry, sweaty, or anything he generally doesn't feel, especially if he's on a blood sugar lowering drug.

I usually don't recommend Dr. Google, but his doctor needed to do some teaching. Even when they turf it off to a nurse in the office, there is some diabetic teaching that needs to be done, especially when meds are prescribed. The ADA has a great page to get him started in learning about his new diagnosis: http://www.diabetes.org/diabetes-basics/type-2/

It would be helpful to know what drugs he's on, if he's on one that directly lowers glucose. If he is, the doctor's negligence borders on the criminal level.

290 is higher than anyone wants it to be, but it's not a panic value. It's something that needs to be brought down ASAP because the longer it stays that high, the higher the risk of complications.

Tell him the referral he needs to chase is to an endocrinologist. Those are the doctors who take care of diabetics. Even if he is able to control it with diet, he does need to be followed long term.

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Response to Warpy (Reply #1)

Tue Sep 8, 2015, 07:58 PM

2. Brother called...........

The diabetic medication he was prescribed is Invokamet http://www.drugs.com/invokamet.html Also learned that a side effect of Invokamet is low blood pressure.

The 3 other medications he was prescribed are not to control his diabetes and are for a condition he has never been diagnosed with they are:

Norvasc for high blood pressure
Hydrodiuril for high blood pressure
Avapro for high blood pressure

In regard to the Invokamet, he gets $4600 a year from the corporation to pay for it for up to 4 years. There's no means testing for this amount. If there was he wouldn't get it, his income is in the high 5 figures, with just his wife and daughter as dependents.

I told him that some doctors will describe a high blood pressure medication as a prophylactic if you're a diabetic. But it's usually lisinipril or its likes and it's one pill a day.

I told him to call his doc first thing in the morning, demand to know why he was prescribed 3 non-generic high blood pressire medications, when he's never been diagnosed with it, 2 a prescription (order) for a monitor, test strips, access to a diabetes educator and he wants to be changed to generic drug(s) for his diabetes and see how that controls it. I said if the doctor says this program works for his other patients, my brother should tell him he's opted out of this doctor's care.

My question, which brother won't ask, is how much are these pharmaceutical companies paying this doctor to prescribe these medications.

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Response to mrmpa (Reply #2)

Tue Sep 8, 2015, 08:43 PM

3. Interesting

Norvasc and hydrodiuril are old drugs, available as generics, and cheaper than dirt. Norvasc is a caclium channel blocker that regulates heart rate and lowers blood pressure. Hydrodiuril is a diuretic, removing excess fluid. Avapro is an angiotensin II antagonist and is used to help repair kidney problems in diabetics, which makes me think his renal function tests were a little off.

The Invokamet is a fairly new medication that combines metformin and canagliflozin, a drug that stabilizes glucose and lowers A1c. It can also cause episodes of low blood pressure, so he needs to ask his doctor about that one, especially if he feels woozy or starts to black out.

Invokamet has a black box warning because the metformin can cause a lactic acid buildup in some people, so if he has muscle aches and weakness, severe sleepiness, and difficulty breathing, it's ER time. It's an extremely rare problem. I've never seen it in practice.

There is also a lawsuit stating the drug contributes to ketoacidosis, but as yet that one is unproven.

It sounds like a good drug for someone with fairly new diabetes 2, with low risk for things like hypoglycemia. The combination sounds more like it's compensating for kidney problems rather than treating hypertension. It's also good that he's getting help to pay for it, since it's a new drug.

It would still be a good idea for him to get a meter. Anyone with new onset diabetes, no matter how mild, needs to know what his blood sugar is doing.

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Response to Warpy (Reply #3)


Response to Warpy (Reply #3)

Tue Dec 1, 2015, 12:18 AM

7. These days I have two meters

 

one I take with me over the course of the day... and the other at home for daily testing. Yeah, yeah the joy of low blood sugars...oy.

As to metmoriin, it is an extremely side effect. Hell, Metmorfin is usually the first line med for new diabetes diagnosis. It is cheap, it works... I am confused.

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Response to mrmpa (Original post)

Mon Sep 28, 2015, 12:23 AM

4. Type 2 here

If I had to do it all over, I would go to an endocrinologist when first diagnosed. That type of doctor specializes in diabetes and would be the best one to evaluate and prescribe. And, more importantly, monitor kidney function to prevent kidney failure down the line. Knowing all that I know about diabetes now, I wouldn't be satisfied with the doctor's information your brother is reporting. I also would think he would be referred to a dietitian for further advice on nutrition and information on a diabetic diet.

It may not totally be the doctor's lack of informing him. It could be your brother didn't really participate in the appointment. I had a husband like that -- he never asked questions of his doctor and therefore never really knew what was going on with his own body. For example, he came home one time with a bottle of a very powerful cough medicine. I asked him what that was for as I wasn't aware that he was sick. He said he didn't know, his doctor just prescribed it. I really got upset when he came home from an appointment and said he had to have an operation. What For??? He said he wasn't sure but his doctor said he had to have it done. I went to the doctor, got the full diagnosis, had him show me in a medical book just what the problem was and what he was going to do about it (it was a hernia). Husband didn't ask any questions, just showed up when he was supposed to and submitted to whatever the doctor said. Hell, I've asked more about the surgery my CAT is having on Tuesday!!!

Whatever the situation, he should find someone who will give him a more aggressive plan for his condition.

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Response to mrmpa (Original post)

Tue Dec 1, 2015, 12:14 AM

6. Ask, no DEMAND to be referred to a diabetes educator

 

the doctor might not be the person to do the education regardless. Many doctors are really not that good, in particular internists and family doctors.

These are usually Nurses, RDs, or Pharmacists. I would prefer the RD.

As to the testing. again, diabetes educator time.

290 is high, whether it is post prandial, or before a meal, if it is post, not as bad as it sounds, but not that good either.

I suspect the high bp are off label if he has never been diagnosed with it before, to protect micro circulation in the kidneys and eyes, for example but once again... don't take that upon yourself, have a diabetes educator do the work.

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Response to mrmpa (Original post)

Thu Apr 20, 2017, 06:21 PM

8. Type 2 diagnosed in 2015 also....

when I had just turned age 70. I had been active all my life....I was a jogger and I participated for many years in road races and often came in first in my age group. So....it was a surprise to me since there was nothing in my family history to indicate diabetes, though my Dad had high blood pressure, smoked and died at age 70 of a heart attack. My Mother, though, lived to age 92 even though she smoked.

I believe it all started 2 years before when I had a lipoma removed from by armpit....non-cancerous, thank goodness. I had a reaction to the bandaging (I think) that I had to keep on for 2 weeks before it was removed....I broke out into itchy hives, starting at the bandaged area and then spreading to my trunk, arms and legs. That rash took 6 months to get under control and I couldn't run because it made me sweat and that made the rashes worse. So for 2 years I did not exercise, and because of a situation at work, I was under a great deal of stress. I gained 40 pounds over my normal 105 weight, was drinking wine way too much and I was just miserable. Late in 2014 I got the flu and the symptoms, including on-going ear infections, went on for months. I still have a hearing loss from that episode.

Early in 2015, my health care coverage changed and they insisted on having a nurse make a home visit to evaluate my current health. She arrived on the appointment day just one day after a severe symptom flare-up when I had been taking ibuprofen and cold meds for 10+ days. Everything went fine until she took my blood pressure which was a shocking 220/110. She was so shocked that she waited for about 15 minutes and took it again....only this time it was worse. So, I made an emergency visit to my physician...actually she's a nurse practitioner.

At the Doctor's office, my high blood pressure was confirmed, so she ordered blood work and she discovered that my blood sugar was high too...the A1C showed that my sugar had been as high as 120-130. That day, my blood sugar was 110. She started my on a regimen of Amlodipine (10 mg) for high BP
and Metformin that two years later I'm still taking.

After that, I started on an aggressive exercise program (without any advice from health professionals) and I lost 40 plus pounds in 7 months so I now weigh about 101 lbs and I've maintained it since then. I measure my blood pressure every day and it's ranges from 104/65 to 118/71. My blood sugar is usually in the 80 to 90's range but will spike to 101 when I'm under a great deal of stress.

I really don't know why I have to continue with the medications and I worry that I'm taking them without thorough consideration ...

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Response to Useless in FL (Reply #8)

Thu Apr 20, 2017, 06:51 PM

9. I was diagnosed in 1998.......

When you wrote that your A1C showed that your sugar had been 120-130, that's not high that is a good normal reading. Your current readings of 80's-90's range are fantastic. Spiking to 101, well 101 is a fantastic reading. I've spike to over 500 when I've been under stress.

My suggestion (I'm not a professional health care person) is to ask your doctor to allow you to remove the metformin from your regimen for say 2-3 months. During this time you would take your blood sugar, in the morning, after every meal & before bedtime. You would keep a log of these readings & if they're good you then could totally discontinue the metformin.

I negotiate with my doctor on occasion. I had terrible bowel disturbances while taking metformin, I was at 2000 mg a day. My doctor said that many of her patients were much better when taking metformin extended release. She wanted me again at 2000 mg a day. I told her that I would prefer 1000 mg a day. The 1000 mg ER a day has helped with the disturbances and my numbers are all good.

Our next negotiation will be how to remove the Lantus and novalog from my regimen. In 4 years I will be on medicare & I will not be able to afford these.

Let me know what you do. But I think your numbers are so normal.

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Response to mrmpa (Original post)

Tue Sep 19, 2017, 10:35 AM

10. Self-education is a must for anyone with diabetes

or "pre-diabetes". I do not have a diagnosis of diabetes, but that is only because I took proactive steps to prevent it when my blood sugars began to trend too high (checked with my own meter). Higher blood sugars and/or Metabolic Syndrome are common as we grow older, and both will shorten our lives unless controlled.

Two resources I cannot recommend highly enough: the comprehensive website Blood Sugar 101 (there is also a companion book):

http://www.phlaunt.com/diabetes/

and Dr. Richard Bernstein's book:

"Dr. Bernstein's Diabetes Solution".

Master the information presented in these and make it your own, and you will not suffer the catastrophic complications of diabetes.

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