Do yourself a huge favor and get yourself of a copy of Dr. Richard K. Bernstein’s Diabetes Solution.
Many diabetics use insulin pumps. If that was the case they’d have no reason to buy syringes with the insulin.
Also how would the pharmacist know you need syringes unless you tell him or her? Maybe you already have a couple of hundred count boxes at home.
Someone using an insulin pump should have back-up supplies - including syringes - in the event of pump failure.
I don’t think the OP’s issue is with the pharmacist. It is the provider who should have recognized the need for - and prescribed - the syringes.
mmm
Yeah, we docs know that. But some patients with type II need to go right to insulin, given how out of control they are. Maybe they can get off it later, and on to a sulfonylurea. Maybe not. But what they need to do is get under better control in relatively short order.
I’m not a doc who demands tight control for many/most of my patients, at least not to start. Too much risk of hypoglycemia, which can be a lot worse than hyperglycemia. But I see patients all the time with A1C levels at 13 or higher; my record is 20. That means some folks are averaging glucose levels of 400 or more in the previous 3 months. That will NOT respond quick to oral meds only.
I am a counter example to this. I was prescribed glyclazide, a sulfonylurea, alongside metformin and several times my blood sugar dropped suddenly. On one occasion I happened to be in hospital visiting my dad when it happened and I went dangerously low in the space of a few minutes. I was sat talking to my brother at dad’s bedside when I began to find it hard to follow what he was saying. I thought I need some air but had to sit down on the way off the ward. At this point I realised what the problem was and sent bro to find chocolate. Luckily he ran into the doctor who was treating dad whilst hunting for a snack machine. The doctor had me plied with hot chocolate and biscuits and my blood sugar taken. It was around 3. Yes, I started carrying sugary things after that and had my prescription changed to insulin instead. I’ve still had a couple of low blood sugar episodes but it hasn’t happened so ridiculously fast.
20?! You have my record beat by at least 6. Impressive. Well, maybe not the best word choice but it certainly made an impression. As Qadgop said, when A1cs are high enough, oral pills alone won’t cut it, at least not at first. I would assume that the OP’s PCP made the appropriate initial treatments. DM management still has a lot of art to it. It is definitely not a one size fits all, and more education is always a good thing.
Syringes have gotten crappier over the long time I’ve been using them. I agree they need more than the little wings.
Well a lot of QTM’s patients lead extremely sedative lives and never get any exercise. Also their options for meals is limited and very routine, so they probably eat a lot of junk food.
Or don’t. This book caused me no end of frustration and fright when I was initially diagnosed. Though some folks may choose to follow Bernstein’s next-to-no-carb diet, it’s only one of many ways to control blood sugar and certainly not the easiest/only way.
(For those not familiar, Dr. Bernstein advocates extremely tight blood sugar control in part by adhering to a very low carb diet - 30 grams or less per day for an adult divided between breakfast, lunch, and dinner. For clarity, an average slice of bread is around 25 grams of carbs. I have no doubt his diet works, but for me, it represented a life style change that I absolutely did not want, and turned out to be unneeded for decent blood sugar control, and caused me no end of angst to keep hearing people tell me to use it.)
It’s not well known but you don’t need a prescription for insulin in the US except for Indiana. Wal Mart and other places will sell the older style insulins to anyone at a pretty low cost. The newer insulin types such as Humalog are way more expensive and if you want insurance to pay then you need a Rx.
It’s not the easiest but it certainly is the most effective way:
https://pediatrics.aappublications.org/content/141/6/e20173349
An HbA1c of 5.67% corresponds to an average blood sugar of 116 mg/dl.
These are the guys coming into prison, been on the run (but not running real hard, apparently), avoiding medical care and insulin and other meds. I generally can get their A1Cs into single digits. Mostly. Some refuse to do a damn thing to take care of their diseases though.
It’s significantly more than that. An A1c of 20 = a 90-day blood sugar averaging 527 by my calculation.* That dude not only needs insulin, he needs it IV.
I actually saw a 16.9 today, which may be my record.
mmm
*(28.7 - A1c) - 46.7 = average blood glucose
I disagree with “most effective.” I (and many other T1Ds) maintain similar or lower numbers using non-Bernstein methods. (I’d actually be worried if I had an A1c as high as 5.67%, mine is typically between 5 - 5.3)
I don’t want to hijack this thread, but you’re sort of doing what caused me so much angst way back when. Bernstein is ONE method, and great if someone wants to use it! But for me (and many others) to adopt such an austere diet would be so miserable in so many ways & represents a life change MUCH larger than the life change that any T1 has to take on in order to manage the disease. Touting it as the “best” or “necessary” method is a scare tactic IMO.
I distrust the lab accuracy, frankly. I’ve seen an A1C on a patient one day be 9.8 and a week later when accidentally repeated it’s 10.7
:mad:
Yep. We do point-of-care A1c testing and often send a sample to the lab to verify/correlate. They are typically off by a percent or so.
If things really look funky we do a fructosamine.
mmm
Dr. Bernstein has said his A1c is consistently 4.5%, even though he’s been a Type 1 diabetic since 1946 so he likely doesn’t have any pancreatic beta cells remaining. Point being that anecdotes such as these don’t prove anything.
I’m not aware of other methods of diabetes management that have been scientifically proven to be as effective as Dr. Bernstein’s, but the logic of his “law of small numbers” is absolutely incontrovertible. Small amounts of carbohydrates require smaller insulin boluses and result in smaller errors; large amounts of carbohydrates require large insulin boluses and result in larger errors.