Because I don't have enough problems as it is...
September 26, 2011 4:46 PM   Subscribe

I am going in for a doctor's appointment tomorrow, where it's likely I'll be told I have diabetes (or pre-diabetes, or diabetes caused by medications, or something like that.) What questions should I be asking?

I had a blood test done last week that showed an A1C of 7.3% and a fasting blood glucose of 163. There is a history of type 1 diabetes in my family, and according to 23andMe I'm at elevated risk for type 2 to begin with. I'm also taking Geodon for bipolar disorder, which drug has a warning about causing type 2 diabetes. My glucose levels five months ago were fine, such that my doctor actually volunteered that I don't have diabetes. So I'm a wee bit bitter.

I don't have most of the symptoms of diabetes, except for extreme exhaustion and fatigue and sleepiness and I've seriously been up for 13 out of 19 hours today and am ready for bed. My psychiatrist is the one who ordered the blood test.

I mostly just want to know what to be asking and looking for out of this appointment. I've warned the doctor about the blood test so I'm sure she'll be prepared; I just don't know what to say for sure. My experience with diabetes is largely limited to memories of my grandmother eating crackers before we bought them, and being raised to think that Triscuits and cottage cheese is an excellent snack. Grandma was, however, a very low-key diabetic - we had Oreos in her house and stuff. I also have OCD food issues (there are about twenty foods I ever eat, and I eat two of them on a near-daily basis; I also have almost no nutritional education at all, and was surprised today to learn just how healthy tomatoes are.)

(I am planning to ask the psychiatrist to consider dropping the Geodon, but I don't know if that'll fly. The meeting tomorrow is with a regular doctor)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! to Health & Fitness (14 answers total) 3 users marked this as a favorite
I don't know specifically what questions to ask, but a good tactic for speaking with a doctor about really overwhelming news (I've had a few instances of this) is to either take a notebook with you to take notes that you can review in a less emotional state, and/or bring a friend/family member with you to remember to ask questions and remember the answers.

Good luck!
posted by xingcat at 4:48 PM on September 26, 2011

No matter what your doctor says tomorrow, I'd suggest going to see a dietitian. If you need a referral, your doctor can likely refer you. Make sure the person you see is a registered dietitian, not a "nutritionist," because anyone can call themselves nutritionists without any particular training or expertise. Try to speak with someone who has expertise with eating disorders, not necessarily because you have one, but because someone with that sort of training is more likely to understand your food issues. So that's what I'd ask for. But if I were you, I'd ask for that even if your tests come back fine and you're not diabetic.
posted by decathecting at 4:51 PM on September 26, 2011

I don't have diabetes, but it runs in my family and I have to be careful with my own diet and habits (my insulin resistance has responded dramatically to weight loss).

A notebook is an excellent idea. If you have a friend or family member willing to come with you and serve as an extra pair of ears, that's a great idea too. Sometimes this person will ask questions you might not think of and/or be able to hear or decipher what the doctor is saying because they are less overwhelmed by the diagnosis.

on preview: Decathecting said what I was going to suggest - get thee to a dietitian! Most hospitals and health plans have them; my own health plan is very generous with providing dietitian-led classes and giving people who need them individual consultations with registered dietitians. Dietitians have training in managing diabetes and other conditions where it's important to watch what you eat. They can help you with meal plans, refer you to cookbooks, help you manage eating healthy at restaurants, even give you recipes. I had a consultation with a dietitian a few years ago for other issues and it was immensely helpful; I still have the guidebook she gave me.
posted by Rosie M. Banks at 4:58 PM on September 26, 2011

Response by poster: Thanks for the advice so far, I will totally have a notebook. And I'll try and find out about the dietician thing.

I mostly just wanted to correct one thing. I've slept 13 out of (now 20) hours today. And two more of the remaining 7 were spent lying down but awake.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:05 PM on September 26, 2011

I was diagnosed with gestational diabetes last year when I was pregnant, and I was referred to a diabetes educator. She taught me how to properly test my blood glucose and gave me a huge packet of papers with common foods and how many carbs were in one serving of each. I had track my food with a diary for a few weeks, and went back to her for a follow-up to check in on things. She also gave me her card so I could call or email if I had questions in between visits. So my advice would be to get referred to a trained diabetes educator and make full use of his/her knowledge.

Also, go easy on the sugar free chocolate candy. That way lies poop-related madness.
posted by chiababe at 6:00 PM on September 26, 2011 [1 favorite]

Best answer: Background
Mr. BuffaloChickenWing has type I diabetes since he was 4. This Halloween will be 30 years.

I had gestational diabetes and now diagnosed as insulin resistance syndrome (my highest A1C was a 6.4) Type II runs in my family.

My advice is going to go under the assumption you know nothing about diabetes. IANAD.

I am unable to tell from your description what type of diabetic (if not pre-diabetic) you are.

Your Pre Appointment
*Do not let your primary care physician treat your diabetes. Please see an endocrinologist. They are specialists up on the latest diabetic research. I am always amazed at how poor primary cares are up on diabetes. Their knowledge is gained from reading a few papers and articles on the topic.

*I agree with the comments to see a dietician. They will help you understand the carb counting and how that will fit into your diet. Do not be surprised if your dietician will tell you something in conflict with your endocrinologist. Remember - one is more up to date on the latest research the other is not. Regardless - see someone to help you understand the diet.

*I refer to the diet as "the cowboy diet". It was my way of making it fun for myself. I focused on what we could eat rather than what we could not. Bacon - Yes. Spaghetti dinners - Yes, but only a small portion size. This brings me to my next point.

*We do not eat a no carb diet. We eat a low carb diet. We still eat pasta, but portion control better.

*Do not waste your money on "sugar free" foods. This is just an example I created - if you look at a sugar free ice cream, you may eat 24g of carbs in a 1/4cup serving, but if you eat the real stuff you may eat 30g of carbs in the same serving size. Not worth it to me. Portion control.

*No carb or sugar free foods often have sugar alcohol in it to make up the flavor. This has a laxative effect on the body.

*You are going to be give tons of advice on how you should have lived your life. That the diabetes is your fault. Do not listen to those that are not walking in your shoes. You did not eat your way to diabetes. You eating meat or not eating meat did not cause you to be a diabetic.

What to Expect - YMMV
1. If you are going to see your primary care doctor chances are you are going to get a referral to an endocrinologist.
2. The endocrinologist (if they are apart of a large practice) will want you to see one of their diabetes educators and dieticians first - to get you started.
***Here you will get a prescription for a blood meter***********
2a. Despite the fact you had blood work done - they will want to run their own panel of tests.
3. Then you will have an appointment with the endocrinologist.
***Here you will learn what type of diabetic you are***********
4. After the initial appointment with the endocrinologist from then on you will probably see their physician's assistant.

Get proactive and take your blood sugar count for a week before seeing the doctor (after the dietician). This is my favorite blood sugar log sheet [pdf].

To be honest, most blood meters have the ability for your doctor to download the data, so ask the educator what their office does. I like the hands on recording personally.

This is not a death sentence. You are joining the ranks of some really cool people.

Best of luck to you.
posted by BuffaloChickenWing at 6:51 PM on September 26, 2011 [9 favorites]

my advice for people in any medical situation like this (based on experience) is to be honest with your doctor about what you are and aren't capable of doing - with regard to diet, exercise, meds, etc. it's better to be honest and find a compromise than overpromise and end up acting out and hurting yourself.

don't feel like you have to cram all the information you need into one appointment. just get what you can and try not to feel overwhelmed. you can schedule more appointments as you need them and call when questions arise.

this is all manageable - but it sucks, and i'm sorry to hear you're going through it. but i've been there and just taking things a step at a time and starting an open dialogue with your doctor is your best course of action.
posted by crankyrogalsky at 7:29 PM on September 26, 2011

I've been concerned that my blood sugar was dropping (possibly as a result of insulin sensitivity problems) and I am at high-risk for diabetes due to family history and having PCOS. I mentioned it to my doctor and he gave me a blood glucose meter for free. Your doctor might have free ones as well. The lancets are cheap but the test strips are what will get you... they're about a dollar each. Forget the alcohol wipes. I've read articles that said

Unless someone shows you how to test your sugar, if you just go by the directions on your meter, plan to waste a few test strips until you get the technique right. (My meter came with 10 free strips and 10 free lancets.) It took me 4 or 5 tries. First I didn't get enough blood, then the blood smeared, then I waited too long to get it into the meter, so then I put it in too soon before the meter was ready. Test on the sides of your fingers, not the tips, it hurts less. Even if you try to opt for forearm testing, there will be times when you need to fingertip test - fingertip testing is essential if you think your sugar is rapidly dropping because the fingertips will show hypoglycemia sooner than the forearm.

There are other meds for bipolar besides Geodon right? I know it's a total pain to try to switch meds and I know how bad you can end up feeling (I've had med switches before) but it may be worth it to get your sugar down... you might ask whichever doctor is managing your diabetes to talk to your psychiatrist about it.

You said you only eat about 20 foods, ever. Be adventurous and try some new foods. If you're really scared to try new foods, instead just try something slightly different from what you normally eat. For an example, if you normally eat spaghetti with meatballs made of beef, try spaghetti with Italian sausage instead. (Not saying this is a good diabetic food, make sure you portion control.)
posted by IndigoRain at 8:03 PM on September 26, 2011

Adult-diagnosed type 1 here.

First, educate yourself. I've learned more on my own than from my doctors. Some recommendations:
Online forums like TuDiabetes
Books. My own recommendations are type 1 specific (which you may be) but -- Type 1 Diabetes for Dummies, Using Insulin, and Think Like a Pancreas are all good. (sorry, having trouble linking on my iPad)

Second, learn to carb count. Diabetes is not a good disease for people with tendencies to OCD food behavior, I'm sorry to say.

Third, I totally agree with BuffaloChickenWing about sugar free food. In fact most food with the word "diabetic" on the label, including all Atkins brand stuff. I'm shocked it's legal, especially given that sugar alcohols affect many people's blood sugar, including mine. Eat the real stuff, in small portions. (Fatty sugary food, like ice cream, is far easier for a diabetic to tolerate than pure sugary food like juice, because the fat slows down the absorption and tames the spikes.)
posted by kestrel251 at 8:09 PM on September 26, 2011 [1 favorite]

I have insulin resistance as well, and BuffaloChickenWing said what I was going to say. WHEN you see the endocrinologist, ask if they have free glucose meters and test strips. Mine pretty much told me to check with them before buying test strips because they always get free samples and are willing to give them out. I no longer have to test everyday though...YMMV.

If they want to put you on meds, ask lots of questions about side effects and such if they talk about different options. There are meds that help your body use the insulin you are making (if you are still making some) instead of simply replacing insulin. Each one has side effects and you'll have to change your diet and time your meds around meals. It's not hard once you get a routine going, but I felt very overwhelmed in the beginning. Keeping a small notebook where you track everything is kept me thinking straight and helped me figure out what worked for me and what didn't. I started on Metformin and I'm currently on Victoza, so if you get put on either of those I can tell you my experiences.

The book The Insulin Resistance Diet really helped me make better food choices. It's more than just what you can't explained carb exchanges differently and helped me grasp everything, instead of just being told "eat low carb".

Good Luck, and feel free to MeMail me if you have questions or need support.
posted by MultiFaceted at 8:24 PM on September 26, 2011

First, I agree with buffalochickenwing bout seeing an endocrinologist and your doctor should be the one to recommend it.

Second, in late April I was diagnosed with type II diabetes (triggered by a psychiatric medication known for this along with genetic predisposition, so we may have that in common). It was emotionally devastating for me but I was also dealing with all of the horrible symptoms and developed a fear of food (afraid everything I ate would make my blood sugars rise and cause doom). So I might also recommend working with a nutritionist who has experience and knowledge regarding diabetes, preferably extensive experience and not just a class or two, as I had the benefit of that and it helped immensely.

Finally, this website helped me a LOT, and specifically this page about dealing with the doctor. Remember, it's your body and your health and it's best to be as educated as you can (without scaring yourself). Some of the advice contradicted what my doctor said (for example, she recommended eating lots of carbs and she also said it's not important to take blood sugar after meals). Some of the advice also helped me be more proactive in my treatment.

I got my a1c down from 11.1 to 5.5, which is a huge drop from May to September. I feel absolutely fine and like I have a new lease on life
posted by Danila at 2:08 PM on September 27, 2011

Response by poster: Thank you all for your help. The appointment went well, and I'm now trying to find a dietician who is a) under my plan, b) good with eating disorders/OCD, and c) familiar with diabetes/pre-diabetes/hypothyroidism. Which last illness I now have a (sub-clinical) diagnosis of. I just love it when I make medical professionals feel sorry for me.

My doctor has said to officially not worry (literally - her exact words) until I've been off the Geodon for a month (they took me off today,) so I'm bookmarking this thread for then.

My glucose in May was 88, which is why she's so calm about this, and while it's supposedly not that common to have such a dramatic spike with Geodon, it's apparently not unheard of. It has officially entered the ranks of drugs I wish I'd never been prescribed, alongside Lamictal (I worry too easily) and Abilify (oh, the nausea and dizziness...)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 2:15 PM on September 27, 2011

Glad you're not supposed to worry. :) Abilify can also raise blood sugar, but sounds like you're off it already. :)
posted by IndigoRain at 2:53 AM on September 28, 2011

Sorry to hear about all your troubles. Hypothyroidism often comes with autoimmune (aka type 1) diabetes -- Hashimoto's is an autoimmune hypothyroid disorder. (I got both.)

But, here's a cheery thought: managing hypothyroidism is no big deal once you have a doctor that acknowledges that you have a problem. You just take one pill -- levothyroxine -- first thing in the morning. That's it. Done. (OK, well, you have to wait to take vitamins until later in the day; they interfere with the absorption of levothyroxine.)

You do have to get a thyroid panel done every once in a while, and every month if you get pregnant.

posted by kestrel251 at 6:17 PM on September 30, 2011

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