Sunday, November 12, 2006

Tucson is hot

I am back in Tucson. My old endo has agreed to see me on Monday. So obviously I am freaking out about this endo visit. It's on Monday at 2. The problem is, I am 99% sure that he will argue with me about revising my diagnosis. I am about 75% certain that he will ultimately say no despite all my arguments. I think so because he made a conclusive statement on my lastreport that it wasn't Type 1, based entirely upon the unpositive antibody test. (They can't even accurately say that the test is negative). So, I need suggestions. I do have arguments, but I am a terrible arguer, so I can't guarantee that I won't screw them up. I'm also naturally unconvincing and it's a tough obstacle to overcome in general. Also, I will at most have 5 minutes of his time to cover everything in the entire visit (and I suspect we will be covering my decision to stop taking the metformin). I even have a book of articles by endocrinologists (that support me) but I seriously doubt he would even look at it - it would take too long. So, what should I do? Would it help if I made charts?

Characteristics of LADAYes
Positive GAD65 Antibody test

Thin and active

Quick progression to insulin dependence/ failure of oral meds

Intermittent beta cell function

Lack of or very low insulin resistance

Rapidly falling C-peptide

Normal blood pressure and triglycerides

Characteristics of Type 2 present
  • No positive GAD65 antibody test

Possible negative consequences of being diagnosed as Type 2
    That have already happened

  • Nonspecialists see insulin treatment as unnecessary to maintaining health, especially due to small TDD

  • Timely treatment and more frequent appointments are denied due to perceived lack of "seriousness" of Type 2

  • Nonspecialist ignores C-peptide levels, history, and insulin dependence that indicate Type 1 (or at least similar treatment) simply because diagnosis is Type 2 - treating the diagnosis instead of the patient

  • High bg of no concern to nonspecialist

  • Specialist's office assigns low priority for scheduling of appointments due to Type 2 diagnosis

  • Inappropriate medical advice given. i.e. "eat fewer carbs and exercise more" based on false assumption of high carb intake and infrequent exercise due to Type 2 diagnosis - a waste of both time, money, and opportunity for appropriate treatment
  • Perceived as neurotic and therefore concerns are taken less seriously, due to actions such as frequent daily bg testing which is perceived as unnecessary and excessive for Type 2s

  • Negative, sometimes openly hostile reactions from Type 2s in support-type situation due to having nothing in common with them

  • Inability to gain access to Type 1 or LADA support resources despite their appropriateness

    That have not yet happened but are possible

  • Inability to obtain adequate insurance coverage of treatment due to Type 2 diagnosis

  • "Sick day" assistance not available from primary care doctor

  • Presentation at ER with moderate or high ketones results in bottom priority once Type 2 diagnosis is discovered in records, resulting in several hours' long wait before ketones even confirmed or treated

  • Emergency treatment results in inappropriate action because "Type 2" diagnosis indicates overproduction of insulin and nonseriousness to most providers

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