Thursday, October 30, 2014

Corporations are people too: MedEQUIP tries to save face through repeatedly lying

As I complain to my husband about the much-hated, much-talked-about-in-our-household Med EQUIP--the medical supplies company that my insurance company forces me to use--he reminds re, "Remember, corporations are people, too."

Apparently they are, because this company would apparently rather save face by lying repeated (verifiable lies, mind you), and hanging up on their customers, rather than actually solving a problem or having good customer service.

Here's the latest: I get a call roughly every month from MedEQUIP asking if I need my Dexcom sensors. "Yes," I tell them every time, "Still a diabetic." Some months they are a few days late in calling, some months they are a week or two late. (Why not just automate the process? We'll get to that later.)

This month, after coming back from a trip, I went to grab a new sensor, but I didn't have any left! Odd, I thought, I didn't get a refill call yet. So I called The Dreaded MedEQUIP (they get an angry fist shake every time I drive by their office), and they told me this very verifiable factoid:

"According to our notes, we called you on October 13 to refill the order."

Here's the thing--my number is a GoogleVoice number and every call, missed call, voicemail, and text message can be looked up in my GoogleVoice inbox. So I looked. Oct. 11, missed call from my mom. Oct. 16, voicemail from my dad. October 13: NOTHING.

They simply lied to me.

I was pretty stern with the woman, letting her know that this was not acceptable and telling her that it is seriously not OK for me to be off my sensors (bordering on rude, but still within the bounds), and next thing I know, I'm HEARING THE DIAL TONE. Lady hung up on me! I called back, but the office had since closed. I called again this morning, and the woman I am used to dealing with, Vicky, was not in the office yet. Not to mention that I need my #$@!ing sensors.

This is not the first time MedEQUIP lied to me.

Last June, when my Dexcom receiver died (the USB port gave out), I ordered a new one through MedEQUIP. Several days went by; nothing. Three weeks passed and still no receiver. So finally I went and camped in the MedEQUIP office (thinking about doing that again today), and talked with Vicky, who told me that it was held up because they were waiting on insurance approval.

I later verified that this was absolutely false, and that the insurance had approved it within a few days.

If you are looking for a medical supplier for sensors that it reliable rather than ego-driven and substandard, my advice is to order through Dexcom and complain to the insurance company, your endo, anyone, so that MedEQUIP is held accountable for its distinctly mediocre service. At least Dexcom will be motivated to get sensors to you on time (they want to move more units, after all). They are also available when you need them, and will overnight sensors in a pinch.

*As a note, I found out that Blue Care Network (University of Michigan's largest insurance provider) does not allow companies to autoship sensors, nor does it allow 90-day fills of sensors. WTF?

Thursday, March 20, 2014

"Your message is in the system."

So... (this is how most of my blog entries start).
The traditional health system in this country sucks. I mean, royally blows. It's pathetically broken.

I've been having a fun time with high blood sugars. And by high, I mean 120-200, which is by no means crazy high. Ever since I started my anti-diet (I had bacon fried in oil, topped with guacamole for breakfast), I have had really good control, and very few highs over 150.

Starting two days ago, my blood sugar started getting really stubborn and would not be nudged down with insulin. I took far higher doses than normal, but still no dice. I corrected for a BG of 180 with 3 units (each unit brings it down 35 points), so it should go down to 75.

Didn't happen. Only got down to 160.

No matter what I tried (short of crazy dosing with 10 units--I didn't try this as it would likely kill me), the BG stayed high, or came down temporarily and bounced back up.

Like a good diabetic, I called my endo yesterday morning. I explained it to the nurse (remember, a nurse in the clinic once told me that I could ease up on testing now that my A1c was 6.1).

"My blood sugars are not responding to insulin," I explained. "I've taken twice as much insulin as would normally be needed, plus a max dose of symlin. I haven't eaten anything carby, and still the BG is not budging. I don't know what it could be -- my insulin, my pump, perhaps I'm getting sick, maybe it's my time of the month... I am concerned that I might be in ketoacidosis. Here's what I've done: I've increased my basal rate by 35% and am drinking lots of water."

She said someone would get back to me.


I called back in the afternoon.
"Oh yeah," I was told. "Your message is in the system."

Oh crap. Now I know I'm doomed.


Here I am, potentially stewing in my own toxic acidic blood, and "my message is in the system."

Taking matters into my own hands (and after polling the community), I went and did some yoga flows and strength training to get my blood flowing. By the time I was done, my levels were below 60.

OK. I can deal with lows. I turned my pump off for an hour, and it came back up slowly. The night was OK, never went above 125. Woke up this morning, went to work out, blood sugars are looking good.

Then, after eating breakfast (bacon and guac) and sitting down to work for an hour, the stubborn BGs are BACK! My blood glucose was 180. I took a total of 8.8 units (6.8 through the pump, and an additional 2 injected just to make sure it was getting in, plus 60mcg Symlin), and it only came down to 140! WTF, as my husband put it.

I called the clinic back. She said, alright, she'll make sure the doctor gets the message and will get back to me. I told her to note that I understand that they do not approve of my diet, but they will never convince me to go off it.

A few hours later, here is the call I receive from a nurse in the clinic:

Starts out with a disclaimer: "We do not recommend the zero carb diet, but if patient wants assurances that she is not in DKA, she can come in and take a ketone test. I recommend increasing her basal rate by 0.1 units and setting an alarm for 3:30am to wake up and test to make sure she isn't low.
I recommend the patient see if she is eligible for the continuous glucose monitor."

How does one describe the biggest pile of stinking, unhelpful dogcrap ever known to pass as "patient care?"

There are so many things wrong with this. It should be obvious, but I'll still take the time to outline why there are so many problems with this chain of events.
  1. If the doctor is too busy to deal with patients, he should not have any patients.
  2. This is the very doctor who prescribed me the CGM, so his advice to get one is just pure laziness on his part. 
  3. Really, doc? You thought I was calling to ask what my basal rate should be set at? Do people still do that? Did you not get the part of the message that I had to relay through 3 different nurses that I already upped my basal by 35%
  4. Lastly, and I say this with the utmost patience, it is not a ZERO carb diet. That is next to impossible to achieve. It's a 30-50g carb diet. But thanks for your accuracy and your malpractice concern.

I said thank you to the nurse, who clearly didn't know what the hell she was talking about and at several points in the conversation, actually said, "that's what the note says."

I also expressed some of the points outlined above and said, as I'll say again, THIS IS NOT CARE.

Here's my unsolicited advice. Get a doctor you like and who works with you, even if they are out of network or not covered. Honestly. I called my new doc, he called back right away. He took a moment to tell me sorry for the frustration I was experiencing, and brainstormed a series of events to try to make sure I was dealing with the problem (switch to long-acting to make sure it's not the pump's fault), and insisted that I check back in with him later in the day.

Tuesday, March 18, 2014

I'm having a really bad day but you would never know

While most days I feel relatively normal, today I really feel like a person with a disability.

What you would see on the outside is a seemingly able-bodied person, going about her day doing seemingly normal things. She goes to the gym in the morning she drives to work she eats her lunch and she does her work. 

But here's what you don't see: you don't see her getting dry mouth from having elevated blood sugars. You don't see her trying not to step too hard on her right leg because she put her continuous glucose monitor there this morning and it twitches a nerve every time she steps. You don't see her stress levels rising because no matter what she does, they don't seem to come down, which is only making the situation worse. You don't see her vision getting blurry from having elevated blood sugars. You don't see her feeling shitty about herself because she can't seem to keep things in control. You don't see the sticky marks all over her body where she placed her various devices. You don't see her hunger when she wants to eat like a normal person but can't, knowing that if she eats too many carbs she'll really be in trouble. You don't see her trying to ignore her high blood sugars and do her work well she patiently wait for them to come down with little success, but eventually caving in and having to go straight to the gym to run until they come down. 

All you see is that lazy girl next-door leaving work early again. 

Wednesday, March 12, 2014

Breaking up with conventional thinking on nutrition

I'm not trying to be all negative here, but I'm starting to get the feeling that we have got it all wrong.

My husband and I watched Cosmos last night, hosted by Neil deGrasse Tyson. I loved how he emphasized how dedicated science is to follow where the evidence leads. Except when it comes to nutrition, I guess.

Here are some revelations I have discovered in my nutrition awakening, relevant only to what I previously believed:

1. You have to limit fat if you want to lose fat.
FALSE. Limiting dietary fat is no fun and is largely unsustainable. Instead, try limiting carbs, which will subsequently lower insulin production (the hormone responsible for triggering fat storage). Of course, you shouldn't outeat your true energy needs no matter your macronutrient ratios. Fat is amazing. It tastes great. And if you can change your metabolic pathways to better utilize fat for energy, fat can be so beneficial in curbing hunger, providing sustained energy, and burning fat.

2. Every meal should be a balanced meal.
NOT REALLY. It kind of depends on what your body needs. If you need some quick energy (as an efficient fat burner), you should go for some medium-chain triglycerides or saturated fat, such as coconut butter, butter, coconut oil, and palm oil. If you need micronutrients, you should go for chia seeds, avocados, asparagus, spinach... Carbohydrates are the only non-essential macronutrient. We would die without dietary fat. Same for protein. We would function just fine without carbohydrates. The body has other mechanisms for creating glucose, which is essential for a small portion of the brain.

3. It's best to eat small meals throughout the day.
NOT IF YOU CAN BREAK YOUR CARB ADDICTION. While this may be true for the majority of the population that depends on the quicker burning (non-essential) carbohydrate diet, this is good advice. If you are working with mostly fats, then your meals will naturally be small (fat packs in a lot of calories), but you can (and should) go for at least 5 hours in between meals. Some people even try intermittent fasting (IF) and do just fine.

4. Breakfast is the most important meal of the day. 
AGAIN, TRUE FOR CARBERS. NOT TRUE FOR EFFICIENT FAT BURNERS. The reason that carbers should never skip breakfast is because their body is at the whims of the blood glucose cycle. Your body needs to replenish the glucose stores it went through during the night. If you don't replenish these supplies, you can land yourself in big trouble (read: famished by lunch, craving carby foods and further exacerbating the cycle). However, if you train your body to use fat for fuel, you will efficiently burn stored fat throughout this morning period without getting super hungry and without losing energy. This is freeing.

5. If you skip meals, your body will go into "starvation mode."
KIND OF TRUE, BUT MISREPRESENTED. Starvation mode is the amazing mechanism of our bodies turning to stored fat for fuel. But your brain needs some glucose, so it will use some stored glucose for that ~20% brain function that relies on glucose (the rest can use a byproduct of fat breakdown called ketones). If need be, your body can bust into lean muscles and tissues for protein, and create glucose from it, called gluconeogenesis. If you are already an efficient fat burner, "starvation mode" makes little difference. See the previous point about skipping breakfast. You should eat. Your body needs fuel eventually, and you do NOT want to start metabolizing muscle and tissue.

Until recently, I was participating with a group of health coaches promoting the low-fat, high-carb, restricted calorie lifestyle. I think this approach is one that will work for many people who lack the discipline to stay away from carbs and realize that they "like" carbs because carbs stimulate pleasure in the brain--let's think of other ways to do this! But if we are going to really educate people, we should be screaming from the mountaintops: There is no one size fits all approach! And if there were, it would certainly not be a high-carb, low-fat approach. Calorie restriction and low-fat, high-carb usually does not work long-term, and it certainly isn't working as a societal recommendation.

It can work short-term, and it can work for people with the right kind of genes to handle all those carbs, but I am convinced that our dietary guidelines should be steered to a lower carb approach. Maybe 60% of calories from fat, 20% from carbs, and 30% from protein.

For your entertainment, here are a few gems of the "fuzzy math" of nutrition being promoted by self-titled health coaches:
  • Your body turns protein and fat into glucose. Huh? Since when? Your body turns carbs into glucose at very high rates, turns 30-50% of protein into glucose (which is why you shouldn't overdo protein), and, in rare circumstances, can turn as much as 10% of fat into glucose (like, if you have been running for 40 hours and have run out of glucose stores and you broken down a significant amount of muscle and tissue--not a common scenario).
  • Complex carbohydrates are called as such because they have protein in them. Yeah, that's not really how the naming convention works in science. It's based on the structure of the carbohydrate molecule, and how complex it is compared to a simple sugar. Nothing to do with protein. 
  • You should eat 1.5 g of protein per pound of body weight. OK, all you are doing here is providing an excess of protein to be turned into glucose. Good job. The recommendation on this one is pretty sound, actually (about 54 g of protein for a 150-lb adult; not at least 54, but 54). It's mostly comes from the performance oriented goals of sports nutrition science. As a caveat, if you are truly building muscle, then your protein needs will be a bit greater. Also--a good benefit of protein is that is slows digestion and hence, makes you feel full. An overage of protein can stop up the works. The best approach to calculating your protein needs is to start with your bodyweight, and from there, account for any significant muscle-building you are consistently doing.
And while we are on the subject of protein, all of these protein-pushers may be making a quick buck on the trend now, but some new research even suggests that a surplus of protein might have detrimental health effects.

Unfortunately, I don't think there's as much money to be made from promoting a high-fat, low-carb, moderate protein lifestyle. Protein is expensive and has many allies (meat and soy industry, nutrition companies that are on the protein bandwagon), carbs are a cash cow for the food industry (cheap to make and you can rely on people's cravings for them), and are especially lucrative when you throw a "low-fat" banner on the label.

Where's the money to be made in promoting whole foods that naturally promote less consumption, like olive oil, butter, green vegetables, coconut milk, etc... ? In this approach, you would need to eat a lesser amount of food, as your energy is mostly coming from fats, which pack more that 2 times the amount of energy per gram than protein or carbohydrates. Instead of a huge, $15 salad with fat free dressing and chicken, you could have what I had today: 2 eggs cooked in coconut oil plus 1/2 an avocado. Last night I fasted from 4pm to 11am this morning and felt totally sustained. Not to mention my blood sugar stayed on a straight path between 75 and 110 all day. Pretty good for someone with a dysfunctional pancreas. And for someone living in a country with dysfunctional thinking on nutrition.

Thursday, February 27, 2014

Going rogue... with the guidance of a medical professional

Ever have one of those moments where you decide to act upon something you have been thinking about for a long time? Well, I'm having one of those moments. It feels like I'm breaking out of prison.

Fine, I'm not batting 1.000 as one member of put it. We will see what my next A1c is. I can't be sure it's amazing, but I do know that I have been AT EASE for the past 3 weeks. Ever since Feb. 7, the day before my birthday, when I decided to break up with carbs.

The moment I spoke of before was not deciding to break up with carbs, but was the moment I went into my online health portal and CANCELED all my appointments. It was symbolic, of course, because I can always go back in and reschedule them. But still...

So, here's a breakdown of how everything has been since then:
I went to see this holistic doctor. I had seen him before. Before I was on the University of Michigan's HMO, when I was still on COBRA and I would have had to pay outright no matter where I went. But when I jumped on the UM HMO, I made decisions based on what would be covered. So, instead of seeing the doctor I wanted to see, I ended up with 5 doctors that I didn't want to see: a PCP, 2 endos, a pump specialist, and a nutritionist. All with a copay of $20-30, so I didn't even end up saving anything! (The holistic doc charges $105 per visit.)

UNSOLICITED ADVICE: Paying out of pocket for GOOD medical care is a much sounder financial decision than paying copay after copay for BAD medical care. 

Here's what I liked:
  1. He gave me a hug when he saw me, and upon parting (warm fuzzies!)
  2. He has a dog in the office that is super friendly 
  3. He is willing to say "I don't know" when he doesn't know (unlike, ahem, some people in the diabetes clinic who would rather spout off 45 minutes of 100% grade A bullshit than admit they don't know). 
  4. He's totally on board with low-carb (He said, "Anyone who isn't on board hasn't read the literature in the last ten years). I happen to think they are unwilling to depart from the old ADA guidelines, even though ADA has now updated their guidelines to say that, in fact, there isn't a one-size-fits-all approach to carb intake, and even reference studies with 20g daily carb up to 40% of calories from carb as having great impact on glycemic control. 
  5. He's going to "go rogue" with me... ie: be there to give me sound medical advice, but not treat me like a number (test result number). He told me to still see my endo, and I told him, fine, but I'm just going to smile and nod and then go off and do what I feel is right. 
  6. He isn't going to designate me as a "high-risk" anything, because I'm not high risk. My numbers are good. I'm super healthy. I don't need to be cradled and babied just because I have type 1. I can experiment with things like diet and exercise and that's OK. I don't have to sit still all day and nibble on three meals and three snacks throughout the day and eat the same thing and never try anything new.
And now, for an update on my BGs:
It's a bit rocky (by my new standard) today because I am entrenched at work with a deadline. Finally got my report in, and my CGM didn't beep at me all day, so I only just now looked at it.

Funny--when I first got it, I was OBSESSED. I looked at it all the time. And was often surprised at what was happening. Now I kind of assume my BG is in range.

Wednesday, February 19, 2014

Breaking up with carbs, too

It's been two weeks since I decided to go low-carb. I'm talking LOW carb. Less than 30 grams/day. Some days my carb intake creeps up to 50g, but I always make sure my net carbs are staying under 30 (total carbs minus fiber).

Other closely related nutrition philosophies include: Paleo, Atkins, South Beach, The Zone, Ketogenic (more accurate for what I'm doing), Dr. Berstein's Diabetes Solution, Primal Blueprint...

I started on Feb. 7, the day before my 31st birthday; 18 years into my life as a type 1 diabetic. 

The result has been this: I have never had such good control. My lows are as low as 50 (one instance in the last 2 weeks), but usually no lower than 60 (also rare, and I don't feel them because my body isn't relying on blood glucose for energy). My highest high was 250 on the second day of this experiment; other than that, it's gotten as high as 210 twice, the next highest high was 170 (about 4 times), but mostly stays under 140 after meals.

And as my body adapts to this new way of doing things, it's getting better.
  • The last 24 hours didn't see a blood sugar over 125. 
  • I went to the gym for the past three mornings and didn't worry about getting low or high. It stayed FLAT.
  • I've been able to get OFF the constant snacking that is required by the traditional restricted calorie, low-fat diet. 
  • I'm warmer.
  • I am NOT hungry. Seriously. Not ever. Unless I go for 24 hours without eating. Then I get cold and hungry, but only after around 20 hours without eating. It's called intermittent fasting. Google it.
  • I'm feeling more even keeled/sustained energy.
  • I have reintroduced nuts into my eating! And dips. And bacon. And other delicious, satisfying foods. Just no carbs (but I do NOT miss them).
Here's my 24-hour readout from Dexcom. The "high" is set at 120 (this used to be my target BG, not my target is 90).

Can you guess when I ate? When I worked out?

I would absolutely recommend this plan to anyone willing to do the research it takes to understand it, and who is willing to be 100% committed to giving up carbs. This means (for me at least):
  • No sugar
  • No bread
  • No pasta
  • No grains
  • No fruit (except <50g berries)
  • No milk (too sugary)
  • No juice, soda, Starbucks fancy pants drinks, hot cocoa, etc.
  • No tubers--beets, potatoes, carrots, parsnips, etc
  • No legumes--too carby
  • Careful with veggies--some might have surprising amounts of carbs. I once cured a low blood sugar with Brussels sprouts!
  • Make sure you have a really good understanding of the carbs in foods--cashews, for example, have 8g carbs in a small handful! 
Here's a typical day for me these days:

Breakfast: Breve latte (half & half + espresso), cheese omelet, turkey sausage
Lunch: Avocado, Soy pups, tehina sauce, unsweetened iced tea
Dinner: Coconut chicken curry, cauliflower mash, with peanut butter balls or cheese for "dessert"

It's not a lot of food because fat is more densely packed with calories. 9 calories per gram as opposed to 4 calories per gram for carbs and protein. 

I am NOT doing this for weight loss, although I did lose a lot of weight in the first week as my body emptied its glucose stores (which requires water). I'm hoping that I will lose a bit of weight as I stay on this plan (and bring down my calories), but I am entirely doing it for BLOOD SUGAR CONTROL.

My endo told me not to do it, so I fired her and found a new doctor. She couldn't really give me a reason not to do it. The nutritionist pushed me to eat at least 130g of carbs a day, so I also fired her. Her reasoning is that your brain needs glucose--which is true, but the body has a mechanism for making glucose from protein, a process that results in much smoother blood sugars than carb consumption. Check out my previous post for a recap of that frustrating set of events.

Here are some amazing resources I have come across:

Mark's Daily Apple
Dr. Mercola - does video interviews with some of the best thinkers on nutrition and sports is a community of type 1 diabetics, and supporters of type 1 diabetics. There are a good sprinkling of type 1s who are catching on to this way of controlling BGs
Dr. Bernstein's Diabetes Solution - is a quirky read that has revolutionized the way I think about blood sugar management

Also -- playing with intermittent fasting. It tends to push your body to more quickly adapt to dietary fat as energy. 

Here's my Pinterest board for good recipes for low-carb, high fat foods.

Friday, February 14, 2014

Why I'm breaking up with my endo (and entire diabetes team)

I have officially broken up with my diabetes team at the University of Michigan. Eff it; I'm going to see a holistic doctor next week and we will see what happens. I'm thinking about breaking up with Western Medicine altogether (but have enough respect for science that I won't do it).

While I'm a huge fan of taking your medical condition by the horns and owning that sh#!, I'm less of a fan of listening to doctors, diabetes educators, nurses, and nutritionists who CAN ONLY SPOUT DOGMATIC GUIDELINES.

Here's what led to my break-up:

1. My endo (head of the clinic, BTW) found a teeny tiny module in my thyroid, put me through all these tests (ultrasound, biopsy--large needle straight into my neck, and testing thyroid hormones). First-of-ly, the nodule is so super teeny that it isn't big enough to be a concern! Second-of-ly, he told me the there was no way to take preventative measures to make sure my thyroid production stays normal. Pshaaaa!!! I started taking iodine, and like MAGIC, my levels got even better! Not that they were AT ALL worrisome in the first place.

Red flag #1: Doc takes the approach "wait until it's really bad and then treat it."

2. The pump specialist. Oh, the pump specialist. Bless her, she's a nice person, but wow. "Specialist" is a strrrrreeeeeetchhhhh. Point one: she's a type 2 diabetic on a pump. Nothing is wrong with that, but there are just different considerations for type 1s. And wouldn't you want a type 1 pump specialist? Or someone who is up on the latest research on type 1s/pumps? Considering most candidates for pumps are type 1s?

Next point: She has folks start on a flat rate and kind of wing it from there. I don't know about other type 1s, but I need more accuracy than that! So I looked up Medtronic's guidelines for adjusting rates to account for Dawn Phenom, higher day basal, etc, and started there. (OK, this is for preggers women, but is based on Medtronic's guidelines, and down the page lists out the calculations.) She was upset about this and told me she was "very concerned" that I had done this without consulting her. Wah?!?!?! Do you know type 1s? They are constantly making decisions about their doses. Seriously. She instead wanted me to go on a flat rate and just "wait and see" how Dawn Phenomenon affects me. Hon, I know how it affects me, I've been on a pump before, I'm on a CGM, and I've been a diabetic for 18 years! UGH.

Red flag #2: Pump specialist not so much a specialist, but someone who knows the basics of pumping.

3. I was shipped off to the clinic's nutritionist, who did little more than tell me the ADA Guidelines for nutrition. And the OUTDATED GUIDELINES at that! They have since updated their position, saying that there is no such thing as a one-size-fits-all nutrition guideline for carbohydrate, fat, and protein intake. They go on to cite several studies that show the benefits of low-carb diets on glycemic control:
Carbohydrates: Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.
They go on to say:
Some published studies comparing lower levels of carbohydrate intake (ranging from 21 g daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes... Some studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels revealed improvements in serumlipid/lipoproteinmeasures,
including improved triglycerides, VLDL triglyceride, and VLDL cholesterol, total cholesterol, and HDL cholesterol levels...
I wrote the nutritionist a note today, voicing my concern at her bad advice (trying to be diplomatic, but not too condescending). 

Red flag #3: Not up-to-date on the latest research and prescribing a one-size-fits-all solution that doesn't actually work for most people.

4. When I did share with the endo (another endo on my "team" who I see more often than the head of the clinic) what I was doing, she balked. First, a little backstory: She congratulated me on my excellent HA1c (6.1 woot woot). Keep in mind that glycemic control is the NUMBER ONE indicator of overall health of a diabetic... poor control potentially leads to all of these complications you hear about. So she says: GREAT JOB! and furthermore, REALLY GREAT JOB on not getting plummeting lows anymore. Yet, when I shared what I was doing (less than 30g carbs daily) she said, "No, no, don't do that."
"Why?" I asked.
"It's not recommended."
"Why?" I repeated.
No answer.
Thanks for the advice, doc, but unless you can give me a why beyond the tired dogma of the traditional nutrition guidelines (which, by the way, I've read, and it's a REALLY SHAKY set of events that led to the current guidelines on carb consumption), then I am going to listen to my body and my numbers. Here's an interesting read by Gary Taubes on the history of the creation of low-fat, high-carb guidelines.

Red flag #4: Dogmatic approach to diabetes control. Can't answer "why." (Side note: I would have far more respect for "We don't know" as an answer.)

5. The cherry on top: The nurse that weighed me, took my HA1c, etc... told me the following:
She was going over my prescriptions: "Your prescriptions for test strips is for 10/day."
"That's right," I told her.
"Insurance won't cover that." She told me.
"Don't worry about insurance," I told her. (I get my 10 strips covered no problem.)
"But your A1c is good so you don't need to test so often," she offered up as unsolicited advice.
"Um, my A1c is 6.1 exactly because I test ten times a day," I let her know.

Red flag #5: Bad advice is coming out of the walls!

Here's my new plan:
I cancelled my appointments; my thyroid follow-up, my next two visits with the endos, a visit with another specialist. I'm going to a hollisitc doctor who I have seen before. Hopefully he will get it. His son has type 1 since childhood, so I'm very confident that his approach will be more about what's going to work for me, rather than what the guidelines state.

I also hope that he will be supportive of my low-carb approach and help me work through the kinks, rather than being dogmatically against it without any scientifically sound reason.