The Platinum Rule asks clinicians to look at their values

(Forgive the stock photo above)

You may be familiar with what’s known in the diabetes and medical community as #languagematters. It began as a global advocacy movement and now has a lot of research and recommendations behind it. As you might imagine, it reminds health professionals that the language they use with people who have diabetes should not be judging and negative but realistic and supportive. That this affects outcomes.

Similarly, this morning I read in the Scientific American, “Beyond the Gold Rule: Clinicians need to understand patients’ values, not apply their own.” That what also makes a difference in how we tend to people is values. Physicians, largely, of course not all, tend to swim in the sea of their values mostly ignorant of their patients’.

As the author, science journalist Claudia Wallis, points out, “We have to acknowledge the ways in which our own personal biases can shape the way we perceive and respond to patients.”

Here’s a brief excerpt from the article:

“In the arena of medicine, the stakes for making or influencing choices for others can be especially high. Such choices impact people’s quality of life and even their chances of survival. As health care becomes less paternalistic and more individualized, the time seems right for a new ethical guideline. Enter the “platinum rule,” proposed by Harvey Max Chochinov, a professor of psychiatry at Canada’s University of Manitoba: do unto others as they would want done unto themselves.

Chochinov, an expert on palliative care, eloquently describes this principle in his essay “Seeing Ellen and the Platinum Rule,” published last year in JAMA Neurology. He begins with a story about a health crisis affecting his late sister Ellen, who was severely disabled by cerebral palsy…”

How refreshing it is to remind all of us that we all see the world according to our unique experiences, conditioning and values. The whole article is worth reading.

Medicare’s $35 cap on insulin now in effect

Starting this past January 1 if you are on Medicare insulin will cost you no more than $35 per script per month. For people with type 1 diabetes, like myself who are not on a pump, that’s more like $70 per month, as we use two different insulins a day, both a rapid and long-acting insulin.

You do not have to first meet a deductible and the cost is intended to be applied at point of sale, like when you buy your insulin at the pharmacy, but some Medicare Plan Ds (Pharma) will not have their payment systems updated until the end of March.

For more details, here’s an article in today’s Wall Street Journal, “How the New $35 Cap on Insulin Costs Will Work.

Increasing and decreasing insulin for steroid medication

Okay, so this headline may be misleading because what works for me may not work for you. Still, it may, and what I did coming off five days of prednisone for bronchitis and a sinus infection was based on what diabetes educator extraordinary, Gary Scheiner, advised me to do.

This picture is also misleading, but sitting here readying myself to write this, I had to play with my fountain pens first, because they give me so much joy. Above from left to right: Sailor, TWSBI, Sailor mini, Sailor Realo. I am a real Sailor fan, they make a nib like no other company.

Okay, back to the topic at hand. I found I had to double my daily Tresiba dose, for me that meant going from 7 to 14 units, to manage the high from prednisone, a steroid medication prescribed to reduce inflammation. Gary says you will need to double, sometimes triple, not your bolus, but your basal. Surprising, huh? But true.

That worked really well for the five days I was on prednisone. But then, how do I decrease my Tresiba back to my usual dose when the prednisone stops? I read that prednisone stays in your body for approximately 20 hours after you stop taking it, so the first day I didn’t take it, I took 12 units, dropping down slightly from my 14 thinking I was covering most of a day.

I noticed, however, late that evening that my blood sugar was dropping. Now, in truth, it could have been that I took too much insulin for my dinner, as I was eating a carb meal I don’t ordinarily eat, but I sensed it was the prednisone no longer raising my blood sugar.

I was nervous, as of course, these things always happen before you’re going to sleep. So, this is what I did. First I had a text exchange from 10:30-11:30 pm with a fellow type 1 friend whom I knew had recently double dosed her Tresiba. She shared her experience, the need to watch your blood sugar like a hawk and be prepared to eat 20 and 30 more grams of carb when you see yourself dipping.

So I raised my blood sugar to 120 mg/dl with honey before going to sleep to give me some cushion. Normally I like to be between 90-100 mg/dl. Then I ate half of an extend bar, which says it keep blood sugar stable for 9 hours. Then I put the baqsimi I’ve never used on my husband’s night table and told him he may have to use it. Then I watched on Netflix three episodes of Virgin River to keep myself up til 1:30 am so I could watch my blood sugar.

The next morning I was okay with a reading of 71 mg/dl, but I didn’t know, do I skip today’s Tresiba, since Tresiba stays in your body for 42 hours? That seemed sensible to me and my friend said her endo told her to skip her next day’s Tresiba. Or maybe should I split my normal dose and take about 3 units in the morning and 3 before bed…? So I reached out to Gary who said, take your normal 7 unit dose and just watch your blood sugar. You may need to eat more carbs or snack more. Really?

It seemed not to make sense, but of course I trust Gary’s knowledge, so I did just that and actually my blood sugars stayed stable all day. No noticeable drop or elevation. Amazing.

Again, YDMV (your diabetes may vary) and you should know by now that I am not any sort of medical professional, but these are basic guidelines that have a good chance of working for you.

Treating the highs and lows that come from steroid meds, is scary. I’m never comfortable having to do it, and I wish there were a better way, but there isn’t. So, wishing you an easy trip if you find yourself on this particular journey and some good advice from my friend Gary Scheiner, former educator of the year. Gary’s services are available at Integrated Diabetes Services, and he works remote.