Would you be assertive or aggressive with new doctor?

My sister has a new endocrinologist appointment this week (diabetes). Her case is very brittle and several doctors over the last 8 years have no idea why her sugars plummet low too FAST, and thus she can't take the amount of insulin she truly needs😢 She's now had neuropathy from such high sugars over the years- (awful, debilitating pain and numbness in both feet).

Her last doctor said going in the hospital and getting sugars down and regulated every month is what they USED to do, but insurances stopped over costs😦 He said "if you can find a way to override the insurance, do it. It's really the main option of getting your sugar down, and improving neuropathy."

She's going to ask new doctor this week if she can get her in the hospital. She's tired of all other doctors brushing it off and not going an extra step to help any part of this disease. Often just saying, I don't know, and walking out. Her therapist years ago said, " start to get even aggressive with these physicians" , but she's shy like me. Would you say, I need help in ANY way before leaving this office? Would you be assertive, or aggressive? Her kidneys are in danger too, so this is Really vital getting true treatment.

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GovanDUNNY · M

Your a person of great character ,your sister is blessed having you caring for her.

GoFish ·

What does she eat/drink? They say taking cinnamon helps too

Baybreeze · 41-45, F

@GoFish she eats low carb and it's still high, her sugars. She needs more insulin but her body is so sensitive to it, it's dangerous 😢 The hospital can help her but we need a way to appeal insurance. So she's going to be assertive and say I NEED you to help me get into the hospital.

GoFish ·

@Baybreeze what about actual sugars in foods tho not carbs

HikingMan · 56-60, M

Have you looked into finding a patient advocate! These people have familiarity in dealing with doctors, insurances and often know some of the legalities of both.

LadyBronte · 61-69, F

I'm truly sorry your sister is a brittle diabetic. Not a lot of people actually understand what a terribly rough and frightening situation that is. Honestly, she, or someone o her behalf, is going to have to be bold enough to speak honestly and openly to the doctor. Perhaps finding a patient advocate for her is the right step. Perhaps it is time to seek a new physician. I wish I had answers for you but all I can say is to be consistently vigilant in seeking appropriate medical care for her.

samueltyler2 · 80-89, M

Getting control in a hospital environment is totally different from control at home. I am not her physician and would never be an internet treator, but it would seem to me that she needs a closed loop insulin pump-glucose monitor they are becoming more available.

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samueltyler2 · 80-89, M

@Baybreeze i hate to argue with physicians on the scene, we have known for decades that hospitalization to control is unlikely to improve home therapy. Have you reached out to see if there is anyone within close range that is involved with a closed-loop device, or reach out to NIH?

Are there any closed-loop insulin pumps?
AI Overview
Yes, commercially available systems exist, but they are technically hybrid closed-loop systems (also called Automated Insulin Delivery or AID systems) rather than fully autonomous artificial pancreases.

Gluroo
+1
These devices combine an insulin pump and a continuous glucose monitor (CGM) using an internal algorithm to automatically adjust basal insulin rates up or down based on real-time glucose readings. However, you still need to manually input carbohydrates or announce meals.

Diabetes UK
+2
Popular Hybrid Closed-Loop Systems
Omnipod 5: A tubeless, wearable patch pump that works with compatible CGMs like Dexcom and FreeStyle Libre.
Medtronic 780G: A tubed pump system using the SmartGuard algorithm and Guardian or Simplera Sync sensors.
Tandem t:slim X2 (and Tandem Mobi): Tubed pump options featuring Control-IQ Technology which syncs with Dexcom sensors.
CamAPS FX / mylife YpsoPump: Systems pairing algorithms with specific pumps like Dana or Ypsomed and Dexcom or Libre sensors.

Breakthrough T1D UK
+3

closed-loop insulin delivery system—also called an artificial pancreas or Automated Insulin Delivery (AID) system—automatically adjusts insulin delivery based on real-time blood sugar readings. [1] (https://gluroo.com/blog/diabetes-101/closed-loop-insulin-pumps/), [2] (https://www.omnipod.com/diabetes-hub/learning-center/diabetes-technology/automated-insulin-delivery-explained)How It WorksA closed-loop setup connects three main components: [1] (https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems)Continuous Glucose Monitor (CGM): A small sensor under the skin tracks your sugar levels every few minutes.Control Algorithm: A computer program in the pump or a phone app reads the sugar data and calculates the needed insulin.Insulin Pump: The device automatically increases, decreases, or stops insulin flow depending on your body's real-time needs. [1] (https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/), [2] (https://gluroo.com/blog/diabetes-101/closed-loop-insulin-pumps/), [3] (https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems)Hybrid vs. Fully Closed-LoopHybrid Systems: Most available systems are hybrid. They automatically manage background (basal) insulin, but you still need to manually enter carbs and give yourself a dose (bolus) before eating. [1] (https://www.nature.com/articles/s41591-022-02144-z), [2] (https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/), [3] (https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems)Fully Closed-Loop Systems: These advanced systems require no meal announcements or manual carb counting, though they are still emerging in broader clinical use. [1] (https://diatribe.org/diabetes-technology/fully-closed-loop-automated-insulin-delivery-takes-next-step), [2] (https://www.nature.com/articles/s41591-022-02144-z)BenefitsKeeps your blood sugar in the target range for longer periods.Lowers your HbA1c and reduces the risk of long-term complications.Prevents low blood sugar (hypoglycemia) by pausing insulin when levels drop.Eases the daily mental burden of managing diabetes. [1] (https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/technology/closed-loop-systems), [2] (https://breakthrought1d.org.uk/knowledge-support/managing-type-1-diabetes/guide-to-type-1-diabetes-technology/hybrid-closed-loop-technology-artificial-pancreas/)If you're considering this technology, let me know:Are you looking for options for type 1 or type 2 diabetes?Do you have a preferred brand of pump or CGM already?I can help you explore compatible devices to discuss with your doctor.Making Sense of DiabetesFully Closed Loop: Automated Insulin Delivery Takes the Next StepIn a fully closed loop system, no carbs are counted, no bolus is entered, and no meal announcements are needed. Instead, as blood sugar rises after a meal, rela...GlurooWhich Insulin Pumps Are Closed-Loop? - GlurooWhat is a Closed-Loop System? A closed-loop insulin system is also known as an automated insulin delivery system or an artificial pancreas. In short, a closed-l...Diabetes UKWhat are closed loop systems? | Diabetes UKWhat are closed loop systems? Some people with diabetes use an insulin pump and a continuous glucose monitor (CGM) that 'talk to each other'. This happens throu...Breakthrough T1D UKHybrid closed loop technology (artificial pancreas) | Breakthrough T1D UKHybrid closed loop technology (artificial pancreas) Hybrid closed loop technology – also known as the artificial pancreas – automates many of the decisions that...NatureFully automated closed-loop insulin delivery in adults with type 2 diabetesClosed-loop insulin delivery offers a new, glucose-responsive method of glucose control and comprises a continuous glucose monitor, an insulin pump and a contro...OmnipodAutomated Insulin Delivery Explained - OmnipodWhat is Automated Insulin Delivery? According to the 2026 ADA Standards of Care, Automated Insulin Delivery (AID) systems are the preferred insulin delivery met... This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes. Learn more

Baybreeze · 41-45, F

@samueltyler2 @samueltyler2 Both her doctor said home therapy is not working..it needs to be monthly trips to hospital, for a while. And those new omni are great, if not you're not labile. Because unfortunately the omni will not take into account that stress and pain and heat make her sugars go up a hundred or more. It's only accounting for food, and will subsequent give too much. Her doctor said it would be dangerous going in automatic pump for her labile case. I do appreciate your ideas ..ty

samueltyler2 · 80-89, M

@Baybreeze as i said, it is your decision to make. She cant spend the rest of her life in a hospital.

ArishMell · 70-79, M

I hope very much your sister can find the diagnosis and treatment she needs, but reading this and the ensuing discussion it strikes me the doctors themselves are limited by mere money-men.

It may help being assertive but never be aggressive. That never does anything useful, especially if the victims of the aggression genuinely are limited by a system over which they have no control.

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Baybreeze · 41-45, F

@ArishMell I know, it makes you angry that they're taking such a *whatever * mindset to it. She can't go on the automatic new omni pump either, one doctor agreed it would be too dangerous with her sugars so labile. And her most recent endocrinologist just kept pushing the Omni and when we explained it's not feasible, she literally just kept staring at us like a stoned fool. And offered nothing else. I don't blame my sister for wanting to yell now at doctors. 😞

ArishMell · 70-79, M

@Baybreeze An awful situation for you both. I can only offer all hope for you.

Baybreeze · 41-45, F

@ArishMell I appreciate that, we need hope and a miracle. Thank you 🍂

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