Opiates, Yes. Insulin No: Family Doctor Thinks Insulin Too Risky to Prescribe for Type-1 Diabetes

“Security can only be achieved through constant change,
through the wise discarding of old ideas that have outlived their usefulness
and through the adapting of others to current facts.”
– William O. Douglas

“I’m sorry, but I can’t prescribe you insulin,” said the doctor to the diabetic.

On Monday, Nicole and I were called into see her new GP. As related last week, we had asked her new family doctor to renew Nicole’s insulin prescription. Having type-1 diabetes for 39 years, you would think this was a fairly straight forward request.

Originally, the doctor had told us she would have to think about renewing the prescription. Her main concern was that Nicole wasn’t following the standard insulin protocol pushed by the Canadian Diabetes Society. Instead of writing a prescription, she offered to refer Nicole to an endocrinologist.

“Why would we want to see an endocrinologist?” I asked. “They aim for an HgbA1C of 7%. They aren’t even targeting the bull’s eye.” Nicole doesn’t need a blind shooting instructor… she just needs the darts. I showed the doctor Nicole’s latest HgbA1C of 5.0%. I also showed her Nicole’s recovered thyroid markers. Nicole’s hitting the bull’s eye every month. The endocrinologists aren’t even trying.

The doctor admitted that Nicole’s A1C was better than most of her non-diabetic patients. But she still wouldn’t budge. No prescription.

A frustrating and time-consuming experience:

  1. First it took about 20 minutes to fill out all the forms to see the doctor.
  2. First appointment lasted about 20 minutes. Plus another 20 minutes waiting to see the doctor. Plus a 5-minute taxi ride and $9 fare.
  3. Then Monday involved a repeat of step 2. Except we waited more like 30 minutes. And the appointment was only 5 minutes.

Two or more hours. Nothing accomplished. So we quickly moved to plan B. Plan B should have been Plan A. Nicole called her nephrologist’s office. In a few hours he had the prescription faxed to the pharmacy.

We may have been able to get the prescription from the family doctor if I had said less. My recommendation with most doctors: Say as little as possible.

Otherwise, trying to explain carbohydrate restriction, the law of small numbers and virtues of a high-fat diet will often produce an unwanted miracle: The doctor will put their prescription writing pen down.

Yes, they may have just prescribed enough opiates to their last patient to subdue a cow, enough cholesterol-lowering drugs to destroy a liver and enough anti-depressants to trigger a mass shooting… but they’re not going to give a type-1 diabetic some insulin. The one justifiable, necessary and relatively side-effect free prescription they’ll probably write all day. Sorry, can’t do it. Because you’re not downing orange juice and Captain Crunch for breakfast.

If you’re doing something different, pretend you’re not. We should have just said: “We’d like Nicole’s prescription renewed.” Insulin pump? “Oh, we ain’t so good with them electronic t’ings.”



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