Thursday, January 12, 2006

On Monday, I had my Endocrinology appointment. Originally, I was supposed to have it January 19th (my Mom's birthday), but the way my blood sugar has been running lately, I lucked out, and was able to move it up. All in all, it was an ok appointment, but I guess I was hoping that things would have turned out a little differently.

This was my first appointment with my new doctor, Dr. P. Although Dr. S., my previous doctor is a good doctor and good at trying to figure out ways to obtain better control, I felt that we lacked a good doctor-patient bond and I think that's very important. Frankly, I never felt comfortable with him and his personality. I always thought he had a "holier than thou" attitude...which I don't think is so uncommon for doctors. However, with Dr. P, I was pleasantly surprised. He was very down to earth and nice...and he did remind me of my first Endo, who I absolutely adored :) . So that was something good.

Basically, the appointment consisted of the usual routine. The medical assistant took me back to the examining room. I was weighed, I got my blood pressure and pulse checked, and then she did a random blood sugar reading and an A1c. Unfortunately, my level was over 200 :( at the time of the test, which isn't great. But, in a way, I was glad that they were seeing that. I had eaten lunch 3 hrs. prior and there wasn't a reason for why I was that high. After these things were done, the doctor finally came in.

Dr. P, like I had mentioned, was a very nice doctor. However, prior to the appointment, I was a little nervous...I think mostly b/c I didn't know what to expect. I didn't know if he was going to be arrogant or if I would be comfortable. Luckily, he seemed to put me at ease and I was able to talk with him very easily. Instead of sitting up on the examining table, he had me come down to sit in a chair beside him. We discussed some of my "issues"... I mentioned how I constantly dealing with stubborn nighttime highs and how, no matter what I try, I cannot seem to bring them down. I mentioned how I am very interested in trying Symlin, b/c I think it could help me not only bring down those post meal spikes, but also help me control my appetite in the evening. I didn't go into all the details of what happened that prior Thursday, but I did tell him that I did overdo it.

Unfortunately, he wants me to wait on the Symlin. He'd like me to test my basal rates first. This is something I was told to do even prior to my last appointment, but for some reason I have not done this yet. Ok..I know most of the reasons why I haven't tried this yet, and I don't mind sharing them...just don't think I am pathetic, lol :). I'm embarrassed to admit this, but I hate to skip a meal. Testing my basal (they want me to do my night time basal first) means eating dinner and then not eating until lunchtime the next day. Throughout this period of time, I would have to test and see if my blood sugar stays steady (the desired effect) or if it rises or falls (the undesired effect). After my appointment, as much as I hate the meal skipping, I decided finding the right rates was probably worth the hunger pains.

However, now my problem is finding a night to do this. It's not that I'm SO busy that's the problem. No, it's actually that I can't find a night where my blood sugar is in range (as the test requires) to do this. No matter what I do, I'm high (usually extremely high) right before bed. I tend to believe that it has to do with a rebound effect. I truly believe I'm dipping too low post gym workout and then my body tries to compensate for that and I swing to the other extreme. I've tried just about everything I can think of in hopes of making any improvement (ie.temporary basal, snack before the gym, etc.), but I still end up high :o(. It's very frustrating. I'm not sure what to do about this, but if something doesn't change, I think I'm going to lose it :( .

So the disappointing part... My A1c is now at 6.9, up .2 from my last appointment. I know it's not the end of the world, but I'm disappointed that there was an increase. Then the other thing is my weight is up 3 pounds. How can that be? I have been working out like a mad woman and trying to cut back on what I eat (with the exception of a few days like last Thursday)...and I'm up?! I don't get it. Needless to say, I'm trying not to get worked up about this, but, ugh, it's hard not to get aggravated at times. I'm thinking, or wishing, it was just a fluke or water weight, lol.

Also, I guess I'm a little disappointed that he really didn't give me any concrete suggestions or advice to go on. His main suggestion was about focusing on my basal rates. I know that's important, but I wish there was more I could do or something that would hurry up the process of getting back on track. Now, Dr. S., my previous Endo, probably would have told me the same check my basals, but I think he also would have made some changes right away. Don't get me wrong, I think Dr.P, is probably a good doctor, but he's young and I'm not sure how experienced he is. It's probably too early to tell...I need to be patient and give him a chance-but I guess I want a quick fix :). He does want me to come back in 6 weeks, so I think that's a good sign. He's willing to work on this with me and get things where they should be, which is encouraging to me.

I guess I have mixed feelings about this visit. Yeah, I wish Dr. P. believed in taking a more proactive approach, but I think it's more important that I am comfortable with him and am able to share how I'm feeling. If you can't do that with your doctor, I think it can really impact your health management. I was very glad that I liked him as much as I did. Plus, I think he seemed to like me too and, I think, he knows that I am going to be a good patient for him, b/c he told me, on his way out, that I have a sweet personality. While that took me off -guard, I thought that was nice of him to say and it made me feel good. And, ok, yes I checked for a wedding ring. I didn't see one, but I couldn't exactly stare at his hands either! I'll have to look more closely on my next visit-lol :)


Blogger mdmpls said...

I know how frustrating it can be when you want things to change quickly but they just can't! Hey, how about trying one night where you don't work out - just so you can check out the basal rates? That way if you can at least get one rate to a point where you know you are set, then you will have accomplished something.

On the weightloss front - I am also going through the same thing. I have am trying to exercise more but was told that unless you are exercising in your "target" heart rate, you might not be doing much to help yourself lose weight. Exercise is difficult for me, and to now hear that I might not be doing what I need to do - not what I wanted to hear. But it might be something else for you to look into.

Just my two cents!

5:32 PM  
Anonymous Tiffany said...


Congrats on the great A1c! I know that the slight rise must be a disappointment for you, but I think that's a great number. And I hope that this new Endo works out well for you!

We all want the quick fix. Heck, I'd love to have the Tooth Fairy wave her wand and deposit a couple grand into my account; au revoir money stress. But I think that this new Endo has given you the best advice that anyone could. He's asking you to work from the bottom up, to fix any existing problems before adding another ingredient to the mix. An upside to this is that you can trust that he won't just write you a Rx rather than trying to tackle the real issues. Sounds like a keeper to me!

FYI you should eat breakfast the day after checking your overnight basals. Especially if your whole 24 hour profile needs to be revamped; wouldn't want a pesky glycogen dump due to incorrect morning basals and a lack of breakfast!

Also: remember that the three pounds could be water retention, or even muscle mass.

Keep fighting the good fight!

10:46 PM  
Anonymous Cin said...

Yeah, it can be frustrating. I called my CDE with a problem last week. She wasn't in but she called me from home to see what the problem was (think I'll keep her. LOL). She made me realize that in diabetes there are no "quick fixes". Just try not to stress over it and I'm sure things will work out.
I am so jealous of your A1C. Can I tell everyone that your number is my number? j/k LOL.
Also, LMAO on the ring part. Is he cute????

9:41 PM  
Blogger mytime79 said...

Every single time I go to the doctor's question the first question is, "Do you have your basal tests?" And everytime my answer is, "NO."

For some reason I will not do this basal test, my reasons are pretty stupid... 1) You have to do it for each test at least twice to confirm the results, when I have always done it in the past, my results always came back different, but I never did it a third time to confirm either way. 2) I am in no way waking up at 3AM to test my blood sugar, that's freakn' crazy 3) skipping meals (unfortunately, that's a hard one too).

I've actually cancelled appointments because I didn't do the tests and I feel so ashamed that I didn't do it. My next appt. is Monday and I hate the feeling of knowing that you aren't providing anything to help the doctor make informed decisions.

Why is it so hard??? It sounds like you really want to fix these issues though. If your morning result is usually okay I'd start with that basal test. It always seems like the easiest one to do.

12:35 PM  

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