Saturday, May 13, 2006

Update from my appointment...

To my dismay, things did not go as I had hoped regarding the visit and my test results :o(. I got to the appointment about 10 minutes late, due to traffic on 84... But, honestly, I didn't give myself enough time. I was worried about the time lost from work so I left at 4:25 (instead of regular time, 4:30) to make my appointment which was scheduled at 4:40. I probably should have left 15 minutes earlier, but oh well...

Anyway, I get to the office and was a little frazzled from being late,the traffic, and my blood sugar reading I took right before driving to my appointment. After a short while, the medical assistant calls me back. The old familiar path to the scale first-eek!- and then she gets me set in his office. Before I left work, I tested in at around 220, but the medical assistant wanted to test me again. I guess I had started to come down from my correction dose, b/c my reading came in at 189. She then took my blood pressure and pulse and tells me that the doctor would be in shortly to see me.

Soon after, there is a knock on the door and the Dr. P comes in followed by a young woman, who happened to be interning with him. He sits down and tells me to come down from the examining table to sit beside him. He then precedes to ask me how I've been doing and how my sugars are. I tell him that things have been ok for the most part...not great, but about the same as always. I can tell something is up, b/c his tone changes. He tells me that, unfortunately, according to my last labs, my A1c has gone up... and by quite a bit.

My last one (I believe) was a 6.8 and this one is 7.5. This is quite a jump and one that I did not expect by any means. I'm not sure I even took it in fully- I kind of just myself hear what he said, but I don't think I processed it. Because if I had, I know that my reaction would be much more dramatic. In the past, I probably would have freaked out. I kind of surprised even myself that that didn't happen.

Then, of all times, he asks to see my log book. To be quite honest, I don't even keep one. Typically, I'd just scribble down the last few days' readings on scrap paper right before the appointment. Just gotta love my organization. But since he usually doesn't doesn't give them anything beyond a quick glance, I didn't think it was worth even scribbling anything down. Of course the day I don't bring anything, he asks for them-ugh. So he tells me the thing I was dreading to hear- another BASAL TEST. Guess we all knew that was coming :ox

He asks me a few more questions about my blood sugar readings lately and, from what I told him, he thinks it would be wise to test my daytime basals one more time. He thinks my nighttime levels are ok for the moment. Yes, I often go to bed high, but I'm waking up around the same numbers, and that tells him that it's probably set correctly. But the daytime readings are a different story...especially in the afternoon and after dinner. This has been an ongoing problem since who knows when? As much as I was planning on fighting him on this issue- I didn't take into account that my A1c would go up so much. So, no, I didn't argue this time.

Then Dr. P went over the rest of my results... Kidneys- fine, not leaking protein. Thyroid- fine, within normal limits. Cholesterol- excellent, according to him. Just that darned A1c- boo! :o(

I mentioned the Symlin, but I didn't get much of a response. All he said was that he was not against it- well, that I already knew. I think those were his exact words the last time, but he didn't tell me when I would be able to move forward with it. He just said that it's more important to get these basals straightened out before adding something else into the mix....think he said that before too.

One thing that was nice was that he gave me his personal cell phone number. Now, don't jump to conclusions. I think he only gave it to me, b/c he knows that I am not going to call. Ok, let me take that back. Well, I'm not going to call for unrelated or for frivolous matters or abuse having that privilege. I think I probably should call him during office hours if I have a problem or something to discuss.

I don't know that there are many doctors who would offer to help in that way, but I think it's awesome that he is willing to do what he can to help me. Obviously, I could use all the help I can to deal with this disease .

Incidentally, I was planning on getting clearance for surgery , but for some reason I didn't bring it up. I guess part of me said it wasn't the right moment to do so. And then there was the fact that the Intern was with him. I would rather discuss it with him maybe I will be calling him soon anyway ;).

As things stand now- I'm not too thrilled with the turn of events. YES- I know I could be doing better. I have let things slip more than I should have and it's time to make up ground. There's probably a whole long list of things that could stand improvement, but I'm planning on working on 3 major things.

One thing I feel like I definitely need to do is to start keeping better log of what I eat and my blood sugars. I think keeping record can really help in identifying trends and patterns. Since I don't keep any sort of records or notes, it's hard to do that. I guess I have a general idea of what are my problematic times of day, but I could really pinpoint things with a little extra effort. So it's going to mean getting a little more organized, but that's something I should be working on anyway. If this is important to me, and it is, then I'll have to put more effort into doing that.

Also, I'm considering testing more. I really feel like testing is key to control. I test about 5 times a day, but compared to some others that's really not that much. At a message board I am a member of, some of the members test twice that if not more...and they have great control. It's apparent to me that they are doing something right and that could definitely be their testing habits. When I test at those five moments of the day, that reading only applies to that exact moment. I have no idea what my blood sugar is doing during the rest of the time. I've learned that I can't just rely on how I feel, because a lot of times how I feel and what my blood sugar reads are two distinct things.

Lastly, I need to start calculating my boluses better. I used to feel that I was pretty good at carb counting and figuring out what my dose should be- but now I'm not so sure. I think many times I end up underestimating the carbs in my meal. I don't know if it's just bad guesses or if it's something more on an unconscious level.

Maybe it has to do with the fact that the more insulin I take, the more likely I am going to put on weight... so I choose to take less insulin and deal with the possibility of a high later on. I don't know, maybe not, but with my past history it could be.

It's funny, because when I was first diagnosed, I was so frightened about the possibility of complications I took more insulin than I needed to...which often led to lows. Now, that fear hasn't completely gone away, but I guess something has changed. My A1c might have changed due to the fact that I haven't been having a lot of lows at all. Maybe my last couple A1c results were better, b/c, yes, I still had highs, but a lot of times they were being balanced out by lows as well. Now I'm having highs and some normal reading sprinkled into the mix as well, but the average is a lot higher...which clearly means that I will have a higher A1c value :(.

It's frustrating, because I don't like seeing things move on an upward trend. But, I think, in a way, this will be good motivation for me to buckle down and work a little harder to take control. It's a good kick in the a$$ and probably what I need to wake up. I'm not expecting anything over night, though that would be nice, but with small steps, I know I could do so much better. It's not impossible, nor is it exactly easy either, but I'm planning to do my best and that's all anyone can do. :)


Blogger Scott K. Johnson said...

I think that logging has helped a lot for me. If nothing else it just keeps me honest.

I do believe that even just logging will tighten things down for you though. Something about writing everything down.

I've really liked the "My Other Checkbook" logs, but have also started using an excel spreadsheet that Kevin sent me. I'm sure he'd be fine with sending it along to you as well. Let me know.

9:26 AM  
Blogger Johnboy said...

I have to agree with Scott about both logging and testing. I use the same logbook he does.

Your endo sounds awesome btw. It is highly unusual to get a mobile number like that.

Good luck!

9:55 AM  
Anonymous Tiffany said...

First off I want to congratulate you on that A1c. And before you tell me to go to hell, here are my reasons:

- 7.5 is an acceptable GHb level. I know that your concern is more the fact that it has increased, but;
- you recognize that you are having fewer Hypo episodes now than in the past, when your A1c was lower. So in reality, nothing may have changed except the fact that you are not going low and your A1c has increased in relation.

IMHO, physicians and other health care professionals tend to focus Too Much on the A1c as a number. I will not argue its obvious validity, but I will question its deficiencies. The largest being the inability of the GHb test to differentiate between the high's and low's, and the resultant dependence upon those numbers. It's an average, and as with any average, it has limits.

So, having said that, I applaud your desire to start logging. In fact, I encourage you to do so. You need the background in order to see the picture. The same can be said for BG testing. I couldn't imagine testing only 5 times a day; at present I test 12 times daily (on average--sometimes I ring in at 20+ tests) and still feel as though I'm missing an inestimable amount of BG levels. And I am.

You're on the 511, right? Maybe you should consider upgrading to the 515/715. The bolus wizard cuts out the need to do math in your head and stores the amounts of carbs inputted. The whole unit can be downloaded into Minimed's CareLink, where manual entries can also be included (exercise/ketones/etc). It's not perfect, but I've found it to be more convenient than writing every little thing down.

If you need any help at all with your basals, whether it's testing or adjusting or deciphering your results, I'm here for you and glad to help in any way.

Keep smiling. You're doing great!

10:12 AM  
Blogger julia said...

Can I just say ditto to Tiffany's comment? O uses the 715 and it's only fantastic. Also, you can download the pump and meter to your computer and make these cool graphs and stuff. I also second Scott's suggestion of My Other Checkbook. It's my favourite log book. I tried the Excel thing, but found the log was easier for me.

And if it helps, I'd KILL for O to have a 7.5 a1C.

8:23 PM  

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