Search This Blog


Friday, February 27, 2015

Thoughts: high a1c, new endo, babies, stuff, etc

Yesterday morning I went in to meet my new endocrinologist. In the last year, I had a lot of stuff going on - defending my Ph.D., moving, starting a new job as a non-student for the first time (add on top of all that the fact that I had no health insurance for about four months and you might imagine how my D care suffered). My last A1C last spring was 6.8 - I was pretty happy with that and aimed further for 6-6.5. And then life happened. And I feel a giant slew of responsibility on my shoulders now, because I just had my blood drawn yesterday morning and just now I learned that my A1C is 8.6. 8.6 is the highest ever A1C I have ever had in my whole 7 or so years of treatment. I had a 8.3 after my year abroad, where I lacked test strips as well as common sense (I was 21 so you know). Now however, I am going to be 27 in April. And one of the first questions my new endo asked me was : Are you planning a pregnancy? To which I responded : Not quite yet, but I hope to start having children in the next year or two. And he was so supportive and nice and smart and respectful., I told him I knew my A1c was higher that last time, but I thought it would be in the high sevens, certainty not the 8s!

Anyway, I can't help feeling that I let myself down, and that the good impression I thought I made on him yesterday is now marred by this number. I know it's just a number, I know I'm not defined by it. I also know that I have to be more honest with myself and make some changes. We discussed what changes I can make (adjusting my basals up until I finally lose thaty 5 pounds I gained over the holidays, prebolusing, exercising more regularly, making sure my fasting #s decrease, etc.). The thing is the bgs downloaded from my meter (more recent ones) weren't half bad - there were definitely way more 100-somethings then not. And I have like no lows. And overall, it was clear from my logs and our conversation that he thought I was doing pretty well (at least in the recent week) and that with a few tweaks we could really reign in the highs. He told me that my notes from my old endo talked about how good I was at micro-managing my self-care and making dosing adjustments, how my endo trusted me. My new endo said that he gives me the reigns (which is not something that he does for every patient). He told me to tell him immediately if I get pregnant (and I'm half-expecting a call saying something like - DON"T DON'T - Not with that A1C). But I also know the call probably won't come - because he knows that I know better. He already knows that I'm hard on myself. And that I've read too much, I know too much, all the negative statistics (outdated or not).

I told him a story of earlier this week when my bgl was 75 less than 2 hours after lunch and I had to drive somewhere. I ate 4 glucose tablets. And an hour later I was 230. I should've had 1 - I said - but I wasn't sure and I HAD TO drive. He said - that's the thing - life doesn't stop for diabetes - we can only do the best we can do - don't beat yourself up - I would call that over-treating if you were sitting at your desk - but you were driving and it's different. Don't be so hard on yourself, he said. I don't care what your A1C is - he said (not is the sense that it's not important, in the sense that he already understands that I am hard-working and motivated, and that I'm in a transition point in my life where adjustments need to be made).

The good news - I really like my new endo. Also, all my other labs were great - no complications as far as we know. Cholesterol, lipids, thyroid, urine analyses, etc etc were all great. So there's that. I can do this. Just because my A1C jumped almost two points this year does not mean that the world is coming to and end, and it certainly doesn't mean that I will stop trying. I will work harder, I will be more diligent. But I will still live my life (although I need to make adjustments to prioritize my D management more).

It was weird - my husband and I have talked about kids a lot recently. We may even discuss TTC as early as the summer. A lot of work remains ahead but I'm more than ready to put all my diligence for striving for this new chapter of our lives. I really like my endo's perspective on pregnancy - I didn't realize this before, but the pregnancy a1c isn't as accurate as a regular person's one because of the changes the hormones have on the hemoglobin molecules (weird huh?) We are on the same page that we would rather my a1c at 6 with now lows that 5 with 30s all around. He is so well-trained as both a DO and MD and has many pregnant type 1s. He also assured me about the great OB/Gyns he knows that routinely deal with T1 pregnancies - and that I don't even have to see him that often if I don't want to as long as I'm in touch and doing appts with the Ob/Gyns... Anyway, it's good to have a supportive doctor, at least I am now looking forward to hopefully making improvements and seeing him again in 6 months - not feeling scared that he will judge me or make me feel guilty - because he really is great!

Sigh. I am so excited for spring to come. It is after all a relief that all my other labs look good, and that I'm generally healthy despite the high bgls and a1c. I'm going on a cruise leaving from Italy and the end on June and I am so excited! I am excited to start hiking wiht my three dogs on a regular basis again once this cold goes away! I am excited that I have the support of the doc in my diabetes and life adventures!

<3 thanks all

Thursday, February 5, 2015

Meets the eye

I did it! After about 23 months I went in for a dilated eye exam. By went in I mean went down two flights from my office. Really- I had no excuse for prolonging the inevitable other than being terrified. Yup (see previous post). I think after being traumatized by a terribly judgemental eye doctor two years ago I was really dreading this - that's the thing - I wish more docs understood that blame games and scare tactics make me want to run far away and never come back!

It was better this time. I was seen by a 4th year student and then also by the attending - essentially my eyes were double-checked. In fact, I believe that happened because of diabetes. I though I was all done but them more flashing lights (just to be sure). As he examined me he routinely quizzed the student on random shit like "what is the most likely primary location of developing NPDR?" At which point I was like "please stop saying NPDR! You're freaking me out!" He laughed - "don't worry"

The thing is I did worry - from the moment I sat in that chair and the student collected all my info. "Do you have any eye disease?" "Not yet" I replied in my best humorous voice. "Why are you so worried, don't worry" they kept saying (so worried in fact that my bp clocked in a systolic of over 140 with a pulse in the 90s - I assired them that I have a bp monitor at home and it's normally fine -all true). Here's the thing: I realized I feel like my poorish diabetes control especially recently (while not extremely terrible but definitely not great) would definitely warrant complications. I thought the time was now. I fully expected to be told that diabetes fucked up my eyes. Being that the blood vessels are soooo teeny tiny there we all know that that's where the first signs will show up typically. So after 8 years (of which about half I would consider subpar management) I fully expected to be handed a new diagnosis and join the complicated club. I went in prepared for the worst: telling myself that I would not be alone in this and that information is power.

Between the two of them, they found no eye issues related in any way to diabetes at all. I think everyone could sense my sense of relief in a profound way that day. Knowledge is power and I felt very empowered in knowing that at this particular moment my eyes are very healthy. And I'm grateful for that fact. The thing is I feel I dont deserve it and yea I know how fucked up that sounds. I know that ydmv and that people who are well-controlled experience complications and that sometimes people with worse control do not. Genetics, epigenetics,etc. In any case - I felt guilt for having healthy eyes with not great control. Based on my last reported a1c from last spring! (6.8) the docs congratulated me on good control and told me to keep up the good work. I could not bring myself to tell them that my current a1c is definitely higher and that during the appointment my bg shot up into the high 200s. He left me with "there are two things with eyes and diabetes. There's time and there's high blood sugar that contribute to disease." I thought it was interesting that he aknowledges that even with good control time can still influence things. I laughingly dropped a line about well controlled diabetes being the leading cause of nothing whilst knowing perfectly well in my head that perfectly controlled diabetes is impossible.

Ok- lets go back to the fact that my eyes are healthy. That the poor control I experience form time to time (while a consequence of my actions or inactions) is no reason to blame myself for being human and far from perfect. Between the 6.8 and now a lot has happened. There was my dissertation and phd defense in July, coupled with a move and starting a new job in the same month. There were months of     not having health insurance. There was the fuck it I'm out of grad school parties, and Christmas and travel. I am quick to blame myself. It's important to remember that I have a life that isn't all about diabetes management! I should be proud of my accomplishments, proud that I've managed to care enough to test often even if I'm running high a lot. Proud that I haven't experienced debilitating lows. Proud that I'm very motivated to get better control and at this particular moment things are better and I couldn't be happier about that!

Yep, there is much much more to diabetes than meets the eye. Here is my dilated eyeball. Please ignore the incoming  wrinkles that graduate school has induced - love you guys!!!
<3 MM ;)