Endo woes.

This story is not all bad. Like all visits with my endocrinologist, I learned something and had a good discussion. But it wasn’t everything I’ve come to expect from these quarterly get-togethers.

My day began as usual: Get up, get showered, get dressed for work, get breakfast. After breakfast, I headed over to my endocrinologist’s office for my quarterly visit.

I get there, get checked in, and about five minutes later, a lab technician takes me back to get my blood drawn for my A1c. Then I’m sent back to the waiting room until I’m called by my endo. Then… about 3 or 4 minutes after I sit down in the waiting room again, the technician comes out with candy in her hand.

“Here… you need this… you’re 51.” Cue the embarrassing feeling of being stared at by aaaalll the people in the waiting room. Both of them (it was early). Not that I know this was really happening. It just felt that way.

What? I had eaten breakfast about half an hour earlier! And that’s when I began to learn that you can be just as embarrassed about low numbers as you can about high numbers.

Sure enough, when my doctor came out to get me, she said, “Well, not only are you 51, your A1c is [I’m omitting this part, but trust me… it’s significantly lower than the last one]”.

“Are you having lots of lows?” she asked. And I answered, “Well, you know, not too many, blah, blah, blah”. In other words, I lied. Sorry Dr. Pao, if you’re reading this. But you probably already know anyway.

In fact, I have been having (at least) a couple of lows every week. Usually in the 40s and 50s. I’d really gotten my focus to extreme control. In other words, I hated to see even a 120 mg/dL on my meter. A number like that would drive me crazy. So I’d work hard on getting that down to under 100. I worked hard on getting all of my numbers under 100. Of course, that kind of control puts you much closer to the hypoglycemic part of the blood glucose spectrum. Add in additional workouts to get ready for my bike ride and (hopefully) a triathlon, and now I’ve got even more to worry about. I have to write this out, so I can admit it and get it off my chest: I’m too low all the time.

She mentioned something else that’s stuck with me since then. I told her how I’m tired all the time, like really tired, even while working out, which I’m not used to, and which scares me a bit. And she said basically, yeah, when your glucose is low all the time, you’re tired all the time, and your muscles are sucking up all that sugar right away, even if you’re taking on extra for your workout (mentally, she’s probably thinking “Duh!”). So it’s okay for me to have 115 or 120 or 130 on my meter on a regular basis as opposed to 75 or 65 or 55 on a regular basis. Maybe (and I’m extrapolating here), running higher than I have been will help rejuvenate me a bit. Maybe I haven’t realized just how energy-sapping all those lows have been, cumulatively, over the past three months.

So I’m going to have to change my internal messaging to allow myself to think it’s okay if my meter reads in triple digits. Now, I realize how some People With Diabetes who are reading this must think I’m the luckiest guy in the world, and they probably wish they had my stupid problem, and I get that. But getting the numbers in a good range is tough, regardless of which side of the range you start from. This is my problem. It’s not common among PWDs, but it’s a problem and I have to fix it.

We’ve determined that my basal rates were too high, and I’ve ratcheted down every one of them at least a tenth of a unit. Already, I feel like I have a little more energy, though the real verdict on that will come over the next few weeks. On the bright side (additional testing), my kidneys are still functioning well, and my thyroid appears to be humming along nicely too.

In the final analysis, this visit with my endocrinologist is the first one I can remember with this doctor where I didn’t walk away feeling great. My fault? In this case, yes. I feel like I let my doctor down. I also resent feeling that way. But why? I think it’s because—and I think many PWDs feel this way about their HCPs—sometimes incorrectly, sometimes not—having to please one more person just bothers us more than we care to admit out loud. We just don’t want to take on the burden of pleasing one more person. Or in some cases, even one person. We’ve got enough to deal with already.

In my very personal case, I also need to remember that my endocrinologist has helped me a lot. She’s done a lot for me. So given that history, it’s really in my best interests to be open to her advice. But even if that weren’t true, I still have to concentrate on me. Making my numbers work for me. Making my numbers work for me means I’ll be in a place that ultimately makes me happier, and without thinking about it, will make my endo happier too. So as always, yesterday doesn’t count anymore. It’s only information I can use to make today and tomorrow better. I’ll let you know how successful my efforts are in three months.

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  • Rachel Hils  On April 28, 2014 at 11:03 am

    Thank you for sharing! I love your blog! 🙂


  • Katy  On April 28, 2014 at 6:09 pm

    the temptation must be HUGE to ride low when the reward is a low A1c and big gold (imaginary) star on the front page of the chart.

    I’m glad you take good care of yourself. I love reading these stories.


  • Mike Hoskins (@MHoskins2179)  On April 29, 2014 at 9:48 am

    I’d be slapping myself in that waiting room after the barrage of Low-handlers came out… hey, did you feel Low at the time? I totally feel you, in looking at it as a point to learn from and move forward and deal with the lows. Recognizing the trends is the first step, and it’s always the toughest (for me, at least) to actually do something about it. But I also find that writing it out helps me wrap my head around things better and even motivate me to take action. So, here’s hoping for that on your end, and that things balance out soon. Still, although it may be low-rigged, congrats on the A1C decrease!!


  • Karen  On April 29, 2014 at 2:43 pm

    I absolutely agree that it’s just as big (and frustrating) a problem to have too many lows as it is to have too many highs. And that they suck energy like nobody’s business. (Ask me how I know . . . . ) 😉


  • Scott E  On April 29, 2014 at 6:12 pm

    Another story that rings familiar to me. There was a time, probably about 14 years ago, when I strived to get in that 80-90 range. And yes, I had a lot of lows. A couple of overnight ones, and given that I lived alone at the time, they were more complicated to deal with. (My A1c was nothing to brag about, but this is before pumps and CGMs, and possibly before Lantus, so my ability to control was limited). Eventually I got shocked back into reality and raised my targets.

    But even now, all those years later, I get a bit nervous when I see a blood sugar number that is fewer than three digits, and I wish a 95 made me comfortable. It’s not easy to make that mental shift, in either direction… I hope you don’t find it tough do it.


  • Kelley  On April 30, 2014 at 3:32 pm

    Thanks for sharing your story! I had no idea lows could make you tired, there really is a fine balance with diabetes (and it’s so hard to attain!). Hopefully the new rates will help curb the low/lows (40’s aren’t much fun!)


  • Martin  On May 2, 2014 at 4:28 am

    I know you feel that you need to please your endo, but at the end of the day you also need to be feeling good in yourself. Clearly you are a fit and healthy person so if you’re feeling fine, I would worry less about the highs and lows.


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