Category Archives: Endo

My turn.

I went for my quarterly visit with my endocrinologist last week. We talked about a great many things.

My A1c is still excellent, but she’s concerned about night time lows. We lowered my overnight basal rate, and that seems to have solved my problem for now.

But I’ve been concerned about the amount of insulin I’m injecting these days. Along with the overnight lows, I’m seeing more numbers over 200 mg/dL than I’m used to.

For the first time in the eight years I’ve been seeing her, we used the words “insulin resistance”. As in, I feel it’s taking a lot more insulin to bring me within range than it used to. I’m very concerned about that, especially because extra insulin not used means extra insulin stored as fat around my midsection. I have enough of that already.

We talked about the fact that I’m active, but also in my mid-50s, which means my metabolism is crap. I eat less now than I probably have at any time as an adult, but I’m frustrated that I can’t seem to drop the weight in measurable numbers.

For now, the plan is to let my endo manage my basal rates, and I will handle the boluses, possibly including dropping my insulin to carb ratio. The change in basals is keeping me from going low overnight. I haven’t lowered the I:C ratio yet, but I’m thinking about it. Those post-meal spikes are really bothering me.

At the end of the visit, she asked if I was considering another pump to replace my Animas Vibe (Animas is out of business in the USA). I told her my general feelings about the various pump options out there today.

I also told her if those options don’t change by the time my warranty is up, I may consider going back to multiple daily injections. After all, a faster-acting insulin is available now, and maybe that will make a difference. She excused herself for a moment, and came back with this:

A sample vial of Novo Nordisk’s Fiasp, the faster-acting insulin we were talking about. I was under the impression that it could only be injected via a syringe. I don’t do that often, but I told her if I ever needed a correction bolus or my pump failed, I would give it a try.

She encouraged me to try it with my pump. I took the sample home, and then took to Facebook to see if there was anyone else who had used Fiasp in a pump.

If you ever want opinions, just ask what People With Diabetes think about a product, and you will get all kinds of responses. I certainly did. Some people love Fiasp. Some hate it. Some see it as very effective in their pump for a day or two, and then not effective at all after that. Some have no desire to try it at all.

I was glad to get all of that feedback. In the end, the decision will be up to me to decide how I like this new insulin. For a little while though, it’s my turn to try it out in my insulin pump. More to come on this in a couple of weeks.

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More clarity in the Clarity.

I got a chance last week to see my endocrinologist again, my quarterly appointment time coming due, and I’ve got to say, it was an interesting experience.

The appointment started with me arriving ten minutes early, but waiting at least ten minutes to check in at the desk, because the office is under a new medical group with new computer systems. That means additional signatures on additional pieces of paper that are not usually part of the quarterly check-in.

The wait became even greater after five more patients showed up in the next three minutes (it’s a big practice). I was never so happy to have been early for my appointment, even if I did have to stand due to a supply of patients that were greater than the supply of available chairs in the waiting area.

Once I saw my doctor, it was fairly clinical. But it was different from what my quarterly appointment might have been just a year ago.

Back then, I didn’t have a Dexcom Clarity account set up to help track and report on trends from my continuous glucose monitor. Now I do, and instead of using hearsay (from me) to decide where to tweak my basal rates, we were able to use something much more reliable: the actual data itself.

We found out that the lows I’ve had recently have been happening, mostly, right before lunch. If I get lunch at my normal 12:00-12:15 time, no problem. If it’s much later than that, I usually encounter a low. ”It’s because you’re so fine tuned”, says my endo. ”If your schedule is off just a little bit, you’re going low”.

That’s true. We’ve worked over the years to get my basal rates to the point where, most days, I don’t see a lot of BG variation, and my average glucose is in a very good range (I know it’s time in range that matters most, but let me have a little victory here).

We also spent some time talking about the Freestyle Libre. I shared the highlights of my 20 day trial, and she shared that she thought it might be a great option for Type 2s who are really averse to fingersticks. It will be interesting to see where it goes from here.

All of my vitals are pretty good right now. I’m not getting any flack for adding weight since my surgery last year, and I’m half grateful/half hoping she’ll give me a hard time about it. To be honest, I’ve found shedding weight to be a nearly insurmountable task at my age. No matter how hard I work, no matter how I change my diet, I keep adding a couple of pounds per year. Trust me when I say, I would do nearly anything to drop about 30 pounds.

That’s the bad story from this visit. I’d like to add a really good story to the next one. I’ve got about 90 more days until my next check in, and I have a lot to work on in the meantime.

Endo Visit, part 1000 (or so).

Tuesday marked another quarterly visit with my super endocrinologist. Despite the fact that this was the thousandth (or so) visit with her, we still had plenty to talk about.

After going over my A1c result (still excellent, but a little low), the biggest topic of conversation was analysis of my CGM data. This is the first appointment that included a measurable amount of CGM data to look at, and that made this appointment different than most.

She’s concerned more about overnight lows than the lows I’ve had just before dinner. So we dialed back the basal on my insulin pump between midnight and 8:00 a.m. We’ll see if that does the trick.

If I really want to be honest with myself, the truth is that I’ve been a little aggressive correcting post-meal high blood sugars. So I’m getting to 80 to 100 mg/dL before bed, and going to sleep for six or seven hours while my BGs get lower and lower.

I was also honest about all that with my endocrinologist. At some point in my life, I decided that I needed to get over my feelings of what someone might say about me when I let my guard down and admitted where I might have come up short.

Now, this is where you might say, “great, everything’s perfect”. But you know what? What I really needed was to work with a doctor who would listen to what I was saying and work on a strategy to solve those shortcomings, without interjecting guilt into the conversation.

I mean, it’s one thing to let my guard down and speak the truth. But it doesn’t mean much if it doesn’t result in a plan of action put together in conjunction with my medical team.

It’s easy to take that for granted after several years with the same endo. What we really have to remember is to find a healthcare professional (or team of professionals) who will help us find the success we seek with our diabetes. When we do find that healthcare professional (or team of professionals), we have to remain grateful and let the process of working on a better life with diabetes take its course, wherever it might lead.

Both of those things can be difficult, but they are both worth the effort it takes to get there.

Other than that, I got a couple of prescriptions for things that are new (like Accu-Chek Guide strips) and things that need to be replaced (like expired backup insulin pens). We talked about the #BeyondA1c workshop a couple of weeks ago, and the upcoming Friends for Life Falls Church, Diabetes UnConference, and Diabetes Sisters Weekend for Women gatherings.

We only get so much time with our endos and diabetes educators. Precious time. If you can, it’s worth it to spend the time pursuing the best results possible, together.

I admit it… I’ve got a great endocrinologist.

I like my endocrinologist. There, I said it.

Endos are sometimes a source of dread, or frustration, and some people wind up having to explain a lot about newer technology or drug developments to theirs because, let’s face it, diabetes changes sometimes move faster than their doctor.

But I don’t experience any of that. My last appointment a couple of weeks ago included the typical A1c, and a little blood work. Cholesterol, kidney function, that kind of thing. Vital signs, download of the pump data. Everything checked out okay, though I’m carrying around slightly more calcium than I should be. Who knew you could have too much?

We spent the rest of the time talking about a clinical trial I’m considering, about insulin pricing, and about a recent NBC Nightly News story on a family that peruses Facebook groups to find insulin their child needs, trading insulin their family’s insurance covers but their child is allergic to (“I wish some of my patients would ask about freebies… I have lots of samples!”).

Yes, she told me that she wished more of her patients would ask about insulin samples, if that’s what we’re even calling them now. Funny, I didn’t think to ask why she doesn’t suggest freebies for her patients. I’ll put that on the list to ask her next time.

We talked about starting on my Dexcom, since I was only about two weeks in when I saw her the last time. I told her, honestly, that wearing it on my arm has made it seem far less intrusive than if it were in my midsection. Which, by the way, is part of my trepidation of doing this clinical trial, because I’d be required to attach both the pump and the CGM around the middle of my body for the duration of the study.

I also mentioned that the CGM has given me real confidence that my basal rates are still very good, because once my trend graph lands in a good place, it tends to stay there for hours at a time. “But you’re going to let me know if you start training for something again, right? I remember that’s when you’ve had real trouble in the past”.

She knows me well.

We also talked about Dexcom Share. I don’t have an Apple phone, or a Pebble watch, and I’m not sure if the G5 is compatible with that anymore. We don’t agree on everything. But I trust her judgement enough that when she suggests something, even if I have questions, there’s a pretty good chance I’m going to do it and do it with gusto, because I trust her judgement that much.

Working with a medical team you can trust means a lot. The give and take between patient and doctor is a relationship that requires a fair amount of nurturing. And it’s changed over the two and a half decades I’ve been living with Type 1 diabetes.

But when it works out, the end result is terrific. It happens when both sides of the conversation engage freely and openly. It’s really great being with People With Diabetes, because they just get it. I consider myself quite lucky because I have an endo who gets it too. If you can’t talk about diabetes with another PWD, or your endocrinologist, who can you talk about it with?

I feel like I’m healthier, and making better, more well informed decisions than I’ve made under any other medical care team, endocrinologist or not. Finding people who help you with your diabetes and your diabetes knowledge are worth the effort. YOU are worth the effort. And I support you… no conditions.

Still wondering.

So… I’m somewhere around three weeks until the next appointment with my endocrinologist.

My last several A1cs have been excellent for someone living with Type 1 Diabetes.

But how have I gotten there? I wonder.

Did I get there with perfect blood sugar numbers all the time?

Did I get there with lots of lows?

If I had a lot of lows, did I do more damage to my overall health than that A1c number is worth? For the record, my basal insulin delivered versus my bolus insulin delivered always turns out to be pretty much what they are supposed to be, I’m told.

But still… What if I’m using too much insulin to knock down potential highs, leaving me with extra insulin that’s just going to get stored around my midsection? Honestly, I’m really worried about that.

What if those lows are killing off brain cells, causing other issues that I haven’t imagined up until now?

What if my A1c looks good, but my highs and lows go up and down through the day like an EKG, instead of like a normal person’s pancreas works?

I mean, look… On paper, I’ve been the model student for some time.

I’m still wondering if the truth is something different altogether.
 
 
 

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