Tag Archives: A1c

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.
 
 
 

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.
 
 
 

The future is not yet written.

Sooooo, how did that visit with my endocrinologist go last Thursday?

For the first time in a long time, I was seriously worried about a visit with my endo. Simply put, I have not been a good citizen. As far as I could tell, my BGs were running higher than usual in the past three months. On top of that, my eating habits weren’t so fantastic either. I was sure that the results of my tests were going to be awful, and I was going to have to make some serious changes to get back to where I’ve been for the last five years.

I was very concerned about letting down my endocrinologist, who’s been instrumental in helping me focus on the right things, helping me keep my numbers in a good place on a consistent basis.

So… So… How did it go?

Surprisingly well.

My A1c stayed exactly where it was last time. I did manage to gain two pounds over the holidays, but I thought the scale was going to show I had gained much more. I’ve got some work to do, but overall, it could have been much worse.

I’ve spent a lot of time thinking about it over the weekend, and I think there may have been one thing that helped me.

I did a lot of glucose checks every day. Probably more than ever before. Even when I knew the number might not be good, I tested anyway, so I could make corrections if necessary. And there were days when I made a lot of corrections. That may have made the difference. Diligence works.

Going forward, I have two things to remember. I need to work out more often, without a doubt. And I need to eat better. Which, thankfully, I’m already doing.

Hey… Listen, it’s true that this diabetes thing is really a marathon, and not a sprint. That said, I’m glad that last week’s visit turned out well, and I’m happier still that I have a chance to be even better going forward. The future is not yet written. And I’m encouraged by that.
 
 
 

Sometimes, I just hate getting blood drawn.

Excuse me while I vent a little…

I had to get blood drawn today for the clinical trial I’m participating in. Instead of going all the way down to Virginia to get it done, the team there sent me a lab slip so I could get the work done here. Fine so far, right?

So I go into the local corporate-owned lab processing place (are there any mom and pop lab processing places?) and gave them the lab slip that had been scanned and e-mailed to me. In the office there was me and three lab technicians. That’s where the trouble started.

“This says ‘Virginia’ on it… I don’t know if we can do that here”. Well, yes, you can. You’re a multi-state organization, which is why they chose you to do the work (I live in Maryland, for those who don’t know).

“This doesn’t have your name on it, just your initials… I don’t think we can do this without your name on it.” They’re trying to keep the study participant information as private as possible, I think, and I just let you look at my driver’s license, and by the way, the form says “patient’s initials” where my initials are.

“Okay, we just need your name, date of birth, your phone number, and your address.” Really? Do the words “Patient Privacy” mean anything to you? Actually, that’s only what I was thinking, it’s not what I said. I eventually gave it to them to keep the process-at-a-snail’s-pace moving.

What I said, eventually, was: “Look, I’m not going to come in here out of the blue with a forged lab slip because I like going around and getting poked in the arm all the time. No one would do that.”

Ten minutes later, the blood was drawn and I was on my way. After answering questions like “did we get your date of birth?” (Yes) and “This goes to Johns Hopkins, right?” (No, University of Virginia). Start to finish the process took about 50 minutes. And I was the only patient in the place.

I was a retail manager in a previous life, and I know this is a different setting, but let me put it this way: I never believed in the notion that “The customer is always right”. My feeling was, the customer should never be made to feel that it’s their fault if they’re wrong. If I hand you a piece of paper that doesn’t look like every other piece of paper you receive (even though it does have your company’s logo at the top), let’s work together so I can ease your fears and you can ease mine.

If we had worked together, the whole episode would have taken less time, and you and I probably would have had smiles on our faces at the end of the process. If you even care about that kind of thing. Which, maybe, you don’t.
 
 
 

Has it been 3 months already?

Happy Labor Day in America! Here in the USA, we set aside the first Monday in September to celebrate those working souls who have, and continue, to help make this country what it is. At least the good things that it is. Those working souls are most of us, so here’s to us.

Has it been three months already? In fact, it has been three months since I last visited my endocrinologist. Last Friday was the time to get some tests done, talk about the last three months with regard to my diabetes, and make any necessary adjustments.

My A1c? It was a little better than last time. Out of deference to some of the people I’ve been reading in the DOC (Diabetes Online Community), I’m not revealing what that number is anymore. Those people are right… it’s just a number, and I don’t want anyone feeling really good or really bad about where they are based on my numbers. Everyone is different. Your Diabetes May Vary.

We talked about a lot of things in this visit. We decided that I need to adjust my nighttime basal rate down a bit, and also adjust my morning basal down a bit.

But I also admitted to something that I think I’ve been doing for a while, but I haven’t let on to yet:

I feel like I’m starting to bolus based on where I want my BG to be, rather than based on where my BG is and what I’m eating. I think that I’ve been starting to say to myself, for example, “Okay, I’m a little high now; I’m going to bolus a little extra to get to where I want to be, and 100 mg/DL is too high”. Do you do that, or is it just me?

My endo told me that my insulin usage has been about 60% basal, 40% bolus. Interesting to know, but is that good? It turns out that the percentages should probably be a little closer to 50-50. However, she added, “That thing where you’re over-bolusing to get to a certain low target? Stop that.” Okay, Doctor.

We also talked about my 100 mile bike ride back in June, where I had gotten dehydrated at the end. I’m hoping to do a ride co-sponsored by JDRF in a couple of weeks, and I was seeking advice on how to keep history from repeating itself.

The answer is to get a little more salt in my system prior to the ride, to get a little more protein in my system during the ride, that electrolytes are good early in the ride (but not late), and to listen to my body, and if it’s bothering me, to give it up and live to ride another day.

That’s about all. It was a good visit. I like being able to talk with a doctor who speaks the same language. Who I can ask questions of, and who I feel comfortable answering questions from. Not much more to it than that. I hope your next visit goes as well.
 
 
 

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