Tag Archives: endocrinologist

Diabetes By The Numbers: Dr. Vivian Pao (Part 3)

I’m so grateful to my endocrinologist, Dr. Vivian Pao, for taking the time to speak with me on the complex relationship between a diabetes patient and their endocrinologist.

This is the third and final part of our talk, and in this episode, we talk about the importance of being honest with your endo, and what keeps her up at night.
DBTN
 
Reference Material – Click below for more information on this topic
Learn more about endocrinologists, read research and updates, and even search for an endocrinologist by clicking on one of the links below:

American Association of Clinical Endocrinologists

Endocrine Society

Pediatric Endocrine Society
 

Diabetes By The Numbers: Dr. Vivian Pao (Part 2)

Some people only get to spend about 40 minutes each year with their endo… I got to spend close to an hour with her last week. The conversation was so good that I’ve broken it up into three parts.

In this episode, we talked about how an endocrinologist considers outside factors, including depression, in treating a Person With Diabetes. Also, she talks about how she stays up on the latest and greatest in her profession, including a reference to Dr. Oz and some “raspberry, ketone thingamajiggy”.

This is part two of our conversation. We get into a lot more in part three. I hope you’ll join us for that. In the meantime, here’s Part 2.
DBTN
 
Reference Material – Click below for more information on this topic
Learn more about endocrinologists, read research and updates, and even search for an endocrinologist by clicking on one of the links below:

American Association of Clinical Endocrinologists

Endocrine Society

Pediatric Endocrine Society

Diabetes By The Numbers: Dr. Vivian Pao (part 1)

“Who is this Dr. Vivian Pao anyway?”, you might ask.

She’s my endocrinologist.

Some people only get to spend about 40 minutes each year with their endo… I got to spend close to an hour with her this week.

Together, we talked about what exactly an endocrinologist specializes in (in addition to diabetes). We also covered what she’s looking for from a diabetes patient at the quarterly appointment (and more importantly, why); and why she made me wait before allowing me to begin on my insulin pump. Hopefully, you’ll begin to understand why I believe in her the way I do. She is a huge, important part of my diabetes care team, and I value her input very much.

The best part is, this is just the first part of our conversation. We get into a lot more later on. But you’ll have to wait for that. Sorry. Our talk was just too good to cut out questions for the sake of brevity.

Part 2 is coming in the next installment. In the meantime, I hope you enjoy this view from both sides of the desk.
DBTN
 
Reference Material – Click below for more information on this topic
Learn more about endocrinologists, read research and updates, and even search for an endocrinologist by clicking on one of the links below:

American Association of Clinical Endocrinologists

Endocrine Society

Pediatric Endocrine Society

Endo visit: 20 Follow-Ups.

It was 90-day endo visit time this week, and things went pretty much according to plan.

Stethiscope

My hemoglobin A1c is still in a very good range. But the really good news is that I seem to be getting there with fewer crazy blood sugar swings over the last three months. The data she downloaded showed only a few morning lows, and nothing super-duper low. I had a few other lows sprinkled in there, but not too many. We made a change to my overnight basal rate, dialing it back just a tiny bit to see if it gets me up enough that I don’t risk nighttime hypos. Other than that, I seem to be doing just fine with my settings where they are.

We also spent a little time talking about insulin pumps. I’m still thinking about which pump to go with. Which secretly means I’m hoping for newer versions or different offerings to be announced for the pumps I’m considering. Of course, that’s crazy talk. Nothing’s perfect. I just need to pick the one that works best for me and just go with it.

I’m a little worried about the startup cost too. It’s hard to get me to spend money, even if it is for a good cause… me. But we just had to have some work done on the house, and it was very expensive. Although it looks like I will get an exercise room out of the deal. So I’m at a different level, but I still have to decide right now between doing something to make me healthier, like getting a spin bike for my exercise room, or doing something to keep me healthy, like spending $500-$600 to get started on a new insulin pump (my cost after insurance). I’ll spend money like this sometimes, but almost never without seriously thinking about it. That’s part of what’s kept me from incurring huge amounts of additional debt. I’ve said “No” to myself more times than I can count.

I also got a good check on my blood pressure, my lungs, and my feet… all of which appear to be okay right now(!). When it was all over, I wound up with a couple of backup insulin pens (because my previous ones had expired), new prescriptions for test strips and other meds, and a new appointment in February.

I did notice something in my paperwork before I went in to see her. It noted that this was my 20th follow-up visit with this endocrinologist. That’s over five years with one doctor… I’m pretty sure that’s a record for me. Otherwise, not much to tell this time around. But isn’t that a good thing anyway? I mean, if I ain’t broke, don’t fix me!

But feel free to take care of that malfunctioning pancreas thing as soon as possible…
 
 
 

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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