Friday, January 4, 2008

"Very Poor" Diabetes Control

I awoke this morning to a message from my primary care doc. The tests showed no infection, but a blood glucose level of 345 and an A1C of 8.5. She informs me that 8.5 is "very poor glucose control", and advises me to make an appointment with an endocrinologist.

Since I was just getting out of bed and grumpy, I momentarily questioned whether I should keep this woman as a doctor. I know 8.5 is not a good number by any standards, but it's actually better than what I was expecting. At my worst, sometime in late high school or early college, my A1C was once 10.5 or something like that, maybe even 11. (Snarky Author's Note: 11 is good, if you're Spinal Tap. Not so much if you have diabetes.)

I breathed for a moment, and realized of all the diabetics out there, it's been proven that many of them have no interest in getting their disease under control. I think it must be standard doctor's rigamarole to make you feel as terrible as possible for whatever your A1C level turns out to be so you'll be interested in seeking help. My primary care doc had pretty much talked to me for the first time the other day, so I can't expect her to know anything about me. My medical records from my last primary doc haven't been sent over yet.

I think I've been lucky in the past with general doctors. My doc in Delaware worked right next door to Nancy the NP from the Diabetes Center. Their reception offices were actually connected! Way back, when I was still living in Williamsport, my endo was the only one in town, and my doctor was a pediatrician who had previously employed my grandmother as a nurse, so I was already known there...haha, since birth, actually.

For now, I shouldn't hold it against my regular doc for sounding so scolding. I also did exactly what she told me, which was to make an appointment with the endocrinologist we talked about. That won't be until February 20, but in another show of trying to make up for people who have no interest in controlling their diabetes, this new endo's office requires a $75 deposit for the first appointment. If you show up for the appointment, they refund your money. Actually, I think they'll just hold the check and give it to you when you show up. If you're a no-show, it'll cost you $75. I had never heard of such a practice before. I wondered if this endo was going to be worth seeing, but then...

I got an email from Gary Scheiner. After the other day's self-rallying-cry/mopefest, I realized that Gary, one hell of a highly-respected CDE who definitely knows what it's like to be Type 1, is practically around the corner from me. His Integrated Diabetes Services office is probably only half an hour or so away from here. Geez, I thought, if I'll drive half an hour to go to a poetry slam, I can certainly drive half an hour to make an investment in my health with somebody who knows what they're doing. I had asked him some questions, which he answered, and then he made a recommendation for an endo who's nearby.

Amazingly, this is the same endo I already made an appointment with at the request of my general doc. Maybe my doc is not so bad after all. And once I show her that I'm serious about making a better effort this year, I won't get those scolding looks at my next office visit.

I've got a lot of plans for the day, but I know if I don't call the Integrated Diabetes office today, I'll definitely do it on Monday.

I got a flu shot the other day as well, and it's definitely given me a cold. Lots of coughing. Had I known this wasn't going to go away, I would have bought cough drops and medicine at Walgreens yesterday when I refilled 4 different medications. Sigh. Cough.

Things are, once again, on the up-swing at least.

Hope you all have a great weekend.


  1. Gary is the best. That is all.

  2. I think Sara, Amylia, Rachel and I must have given you our colds. Damn this blogosphere germ fest!

    On a serious note, good for you. It's a brave thing to make an endo appt. Maybe it's become commonplace as it's something we all have to do several times a year, but the bravery aspect really comes into play when you move and suddenly don't have auto-set appointments anymore. So I'll say it again, good for you. :)

  3. I hope the new endo works out. It's a big brave step. Your PCP, like many others seems not to be the most delicate when it comes to diabetes issues. If my PCP saw my last A1c of 8.2, he would read me the riot act. What he wouldn't know is that was a vast improvement from the 10.5 3 months prior. I wish you luck in improving your control and starting fresh with the new endo. Also feel better!

  4. Hannah,
    Sometimes I think general practitioners seem to freak out a little more than endos or CDEs. My PCP is a good general practicioner, but he's not exactly an expert on diabetes. One time, after I had driven 1/2 hour to his office, he told me that my fasting BG was too high at 107. I thought that was great! After all, my endo told me not to drive unless I was over 100 since I have a tendency to drop pretty quickly. So I would tend to listen more to your endo or CDE when it comes to your diabetes. They're the experts. Good luck with your visit!

  5. Good for you for calling the Endo. I never heard of a $75 deposit. Yikes! Diabetics can't be trusted--is that the message?

    I think it's a step in the right direction, and an A1C of 8.5 is what it is. My last A1C was over 8 and my doctor did the same thing to me, and it made me feel like rebelling, since I had been working damn hard to get my sugars down.

    Anyway, we're rootin' for you and I hope the Endo helps get you where you want to be.

  6. I read an old nursing textbook the other day in the DePaul library that said that good control was an HbA1c below 9%.
    8.5 isn't great but for a type 1 it means that you're still putting in considerable effort.
    I read Gary Scheiner's Think Like a Pancreas. I think that the absoluteness of his beliefs really wouldn't work for me (especially because I'm not interested in pumping), but I really get the impression that he cares a lot, so that's probably good.

  7. I've been working with Gary over the last year and it's been informative and great. I really like the entire team at that office.

    And I'm paying for it myself, I've not bothered to try and get reimbursement for this.

    Good luck on getting a good endo.

    By the way, I'm with Donna. What does a GP know about life with diabetes? Unless they've got it themselves or have a child or partner with it, I'd not take what they're saying too much to heart.

  8. feona4:08 PM

    There are people out there just like me. Poor control but then I have type 2 and it's all my fault. I've even been to an endo and didn't get much help she dismissed me as non compliant. Said I could come back when I got myself streightened out ???
    Well just what was I there for? And if I got myself streightened out then I wouldn't need her.
    My last a1c was up around 9 so I'm trying harder to get control but won't go back to the endo as I feel she's a quitter and I don't want a quitter on my team.

  9. Hey Hannah,

    Good for you for taking steps in the right direction.

    I am a Big Fan of Gary's books and help - I think that if he too recommended this endo, it must be a good sign.

  10. Anonymous4:14 PM

    I am a type 1. listen, here are some cold, hard facts. if you have an a1c higher than 5.5 you should be freaked out and doing everything you can to get it to 5.5 or lower. no excuses, no complaining 'the doctors is reading you the riot act'....stop kidding yourself. get your a1c low and make it a life choice to keep it there. end of story case closed. use novolog and levemir, or a pump. and, if you have a BMI > 30 you are just fooling yourself, no one else.


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