"Coming Down", as sung by My A1C

I've lately found I have a good rapport with my female health care providers.  Dr. M (my endocrinologist) and I get along fabulously.  At my last visit at my primary care doc's office, Kate, who is an amazing nurse practitioner, and the office nurse both remarked that they like when I come in to see them because I make them laugh.  I think being able to be yourself around your healthcare team is a huge key to success. 

Today, I went to Dr. M's office for a checkup.  She is a very nice woman, usually on the perky side, always willing to answer my questions and often smiling at my jokes, as hinted at above.  This is good, because I'm usually nervous when I go to the endo.  Not for anything she's doing wrong, mind you.  It's just me.  Thoughts of bad A1C's or surprise bad results on other lab work make me anxious.  

I've been told a million times that I am more than an A1C.  I am more than just diabetes.  Usually, this isn't an issue for me.  I live my life, I get along, and if diabetes tries to throw me a curveball, I do my best to catch it.  But when you're staring down the barrel of an endocrinologist appointment, it's easy to catalog all the things you haven't done right, all the things that could have been so much better if you just tried.  You worry.  You wonder what all the neglect is actually doing to your body on the inside.

I have said it here a zillion times:  I am a diabetes blogger.  I am not a model diabetes patient.  I don't have an amazing A1C.  Compared to some people, I may take "a lot" of insulin.  I am definitely not getting enough exercise.  I'm not a role model--I'm just a person who is here to share her experience, to find support, oh, and to mouth off when I feel like it.  Does the world need my 2 cents about living with diabetes?  I like to think so.  I enjoy being able to lend my unique perspective to the world.

I was able to start breathing the sighs of relief early in this appointment.  My blood pressure was great.  My weight was not really any different from last visit.  The nurse didn't even make a face when my BG reading was 235 mg/dl after lunch.  Dr. M came in pretty promptly, and we started talking about doing basal tests before we make any adjustments.  We talked about how I want to continue with the Symlin, even though I had taken a break from it.  We talked about her belly!  She's expecting her second child in January.  Then I talked about the biggie.

I told her I've been thinking about a Dexcom.  She said that normally, when people want to get an insulin pump and they haven't had one before, she doesn't just let them contact the company to ask about one.  She said she likes to meet with her patients and make sure they get the training they'll actually need.  Dr. M then told me for somebody considering a CGM and a sensor, she's quite happy to write a prescription for the system without any kind of preparatory visits.  She also reassured me that if I want to get a continuous glucose monitor, the Dexcom is the way to go.  She told me it wouldn't hurt if I also find some kind of exercise that I really like and start doing it.

So I have a plan for the next few months.  I won't see Dr. M again until April, when she is back from maternity leave. 

The biggest surprise today?  The in-office A1C test.  My last A1C was 9.8.  I know, nothing to cheer about, something to improve.  Today's A1C?  9.0!  Again, not perfect, but enough to make me do a little happy dance.  That's almost down a full point!  I was smiling; Dr. M was smiling and told me that was actually a great job and way better than she expected to see given some of my numbers we had been talking about.  It may be a tiny victory, but it's a victory for me nonetheless.

As Dr. M and I said our goodbyes, she told me to keep up the good work.  She then also added, "But make sure you really enjoy your Thanksgiving!"  I told her I was looking forward to the pie.  "And you should!" she said. 


I know I need to do some serious basal tests, but you know what's amazing?  When your endocrinologist acknowledges that you shouldn't guilt yourself along through a holiday.  I may just drink a toast to Dr. M with my turkey on Thursday. 

And in case you need a reference, here is the theme song to my A1C today:

World Diabetes Day 2011: Devil with a Blue Dress On

Oh dear god how I wish I had a blue dress to wear today!  Instead, I settled for a blue camisole under a brown printed wrap dress that I like.  The blue is for diabetes awareness.

The brown is because...diabetes makes us feel like crap? *grin*

Diabetes sucks.  Diabetes is everywhere in the world.  It shortens people's lives.  It kills children and adults in places where good care is not available or even remotely affordable.  Diabetes is right here in Philadelphia, and unfortunately, it's huge.

We can try to light buildings in blue or have fun flash mobs or advocate for a symbol to unite everyone with the cause of diabetes.

Diabetes, for many, is deadly.  If current trends continue, 1 in 3 Americans could be diabetic by 2050.  I'll be 68.  I love the Diabetes OC, but look, if every 3rd person in the US has a d-blog by then, I'll never catch up!  Heck, I barely catch up now.

I'm not saying I need the country to be purchasing blue appliances, but it might be nice to see some blue circle magnets on the backs of cars.  I want to see people to actually unite on World Diabetes Day the same way people rally around World AIDS Day.  We don't see advertisements of crying, hugging families after the JDRF or the American Diabetes Association walks, but breast cancer walk advertising is everywhere.  Pink things are everywhere.  People are definitely aware of breast cancer. 

I believe diabetes is an even bigger threat than that, and our levels of "awareness" on the whole in this country are pretty sad.  You might think you have a touch of the sugar.  You may think you can be cured, just like Halle Berry. (*snort*)  Diabetes is here.  It's not going anywhere.  I think it's high time everyone in this country realizes it is a serious problem. 

What have I done on this World Diabetes Day? I have a blue camisole on. I used blue post-it notes.  I went to the dentist, where I sat in a blue chair and was informed I have to have more cavities filled, which made me...blue.  I paused to think about mortality--it is Dr. Frederick Banting's birthday, and without him, we may not have ever had the insulin that saves all of our Type 1 lives.  I realized, returning from a Symlin vacation of a couple of weeks, that there are blue circles on the Symlin pen.  I took a deep breath, thankful for all I have, maybe just a tad nervous for next week's endocrinologist appointment.

Happy World Diabetes Day, everyone.  I hope that in the coming years, diabetes gains the ubiquitous awareness it rightfully deserves.

Two Weeks on Symlin

I remember now what this feels like. 

The random sweating during the day, the occasionally floaty feeling in my head.  Is my blood sugar dropping?  Is it just kind of a faux-low because I am going from high to normal? 

Symlin has been going well so far.  I am ramping up my doses very slowly, because I remember that's what worked best for me last time.  Going from one dose to another too quickly definitely brought on the nausea, and nobody likes that.  I was surprised at how simple it was to re-adjust to pen injections after so many years on a  pump.  I had forgotten what all that knob-twisting and priming felt like.  I tend to wear dresses to work, so I am perfecting the art of the quick injection through the clothes.  I did my injection so fast at lunch with a co-worker the other day that she didn't even notice I had done anything.  Stealthy!

(Hmm, just realizing you can't spell "healthy" without most of "stealthy"...)

I have been seeing a lot more numbers under 200 mg/dl, which is awesome for me.  I am satisfied with smaller amounts of food, and about that?  I'm finding if you don't take the Symlin at least 10 minutes before your lunch,  you will suddenly find yourself stuffed in the middle of whatever you chose for your lunch that day.  I tend to eat one thing at a time, so it's kind of a let-down if you were looking forward to soup while wondering if you are even going to be able to finish your salad. (First World problems!)

Not THIS kind of Symlin pen, silly.

What's really unpleasant is counting the exact number of carbs, bolusing, eating and then dropping like a rock an hour and a half later.  They are very spikey drops, and with no CGMS, I'm not really sure how fast I'm falling.  If I test after a meal, like last night, and my BG is at 92 mg/dl, and I'm experiencing low symptoms, it's a good bet to just eat some sugar and hope for the best.  I had some glucose tabs and an hour and a half later I was at 97 mg/dl. 

Those are the effects of Symlin right there.  I also forgot about how sometimes when I am on Symlin, my highs sometimes start feeling like lows, just a little.  Normally highs are just times when I'm sleepy, cranky and thirsty, but with Symlin, some of them have been joined by that weird adrenaline-rush drifty feeling. 

For the most part, Symlin and I are pals.  Will this progress into a long-term relationship?  I guess we'll see.  Stick around, and maybe you'll find out.