Monday, April 19, 2010

Late Post on Endo Visit....

I went to the endo last Monday. I was supposed to post this last week. But sadly, my week was spent doing nothing but working and baking/decorating cakes. So there were no blogs. Sigh.
I love my endo. I am a patient at Vanderbilt University's Diabetes Center. The office is huge. There are many doctors, nurses, nurse practitioners, CDE's, etc. When I first transferred to this center, I was concerned that I might feel like a number, or like I never saw anyone I knew.
That was not the case at all. I am on my 4th (5th?) visit if I'm not mistaken. I have seen the same endo, nurse practitioner, and CDE every time I've been there. The office staff seems to been the same (I recognize faces when I go in). Every time I've had lab work done, the same guy has done it. Until this visit, the nurse who checked me in was the same lady. This time was the first time I'd had a different nurse.
I like that. It makes me feel like I'm part of something. Even though I'm sure the doctors and nurses may not remember me every time I'm there, I know that the chances of them remembering me are higher, simply because I see the same person every time. That in itself is a comfort to me.
At this visit, I was scheduled to see the CDE and my endo. I was looking forward to it. I had a list of question to talk with the endo about (one of which was Symlin) written down before I even got there.
For the past several visits (almost a year), my A1c has been stuck at 6.9. Everyone was really happy with that number, but having seen a 6.3 (and held it for 6 months), a 6.9 had been very frustrating to me. The first thing they do when they check me in is my A1c and vitals. It takes about ten minutes to get results back, so I was in the exam room waiting by the time the nurse got my results back. She knew I was anxious to know the results so she stuck her head in the door and said "6.6".
My joy knew no bounds. I'm quite positive I looked like a total idiot as I cheered for myself. But I really didn't care. And still don't. That 6.6 was so much nicer than the 6.9 I'd been glued at for so long. I feel like I had been working somewhat harder at getting that number down, so it was nice to see somewhat of a payoff.
When the doctor came in, I started off by discussing my morning spikes in blood sugars. Almost every day when I get up, my blood sugar is in range. I don't eat anything. I am not a "first thing" eater. I have to wake up some. So I get up around 6:00 and get ready for work. I usually grab something to eat as I'm walking out the door to work at around 8:00. And almost without fail, between 8:00 and 8:30 I start to spike. And it tops out in the 200s before coming back down.
It doesn't matter what I eat, when I eat, or even if I eat. It happens 95% of my work mornings.
Weekends aren't the same. I typically don't have that spike. If I do, it's rare, and not as violent increase or decrease.
This leads me to one conclusion: Work causes my blood sugar to rise. Or more specifically, the stress I feel when going to my job and while I'm working. Don't get me wrong, I'm beyond thankful for my job. But it's high stress, not something I enjoy most of the time, and not something related to my field. But, when a diabetic has great health insurance and a steady paycheck....well, let's just say I don't want to rock the boat.

*cue Glee version....*

During the discussion, I bought up Symlin. My doctor gave me some information on it and told me to think about it and we'd discuss it at the next appointment. I was glad she said that. I wasn't sure I wanted to go on it. But I did want to learn some more about it and wanted to know if she thought it could be something to help me. We also did some adjusting to my basal rate during the week. We increased my basal around the time that I am spiking in the morning and hoping this is something that will help take care of the spike so that I don't have to go on any other medications at this point.
I also asked her about my eyes. As I shared not long ago, my regular eye appointment showed some bleeding in both of my eyes. I was worried about what to do and how to handle the situation. My doctor immediately confirmed that I needed to not only make an appointment with a specialist, but that I didn't need to wait 6 months. She suggested that I make an appointment fairly soon. She basically said, just in case, it's better to have a specialist look at it now and to keep seeing a specialist in the event that I ever needed eye surgery. So, even though I've not done it yet, I will be making that appointment within the next week. I'm hoping to get in to see someone in the next month.
Next up was meeting with my CDE. I <3 my CDE. She actually listens to me when I talk. The first meeting we ever had, I told her flat out that I was NOT a record keeper. All my insulin info and blood sugars are in my meter and pump, so why bother? And as for a food diary, that's laughable. I might keep one for half a day. And then I forget to write something down, I get frustrated and I quit.
When I told her that, she listened. She, instead, worked with what my pump and meter had and talked to me about the types of foods I eat and when and what I snack on. I love that she didn't try to push me to keep records. It can be really frustrating when doctors or CDEs keep at you to do something that you know you aren't going to do anyway.
I shared with her what the doctor had said about my morning spike and she agreed that the spike was more than likely emotionally based.
Then we started looking at the few mornings when I have an above average blood sugar. Typically they only happen when I eat late at night. After she asked me some questions, she (and I) came to the conclusion that the high blood sugars aren't from anything other than me miscalculating doses and insulin to carb ratios because I'm afraid of dropping too low in the night (I live alone, after all).
All in all, she said that I didn't need to do much. But "if I have to pick on something, I'd say quit eating so late at night. It makes your blood sugars go crazy." :) See? I <3 her. Overall, I was pretty pleased. I have another appointment in a few months. Let's hope that these changes in basal rates take care of my morning spike during the week. If they do, maybe I'll be back at my 6.3 (ohhhh....happy thoughts!).


Karen said...

Wow, great job on that A1C!!!! And I'm so glad to hear you are having such a great experience with this office. Good practices are hard to find, but they really do make all of the difference in the world.

Holly said...

I totally understand about the high BGs and work. I just started my first "real job" in August 2009 after I graduated. I started seeing highs after lunch all the time. My endo asked me if I get stressed after lunch a lot. I said, "Well, I just started this new job . . . ". I think diabetics should have a special job hazard analysis handbook.

Vivian said...

Cara, I am so glad Vandy is working for you. I know we see a different office across the hall from you but all the departments have been so wonderful there. Congrats on your A1c break through, that is awesome! I also love that they listen to you and try to be realistic instead of preachy. lol It is also cool to be able to just email them instead of having to play phone tag. You are doing an awesome job with your D and I hope your visit with the eye doc goes well. Big hugs, Love ya Sis!

Cara said...

Karen-Thanks. I am so glad I found the center that I'm at. I may need to move at some point, but for now, Vandy fits me perfectly.
Holly-Ug. Jobs & stress seem to go hand in hand. The sad part is we have to deal w/ blood sugar crap on top of it! Yuck.
Vivian-I know a few other people who go to the Children's practice and love it. Hearing such good things about the children's practice is part of made me want to start with the Adult center. And I love the intant e-mail too! It's so great.

meanderings said...

Nice nurse! I love it that she came to you to tell you the A1C (which is nice, also!). I do not like having to ask what's there (on the lab sheet) since it's mine, mine, mine.
Sounds like a great office!

Unknown said...

Sounds like you had a really great visit with your team - that's fantastic! And WAY TO GO with your A1C!