Tuesday, July 1, 2014

Starting on the Journey - Diabetes

I had an appointment with my new endocrinologist (diabetes doctor) and nurse practitioner this morning.  After my in-office blood sugar (169 mg/dl) and vitals were taken (turns out I’m 5’ 11 3/4”!) and the nurse went through the standard medical history questions, Carrie, my nurse practitioner, came in and asked about my diabetes care routine.  She then checked my feet, pulse, and lungs/heartbeat.  

After that, she told me about some new medicines that were on the market that some Type 1 Diabetics use to control their blood sugar and asked if I’d ever been on an insulin pump.  I told her I had, several years ago, and that I preferred being “unhooked” from a pump with tubing, especially since my old endocrinologist had told me that being on a pump with my lack of discipline was dangerous for my health (when Dr. Bussey heard this, he said that was a bunch of malarkey).  

I told her about my desperate need for the Dexcom G4 Platinum Continuous Glucose Monitoring System, and she confirmed that it was a good system with the highest accuracy available.  She looked over my blood sugar numbers from the past few weeks (which they had downloaded from my glucometer), asked me some questions about them, and gave me an informational packet about the Dexcom.  She then left the room to get Dr. Bussey, the endo.  

When they both returned, Dr. Bussey made some suggestions for adjusting my insulin doses.  He said since my numbers were still running high that I should increase my overnight basal insulin by 2 units, adjust my insulin-to-carb ratio (changing it from 1 unit per 12 grams to 1 unit per 9 grams), and changing my correction factor from 60 points over 120 to 50 points over 120.

We then discussed my plans for the future regarding children.  I told him we were thinking not for another year or two down the road, especially since my numbers are so high and our finances aren't quite where they need to be.  Dr. Bussey told me that the best A1c during pregnancy is about 5 (but 6 or 7 was okay) and that the most precise way to maintain that much control for a pregnant Type 1 Diabetic would come from being on an insulin pump – however, it was not required.  I’m still undecided on the matter.  I know I at least want a Dexcom.    

My current A1c is 11% (average blood sugar of 269) – so I balked a little.  A chart on the wall across from me said that an A1c of 7% equates to an average blood sugar of 154.  6% = 126.  The lowest I remember my A1c ever being is about 9 (212 mg/dl)…5, 6, and 7 all seem so hard (nay, impossible) to achieve!  However, he assured me that getting my A1c down that low IS possible and they are going to keep me accountable as I work to get my numbers down, down, down.  They told me they wanted me to come back in 2 weeks to go over carb counting (although they are sure I know what to do) and insulin pump therapy information.  I’ll then come back at the end of August for fasting labs.

Before I left, they had me do some lab work for them (a quick and painless blood draw).  I left feeling encouraged but also a little daunted.  I know I have a lot of work ahead of me, but I hope that having a team of people who are committed to seeing me improve my health will give me the motivation I need to succeed.  Obviously the core determination has to come from my desire to prepare the best I can for the future.  I know that with God’s help, all things are possible – even the things that seem impossible.                                  

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