My T1D New Year’s Resolutions

New Year’s resolutions are kinda tacky and silly, especially ones that are broken three weeks into a new year. Even so, I like to put a little thought into how I can better myself when a new year begins, so I guess I’m the sort of person who (somewhat grudgingly) tries to make a commitment to some form of self-improvement around this time each year.

Happy New Year!
Are you making any New Year’s resolutions?

While some of my resolutions are going to remain private, I’d like to share others – specifically, my diabetes-related ones – here because I think it’ll be the first step in making them a reality in 2019. Here’s what I’ve come up with so far, along with some explanations why they’re my goals so far:

  1. Improve my A1c – This is kind of a cop-out resolution, because let’s face it, a better A1c will never not be a goal of mine. I’m in a better range now than I was a few years ago, which is a huge accomplishment in itself. But I know I can do more, and I have the drive and desire to get myself below 6.5 this year.
  2. Make time for more IRL T1D hangouts/meet more T1Ds – I can’t be the only one who scrolls through Instagram and feels pangs of jealousy when I come across photos of large groups of T1Ds hanging out, right?? A significant percentage of these hangouts are the result of T1D conferences, which I’m rarely able to attend. They either cost too much money or take place at an inconvenient time, so I’m forced to miss out on some valuable face-to-face time with people who understand me in a unique way. It’s definitely a bad case of FOMO. As a result, I want to be proactive and try to arrange more meetups in my area in the next year.
  3. Incorporate more self-care into my routine – 2018 was such an insanely busy year. I felt that, at times, I was getting pulled into too many directions and had obligations to so many people that I could barely keep up, let alone make any time for myself to catch my breath. I had days here and there where I could sneak away for an hour or two and treat myself to a massage or exercise at the gym, but I really didn’t have a single mental health day in which I unplugged from everything and kicked back. Though I know 2019 will be just as hectic, if not more than 2018, I still want to be sure to make more time for myself, even if it is just for five or ten minutes a day.

Now that I’ve shared my resolutions, I feel like that will hold me accountable for making a good-faith effort in accomplishing them. And I also feel that they will be good things for me to write about throughout the next year, so I can keep both my audience and myself informed of my progress.

And with that, it’s my final blog post of 2018. Here’s to 2019, a year that will be filled with plenty more content from Hugging the Cactus. To you, my readers, I wish you a healthy and happy new year!

Memory Monday: The First Time I Met an Endocrinologist that I Didn’t Like

One Monday per month, I’ll take a trip down memory lane and reflect on how much my diabetes thoughts, feelings, and experiences have unfolded over the years. Today, I remember…

…the first time I met a diabetes doctor (endocrinologist, or endo for short) who I didn’t like. At all.

I knew right off the bat that we would be a bad fit, because he started the appointment by sharing his own blood sugar with me (as he was also a T1D). “Oh, I’m 136 right now…that’s a bit high, so I’m going to take insulin for it.” He reached for his insulin pump and I stared at him, nonplussed. Since when was 136 a “high” blood sugar? Why was he sharing this with me? If his own target blood sugar range is so narrow, then what the hell is he going to think of me when he reviews my own data?

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The face I make when I think about that awful appointment and the negative thoughts it gave me about my A1c.

The appointment only went downhill from there. At this point in my life, I was a brand-new college freshman, and my diabetes was simply no concern of mine. So my blood sugars and A1c weren’t great.

And I got scolded for it.

Throughout the entire appointment, I felt judged. I held back tears at points because I felt that I had to explain myself to this guy, that I had to somehow get him to understand that the transition to college hadn’t been easy on me, and that’s why my A1c was high. But I couldn’t get the words out. Instead, I sat there, numb, as he lectured me on what I should and shouldn’t be doing to take care of my diabetes. He kept insisting that I go onto a pump, which at that time, was totally scary to me – a non-option. He was so adamant that I got frustrated and shut down towards the end of the appointment, nodding and smiling tightly at his words.

I’m certain that I cried on the way home from that appointment out of frustration over how it went. I didn’t feel motivated to take better care of myself; instead, I felt rotten. I realized that just because someone is a doctor, it doesn’t mean that they necessarily know how to convey messages about health to patients. In other words, not everyone has an appropriate bedside manner.

Fortunately, that was the first and last time I saw that doctor. He moved to a different practice weeks after I saw him. My next endo appointment was with my current doctor, and seven years later, it’s one of the healthiest doctor/patient relationships I’ve ever experienced. When I look at it that way, it was worth experiencing the worst in order to get the best.

Reflections on my Recent Endo Appointment

Last week, I wrote about some anxiety that I was feeling the day before I was due to see my endocrinologist. Now that the appointment has come and gone, I feel like I understand the reasons why I was so nervous…

  • Reason #1: Some part of me must’ve known that my A1c has gone up over the course of the last three months – it rose half a point, much to my dismay. I confessed to my doctor that I’ve been a little careless, particularly in the last month or so, when it comes to carb counting and healthy eating. Luckily, she wasn’t critical of me, but I almost wish that she’d reprimanded me in some way. It would’ve been the talking-to that I felt I deserved.
  • Reason #2: My endo permanently switched locations: She’s now based at the medical center that I used to go to when I was seeing a pediatric endocrinologist. I hadn’t been back there in about eight years, and boy, it brought back some unexpected emotions. I must admit that I had to hold back tears as I walked into the building. I don’t know why all the feelings hit me so hard, but I suspect that it might have been because of the flood of memories that flowed through my mind. It also symbolized the journey I’ve been on in just the last eight years of life with diabetes, in which I:
    • Transitioned from injections to a pump.
    • Stopped using Lantus.
    • Started using a Dexcom.
    • Improved my A1c/overall health significantly.
    • Decided to become a more active member in the diabetes community.

Those are some major changes, and the magnitude of them practically knocks me               out as I think about the last 20 years I’ve had with diabetes.

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Just making some awkward faces while I wait for my doctor. Also, I love that the exam room has a full-length mirror in it: It’s perfect for taking pictures/killing time while I wait!
  • Reason #3: I was meeting all sorts of new people, which is very nerve-wracking to an introverted extrovert like myself. I was used to the receptionists and nurses at the old location. I got to know them and vice versa. It made going to appointments a little easier. At this new/old location, though, I don’t know a soul except for my doctor. A reassuring smile or light conversation would’ve placated me on this visit, but perhaps those things will come in time.

Anyways, now that I’ve had time to think about the emotional aspects of this appointment…I’m going to switch gears and start doing the things that I need to do and that I am capable of doing in order to get my A1c back to where I want it. I know that I’ll get there. As my appointment wrapped up, I looked my endocrinologist in the eyes and promised her that the next time she saw me, I’d be down more than half a point. And I intend to fulfill that promise.

 

Endo Appointment Anxiety

I’m feeling anxious about my appointment with my endocrinologist tomorrow.

I don’t know why. I like my doctor very much: She’s always encouraging, pleasant, and helpful. The only thing I’d change about our appointments is to slow them down a bit; sometimes, she whips through them so quickly that I forget to ask her the questions floating around in the back of my mind.

Could it be that I’m worried about my A1c test? Possibly. I don’t know whether my A1c has gone up or down in the last three months. I have stretches of time in which my blood sugar behaves the way I want it to, but I also experience clusters of days here and there of complete diabetes chaos. In the last month, for instance, there were a few too many circumstances in which my blood sugar was above 300 mg/dL. Each time, I’d correct the high, only to either experience 1) a sudden drop resulting in a low or 2) several hours of prolonged high blood sugar because it was taking the insulin a long time to take effect.

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I love that there are posters about “understanding” diabetes on the wall – it’s too complex to break down into a few bullet points.

Now that I’m thinking about it, maybe those scattered, wicked-high blood sugars are the reason why I’m anxious about this appointment. I know that my doctor will probably ask me about them, and I’m going to have to admit to her that a combination of emotional eating, lack of carb counting, and general carelessness resulted in those highs. I know that she won’t judge me, but…I can’t help but judge myself for causing the blood sugar swings. The rational part of me is aware that it’s unhealthy to blame myself for occasional slip-ups, but the goodie-two-shoes, Miss “Perfect Diabetes” part of me is shaking her head in shame and disappointment.

If nothing else, this is a prime example of how diabetes can be an absolute (warning: foul language following) mind fuck.

A Good Diabetes Day

I’ve blogged plenty of times about my “bad” diabetes days – you know, those posts that I talk about stubborn blood sugar that won’t come down/up, or how technology refuses to cooperate, or how I’m feeling intense diabetes burnout.

This made me wonder about the “good” days. Besides my blood sugars looking so perfect that I question whether my pancreas has magically started to produce insulin again, what sets those days apart from the “bad” (and plain, old, ordinary days)?

 

The answer likely varies among people with diabetes, but let me describe my version of a darn good diabetes day:

  • Going to an endocrinologist appointment first thing in the morning and discovering that your A1c has dropped nearly half a point, down to 6.7. YAAAAAAS!
  • Being told by said endocrinologist that you’re doing an amazing job, and passed all other blood work tests with flying colors – I was most thrilled with my HDL cholesterol (the good kind) levels, which have gone up due to my current exercise regimen. And she said I lost a couple pounds, to boot!
  • Coming home from work to a package from Dexcom containing the brand new G6 receiver, transmitter, and sensors. I can’t remember the last time I was so excited about a delivery!
  • Topping it all off, my blood sugars throughout the day weren’t too shabby.
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Dancing excitedly with my new Dexcom G6! My puppy couldn’t understand what the hullabaloo was all about.

It’s days like that that make me feel validated – like all my hard work is worth it. It isn’t easy to manage diabetes every moment of every day, so when the diabetes stars align like this, it feels…wonderful.

An Abundance of Appointments

Ugh, I don’t know why I did this to myself, but about a year ago, I decided to schedule a bunch of my key doctors’ appointments back-to-back. That means every week for the next three weeks, I’ll be seeing one of my main doctors. Fun!!!

Truthfully, I don’t HATE going to see the doctor. It’s just the waiting and the feeling of being in a hospital-like environment that I detest. And I’ve gotta say, I’m not overly fond of my personal bubble being invaded for the sake of evaluating my wellness, but it is what it is.

First up on the calendar was a visit to the dentist. This is the only doctor I see who never asks about my diabetes, which is very refreshing. But that doesn’t mean diabetes is far from my mind when I go to get my teeth cleaned. My big fear is that my blood sugar will go low in the middle of the appointment, which would make things difficult seeing as I’d have to ask the dentist to stop what she’s doing and let me correct for the low. This would be super frustrating for both parties, as she’d probably have to start her work all over again and I’d have to wait for my blood sugar to go back up to normal.

Fortunately, this fear has yet to come to fruition and my blood sugar is usually fine, if not a little high, at the time of these appointments. And this trip to the dentist was likely one of the easier appointments I’ve got scheduled this month, because I was told my teeth look great. I was also told that my hair is awesome, which made me flash my pearly whites even bigger at the dentist. Yup, definitely the easiest (and CERTAINLY the most flattering?!) appointment I’ll have all month…possibly all year.

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The patient’s perspective.

Next up is my primary care doctor. It’s time for my annual physical. This appointment was basically a complete wash because it occurred within the hour of me fracturing my ulna (see a couple posts down). In between my tears, my doctor asked me standard questions and requested to me to fulfill the usual battery of annual lab tests. My blood pressure was a little high during the appointment, but if I had to make an educated guess, it’s probably because I was stressed due to the excruciating pain I was experiencing in my right arm. Just a hunch.

Thank goodness that everything else came back normally, though. Fewer things to worry about when it comes to my health will always be a welcome concept.

I don’t want to count appointment number three on this list, but I guess it’s worth mentioning my trip to the orthopedic’s office – you know, because of the broken bone. I get to have at least two more with him in the next six weeks as follow-ups. Joy!!!

Finally, the last truly pre-scheduled appointment I’ve got is with my endocrinologist. I’m nervous because I don’t know what my A1c will be like. I have an excellent and empathetic endocrinologist, so I know whether it’s good or bad, this reading won’t affect the overall tone of the appointment. It’s just pressure that I put on myself.

We’ll find out what happens before long. All I know for sure is that I’ll be relieved when I’m finally through with all these appointments.

Testing My Patience: My Struggle Obtaining my A1c

People with diabetes understand the significance of a hemoglobin A1c test well. It provides information about an individual’s average levels of blood glucose over three months. While diabetes is about much more than numbers, an A1c reading is still important because it is one of the main points of discussion between an endocrinologist and a patient. It helps an endo determine how a patient is managing diabetes and can help direct course of treatment.

This test is a big deal, but the actual process of having it done is one of the simpler aspects of diabetes care and management. Historically, all I’ve had to do is show up to my endo’s lab the week of an appointment, write my name/date of birth/insurance provider/whether I’m fasting on a sheet of paper, and walk into the lab to have a small needle inserted into a vein located in my upper forearm. I have zero aversion to needles or blood, so it doesn’t hurt and takes less than five minutes. And it’s always mildly entertaining that every phlebotomist I’ve encountered feels the need to comment on how nice and visible my veins are – one even went so far as to call one of them beautiful! (My response: um, thanks?!)

Since my A1c blood work has been so quick, easy, and (relatively) painless in the past, I was anticipating it to go smoothly once again when I recently went into the lab one Sunday morning. But I didn’t have such luck. Moments after signing in, the receptionist informed me that they could not perform the blood draw. Nonplussed, I politely asked why not. She told me that the lab hadn’t received the orders from my endo. I explained that I would be seeing my doctor in just a few days and that this was a routine part of the process. She did her best to help me by making a couple phone calls to other suites in the medical facility, but it was to no avail. I was frustrated but walked out, accepting that I would need to call my endo’s office first thing the following Monday to figure out why my orders had not been sent to the lab.

Early that Monday morning, I received a message from a nurse who works in my endo’s office. She apologized for my inconvenience over the weekend, and let me know that she submitted orders for lab work for all future appointments for the rest of the year. That was great and all, but I still had to find time to get lab work completed for my upcoming appointment. I couldn’t go on Monday, but I carved out some time in my schedule at work to go back on Tuesday morning.

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The patient’s perspective: too much time spent waiting

I was flustered when I walked into the lab for the second time in three days, because it had taken me twice as long to get there due to local road work. I told myself to relax, it would be done in a couple minutes and then I could head back to work with this task checked off from my to-do list. But…of course it wasn’t, because upon entering the lab, the receptionist told me that the power was down and they would be unable to complete my blood work.

For a couple seconds, I just stood there while I let that sink in. I explained how I was rejected on Sunday and practically begged her, please, isn’t there anything you can do? Despite having access to both my medical history AND the orders on her computer, she said no, but I could try one of the two other “near” lab locations. Completely exasperated, I told her no, that I guess I’d have to try again tomorrow, and walked away with tears stinging my eyes. I was mad that I wasted another trip, confused as to why this was so difficult, and defeated by the lack of understanding from the receptionists.

The bottom line is that I have a few questions after experiencing all this:

  1. How come my lab orders weren’t submitted?
  2. Why did I let this affect me emotionally?
  3. Why does everything about diabetes management have to be so complicated?

While I don’t have an answer right now to the first question, I intend on finding out how the slip-up occurred. And my answer to the second question, I think, is tied to my response to the third one: Diabetes management is hard. I try my best every single day and deal with the curveballs that are thrown my way. But lately, diabetes is like a pesky gnat, flying around my head so it’s always in my line of sight and incessantly buzzing to keep my attention. It’s annoying as hell and gets in the way of living my life. So to have something that’s normally easy, something that barely even requires me to think about my diabetes, become so complicated is just ANNOYING.

The one positive result from this whole ordeal? My A1c was better than I expected. Thank goodness.