A Farewell to my Endocrinologist

Well…the day I’ve been subconsciously dreading has finally arrived.

It’s time for me to part ways with my endocrinologist…the diabetes doctor that I’ve seen for the last decade…more than one-third of my life.

She’s moving onto new things, and I’m sad to see her go. She’s helped me tremendously over the years.

She’s seen me at my “diabetes worst”, when I was a college student who cared more about having a normal college experience than managing my diabetes.

She was the one who finally convinced me to quit MDI in favor of an insulin pump.

She’s one of the few medical professionals I’ve ever interacted with who treated me like an equal – she never made me feel “less than” or inferior to her.

In other words, I was pretty dang lucky to be her patient.

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The “thank you” card that I plan on giving my endocrinologist, pictured with two devices I started using thanks to her.

I’m trying to take this forced change in stride. Maybe it will be good to meet with another endocrinologist. Maybe it will help me continue to improve. But I am allowing myself to feel a little upset and sorry over the situation; after all, it’s never fun to part ways with someone, especially when you had no say in the matter.

Guess what else I’m allowing myself to feel?

Gratitude.

I feel thankful for my endocrinologist, so I plan on giving her a card with the following message during our appointment tomorrow…because it’s important to me for her to know all the positive change she’s brought to my life:

Dear [Name Redacted],

I wanted to thank you for all that you have done to help me (and my mom and aunt) in the last several years. You have always motivated me to take better care of myself after every appointment I’ve had with you. I appreciate you for being patient with me, listening to my concerns, and inspiring me to try new technologies and treatments to improve my quality of life with diabetes. I don’t like having a chronic illness, but having a doctor like you around to help me deal with it means the world to a patient like me.

Wishing you all the best in your future endeavors!

Sincerely,

Molly

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Molly, Meet Metformin

You may have read the title to this post and said to yourself, “Met-WHAT?”

Metformin is the new medication I’ve started taking (along with my typical insulin) to help regulate my blood sugars.

Maybe you didn’t make it all the way to that second sentence; instead, maybe you just Googled Metformin to learn more about it. And you probably immediately got confused, because the Google search results explained that Metformin is a medication normally prescribed to people with type 2 diabetes. You know that I have type 1, though, so what gives? Why am I taking this new pill?

You see, for about a year or so, my endocrinologist has been gently encouraging me to try Metformin. She expressed concerns over the fact that I’ve had diabetes for more than 20 years, and in that span of time, I’ve had to take a lot of insulin. Like, an incalculable amount. And while that insulin helps to keep me alive, there’s also risks associated with it. Namely, she explained to me that there’s research that indicates that people with type 1 who rely on large amounts of insulin have a higher risk of developing cancer later in life.

ClearanceYard Sale

Whoa. The “c” word. Something I never thought I’d hear during a doctor’s appointment. If you know me personally at all, then I’m sure it’s not hard to imagine that I pretty much shutdown at the mention of “cancer”. Almost immediately, I panicked and asked why she thought this research was worth mentioning. She said that it was part of her reasoning for wanting me to start Metformin. The idea is that it would make my insulin more effective, and ultimately decrease the amount of insulin I need each day. She went into a little more detail, mentioning that the only side effects tend to be nausea/upset stomach – and that’s when I stopped listening. I politely told her that I didn’t think Metformin was a wise option for me at that time, and later that day, when I took to Twitter to ask other T1Ds what they thought, I gained swift validation that I’d made the right decision: Other T1Ds with Metformin experience told me that the stomach issues they had when taking it were miserable and that they wouldn’t recommend giving it a try. Plus, I consulted with my T1D pharmacist aunt, and her opinions matched those of the other T1Ds on Twitter. So that was all I needed to hear to feel at peace with my choice to not take Metformin.

In fact, it was enough for me to turn my endocrinologist’s offer down during our next two or three appointments. I was relieved that she never pushed me to try it, but there was a small part of me that wondered whether I should give it more serious consideration. Maybe I should let her talk me into a little, rather than brushing it away and using fear as my excuse.

So we did talk about, during my most recent visit with her earlier this month. She gave me some more compelling reasons to consider taking it. Not only could I reduce my insulin intake, but it might also help me with some preexisting digestive issues I’ve had since childhood. When I asked her about the negative side effects on the stomach that I’d read about online, she told me that she would only prescribe me the “extended release” version of Metformin, which had a much lower (if any) chance of inducing nausea or any less…desirable gastrointestinal disorders.

This news definitely perked me up. We discussed a plan for introducing Metformin to my body: Start by taking one pill daily after dinner. Increase by one pill each week until I’m at four pills per day, the limit. At any point in time, I could message her with questions if I started to notice low blood sugars in the evening.

I felt reassured by this logical plan, as well as her explanations of the benefits of Metformin. So I bit the bullet and I’m in my first week of incorporating it into my post-dinner routine. I can’t say that I’ve noticed even the slightest difference, which isn’t a bad thing. I imagine that will change as my dosage increases.

I intend to blog about this new journey with Metformin; not just for the sake of keeping track of how it affects me, but to also help inform other T1Ds who may have been or may be in the same situation that I was. We’ll just have to see how it goes, but for now, rest assured that I’ll be honest in my writings about my Metformin experience. At this moment in time, I can’t help but feel hopeful that down the road, I’ll be glad I made this decision when I felt ready for it, as opposed to when I was fearful of it.

A T1Diary of my Recent Endo Appointment

I’m trying something new here today, folks. As you can see, this blog post features not just words, but video, too. How exciting! The aforementioned video shows the before, during, and after of my most recent endocrinologist appointment. I share a touch more than I normally would in this format, and I cover something that’ll be a big subject in one of my upcoming blog posts.

Originally, I shared this video (in short clips) directly to Instagram, where it would live in my stories for 24 hours before going away. But the thought occurred to me to save and splice the video segments together to create a full video, albeit a poorly manufactured one. I’ve decided to call it my first attempt at video blogging, otherwise known as vlogging.

Fear not, my fellow wordsmiths: I still plan on writing actual blog posts. I’m not sure how regularly I’ll be vlogging. But I can promise that if people kinda dig this, then I’ll make a point to vlog semi-regularly. I can also promise that the videos will be a bit shorter and shot in one take, because 1) I don’t think anyone wants to hear/watch me blabber for more than a couple minutes and 2) it’ll help ensure that I don’t jump around from topic to topic. And for the sake of full disclosure, I’m not lovin’ my once-a-month Favorite Things Friday post as much as I used to…so this may eventually replace it. We’ll see.

So, without further ado, enjoy this little video from me…and remember that it was initially created for Instagram, which encourages users to make very short video/photo clips, and helps explain why this whole package is a bit choppy. And please do let me know, in the comments or on various social media channels (accessible in the upper-right hand menu of the Hugging the Cactus homepage), what your thoughts are on vlogging.

 

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.

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.

A Shout Out to my Endocrinologist

For the first two weeks of Diabetes Awareness Month, I’m responding to prompts provided by Beyond Type 1 on Twitter (and I’ll post a couple longer responses here). Today’s prompt encourages us to give a shout out to a healthcare provider who has made a difference in our lives. I’m not disclosing the name of my endo for privacy purposes, but that doesn’t diminish the amount of gratitude I have for her.

Dear Endocrinologist,

Thank you.

Thank you for always listening to me during our appointments.

Thank you for making me feel heard and never laughing at the problems I brought up that I thought were stupid or embarrassing.

Thank you for never making me feel bad about my A1c.

Thank you for reminding me that my A1c is just a number, and I’m worth more than what that value represents.

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Waiting for my endocrinologist at a recent appointment

Thank you for motivating me to take better care of myself after every appointment I have with you.

Thank you for being patient with me.

Thank you for inspiring me to try new technology, and not judging me when I used to express my fears about abandoning the known for the unknown.

Thank you for asking me questions, in an effort to make sure you fully understood my thoughts and feelings about my health.

Thank you for being you.

Sincerely,

Molly