The Surprise A1c

I started out 2020 with an A1c that surprised me. It was a good surprise: Anything under 7 is a win in my book.

I won’t specifically say what the number was, because I don’t really believe in doing that and I fear that it will invite unwelcome judgment and/or comparisons. But I will celebrate that achieving this A1c was far from easy. It’s required a lot of work from me in the last few months, which have generally been a very turbulent period of time for me.

It seemed like the “diabetes gods” were really testing me in the latter half of 2019. From a month of unexplained highs to random incidents of technology failing me, I felt like I was being put through the wringer. I felt like a failure on just about all diabetes fronts, and it seemed like my efforts to maintain my desired blood sugar levels were fruitless.

Hey, Handsome
More than one surprise came with an unexpected A1c result.

So that’s why I could hardly believe my current A1c reading. Maybe it seems even more impossible to me because I didn’t even get to discuss it with an endocrinologist. In fact, I never got to talk to my new endo (the one I may or may not continue to see) about any of my A1c goals. Doesn’t that seem kind of effed up? Shouldn’t my doctor want to know what I hope to accomplish, in terms of my diabetes, in the next 3-6 months?

In that regard, this A1c has surprised me in more than one way…it’s not just that I’ve managed to get here (really, I’ve managed to stay here, my A1c in the last 2-3 years has been right around this number), it’s also about how it’s more than just a measurement of my average blood sugars in a 90-day period…it’s a marker of how I feel, emotions-wise, about my diabetes. I never thought about it much before, but as I’ve grown older, it’s really become a sign for me as to whether or not I have my shit together with my diabetes. It can signify how I’ve felt about my diabetes in a given period of time, from the lowest of the low burnouts to the highest of the high determined and motivated.

Kind of crazy and yes, surprising, how a single reading can mean this much.

First Impressions: How I Feel About my New Endocrinologist

Last week, I wrote about how I had an appointment with my first new endocrinologist in about 10 years. I compared my thoughts and feelings about the whole thing to a first date: Many of the same anxieties are felt in both situations.

By now, I’m sure you’re wondering…how did the date go?

Well…I don’t know that there will be another one.

Freedom is the atmosphere in which humanity thrives. Breathe it in.
This blog post serves as a bit of an endocrinologist evaluation.

Before I dive into my appointment postscript, let me just clarify that my thoughts and feelings are just that. They’re my opinions on how my experience was with this particular doctor. That doesn’t mean that she isn’t a great endocrinologist; in fact, I’m certain she is. But I just don’t think that we are doctor-patient soulmates.

For starters, the appointment got off to a weird start because none of my typical vital signs were measured upon arrival. I’m used to having my weight, blood pressure, blood sugar, temperature, and heart rate checked at the beginning of every appointment. But this time around, the only thing that was looked at was my…blood pressure? It was kind of random, and I never got an explanation as to why nothing else was looked at by the nurse, but whatever.

The actual appointment with the doctor herself mostly went as I expected it to. We spent about 20 minutes together (about 5 minutes longer than I usually get with the endo) and I told her a little bit about my diabetes history. She offered me some advice on what to do about the high blood sugars my new inhaler was causing (more on that in another post) and checked my feet as well as my thyroid, just like my previous endo did at every appointment. But she did not check my eyes, and she also…did not review my A1c with me.

This was pretty huge, though not totally unexpected. I knew this clinic didn’t have finger stick A1c machines like the previous clinic did, and that I would have to come to the lab at another point in time to get a current A1c reading. But it was surprising to me that she just glossed over it, like it wasn’t super important at that moment. She didn’t even review my Dexcom/OmniPod/Verio IQ meter graphs with me, despite having downloaded information from all three devices. However, these weren’t the most shocking parts of the appointment.

What caught me off-guard the most is when she said that I could come back in six months instead of my usual three.

In my 22 years with diabetes, I’ve gone to see my endocrinologist every three months, no matter what. Some of these appointments were more like maintenance checks to make sure I was on track with everything, but other appointments came at crucial times for me in terms of improving my diabetes management. I asked the new doc why six months instead of three, and she said something along the lines of…

“Well, it seems like you have everything under pretty good control. And you seem in-tune enough with your body to know to contact us with any questions.”

That latter statement is true, but the former…I don’t know about that. How could she have this impression after talking with me for a mere 20 minutes? It was mildly alarming. I probably could’ve pushed for another appointment in three months, but I got the distinct feeling that I would’ve been rejected had I done so. As a result, I walked out of the clinic that day with another appointment set for July and a feeling of unease settling in the pit of my stomach.

I don’t know that I can wait that long to see an endocrinologist, and I don’t even know if I’ll want to see the same person again. I have no idea how she’d be able to remember me, for goodness’ sake, especially given the brevity of our first and only meeting (so far).

Among all these unknowns, there’s one absolute truth: I miss my old endo.

Why Meeting a New Endocrinologist is Scarier Than Going on a First Date

I have an appointment with my endocrinologist today. Or should I say, the person who I hope is my new endocrinologist. I really want this patient-doctor relationship to work out!

It’s my first new endocrinologist in about ten years and I am effing nervous. It’s comparable to going out on a first date with someone, only I’m not hoping to be wooed with flowers or treated to a fancy meal.

I’m hoping that this person is someone I can trust with my health…which I value a lot more than any of the associated costs of a first date.

Why Meeting a New Endocrinologist is Scarier Than Going on a First Date
There are higher stakes with a new endocrinologist than with a new dating-app match.

Why is this new doctor terrifying to me? For starters, I have so many questions. What if she doesn’t like me? What if I don’t like her? What if she judges me? What if she’s too lenient? What if…? The list goes on and on.

Plus, I’m seeing her after smack dab in the middle of holiday celebrations, also known as the most turbulent time of the year for me and my blood sugars. I’ve had so many highs in the last month that I’ve tried to stay on top of, but she’s bound to notice them and ask me if this is a regular thing for me. It’s also pretty likely that my weight has gone up as a result of the many indulgences I’ve enjoyed in the last few weeks, and I’m worried about whether comments will be made on that.

Not to mention that I haven’t seen an endocrinologist since…late August, I think? And that appointment was with my “old” doctor, who left to practice somewhere far, far away. It was a bittersweet parting, and it wasn’t on amicable terms because neither of us was ready for it to be over. So I’m heading into a new potential endocrinologist relationship with that in my mind, and my new doctor has a lot to live up to when compared with my old doctor.

I just want everything to go well. I know that if it’s not a perfect fit, it’ll be pretty evident straightaway, and I can seek another new endocrinologist. But to continue with the dating metaphor, it’s not as easy as just swiping along and seeing what other nearby options I have. There are other concerns beyond location: I need to make sure my doctor can accept my insurance, on top of them being likable, knowledgable, and eager to help me manage my diabetes. It might be surprising to learn that this particular combination is a tall order, but again, when it comes to my health I refuse to just settle.

Fingers crossed, it’s a match from the start and all of my concerns will be rendered invalid late this afternoon at the conclusion of my appointment…

 

Metformin Update #4: Here We Go Again…

Frequent readers of this blog are probably familiar with my journey with Metformin. If you aren’t, or want to brush up on my history with it, read here, herehere, oh, and here in order to get caught up.

Well, well, well…here I am again, taking yet another attempt at integrating Metformin into my daily diabetes routine.

I didn’t want to, certainly not after last time, when I thought it might be responsible for some unpleasant side effects I was experiencing.

But desperate times call for desperate measures…

METFORMIN UPDATE #2
Yep, I’m giving the giant white horse pills another go.

Long story short (because I’ve explained in previous posts that I had a rough September), my diabetes was totally rebelling against me about a month and a half ago. Each morning, I’d wake up, check my blood sugar (which nine times out of ten was very good, between 100 and 130), and prepare one of three of my standard breakfasts. I’d bolus for them just as I’ve always bolused for them, only to discover that my blood sugar was climbing much higher than it should have in the hour or two after the meal. It was so confusing. I thought it was only a breakfast problem, but when it carried over to lunch, and then dinner…I realized I was facing a bigger issue.

I’m sure you’re thinking that higher insulin dosages were the simple fix to what was happening. But I didn’t want to take approximately 30% more insulin each day to handle something that I couldn’t even begin to rationalize. I didn’t think that should be my only alternative. There had to be something else I could do.

Enter Metformin.

After consulting with my endocrinologist, we agreed that I’d take one Metformin each morning with my breakfast. I explained to her that I was reluctant to go back on it, but she gently reassured me that the side effects I’d mentioned were pretty rare and perhaps there was another explanation as to why I’d experienced them. She also made me feel a lot better about skipping doses here and there – I wasn’t sure if that would reduce the effectiveness of the Metformin – by telling me it would be fine if I forgot a dose or actively chose to miss one.

And so began my third go-round with Metformin.

As of this writing, I’ve been on it for several weeks. And I’ve noticed a difference. My total daily insulin intake is back at a number that I’m much more comfortable with, and I’m not having to take correction boluses multiple times throughout the mornings and afternoons just because I ate my regular meals.

It isn’t exactly the solution that I wanted, but it’s the one that I needed as well as the one that works for me, for now, anyways.

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

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.