7th Month Endo Appointment

This morning I went to the Endo’s office for our standard monthly appointment. I am starting to feel like a regular over there. The nurse and receptionist know me by name when I walk in the door, and the doctor and I seem to have found a sort of common ground upon which to manage my diabetes. You might remember that I was not 100% sold on him in the beginning, but things have improved immensely.

We are working more like a collaborative team now. In the beginning, it was more of a power struggle … It seemed like he wanted to control everything and, well … so did I. Maybe he has gained some confidence in me and that has allowed him to grant me a little bit of autonomy. Maybe I have just relaxed a bit because he has proven himself to be knowledgeable and accommodating. Whatever happened, the result is a much more agreeable relationship, one where we can work together to get the results we both want.  I couldn’t be happier.

Anyhow, the appointment went very well. I was in and out in less than a half hour. My A1C is STILL 5.2. How is that even remotely possible? Truth be told, I am suspicious that the A1C test is not really an accurate read on my diabetes management, but I’m a little too preoccupied with this whole baby thing right now to dig into that whole can of worms.

He commented that I’ve only gained two pounds since my last appointment and asked if the High-Risk OB was concerned. Thankfully, I just had an ultrasound last week, so we know that BabyNoName is clocking in at exactly the right weight. So there are no concerns on the weight front. It turns out that when you are already overweight before you conceive, you do not need to gain nearly as much weight as you would need to if you were at a healthy weight. For once, my weight issues have turned out to be a good thing, and my fears of ballooning to the size of a semi-truck during pregnancy have been unfounded. Hopefully I can keep it up for the next three months!

My blood pressure was also great: 120/70 or something like that, and the pulse and feeling in my feet were both strong. Because it was early in the morning, he did not even get to see my swollen ankles. Pretty amazing all things considered.

I have one more appointment scheduled with him before my due date. I will see him in May, but not in June. I can’t believe that I only have one more appointment with the Endo before I deliver. I remember standing at the receptionist’s counter seven months ago and scheduling all eight appointments at once. I was wondering how I would ever make time to fit all of them in. It seemed like the end was a lifetime away.

Fourth Month Endo Appointment

This morning I had an appointment with my Endocrinologist. Now that I’ve been doing this monthly thing for a while, I am starting to know what to expect, and that helps with the nervousness, but the clammy palms and queasy stomach never go away completely. What if that one high blood sugar spike this week hurt my baby? I know it is not really a reasonable thought, but I am pregnant, so I am allowed to be unreasonable, right? I blame it on the hormones.

Actually, the visit went pretty well and, as usual, helped ease my mind a bit. My A1C is still 5.3 (Amazing) and my weight is up about a pound since last month. My blood pressure was still awesome, too (120/75).

On the down side, my overnight visits from the ketone fairy are coming too often. Last week I had two mornings with small ketones, two mornings with trace ketones and one morning with moderate ketones. I think it was that one moderate day that set off the warning buzzers. The doctor instructed me to eat a snack around 2 am. Crap. I just got my bladder and BGs adjusted so that I can sleep through the night, and now I have to get up to eat. To eat! Who would’ve thought?? Oh well, I guess this is just a prep course for the sleepless night that are on the horizon, huh?

We also drew blood to check my thyroid. I have been absolutely freezing lately, and I don’t think it’s just because of the freezing temperatures and blowing snow. The Endo says it is normal for the thyroid level to change over the course of a pregnancy, and my dosage was a smidge low last time, so we will check it out.

We also talked about the high risk OB. The Endo says the local guy that my regular OB recommends is great, and that they work well together, so I guess I will give it a go. He was not 100% clear when I asked how the communication will work (i.e.; how will they stay on the same page given that they will both be making changes to my therapy and who is “in charge” of my diabetes), which leaves me a little uneasy, but I guess we will just have to let that one work itself out. So today on my lunch I made my first real appointment with the high risk guy. It’s next week.

On the agenda for this weekend: shovelling out from the huge snowstorm we’ve been receiving ALL week, and investigating snow blowers. This fall, we bought two new snow shovels in anticipation of this winter, but mine sits unused in the garage and it has been snowing like mad since Christmas. By the end of the day when I get home from work, I am just so exhausted and achy that when my husband says he’ll take care of the driveway, I let him. It takes him two hours, and by the time he gets in and warms up, I am nearly asleep. I feel like we hardly see each other anymore! So I am counting our pennies to see if we can’t squeeze a snow blower out of this month’s paychecks.

That’s all from here today. It has been another whirlwind week of testing, treating, and visiting doctors.  Only 25 weeks to go!

The Endo is Growing on Me

Last week I had my second “pregnant” appointment with my Endo. If you are a regular reader, you will remember that we have had some … er .. communication issues in the past.

This visit went better than previous visits, though. I think maybe we are getting used to each other. We are, after all, seeing each other once a month now. Granted, he still does not respond when I send him my weekly BGs, and still complains when I send them a day or too late, but his pluses are starting to stack up and offset his minuses.

In particular, I was especially pleased with the way he handled the OB when I was admitted to the hospital for IV fluids. You see, I am still only seeing the “regular” OB, not the high risk one, because I am so early in this whole pregnancy journey. His office typically does not do much with type 1 diabetics and the hospital in our city does not even perform deliveries for  diabetics that are on insulin because they do not do IV insulin drips. So you can imagine their concern when I showed up in Labor and Delivery for a couple of liters of fluid.

The nurses were sort of out of their element with me in the beginning. I did my best to ease their worries, but they were simply not comfortable with my just-below-target-range BGs.

But then my OB called my Endo and he seemed to have all of the right words. Apparently the OB was concerned that my sugar might be too low. It was 72 at the time and I was testing hourly (!)

The Endo, now one of my favorite people, assured the OB that everything was fine and that I was doing very well. He instructed them to let me handle my diabetes and to contact him if there were any problems. Can you believe it?! And even more remarkably, the OB consented! This act earned my Endo my Hero of the Day award. If not for his kind words, the OB was considering transferring me to a neighboring hospital for the night where they would be “better equipped” to handle my diabetes. We diabetics know what that means: A total loss of control over our own care. What a relief that I would not have to deal with overbearing nurses, “diabetic diets,” and my own stealth blood-sugar tests in between the official ones that the hospital would perform.

Additionally, during this last appointment, I saw the lowest A1C I’ve ever seen. Are you ready for it? It was 5.3! Of course, this has a lot to do with the numbers I have been seeing in the 30’s and 40’s, but it also has to do with the 10-15 tests a day I’ve been doing and the almost complete lack of numbers in the 200’s. The 30 day average on my meter, computed from 360 total tests (12 per day,) is 112! Amazing. I guess maybe this guy knows what he’s doing.

The rest of the visit was also successful. Aside from a slap on the wrist for not testing for ketones while on vacation, he verified that my blood pressure was really good (104/70) and my feet still have plenty of feeling. He will check my Thyroid again next time. It is running a little low, but this is apparently normal in the first trimester.

All-in-all, the appointment was a relief. I spend a lot of time stressing over those couple of high numbers, and his reassurance has meant the world to me. He also reminded me that there is no evidence that BG spikes cause harm to the baby, only highs for extended periods of time. And I am also relieved to hear that the lows are only painful for me, not the baby. Apparently the baby takes whatever sugar it needs and leaves the rest for me.

With that appointment out of the way, I am now stressing about the 12 week appointment with the OB tomorrow.  If all goes well there, I might be able to relax (a little) for the holidays.

In the “Safe Baby Range”

I saw my Endo yesterday. The best news of the day was my A1C: 5.6! Can you believe it?! I am so happy with that number! I only hope I can keep it up for the next eight or so months.

He spent a good deal of time with me, which was welcome  because I came to the meeting with a list of questions (big surprise, huh?)

One of his most surprising answers was about the flu shot. He said I am not in the “target demographic” for the regular flu shot, but that I should ask my OB about the H1N1 shot. That was a shock to me and I’m not 100% convinced that I believe it. Everything I’ve read says that I have two risk factors — diabetes and pregnancy. Don’t get me wrong, I really don’t want to get the flu shot. It usually leaves me with a mild case of the flu for about five days. But if it  is important for the health and safety of my baby, than I am all for it.  So I guess I need to do a little more research on this.

Another (somewhat disappointing) response was when I asked to talk to a dietician. I really need to get my food choices under control. Donuts out of the vending machine are never a good choice, but especially now. It turns out that he does not have a dietician that works with him exclusively. He would just send me over the hospital where they will likely push the ADA’s carb-laden, high calorie meal plan on me. Sigh. It is as if I am living in the dark ages. I am going to give it a try, but I am not holding out much hope.

We talked briefly about a CGM.  He is still pulling for the  Medtronic Minimed product. I have been trying to figure out why given all of the anecdotal evidence I am finding that suggests the Dexcom is better. I am guessing it is because it’s  easier for him to assess the reports if they all come from the same device. I have to admit, the Medtronic reporting is pretty  impressive.

Aside from these responses, his knowledge seems impressive, but he really  doesn’t have that compassionate, you’re-going-to-be-fine bedside manner that I am looking for. I guess I am on the fence about whether I should stick with him or jump ship. Afterall, how important is the reassurance if he is helping me reach the “safe baby range?”

This morning I have my first “pregnant” appointment with the OB. I think I will ask  him what he thinks about my Endo and see if he has any advice for me.

What have you been hearing about flu  shots for diabetics? And for those of you who have already had children, what was your medical experience like? Did you have a team, or did you work with individual doctors? If you worked with a dietician, did you find it helpful?

Chili for Halloween and a Truce with the Endo

Just a quick post today as I’m putting the final touches on my chili for the third annual chili cook off at work. Every year, we have a Halloween party complete with a costume contest and chili cook off. My company is not exactly the best place to work on a day-to-day basis, but they really do know how to throw a good party.

My Endo finally called yesterday evening. We ironed out a few things and we’ll reassess at my appointment on Monday. Basically, he does not want me to increase my basal rates, even through a temp basal. Instead, he wants me to use boluses to treat out-of-range numbers. I am also going to have to buckle down and log all of my insulin and carb intake, because my insulin pump does not do it for me (long story, but it does not communicate with the Medtronic reporting software.)

He also encouraged me to think about a CGM, which I have been thinking about, but I am leery of yet another hole in my skin. Also, he is pushing the Medtronic, and I have heard that it is not as accurate as the Dexcom. I also don’t look forward to the insurance fight to get coverage. So I guess I am still on the fence on this one.

Does anybody have any experience with any of the CGMs? How accurate do you find them? Did your insurance company make you jump through hoops to get the supplies covered? How are the insertion sites? Those sensors are so long!

Thanks for any advice you can offer! Have a wonderful weekend and a great Halloween.

What’s Up, Doc?

I have been a little unhappy with Endocrinologist for a while now.

I just moved  to the area a little over a year ago, and  one of the first things I did was find a new Endo. My husband and I had been wanting to start a family, but were  waiting to get settled, so I was anxious to find a good doctor.

In the first appointment, he seemed quite knowledgeable, but made me a bit uncomfortable. I can’t quite put my finger on it, but it was sort of like an authoritative or egotistical vibe that he seemed to be giving me.

In one, rather shocking example, I mentioned that I was concerned about weight gain and increased insulin needs over the course of the last three or so years. I said that I thought this was probably insulin resistance (something that my last two Endos have agreed with). He said, it was probably that I was still making some insulin until the last three years. I pointed out that this would be quite amazing considering that I have had this disease for 27 years.

He also tried the shock-me-into-compliance attempt when telling me about what I needed to do to prepare for pregnancy. Of course, I knew that I had already accomplished most of the items on his checklist, but his tone made me anxious anyway.

Having relocated three times in ten years, I have gotten to know a lot of Endos. The ones that seem to be the best for me are the collaborative, supportive ones. I am hard enough on myself; I don’t need someone telling me that my feet are going to fall off if my blood sugar spikes occasionally. My irrational mind goes there on its own.

Anyway, he told me that I needed to send my BGs in every two weeks and that he would call with changes to my basal rates, etc. Then, when  I became pregnant, he would want me to send them in every week and I would need to visit him once a month.

The every two weeks BG faxing seemed a bit extreme considering that I was not even pregnant yet, and my A1C was 6.2, but I was willing to comply. I am always eager to get tweaks for my rates, it just makes life easier. So I started sending in my numbers.

The problem now is that he never responds. Often, I have to call in a week later to see if he even received the fax. And I never actually get to talk to him, just his office assistant, who simply reads off a list of changes he has noted in my file.

So how am I supposed to learn anything here? And often, due to the lag time between my fax and his response, the changes he suggests just don’t make any sense any more once I finally receive them.

Now that I am pregnant, this is really concerning me. I sent my first “confirmed pregnant” BGs on Monday. Here it is Thursday and still no response. I have been using temp basal rates all week to try to keep my numbers in range. I swear, my numbers are bouncing all over the place all day; I assume this is a result of first trimester hormones.

I’ve decided that I’ll give him one more chance. I have an appointment scheduled with him for Monday, and an appointment with my OB on Tuesday. If Monday’s appointment is just more of the same, I am going to ask the OB if he knows of someone who might be a better fit for me and for my baby.

Have any of you had similar experiences? Were you able to work it out with your Endo, or did you have to move on to someone else?