Since I changed my endocrinilogist last year, I've really been happy with my experiences with Dr. K. She's the kind of doctor that means business but doesn't come off as if she's judging you. She tells you what she thinks, but leaves it up to you what to do. So usually, I'm fairly excited (yes, I said excited) about going to see her. Even when I know I've been doing 85% of things wrong.
This appointment didn't feel that way though. I just really didn't want to have to go. I've been making some changes and my averages are down. I didn't want to hear that I'd been doing this and this wrong, even if she does leave off the judgement. I just wasn't willing to expose all those mistakes to the light.
And I feel torn between wishing I would have canceled and being excited about the outcome.
The positive...my A1c dropped from 9.0% in late January to 8.3% in early March. That's not even including the recent average drop from bolusing with my pump. I'm impressed with my own progress. The major positive is that she gave me the Metformin prescription that I was hoping for. (More on this later...it'll take a whole blog.)
The negative...well, when your A1c is 8.3%, you obviously are screwing something up. And being told this and having to hash out the details with a trained MD isn't fun. It's sometimes humiliating. Even if they aren't so judgemental.
Like admitting that you ate too many cookies and obviously didn't bolus correctly. Or the chocolate shake that sent you to 381. Even the fact that you sometimes cut boluses or insulin because you're just plain scared...of seizures, night lows, missing a workout, missing your life.
It feels like perfection is the ultimate goal. A balanced life, a steady schedule, the perfect diet. But it's just not obtainable. At least not right now. I sleep till noon if I get the chance. I eat at 2am if I'm hungry. I don't follow the same eating, exercise, or sleep schedule every week much less every day. I am a college student, after all!
She doesn't berate me. And that makes it easier to open my secrets. She suggested fewer simple sugars (those cookies and shakes, which are usually rare but have been a bit more common with the Accutane). My carb ratio also needs to be changed, according to her but I think I disagree. And she keeps pressing that my logbook doesn't contain every carb or food choice...only cookies or shakes or abnormal foods.
I'm doing better with my averages. I'm not swinging as much as I was in the recent past. And I'm just waiting for the Accutane to be over. I know that I need to work on some things. But I also need to take this at my own pace. I can't force myself to do everything right all at once. And with the stress and busy schedule of school...I just need to focus on staying in a specific range (like 100 to 200) even if my A1c stays in the 7 or 8% for a few more months.
A major part of this disease is making sure burn out doesn't happen. And pushing my body through Accutane and diabetes has gotten me close to that point. So I think I'm okay with putting her suggestions off for awhile...maybe even until graduation. After all, what's two more months?
Your blog is right on.Thank you for being willing to share your experiance. It was just what I need today.
CathyH
I like my endocrinologist because I trust him to be a fair judge of the quality of my self-management and not to pull any punches if he thinks I'm doing something poorly or dangerous.
My attitude toward "judging" doctors has changed as my control improved. When my control was sloppy and my A1Cs were erratic or high, I found myself getting defensive and was relatively passive at doctors appointments. They were a necessary evil to get access to medications and test supplies.
As I got older, I started listening closer to want the doctors said, less sensitive to how they said it. As I became more proactive and started asking my endo how I could improve- what changes he thought might help me - my doctors became partners instead of perceived adversaries.
Since your profile says you have type 1 diabetes since childhood, I'm curious why your endo prescribed Metaformin. For BG management that's like using a crowbar to tune a piano.
I read in your earlier blog post about the PCOS, and your growing insulin resistance. I've been going back through old studies to see how diabetes was managed in the first half of the 20th century. I see that many of the secondary symptoms you describe that don't appear to be directly related to diabetes, have a high correlation with a high carbohydrate diet. With all the changes in meds, how has your weight been? Have you been gaining over the last 3 years?
psdaengr~ Yes, the Metformin is predominantly for my PCOS. Many type 1 women seem to develop the condition after years of insulin use. Insulin resistance is not unheard of in type 1s of all sexes actually :( and Metformin is being used more wide spread to combat that.
The other symptoms that I have are directly linked to my hormones (through PCOS or PMDD). Diet does not affect them, sadly. And my diet is USUALLY on the low carb end (not lately though sadly). I gained weight at the onset of all my issues in 2006 but medications (besides increased insulin) has not caused any more weight gain. The Metformin should actually allow me to lose a bit of weight by lowering my insulin needs.
Lindsey:
I hope the Metaformin works for you. I'm hoping that you can delay using it until your system has stabilized from discontinuing the medication you were taking previously.
The more studies I read about the effects of diet on disease, the more convinced I'm becoming that many of the problems we have as persons with diabetes are caused by excessive carbohydrate intake. Current research all seems to point in the direction of BG fluctuations, not just average level, being responsible for vascular and endocrine complications.
I'm not a fan of the Aktins diet, especially the "induction" no carbohydrate phase, because it can induce a dangerous level of ketosis. But the weight maintenance diet, which is based on the original research that inspired Dr Atkins, is worth considering. By keeping total daily carbohydrates under 100g, and using protein, not fat, to provide more of the total calories, both total insulin requirements and BG fluctuations are lowered substantially. One thing that Atkins covers in his books and diet plans are the symptoms and conditions that are aggravated by modern American dietary choices. The one that caught my interest originally was adult acne, which I developed in my 30's after my type 1 diabetes was overt. I've had it for 25 years since then. When I cut back my simple carbohydrate intake last year and replaced it with fiber and more slowly metabolized carbohydrates, my acne subsided, and I've been losing weight gradually- with no other changes to my diet.
I also recall reading that PCOS was mentioned as having a high correlation with carbohydrate intake. You may want to do some research on this.
Anyway, best wishes. I look forward to reading of your results in your blog.