In Thursday’s blogpost I discussed how I had considered postponing my endocrinologist appointment because I didn’t like what it might reveal.  I went to the appointment as scheduled and except for my interaction with one of the nurses, it was uneventful.  My doctor is part of a large endocrinology group and I have never received anything other than knowledgeable and professional care from her, the nurses, and the support staff.  Thursday was an exception, but in a more humorous than problematic way.

I had never met the nurse who called me back, but I assumed that she was a regular in the practice.  The first question she asked was “Are you taking your Lantus?”   No, because I don’t take Lantus. I use an insulin pump.  “Are you taking insulin with your meals?”  Of course I am because I have Type 1 and rarely eat without taking insulin.  “How is it going with your Novolin?”  Rather than explain that Novolin refers to NPH, Regular, and various mixed insulins produced by Novo Nordisk, I explained that I had never been asked these questions before and suggested that maybe they didn’t make sense.  “Did you bring your meter today?”  Yes, but I downloaded everything to Diasend and you can print out the reports for my doctor.  “That’s good and I’ll do that.  Did you bring your pump with you today?”  Silence.

Later in the appointment I learned that this nurse is one in a series of temps replacing the usual nurse who is on maternity leave.  Her ignorance wasn’t particularly annoying; it was just odd.  She couldn’t have been nicer and was doing her best to follow whatever instructions she had been given for updating my chart.  After taking my blood pressure, she said that she’d leave everything else for the doctor and quickly escaped to print Diasend reports.  For my visit her lack of knowledge was inconsequential, but it was a reminder of how little some medical professionals know about diabetes.

And now (drumroll please) my doctor appeared.  Her first question, as always, was “How are you?”   That can be an ultra-trite question, but I think she asks it to give me the opportunity to set the direction of the appointment which is never long enough to cover everything.  I believe that she would be open to discussing anything whether it be BG numbers, thyroid issues, or mental health.

My concern of the day was my multiple autoimmune/inflammatory issues and wondering if she had any opinions on whether a change in diet (particularly gluten-free) might be beneficial.  She indicated that there is no strong scientific evidence to indicate that a gluten-free diet would make a difference in my health, but anecdotally she has patients who feel that it has made a difference.  She suggested I give it a 3-week trial.

Now is not the best time for a gluten-free trial.  I am dealing with a frustrating skin condition called granuloma annulare (a topic that warrants its own blogpost).  Because I have the disseminated form of GA, I have abandoned topical products and am in the early stages of trying to find a drug that will slow down or eliminate the autoimmune/inflammatory condition.  I see my dermatologist this week and expect that I will be moving to a new class of drugs.  It doesn’t make sense to change my diet at the same time that I change medications because I won’t know if any improvement is from the new drug or the elimination of gluten.  So a gluten-free experiment will have to be put off for a while.  My opinions about going gluten-free are also worthy of a dedicated blogpost and I’ll save those thoughts for another day.

Back to my endo appointment.  I have been frustrated by overnight highs that occur between midnight and 2:00AM.  My endo ignored those and was more concerned with the lows that precede those highs.  I guess that I was aware of the lows but didn’t see the cluster of them the way that she did with her usual expertise at seeing patterns in CGM tracings.  Sometimes I think that I’m too deep in the trees to see the forest.  In my opinion, both the lows and highs are caused by the same thing:  too much after-dinner eating that is not matching up well with my insulin.  She’d like to see me reduce my basal and bolus rates through the evening.  I’d like to see a reduction in post-dinner snacking which is really the cause of both the highs and lows. I am working on the problem and already seeing some improvement.

I didn’t get any comments on my weight gain (!) so it’s back to me to deal with it or not deal with it.  At the very least I don’t want to gain more weight.  My guess is that if I take care of the blood sugar problems from evening snacks, the weight will take care of itself. Imagine that.  Everything is related to everything else.

In summary I survived the appointment.  My thyroid tests were in range and my A1c was much better than expected.  I only see my endocrinologist twice a year so the countdown to December has started.  20 minutes with her.  262,780 minutes with me running the show.