I visit my endocrinologist twice a year. I used to go quarterly, but many years ago we decided that there just wasn’t much to talk about every 3 months. Sometimes even the semiannual appointments seem overly routine. My endo respects that I have had Type 1 diabetes for almost as long as she has been alive and that I am essentially a self-managed patient. At the same time she has the ability to pull me out of the tangles of diabetes minutiae and help me focus on the big picture of my overall health. And of course she is the portal to lab work, diabetes technology, supplies, and medications.
If you asked me how my diabetes has been for the last few months, I would answer frustrating. Too many lows, too many highs, too much of this, too little of that. I remember the bad stuff. The overnight lows in the 30’s when I must have acknowledged Dexcom alerts and gone back to sleep. The weekend of intractable highs from sampling a few gorging on Hershey’s chocolates. The party with too much wine and too little willpower. The days of “doing it right” and baffling wacky blood sugars. Insulin acting like water one day and nuclear fuel the next. Nothing unique to anyone with Type 1 diabetes. Probably no better or worse than other months in recent history.
I had my endo appointment on Monday. I arrived on time with Dexcom and Diasend reports in hand. We spent the first part of the appointment discussing a recent physical with my internist. Some of my numbers have been creeping out of the normal range into that zone that is within target if you don’t have diabetes, but not okay if you do. This is a discussion for a later blogpost, but I agreed to start taking a statin. She could see my distress at these recent changes and emphasized that the differences from last year were not hugely significant. She also discussed that current standards indicate that all patients with diabetes should be on statins unless there is a reason not to be. But ultimately it was my choice.
As she pulled out the Dexcom tracings, I said that I knew they looked good, but they weren’t. This was bad. That was bad. I starting babbling about basals, highs, lows, chocolate.
“STOP” she said.
Stop being so hard on yourself. Stop micromanaging. Stop obsessing over insignificant changes in health indices. Stop driving yourself crazy. Be confident that you are doing a good job. Relax. Take two aspirin with a glass of wine and call me in the morning. Oops, not the last one.
Very kindly she told me that she doesn’t know how people with perfectionist tendencies and diabetes do it. The frustrations, the illusiveness of perfection, the inconsistency, the unpredictability. She shared that her father is a “rocket science” engineer who does not have diabetes but would never being able to reconcile the “do it the same, get different results” illogic of Type 1 diabetes. I am not sure what she said next, but what I heard was “You are doing fine. Continue to respect your diabetes. Be kind to yourself. Keep up the good work.”
Then she walked me to the lab for my blood work. I went home. Definitely better off than when I came.
In 
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 have an appointment with my endocrinologist this afternoon.
Avoiding this appointment would be little different than refusing to step on the bathroom scale. Avoiding this appointment would be hiding and in some ways “lying by omission”.
Test Guess and Go 