The inevitable happened today, and now I'm on the road to starting anew what should have been happening all along.
With a morning visit to my trusted endo Dr. P, I went from being a 30-year-old in control to what felt like a 5-year old being punished and having to sit in a corner and take his medicine (no pun intended). My semi-regular visit to her office wasn't a pleasure for either of us, as the expected unhappiness about my diabetes care boiled to the surface. I knew it was coming, but even as the past week went by, it was as if I was stuck in an orbit and being sucked toward the inevitable.
It began with the nurse-assistant lady, who did the basics such as measuring, weighing, blood pressure and initial blood testing. She observed that I'd lost a few pounds, likely a combined result of eating less in recent months but also lack of adequate D-care. No, this wasn't a goal of mine. She pricked my finger, and took a reading of 270 mh/dL - this was fasting, she asked in wonder??? I replied it was, not elaborating and already lowering my head in shame.
She left, and within a few minutes Dr. P appeared. She shut the door. I got a look - one of those expected looks, which can only mean a lecture is on the way. As she spoke, I sat speechless with my head hung low, trying to avoid eye contact, nodding compliantly as she scolded me for not taking better care of myself. Despite my A1C dropping slight, she correctly pointed out that it's still WAY TOO HIGH at 8.8. She let me know her frustration about not only that number, but also my lack of faxing her weekly results and the lack of overall care in the past months.
For reference, my quarter century of diabetes has had A1C tests ranging from the high teens (in my teen years) to a wonderful 6.7 in the initial months of pump therapy at the end of college. But the past years have ranged between 8-10 and it's been a work in progress trying to lower them. Dr. P has tried her best, but I do make things difficult.
My last visit was in August, about the time of a costly trip to the local hospital ER that came after a low-while-driving afternoon incident. Luckily, no one was injured as my blood sugar dropped behind the wheel and I ended up parked in a roadside ditch in front of my subdivision, as the paramedics arrived and strapped me down and carted me away. At that point Dr. P and I established better control was needed, and that it would happen once my new insurance kicked in Sept. 1.
That was then. Now, it's mid-November and we are where we are - that progress hasn't materialized.
Why, Dr. P demanded to know.
I didn't have any answer, but knew it's largely laziness on my part. More significantly, though, It's a result of the overwhelming sense of frustration and fear that's been a common companion in my 25 years of D-Life. That fear of running low, not being in control and possibly hurting myself, those I love, or just those who happen to cross my path. It's a fear that many of us insulin-dependent D-Lifers know well, and it can be crippling.
That universal question came back to haunt me again, bringing me to ponder what's better: Immediate Impact of Safe Sleeping and Living v. Unseen Future Possibility of Complications? Despite all the efforts to be in control and have good blood sugar levels, do we risk losing control and possibly cause something bad to happen now, or do we sidestep that for the safety and risk a future POSSIBILITY of complications? Nothing is certain, except maybe that more-immediate safety.
It's obvious now that the latter became my choice, following the August driving incident and subsequent ER visit that threw my game off. Everytime I see the high hospital bill or think about driving it comes back. I don't feel in control, and that scares the hell out of me. We can turn to humor and laugh or tell creative stories about these situations, which can seem insane and crazy to those not living in this D-World, but these moments mark us and sometimes can scar us... It's a constant battle, one that I try to mask and avoid if only not to bring people down.
But with the help of my supportive and loving wife (who isn't an alien) and the care of Dr. P, I can conquer this fear. It's necessary to get things back under control. It means: More testing. Writing the results down so that I can see them. Faxing those results. Basal testing. Carb counting and bolus dosages. The whole banana and peel.
If not, Dr. P. warns me the dangers of future complications will likely become a reality - they already are. Beginning signs are already present: protein in the urine, a little neurapathy that's more a nuisance than anything, some retinopathy found by the eye doc, and even a little heart concern more recently. None of this is good, and it must serve as motivation for better control.
I agree, as I have before, but this time I'm paying more attention to Dr. P's words and hope that my wife and thoughts of a future family can conquer that overwhelming fear. I've triumphed before, and I can do it again. That hope outweighs it all, even the fear about what can happen when sugars drop too low as I push for tight control. At least I have the tools in my arsenel to manage and keep them in range.
After the 8:30 a.m. endo visit, I've already started. The higher morning sugar of 270 mh/DL at her office had dropped within a couple hours to 45, throwing off my morning work schedule. I corrected it within a half hour to get to 120, and a couple regular Old Fashioned Dunkin Donuts with my morning coffee and correct carb counting kept me on target for a 1 p.m. lunchtime reading of 176 mg/dL - I'll take it. Free lunch followed, as a lunchtime meeting produced lunch meat and salad combos in the breakroom (without bread, but it was still something for the stomach).
Now, I look ahead: Results due by fax to Dr. P. on Thursday. Then, the weekend. Writing all results down, and faxing again each week. Our next visit is set for mid-December, just before Christmas, and another is set for early March. The goal: get the A1c level down, hopefully to at least 7.8 by that first visit of 2010.