Monday, December 7, 2009

My Endo: A Control Freak?

Those who read The Corner Booth regularly know that I've been on a tight control kick recently. It's not that I've necessarily been in "poor" control, just that I haven't monitored my sugars as closely as is needed and that carb-counting and bolusing has sometimes fallen to the backburner. My last A1C was 8.8, which is too high but not nearly into the higher double digits I've seen throughout my 25 years of living with the D. Anyhow, being 30 years old now and wanting overall better control for a variety of reasons, I have begun closely monitoring my blood sugars once again and getting to where I need to be. The goal: 8 by my mid-December appointment when I get more bloodwork done; by the next visit in early March, I hope to have that down as low as possible.

With this tight-control comes more communication and work with my all-knowing Endo. Through the years, I've had three endos - in addition to my two pediatric-focused ones who were part of the package until age 18, and the primary care physician who during my early 20s basically handled all my Rx needs and allowed me to handle my own diabetic needs. I've been with my current endo for about three years, and she's highly-praised and sought after in this area of Indianapolis - evidenced not only by recommendations from other docs but also her schedule that is always booked full at least three months out. So, if you cancel an appt, be ready for a wait. She also has this fix on having you fax results each week to her for review, on a specific form. I oblige.

In getting back on track, I have decided to tweak some basal rates a few times in a few places. Again, I've just been getting back into the routine of regular carb-counting and testing and realizing where a couple points were off . My experience tells me what's wrong, and what the consequences would be in making those adjustments - so I determined what they were, let her know what was going on, and the reasons for why the changes are needed.

This morning, I get a voicemail from assistant at my endo's office: "She wanted me to tell you that she can't help you if you insist on changing basal rates yourself. That's her job." I chuckled, then heard the rest: Don't change anything. Leave it as is for a week, then fax the results again, and she'll determine what's needed.

I differed, knowing exactly what I've seen and experienced in recent days and that changes were needed. Bedtime lows, resulting in a lack of sleep in order to stay up and monitor my low sugars and eat accordingly, weren't what I wanted to live with for another week. The higher results in mid-morning wasn't a result of carbs, as I'd skipped breakfast and still observed higher results.

My thought: "No, the changes are needed and I'm going to make them regardless of what you say. Then, I'll do my best to work with you in making sure everything is kosher from your perspective and that we're on the same page."

I realize the importance of having an endo as part of your diabetes care team, and realize that many of that endo's functions are irreplaceable. However, after 25 years of managing this myself, I am well-equipped to recognize what needs to be done and make those SMALL adjustments myself. This by no means translates to me wanting to do it all myself and keeping her in the dark, or not listening to what she says. Not at all. We have to work together, as I've done in the past with other endos. The last one I had in Michigan (before moving) encouraged my taking control of my diabetes and recognizing these, as long as I let him know about it up front.

But it's not like I've just fallen onto the Diabetic Bandwagon, or even that I'm a Type 2 who's recently been diagnosed after living without the D for an entire lifetime. This is a way of life, and I know what I'm doing here. That lifetime experience means something in my opinion, and it's just as important as the expertise of a non-diabetic who's gone to medical and endo school and studied this for the same amount of years I've been living with it.

It's a partnership, a two-way road. But the bottom line: I'm the one driving the car, and will ultimately crash or burn based on what's decided or not decided.

1 comment:

Casey said...

I wouldnt continue to be low either. Don't blame ya ;)