Last Friday I went to see my endocrinologist.
Out of all of my doctors and diabetes support team folks, she is by far my favourite.
She doesn't waste time going through things we don't need to go through and she spends lots of time talking about the things I want to talk about.
So, in my 20-minute appointment, we talked diabetes for about two of those minutes. And we talked running and blood pressure and other things for the rest of the time. Because that is what I needed.
Diabetes? Well that's going just fine thank you very much.
I printed off the latest report from Diasend and we reviewed the last month worth of data from Rose, my trusty insulin pump/continuous glucose monitor.
Having the ability to prevent lows before they arrive and catch sneaky highs before they get too high has made such a difference in my overall diabetes management. For example, in the last month, I spent 81% of the time with a blood sugar between 4-10. I spent 4% of the time with a blood sugar below 4.0 and 15% of the time with a blood sugar above 10.0. That, my friends, is pretty freakin' fabulous.
And it all payed off.
My A1C result clocked in at 6.3. I believe that is my lowest one ever and it was reached with fewer lows that I have ever had. So yay!
(Anyone out there considering a Dexcom CGM, take it from me. It's absolutely worth the cost and having to wear extra cyborg parts.)
We spent a lot of time talking about the strange blood pressure drops I've been having on long runs and the alarming increase in them this year. I used to have them every handful of long runs. Now I'm having them on almost every run, sometimes as early as 7k in.
Turns out that this little girl is not getting nearly enough sodium in her diet. Doug and I eat very little in terms of processed food so my typical diet is naturally low in sodium. In fact, when I input my food into My Fitness Pal, I was only getting 1300mg(ish) of sodium on any given day. Significantly lower than the 2300mg that most people struggle to stick to.
Add to that the fact that Doug and I have been making a concerted effort to remove almost all processed foods from our cupboards and I was getting even less sodium, other than the naturally occurring sodium found in veggies etc which, as it turns out, is not very much.
Add to that the fact that, for the past few years, Doug and I often ate out on Friday evenings, the night before long runs, and I would often choose more salty choices (like a side of fries) because I was burning plenty of calories the next morning. We still eat out most Fridays but I was opting for salads and other naturally low-salt foods instead meaning that the pre-long run sodium intake my body was counting on wasn't happening either.
Add to that the fact that I am a very active person who is also a heavy sweater who also happens to be a very salty sweater and it turns out that my diet is dangerously low in sodium.
"You need to start salting your food" she told me.
"That sounds crazy to me" I said "even though I know you're right".
So I went home and had a saltier than usual dinner on Friday night. Saturday's 10k run was a hot and humid one. It started off ok but, by 5k, I knew in my heart that one salty dinner wasn't enough to make up for months of not enough sodium. I had two pickles with my lunch and added a bit to my dinner as well.
I have a handful of days left until race day. I have salt tablets for the race if I need them and I'm trying to make sure I get a little more sodium in my day - without going crazy and ending up with the opposite problem.
I must say, it would be very nice if the solution to my long-run woes turns out to be as simple as having a plate of french fries on Friday evenings.
Showing posts with label A1C. Show all posts
Showing posts with label A1C. Show all posts
Tuesday, June 2, 2015
Thursday, November 6, 2014
Let's Change the World
I had an appointment with my diabetes doctor yesterday.
We got through the business part of the appointment fairly quickly.
A1C of 6.6
Cholesterol: fine
Blood pressure: fine
CGM readings are good and the fact that I achieved an A1C of 6.6 while only being below 4.0 5% of the time was the icing on the cake.
My doctor started flipping through my file as we spoke and she spotted my one page profile.
This is my one page profile. I gave it to the nurses and dieticians at the Diabetes Centre so that they could have a sense of who I was as a person and then be able to support me in a way that made sense for me. Because I am more than just diabetes right? And I am also different than the next person who will walk into the meeting room.
My doctor, as it turns out, had never seen it before.
She loved it at first sight. When I explained what it was and why I created it, she loved it even more. She asked if she could share it with some of the administrators. She asked if she could share it with some of the students. Yes, yes yes!! "Share it with whoever the hell you want" is what I said to her.
I told her that I had used it in presentation to diabetes educators and that the feedback was extremely positive. I said that I really felt strongly that the best way to support someone is to see them as a person first rather than a diagnosis. I told her that I was speaking to a group of women with Type 1 in a few weeks and was going to talk about the difference between living with diabetes and diabetes living with me.
My doctor told me that she had started directing patients to my blog if they were struggling with their diabetes. She said that she encouraged them to read it and contact me if they had questions. I told her that we could do even better than that. I suggested that she get their permission for me to email or call them directly. That way they don't have to find the courage to reach out to a stranger. That stranger would reach out to them. All they had to do was answer the phone. I told her that I had done that before several times and that it always worked well.
When people are struggling, I said, it can be too much to expect them to meet you half way. Sometimes they can only meet you 25% of the way.
By the time I left, my doctor was thanking me for my time rather than the other way around. I told her not to hesitate if she had a patient who wanted to connect with me. Not to hesitate if she saw an opportunity for me to speak with diabetes educators, medical students, patients or hospital administrators. Not to hesitate if she saw a way for us to make things a little better for people with diabetes.
"Let's help people" I said. "Let's help change the world"
We both left the room with smiles on our faces.
Monday, March 3, 2014
Dexter's Many Talents
There are a lot of things I love about Dexter.
The fact that, at a glance, I can see if I'm climbing or dropping and (try at least) to deal with small blood sugar changes before they become big ones.
The fact that he wakes me up when I'm in a wee spot of trouble before I end up in a big one.
The fact that he teaches me what is going on between finger pricks. Thanks to him I really do see the value of bolusing 20 minutes before I eat instead of waiting until we have put the dinner on the table. I also really do see the effect that sitting all day (in the car or in meetings) has on my blood sugar during the day and during the next night.
Thanks to Dexter, I have fewer lows that I used to have simply because I catch them at 4.5 instead of at 3.5. I also have fewer and less dramatic highs thanks, in part at least, to the fact that I've set him to alarm the minute my blood sugar hits 11.0. I wouldn't normally feel any different at 11.0. Those awful high blood sugar feelings don't usually kick in until I'm 13 or higher. Without Dex I could easily sleep 8 hours with blood sugar numbers in the 12s. Now he wakes me up, I bolus and drop down to a much safer 6-7 for the rest of the night.
All this to say that, after three months of living with him, I was pretty excited to see my latest A1C results.
Would the fact that I have had fewer and less dramatic highs and lows translate into a good looking A1C? Would my A1C go up because I had fewer lows?
Last week I headed to the Diabetes Centre to find out.
My last test came back with an A1C of 6.6 but I was still having too many lows according to the doctor.
Last week's test results?
6.5
And I could, without even a hint of dishonesty, say that I reached that number with fewer lows. Not no lows, but definitely fewer and, when they happened, I usually caught them when they were 3.9 rather than 3.0.
Yet another reason why I have a mighty big crush on Dexter.
He teaches me things, he keeps me safe AND he helps me get an A+ on my tests.
The fact that, at a glance, I can see if I'm climbing or dropping and (try at least) to deal with small blood sugar changes before they become big ones.
The fact that he wakes me up when I'm in a wee spot of trouble before I end up in a big one.
The fact that he teaches me what is going on between finger pricks. Thanks to him I really do see the value of bolusing 20 minutes before I eat instead of waiting until we have put the dinner on the table. I also really do see the effect that sitting all day (in the car or in meetings) has on my blood sugar during the day and during the next night.
Thanks to Dexter, I have fewer lows that I used to have simply because I catch them at 4.5 instead of at 3.5. I also have fewer and less dramatic highs thanks, in part at least, to the fact that I've set him to alarm the minute my blood sugar hits 11.0. I wouldn't normally feel any different at 11.0. Those awful high blood sugar feelings don't usually kick in until I'm 13 or higher. Without Dex I could easily sleep 8 hours with blood sugar numbers in the 12s. Now he wakes me up, I bolus and drop down to a much safer 6-7 for the rest of the night.
All this to say that, after three months of living with him, I was pretty excited to see my latest A1C results.
Would the fact that I have had fewer and less dramatic highs and lows translate into a good looking A1C? Would my A1C go up because I had fewer lows?
Last week I headed to the Diabetes Centre to find out.
My last test came back with an A1C of 6.6 but I was still having too many lows according to the doctor.
Last week's test results?
6.5
And I could, without even a hint of dishonesty, say that I reached that number with fewer lows. Not no lows, but definitely fewer and, when they happened, I usually caught them when they were 3.9 rather than 3.0.
Yet another reason why I have a mighty big crush on Dexter.
He teaches me things, he keeps me safe AND he helps me get an A+ on my tests.
Thursday, September 5, 2013
Diabetes Centre Visit - The Results
Yesterday I had my six-month appointment at the Diabetes Centre.
You might remember last week when I wrote about my two-week log of food, exercise, blood glucose readings and insulin doses. I mentioned that I had been experiencing one low per day, pretty much every day, for two weeks. Without much of a pattern to it. Sometimes at 3am. Sometimes after breakfast. Sometimes before dinner. Or after dinner.
I had a nice chat with my diabetes doctor and here is what I learned.
I'm having too many lows.
We both agree on that.
She reminded me of the general rule of thumb when it comes to lows:
- If I'm low within two hours of eating, I need to reduce my bolus amount.
- If I'm low before a meal, or in the middle of the night, I need to adjust my basal rates.
I told her that I had reduced my basal rates across the board because the lows seemed all over the place. She said that was fine. I also said that I was just (and I mean just as in five minutes ago) reduce my dinner bolus calculation to avoid the pre-bed second dinners I've had to eat to avoid 3am lows.
Within seconds of flipping through my information she noticed that I was low or under 5.0 every day at lunch time. She recommend that mornings are probably a good place to start. Since I was low by lunch, not after breakfast, my basal rates are probably too high, especially considering I exercise most mornings. So I'm dropping those down and we'll see if that helps with the before lunch stuff. Once those are better I'll be looking for after lunch and before dinner patterns.
She was really helpful. No judging. No lectures. Just another pair of eyes to pour over the numbers and try to make sense of them.
She also suggested that I try uploading the information from my pump which I have yet to try. She said it will help me identify patterns there too. Looks like I need to pull out my big bag of Animas stuff that I have tucked away in the closet and figure out how to do that this weekend.
End result?
My A1C was 6.6 which, as she put it, is fabulous if I can achieve it without too many lows. I'm experiencing too many lows so she wants me to fix that and aim for closer to 7.0 for my next appointment in February.
Yes ma'am.
You might remember last week when I wrote about my two-week log of food, exercise, blood glucose readings and insulin doses. I mentioned that I had been experiencing one low per day, pretty much every day, for two weeks. Without much of a pattern to it. Sometimes at 3am. Sometimes after breakfast. Sometimes before dinner. Or after dinner.
I had a nice chat with my diabetes doctor and here is what I learned.
I'm having too many lows.
We both agree on that.
She reminded me of the general rule of thumb when it comes to lows:
- If I'm low within two hours of eating, I need to reduce my bolus amount.
- If I'm low before a meal, or in the middle of the night, I need to adjust my basal rates.
I told her that I had reduced my basal rates across the board because the lows seemed all over the place. She said that was fine. I also said that I was just (and I mean just as in five minutes ago) reduce my dinner bolus calculation to avoid the pre-bed second dinners I've had to eat to avoid 3am lows.
Within seconds of flipping through my information she noticed that I was low or under 5.0 every day at lunch time. She recommend that mornings are probably a good place to start. Since I was low by lunch, not after breakfast, my basal rates are probably too high, especially considering I exercise most mornings. So I'm dropping those down and we'll see if that helps with the before lunch stuff. Once those are better I'll be looking for after lunch and before dinner patterns.
She was really helpful. No judging. No lectures. Just another pair of eyes to pour over the numbers and try to make sense of them.
She also suggested that I try uploading the information from my pump which I have yet to try. She said it will help me identify patterns there too. Looks like I need to pull out my big bag of Animas stuff that I have tucked away in the closet and figure out how to do that this weekend.
End result?
My A1C was 6.6 which, as she put it, is fabulous if I can achieve it without too many lows. I'm experiencing too many lows so she wants me to fix that and aim for closer to 7.0 for my next appointment in February.
Yes ma'am.
Tuesday, March 12, 2013
Diabetes Doctor Details
Last week, the day after my presentation, I had an appointment with my diabetes doctor. My regular bi-annual appointment. I arrived armed with my blood sugar/food log and a whole bunch of questions. She arrived with my blood work results.
My A1C was the lowest yet at 6.5%. I have been more stable lately - less lows - and I thought perhaps I'd be somewhere around 7%. Seeing a 6.5% knowing that it happened despite fewer lows made me happy.
A1C is essentially an average of your blood sugar over the last three months. There are different ways to reach a good A1C average. You can reach it with good numbers but you can also reach it by having lots and lots of lows which help lower the average but that's not a particularly safe or smart thing to do. I'm glad that my A1C this time was most likely due to good numbers.
My cholesterol was in the healthy range and there were no signs of protein in my urine. High fives all around.
After looking at my blood sugar log, my doctor noticed a trend that I had not seen. Apparently I have a low blood sugar in the early mornings after I swam the morning before. It's almost 24-hours later but seems to be a pretty consistent pattern. So I'll be more aware of that.
My turn.
I started off by asking for a prescription for test strips for my new Verio meter which she readily wrote. By the way, two people commented on a post I wrote last week saying that the Verio meter gave them readings that were higher than their other meters. I noticed that too on the first night when I tested my blood on my old and my new meter and then tested both with a control solution. The was almost a 2mmol difference. The question is: which one is off? My OneTouch Ultra Mini or my OneTouch Verio? Hard to know. I'm bringing both with me to Israel with lots of test strips for each so, if one starts feeling like it's giving me wonky results, I have a backup.
I then asked for a prescription for long-acting insulin. I told her that I decided not to bring a back-up insulin pump with me because of the potential $5,000 charge if I lose or damage it. I said that I was planning to bring a prescription for long-acting insulin with me as a back up. She did even better than that and gave me a pre-loaded Lantus pen with enough long-acting to get me through 20 days. I was given instructions for how to calculate the dose. Sweet!
The last thing I did was mention the issue that I had had with my toes. Anyone remember my blog a few weeks ago when I went to my family doctor and showed her tiny dots on the tips of my toes? They had been itchy but not painful and had appeared seemingly out of nowhere. My family doctor told me I had small blood vessel disease, told me to keep my feet warm, to take low dose aspirin and to show my diabetes doctor. Well, the black dots are gone now so I had nothing to show. My diabetes doc listened to me explain my symptoms and said that it probably wasn't small blood vessel disease. It was most likely a wart virus I had picked from the pool that had flared up and then disappeared once my body fought it.
She said that my family doctor probably didn't think of that because I have diabetes. (Insert rant here about looking at me as more than just a diabetic).
So my A1C was good. My other blood work was good. I have a low blood sugar trend to be aware of. My feet are fine. I have a back up plan in case my pump collapses from the Israeli heat.
All in all a very positive day at the doctor's office.
My A1C was the lowest yet at 6.5%. I have been more stable lately - less lows - and I thought perhaps I'd be somewhere around 7%. Seeing a 6.5% knowing that it happened despite fewer lows made me happy.
A1C is essentially an average of your blood sugar over the last three months. There are different ways to reach a good A1C average. You can reach it with good numbers but you can also reach it by having lots and lots of lows which help lower the average but that's not a particularly safe or smart thing to do. I'm glad that my A1C this time was most likely due to good numbers.
My cholesterol was in the healthy range and there were no signs of protein in my urine. High fives all around.
After looking at my blood sugar log, my doctor noticed a trend that I had not seen. Apparently I have a low blood sugar in the early mornings after I swam the morning before. It's almost 24-hours later but seems to be a pretty consistent pattern. So I'll be more aware of that.
My turn.
I started off by asking for a prescription for test strips for my new Verio meter which she readily wrote. By the way, two people commented on a post I wrote last week saying that the Verio meter gave them readings that were higher than their other meters. I noticed that too on the first night when I tested my blood on my old and my new meter and then tested both with a control solution. The was almost a 2mmol difference. The question is: which one is off? My OneTouch Ultra Mini or my OneTouch Verio? Hard to know. I'm bringing both with me to Israel with lots of test strips for each so, if one starts feeling like it's giving me wonky results, I have a backup.
I then asked for a prescription for long-acting insulin. I told her that I decided not to bring a back-up insulin pump with me because of the potential $5,000 charge if I lose or damage it. I said that I was planning to bring a prescription for long-acting insulin with me as a back up. She did even better than that and gave me a pre-loaded Lantus pen with enough long-acting to get me through 20 days. I was given instructions for how to calculate the dose. Sweet!
The last thing I did was mention the issue that I had had with my toes. Anyone remember my blog a few weeks ago when I went to my family doctor and showed her tiny dots on the tips of my toes? They had been itchy but not painful and had appeared seemingly out of nowhere. My family doctor told me I had small blood vessel disease, told me to keep my feet warm, to take low dose aspirin and to show my diabetes doctor. Well, the black dots are gone now so I had nothing to show. My diabetes doc listened to me explain my symptoms and said that it probably wasn't small blood vessel disease. It was most likely a wart virus I had picked from the pool that had flared up and then disappeared once my body fought it.
She said that my family doctor probably didn't think of that because I have diabetes. (Insert rant here about looking at me as more than just a diabetic).
So my A1C was good. My other blood work was good. I have a low blood sugar trend to be aware of. My feet are fine. I have a back up plan in case my pump collapses from the Israeli heat.
All in all a very positive day at the doctor's office.
Wednesday, September 5, 2012
Bike Helmets versus Brain Injuries
Yesterday I went for my six month visit to see my doctor at the Diabetes Centre. It went well - bloodwork came back fine, logbook got the nod and my blood pressure was textbook. We were done the required stuff in about five minutes, including my questions.
"Have you heard anything about the Disability Tax Credit?" asked my doctor.
"No," I replied.
"Oh good, something useful I can tell you," she replied and proceeded to explain it to me.
The disability tax credit is something that some people are eligible for...if they meet the criteria.
"Basically," she explained "you need to prove that you spend 14 hours (or more) per week doing life-sustaining therapy".
She handed me a list of things that qualify, or don't qualify, as life-sustaining therapy.
Qualify:
- time spent monitoring blood glucose
- time spent setting up pump or equipment (site changes, drawing up insulin into the pump etc)
- calibrating equipment
- treatment of low or high blood sugars
- insulin adjustments
- logbook maintenance
- time away from normal activities
Doesn't qualify:
- pump delivery time of insulin
- travel time
- medical appointments
- carb counting (why the hell not??)
- exercise (really??)
I have to track for two weeks and, if I can prove that I spend 14 hours per week doing life-sustaining therapy, they will sign the paperwork and I will qualify of the disability tax credit.
I will most certainly be doing that.
But it got me thinking about a conversation I had with my mother a while ago. About the amount of money I spend to stay healthy. The cost of healthy food. The cost of my pool membership and now my masters swimming classes. The cost of my 4-5 pair of running shoes and inserts per year. The amount I spend on gels and other fast-acting carbs so I have enough emergency stuff for long runs. The cost of upkeep on my bike so I can cycle and help my legs recover from long runs. The cost of massages and chiropractor appointments to keep my body in good shape so I can keep exercising. The cost of all the test strips I use (10+ a day, every day). My compression socks to keep my circulation moving.
Rough calculation of annual costs:
$100 annual bike maintenance
$600 running shoes and inserts
$600 pool membership and classes
$150 gels and fast-acting carbs
$500 for massage (after my insurance covers $500)
$50 compression socks
Total: $2000/year
That doesn't include healthy food like my protein shake powder or race entry fees which, while not necessary, keep me focused and motivate me to train. That doesn't include the cost of running clothes or bathing suits because I wear them until they disintegrate. That doesn't include the cost of vitamins, of gas to drive to my pharmacy every two weeks or to my 15+ medical appointments a year - most of which are in a different city.
Two thousand dollars a year minimum to stay healthy and active. Not to mention the time I spend exercising, preparing to exercise, recovering from exercise or cooking healthy meals.
Two thousand dollars a year to stay healthy.
Who knows, I may still get good A1C results without all the cost, time and effort. I may still have textbook blood pressure and great blood test results. I may still maintain a healthy weight and fight off diabetes complications. Or I may not.
But I'm guessing two thousand dollars a year is much cheaper than the cost of dialysis. Or hospital stays. Or amputations. Or long-term disability.
My mom and I chatted about how nice it would be if the system encouraged and supported us to maintain good health instead paying for us when we get sick.
You can either buy me the bike helmet or you can pay for the brain injury.
"Have you heard anything about the Disability Tax Credit?" asked my doctor.
"No," I replied.
"Oh good, something useful I can tell you," she replied and proceeded to explain it to me.
The disability tax credit is something that some people are eligible for...if they meet the criteria.
"Basically," she explained "you need to prove that you spend 14 hours (or more) per week doing life-sustaining therapy".
She handed me a list of things that qualify, or don't qualify, as life-sustaining therapy.
Qualify:
- time spent monitoring blood glucose
- time spent setting up pump or equipment (site changes, drawing up insulin into the pump etc)
- calibrating equipment
- treatment of low or high blood sugars
- insulin adjustments
- logbook maintenance
- time away from normal activities
Doesn't qualify:
- pump delivery time of insulin
- travel time
- medical appointments
- carb counting (why the hell not??)
- exercise (really??)
I have to track for two weeks and, if I can prove that I spend 14 hours per week doing life-sustaining therapy, they will sign the paperwork and I will qualify of the disability tax credit.
I will most certainly be doing that.
But it got me thinking about a conversation I had with my mother a while ago. About the amount of money I spend to stay healthy. The cost of healthy food. The cost of my pool membership and now my masters swimming classes. The cost of my 4-5 pair of running shoes and inserts per year. The amount I spend on gels and other fast-acting carbs so I have enough emergency stuff for long runs. The cost of upkeep on my bike so I can cycle and help my legs recover from long runs. The cost of massages and chiropractor appointments to keep my body in good shape so I can keep exercising. The cost of all the test strips I use (10+ a day, every day). My compression socks to keep my circulation moving.
Rough calculation of annual costs:
$100 annual bike maintenance
$600 running shoes and inserts
$600 pool membership and classes
$150 gels and fast-acting carbs
$500 for massage (after my insurance covers $500)
$50 compression socks
Total: $2000/year
That doesn't include healthy food like my protein shake powder or race entry fees which, while not necessary, keep me focused and motivate me to train. That doesn't include the cost of running clothes or bathing suits because I wear them until they disintegrate. That doesn't include the cost of vitamins, of gas to drive to my pharmacy every two weeks or to my 15+ medical appointments a year - most of which are in a different city.
Two thousand dollars a year minimum to stay healthy and active. Not to mention the time I spend exercising, preparing to exercise, recovering from exercise or cooking healthy meals.
Two thousand dollars a year to stay healthy.
Who knows, I may still get good A1C results without all the cost, time and effort. I may still have textbook blood pressure and great blood test results. I may still maintain a healthy weight and fight off diabetes complications. Or I may not.
But I'm guessing two thousand dollars a year is much cheaper than the cost of dialysis. Or hospital stays. Or amputations. Or long-term disability.
My mom and I chatted about how nice it would be if the system encouraged and supported us to maintain good health instead paying for us when we get sick.
You can either buy me the bike helmet or you can pay for the brain injury.
Wednesday, April 4, 2012
Doing Just Fine
Sometimes the anticipation is totally worth it - anyone else remember being 8 years old and completely unable to sleep as you listened for the sound of Santa on the roof and tried to guess what he was bringing you?
Sometimes the anticipation is almost more fun than the actual event - anyone else count down the months, weeks, and days until a movie comes out only to discover that it really isn't very good?
And sometimes the anticipation (read: worry and planning) seems ridiculous in hindsight because the actual event turns out to be a piece of cake.
Yep, I went to the Diabetes Centre yesterday - food and blood sugar diary in tow - ready to get my blood test results and explain my ups and downs.
My doctor walked it and announced that my A1C was...
wait for it...
6.9!
She announced that my kidneys are fine.
She looked through my meticulous little diary of meals and blood sugar readings (15 a day) and piles of notes trying to explain every up and down - and announced that I obviously know what I'm doing, know how to correct for highs and lows and that nothing jumps out as a problem.
She checked my blood pressure (107/69) and said that she only did it in case it was high so we could actually have something to talk about.
I grinned. She grinned.
It's nice to stump the doctor and make her struggle for something to say.
So I asked my three questions:
Can you prescribe me something to check my ketones? I haven't done that in a few years now and probably should get back in the habit when I'm sick or fighting highs.
So she prescribed test strips for blood ketone testing.
Can you prescribe glucagon? I haven't kept any on hand in years and probably should. It might save my life one day.
So she prescribed glucagon.
Can you tell me if there are any options to save $ on continuous glucose monitoring supplies? I want to use it more but can't afford it at $50 a pop.
"Doesn't your insurance cover it?" she asked.
Ummmm, I haven't actually asked (how sad is that?). I was told that no insurance covers it and it never occurred to me that this might have changed in the last three years.
"Several of them do now - check it out and I'll fill out any paperwork they might need. You're an ideal candidate for it because of all the sports you do."
Wicked!
I didn't ask my fourth question because the person I wanted to talk to wasn't there.
Last year, right around this time, I applied to be a Medtronic Global Hero. I wasn't chosen so I'm trying again this year. I figure if I don't grab their attention with my story, I'll grab it with my perseverance. Anyway, I can ask three people to recommend me and I thought I'd ask one of the nurses at the Diabetes Centre. She and I have a pretty cool relationship because, every time she meets someone with T1 diabetes who is struggling with their diagnosis, who wants to start running or who just wants to talk to someone who gets it - she calls me. And I email them. And another relationship is formed.
So I'm going to call her tomorrow to ask her to submit a recommendation.
I walked out of the appointment, past a waiting room full of people and thought "I'm doing just fine!"
Sometimes the anticipation is almost more fun than the actual event - anyone else count down the months, weeks, and days until a movie comes out only to discover that it really isn't very good?
And sometimes the anticipation (read: worry and planning) seems ridiculous in hindsight because the actual event turns out to be a piece of cake.
Yep, I went to the Diabetes Centre yesterday - food and blood sugar diary in tow - ready to get my blood test results and explain my ups and downs.
My doctor walked it and announced that my A1C was...
wait for it...
6.9!
She announced that my kidneys are fine.
She looked through my meticulous little diary of meals and blood sugar readings (15 a day) and piles of notes trying to explain every up and down - and announced that I obviously know what I'm doing, know how to correct for highs and lows and that nothing jumps out as a problem.
She checked my blood pressure (107/69) and said that she only did it in case it was high so we could actually have something to talk about.
I grinned. She grinned.
It's nice to stump the doctor and make her struggle for something to say.
So I asked my three questions:
Can you prescribe me something to check my ketones? I haven't done that in a few years now and probably should get back in the habit when I'm sick or fighting highs.
So she prescribed test strips for blood ketone testing.
Can you prescribe glucagon? I haven't kept any on hand in years and probably should. It might save my life one day.
So she prescribed glucagon.
Can you tell me if there are any options to save $ on continuous glucose monitoring supplies? I want to use it more but can't afford it at $50 a pop.
"Doesn't your insurance cover it?" she asked.
Ummmm, I haven't actually asked (how sad is that?). I was told that no insurance covers it and it never occurred to me that this might have changed in the last three years.
"Several of them do now - check it out and I'll fill out any paperwork they might need. You're an ideal candidate for it because of all the sports you do."
Wicked!
I didn't ask my fourth question because the person I wanted to talk to wasn't there.
Last year, right around this time, I applied to be a Medtronic Global Hero. I wasn't chosen so I'm trying again this year. I figure if I don't grab their attention with my story, I'll grab it with my perseverance. Anyway, I can ask three people to recommend me and I thought I'd ask one of the nurses at the Diabetes Centre. She and I have a pretty cool relationship because, every time she meets someone with T1 diabetes who is struggling with their diagnosis, who wants to start running or who just wants to talk to someone who gets it - she calls me. And I email them. And another relationship is formed.
So I'm going to call her tomorrow to ask her to submit a recommendation.
I walked out of the appointment, past a waiting room full of people and thought "I'm doing just fine!"
Monday, March 19, 2012
Every Bite
I have an appointment at the Diabetes Centre in two weeks. Seeing that appointment looming on the calendar means a few things:
I am also required to track blood sugar numbers for two weeks. That's the fun job of writing down every morsel of food I put into my mouth, every blood sugar result, every basal change, exercise, bolus correction and whatever else I can think of that might somehow explain why my blood sugar was a particular number at a particular time on a particular day. I'm tempted to include weather reports and pollen counts in case they might help decipher the numbers.
I really dislike this part. I dislike writing down a 3.9 an hour after exercise because I know what they're going to say. I dislike writing a 16.5 after a big meal because I know what they're going to say. I hate having more than one low in one day because I know the look I'm going to get. And I hate having to explain every number that they've circled in red pen.
"Can you explain this low?" "This high?"
And the comments like: "Oh, you exercised yesterday, that's why you were low" (Um, I exercise pretty much every day). "Wow, you exercise every day? What do you do to your basal rates before you exercise?"
Well, that depends on:
Sigh.
I know that the Diabetes Centre is really really important for a lot of people. They teach so much and have so much advice about nutrition, carb-counting, healthy living etc. I'm sure they have helped countless people. But I go because I need my bloodwork results and I need to go there a set number of times per year in order to quality for government funding for my pump supplies. They really like me and they love the fact that I take care of myself so most of the appointment is spent chatting about little things like my blog and what race I'm training for.
I also dread going to be appointment because of the A1C results. (For those of you who don't know what that is, this blog tries to explain it). My A1C is usually pretty good (around 7.0) but I've had higher and lower numbers and there's always a sense of randomness about it. I feel like my control is pretty consistent in terms of highs and lows and overall care so when it goes up to 7.5 or down to 6.8, I never really know why.
So I see the A1C result and I start trying to explain things (I was injured, I was sick a few times, I had more lows, I had more highs, I was training for a race, I wasn't training for a race). I feel like that number somehow explains me and defines me and I feel guilty when it's not exactly what it's supposed to be.
I know it's ridiculous - it's one damn number. An average of my blood sugar over the last three months. Someone with horrible control could have an A1C of 7.0 and someone with fabulous control could also have an A1C 7.0. I know the effort I put in and I'm ok with how well I'm doing - but when I see that number I suddenly feel 'not ok'.
I have a love/hate relationship with that test. It validates what I'm doing and yet it invalidates how I feel about it.
So for the rest of this week I will dutifully document how many mini chocolates I snack on during the day and write down every low and every high (trying not to cringe as I do it). At in two weeks I will find out what the A1C results are this time around.
And then I get a few months of just taking care of myself before I get to do it all again.
Aside: Is it just me or do other people care a little less right after your A1C test is done? I figure the next test isn't due for four months and it's only a three month average so....yes I will have baklava for dessert thank you very much!
- bloodwork
- meal tracking
- A1C results
- guilt
I am also required to track blood sugar numbers for two weeks. That's the fun job of writing down every morsel of food I put into my mouth, every blood sugar result, every basal change, exercise, bolus correction and whatever else I can think of that might somehow explain why my blood sugar was a particular number at a particular time on a particular day. I'm tempted to include weather reports and pollen counts in case they might help decipher the numbers.
I really dislike this part. I dislike writing down a 3.9 an hour after exercise because I know what they're going to say. I dislike writing a 16.5 after a big meal because I know what they're going to say. I hate having more than one low in one day because I know the look I'm going to get. And I hate having to explain every number that they've circled in red pen.
"Can you explain this low?" "This high?"
And the comments like: "Oh, you exercised yesterday, that's why you were low" (Um, I exercise pretty much every day). "Wow, you exercise every day? What do you do to your basal rates before you exercise?"
Well, that depends on:
- what time of day I'm exercising
- what sport I'm doing
- how intense the workout is going to be
- how long the workout is going to be
- whether or not I have my period
- what my blood sugar was doing for the few hours before the activity
- what I'm planning on doing after I exercise
Sigh.
I know that the Diabetes Centre is really really important for a lot of people. They teach so much and have so much advice about nutrition, carb-counting, healthy living etc. I'm sure they have helped countless people. But I go because I need my bloodwork results and I need to go there a set number of times per year in order to quality for government funding for my pump supplies. They really like me and they love the fact that I take care of myself so most of the appointment is spent chatting about little things like my blog and what race I'm training for.
I also dread going to be appointment because of the A1C results. (For those of you who don't know what that is, this blog tries to explain it). My A1C is usually pretty good (around 7.0) but I've had higher and lower numbers and there's always a sense of randomness about it. I feel like my control is pretty consistent in terms of highs and lows and overall care so when it goes up to 7.5 or down to 6.8, I never really know why.
So I see the A1C result and I start trying to explain things (I was injured, I was sick a few times, I had more lows, I had more highs, I was training for a race, I wasn't training for a race). I feel like that number somehow explains me and defines me and I feel guilty when it's not exactly what it's supposed to be.
I know it's ridiculous - it's one damn number. An average of my blood sugar over the last three months. Someone with horrible control could have an A1C of 7.0 and someone with fabulous control could also have an A1C 7.0. I know the effort I put in and I'm ok with how well I'm doing - but when I see that number I suddenly feel 'not ok'.
I have a love/hate relationship with that test. It validates what I'm doing and yet it invalidates how I feel about it.
So for the rest of this week I will dutifully document how many mini chocolates I snack on during the day and write down every low and every high (trying not to cringe as I do it). At in two weeks I will find out what the A1C results are this time around.
And then I get a few months of just taking care of myself before I get to do it all again.
Aside: Is it just me or do other people care a little less right after your A1C test is done? I figure the next test isn't due for four months and it's only a three month average so....yes I will have baklava for dessert thank you very much!
Wednesday, September 14, 2011
Standard Deviation
Well, I went for my quarterly diabetes update. The one where I get the results of my A1C test.
If you want a detailed explanation of what that is, feel free to peruse a blog I wrote back in February about it.
My doctor came in, sat down and said that my A1C was 7.3
"What?? How did that happen??" was my response.
She came back with "Is that higher or lower than you were expecting?"
"Higher! Last time, I was 6.9".
She laughed and said that I was the only person she works with at the Diabetes Centre who gets upset by a 7.3 or by a change of 0.4 from the previous test.
She explained that it really doesn't take much to go from 6.9 to 7.3. She also explained that there is a standard deviation that we have to take into consideration. In other words, when they test A1C and come back with a number - what's the margin of error. She didn't give me an exact number but I did a quick internet search and a standard deviation of +/- 0.4 seems pretty typical.
It's been almost twenty years since my first year stats class (which I got 51% in by the way) but here's how I understand it. Feel free to correct me if I'm wrong.
My last three A1Cs were:
7.1
6.9
7.3
If I include the standard deviation, here's how they look.
6.7 - 7.5
6.4 - 7.3
6.9 - 7.7
So, my 7.3 from today might be a 6.9 and my 6.9 from last time could be closer to a 7.3.
I can see why she laughed when I was annoyed at my results.
Fair enough.
I also asked about my recent problem of my ears plugging up during long runs. She asked about blood sugar - I said it was high once but then normal the other times. She asked about allergies - I have the dust/cat/dog allergies but there are no other symptoms other than plugged ears so I don't think that allergies are the cause. I asked about low blood pressure (thanks for the tip Selena). She didn't seem to think so and said that my blood pressure would most likely be high and not low during a run.
She referred me to an Ear, Nose and Throat Specialist. The appointment is booked for December 15th.
Including the marathon, I have four more runs that should be long enough for my ears to plug. I'll see if I can find any sort of clue as to the cause. I'll test my sugar, I'll drink my water. And we'll see if any patterns emerge.
All this figuring out is kinda fun. I like it because it forces me to be even more in tune with my body, with what I'm doing to it, with what I'm putting into it and with how it's feeling. I do best when my body and I work closely together. We have been the best of friends these last few months as we train for a marathon together.
We only get one body.
Best take care of it.
If you want a detailed explanation of what that is, feel free to peruse a blog I wrote back in February about it.
My doctor came in, sat down and said that my A1C was 7.3
"What?? How did that happen??" was my response.
She came back with "Is that higher or lower than you were expecting?"
"Higher! Last time, I was 6.9".
She laughed and said that I was the only person she works with at the Diabetes Centre who gets upset by a 7.3 or by a change of 0.4 from the previous test.
She explained that it really doesn't take much to go from 6.9 to 7.3. She also explained that there is a standard deviation that we have to take into consideration. In other words, when they test A1C and come back with a number - what's the margin of error. She didn't give me an exact number but I did a quick internet search and a standard deviation of +/- 0.4 seems pretty typical.
It's been almost twenty years since my first year stats class (which I got 51% in by the way) but here's how I understand it. Feel free to correct me if I'm wrong.
My last three A1Cs were:
7.1
6.9
7.3
If I include the standard deviation, here's how they look.
6.7 - 7.5
6.4 - 7.3
6.9 - 7.7
So, my 7.3 from today might be a 6.9 and my 6.9 from last time could be closer to a 7.3.
I can see why she laughed when I was annoyed at my results.
Fair enough.
I also asked about my recent problem of my ears plugging up during long runs. She asked about blood sugar - I said it was high once but then normal the other times. She asked about allergies - I have the dust/cat/dog allergies but there are no other symptoms other than plugged ears so I don't think that allergies are the cause. I asked about low blood pressure (thanks for the tip Selena). She didn't seem to think so and said that my blood pressure would most likely be high and not low during a run.
She referred me to an Ear, Nose and Throat Specialist. The appointment is booked for December 15th.
Including the marathon, I have four more runs that should be long enough for my ears to plug. I'll see if I can find any sort of clue as to the cause. I'll test my sugar, I'll drink my water. And we'll see if any patterns emerge.
All this figuring out is kinda fun. I like it because it forces me to be even more in tune with my body, with what I'm doing to it, with what I'm putting into it and with how it's feeling. I do best when my body and I work closely together. We have been the best of friends these last few months as we train for a marathon together.
We only get one body.
Best take care of it.
Tuesday, May 17, 2011
Not. Fasting.
I go see my endo exactly two weeks from today. That means it's time for bloodwork again. Which means the little diabetic girl has to fast for 12 hours. For details on how fun fasting is, check out the play by play from the last time I had to do it. Fasting is no easy feat for the diabetically inclined.
So last night I dutifully counted carbs at dinner, avoided a late night snack and checked my sugar several times before bed to see if it was holding steady. It was. There were no lows in the middle of the night (bonus!) and I woke up feeling fine. Sweet!
Blood sugar check = 3.9 (sigh). I had to eat something which means no bloodwork for me today.
So I hopped in the shower and began working out my plan of attack for tommorrow morning. Suddenly, out of nowhere, two words literally exploded in my head.
Not.
Fasting.
Now February feels like a long time ago but I had a vague memory of my endo writing that on the top of my blood test form.
I thought a little harder....YES!!! She did write that.
See, after years of trying very hard, I finally managed to get my cholesterol low enough (as in super human low) thanks to a wee beige pill I take every morning. Apparently once one reaches the target range, they do not have to have their cholesterol checked for a year. It's that test that requires fasting. All I need to have checked this time is my A1C.
Yes, I did indeed do a little happy dance in the shower.
I waltzed downstairs, made my delicious morning shake, lounged around a bit and headed to work. Because folks, I work right next to the lab where I go for bloodwork. And no fasting means no waiting in line with everyone else at 7:30am. I can skip down the street at 2pm today if I want to, roll up my sleeve and answer "No, I did not fast" when they ask me.
Better yet, I could walk in at 7:30am with a coffee in one hand and a donut in the other. Might piss off the other poor fasting folks but hey, I've been on that side of the table plenty of times and will be there again. If keeping my cholesterol in check means I only have to fast for one test per year - I'm all for it.
It feels good to be in control. I'll go get bloodwork done when I damn well feel like going. Today, tomorrow, before work, at lunch. Who cares really? I sure as hell don't.
And that, my friends, feels fabulous!
So last night I dutifully counted carbs at dinner, avoided a late night snack and checked my sugar several times before bed to see if it was holding steady. It was. There were no lows in the middle of the night (bonus!) and I woke up feeling fine. Sweet!
Blood sugar check = 3.9 (sigh). I had to eat something which means no bloodwork for me today.
So I hopped in the shower and began working out my plan of attack for tommorrow morning. Suddenly, out of nowhere, two words literally exploded in my head.
Not.
Fasting.
Now February feels like a long time ago but I had a vague memory of my endo writing that on the top of my blood test form.
I thought a little harder....YES!!! She did write that.
See, after years of trying very hard, I finally managed to get my cholesterol low enough (as in super human low) thanks to a wee beige pill I take every morning. Apparently once one reaches the target range, they do not have to have their cholesterol checked for a year. It's that test that requires fasting. All I need to have checked this time is my A1C.
Yes, I did indeed do a little happy dance in the shower.
I waltzed downstairs, made my delicious morning shake, lounged around a bit and headed to work. Because folks, I work right next to the lab where I go for bloodwork. And no fasting means no waiting in line with everyone else at 7:30am. I can skip down the street at 2pm today if I want to, roll up my sleeve and answer "No, I did not fast" when they ask me.
Better yet, I could walk in at 7:30am with a coffee in one hand and a donut in the other. Might piss off the other poor fasting folks but hey, I've been on that side of the table plenty of times and will be there again. If keeping my cholesterol in check means I only have to fast for one test per year - I'm all for it.
It feels good to be in control. I'll go get bloodwork done when I damn well feel like going. Today, tomorrow, before work, at lunch. Who cares really? I sure as hell don't.
And that, my friends, feels fabulous!
Tuesday, February 22, 2011
Blood Spatter Analyst
I spent part of my morning at the Niagara Diabetes Centre. I love going there because they always seem really happy to see me. Perhaps because fit diabetics who take an active role in their diabetes maintenance are rare in Niagara, or maybe I'm just so damn cute, but my doctor and nurse are always pleased to see me. Other staff will occasionally pop their heads in to ask about running or tell me about a cool website that I should check out.
Aside from the social chatter and ego boost, I actually go there to get my quarterly blood work results and find out how I've been doing.
Before I reveal the results, I thought this might be a good opportunity to provide a little diabetes lesson. For those of you with the diabetes, it may be a good review. For those of you without it, it may help clarify a few things.
Blood Glucose Testing: Ever seen a diabetic pull out a little contraption, prick their finger, put a drop of blood on a test strip and wait for a beep? That's blood glucose testing. What we're doing (in simple terms) is checking how much sugar is in our blood at that moment. It helps us figure out why we might be feeling weird or what our number is because we need to calculate how much insulin to take for the meal we're about to eat.
Someone without diabetes would have pretty stable numbers (betwee 4-6 normally) and these numbers wouldn't change much even after having a big piece of chocolate cake. Trust me, I've tested people right after dessert - it's ridiculous how little their blood sugar changes. Someone with diabetes can see all sorts of crazy results. I've personally seen 1.2 (which is scary low and feels horrendous) and I've seen 30 (which is scary high and feels like a totally different kind of horrendous). Sometimes we check to confirm what we already know, other times we check and are shocked by the results. It's not always easy to feel how we're feeling.
I test fairly frequently - probably 10-12 times on any given day. That may seem like a lot but it still means that there is a good part of every day when I don't know what my blood sugar is doing. Is it climbing, dropping, staying still? Hard to say. You can miss a lot of highs (and even some lows) simply by not testing at the right time.
(Aside: yes, there are continuous glucose monitoring devices out there but I've found them too expensive and too inconsistent for my lifestyle.)
So, to recap, blood glucose testing tells you what's going on at a given moment but not how you're doing overall.
That's where Haemoglobin A1C comes in. This is a blood test that gives an average of our blood glucose level over the past few months. Someone without diabetes would have an A1C of between 5.0 and 6.0. Someone with diabetes has to set the bar a little higher than that depending on all sorts of other factors.
My doctor has me aiming for 7.0. Anything lower would mean that I've had too many lows and anything around 8.0 is just too high.
Now, here's the trick. I can get an A1C within range two different ways. First way: I can have lots of highs as long as I have lots of lows. Remember: A1C results are an average. The second way is better and much less dangerous. Ideally, I get my A1C as close to 7.0 as possible without too many lows because that means that I didn't have too many highs either. It takes a lot of monitoring, planning and control. It's worth it in the long run because consistently good A1C results means lower risk of complications. Not no risk but lower risk. Heck, I'll take what I can get.
Today's result? 7.1
Yeah baby!
Aside from the social chatter and ego boost, I actually go there to get my quarterly blood work results and find out how I've been doing.
Before I reveal the results, I thought this might be a good opportunity to provide a little diabetes lesson. For those of you with the diabetes, it may be a good review. For those of you without it, it may help clarify a few things.
Blood Glucose Testing: Ever seen a diabetic pull out a little contraption, prick their finger, put a drop of blood on a test strip and wait for a beep? That's blood glucose testing. What we're doing (in simple terms) is checking how much sugar is in our blood at that moment. It helps us figure out why we might be feeling weird or what our number is because we need to calculate how much insulin to take for the meal we're about to eat.
Someone without diabetes would have pretty stable numbers (betwee 4-6 normally) and these numbers wouldn't change much even after having a big piece of chocolate cake. Trust me, I've tested people right after dessert - it's ridiculous how little their blood sugar changes. Someone with diabetes can see all sorts of crazy results. I've personally seen 1.2 (which is scary low and feels horrendous) and I've seen 30 (which is scary high and feels like a totally different kind of horrendous). Sometimes we check to confirm what we already know, other times we check and are shocked by the results. It's not always easy to feel how we're feeling.
I test fairly frequently - probably 10-12 times on any given day. That may seem like a lot but it still means that there is a good part of every day when I don't know what my blood sugar is doing. Is it climbing, dropping, staying still? Hard to say. You can miss a lot of highs (and even some lows) simply by not testing at the right time.
(Aside: yes, there are continuous glucose monitoring devices out there but I've found them too expensive and too inconsistent for my lifestyle.)
So, to recap, blood glucose testing tells you what's going on at a given moment but not how you're doing overall.
That's where Haemoglobin A1C comes in. This is a blood test that gives an average of our blood glucose level over the past few months. Someone without diabetes would have an A1C of between 5.0 and 6.0. Someone with diabetes has to set the bar a little higher than that depending on all sorts of other factors.
My doctor has me aiming for 7.0. Anything lower would mean that I've had too many lows and anything around 8.0 is just too high.
Now, here's the trick. I can get an A1C within range two different ways. First way: I can have lots of highs as long as I have lots of lows. Remember: A1C results are an average. The second way is better and much less dangerous. Ideally, I get my A1C as close to 7.0 as possible without too many lows because that means that I didn't have too many highs either. It takes a lot of monitoring, planning and control. It's worth it in the long run because consistently good A1C results means lower risk of complications. Not no risk but lower risk. Heck, I'll take what I can get.
Today's result? 7.1
Yeah baby!
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