A1C and Salt Licks

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.

Off to the Endo I go

I've uploaded the last month's worth of CGM data from Rose.

I've printed a summary of that data. Complete with pretty colours, pie charts and graphs.

I've breathed a sigh of relief after seeing how lovely my average blood glucose stats were. I then proudly saddle up beside Doug to show him so he could express his delight (or at least make supportive sounds as I clicked through the pages of data).

I have my blood pressure log with detailed notes about each pre and post long-run blood pressure fiasco. I also have my blood pressure meter set out on the counter.

I have my list of questions ready.

It's that time again.

Endo appointment time.

Here's hoping it's a little more helpful than my diabetes centre appointment was a few weeks ago.

I'll let you know next week how the A1C turned out and what her thoughts are on the blood pressure drop accompanied by heart rate spike that keeps happening during long runs.

Blood Pressure

I had two medical appointments yesterday.

I had an appointment with my family doctor because I went to renew a prescription last week only to discover that I had no more repeats on it. They were nice enough to squeeze me in so I could get another six months' worth of a prescription that I will be taking for the rest of my life (sigh).

While I was there, they checked my blood pressure.

It was 127/72.

They said nothing other than to speak the numbers out loud.

I left, prescription in hand, and headed down the road to my dentist for my 6-month cleaning and check up.

When I got there, they tested my blood pressure.

It was 119/80.

"That's pretty much perfect isn't it?" I asked. "120/80 is the magic number right?"

"No", replied my dental hygienist. "120/80 is the highest you want it to be. So you're just on the edge of too high." "Your heart rate is really low though. It's only 55 beats per minute" she said. And then she proceeded to scrub my teeth within an inch of their life for 45 minutes...which gave me 45 minutes to think.

I realize that blood pressure fluctuates for all sorts of reasons. Stress, movement, time of day, the way they did the blood pressure reading etc.

So I'm not particularly bothered by the difference in my readings.

What I am bothered by is the fact that my family doctor didn't bat an eye at 127/72 (and she is the type to prescribe medication even before it's needed) and my dental hygienist's comment seemed to indicate that I was teetering on the edge of problematic blood pressure.

After CoreFit and a late dinner I went online to do a bit of research. Here is what I learned.

The top number indicates the systolic blood pressure which is the pressure in the arteries when the heart is pumping. The bottom number is the diastolic pressure which is the pressure in the arteries in between heart beats. With me so far?

According to the Heart and Stroke Foundation of Canada, low risk blood pressure is a top number  below 120 and a bottom number below 80. (uh oh)

Medium risk is a systolic blood pressure of 121-139 or a diastolic blood pressure of 80-89.

High risk is 140+/90. Unless of course you have diabetes and then it's 130/80.

Bloody hell!

I looked up what the Heart and Stroke Foundation recommends for lowering blood pressure.

• Eat a low sodium diet (stay under 2,300mg/day) - I don't get anywhere near that number most days. I typically hover around 1,500mg. 
• Eat a diet low in saturated fat - again, no problem there. 
• Exercise 150 minutes per week - I do several times that most weeks.
• Don't drink more than two alcoholic drinks per day - I hardly drink two per week
• Don't smoke - you couldn't pay me enough to pick up a cigarette
• Keep stress to a minimum - I have a pretty stress-free life most of the time and work hard to keep it that way. 

Well, I have six more weeks until my next appointment at the Diabetes Centre. They're really good at answering my questions so I'm sure they'll give me a good sense of a) what my readings mean and b) if I need to do anything about them. 

In the meantime, I'll keep on doing all the things I do to stay healthy and I may just pop into the local pharmacy for random blood pressure checks. For research purposes. 

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. 

Misdiagnosed

One of the best things about being connected to the Diabetes Online Community (aka the DOC) is that they stumble across things that I might not stumble across and are then nice enough to share it. Which means that I learn more, read more, appreciate more than I would if left to my own devices.

Like yesterday. When my friend Scott shared a link to a position paper posted on a blog I had never heard of before.

The paper was about adults diagnosed with Type 1 diabetes. As in they were diagnosed when they were adults. Not when they were kids as T1's alter ego, Juvenile diabetes, would suggest.

The paper talked about the high number of adults who are misdiagnosed with having Type 2 diabetes. Who are put on exercise regimes and diet restrictions and pills and who are then judged when things don't improve. They not only don't improve but they get worse.

People have ended up in comas because of being misdiagnosed.

People have died.

I was misdiagnosed. It was November 1st, 2002. It was probably about 10am at the time and I was sitting in my doctor's office. She took one look at my blood sugar of 30+ and told me I had Type 2. She told me I would be put on a pill, that I would have to watch what I ate and that I would be fine. She sent me for bloodwork and sent me home.

She called me a few hours later to say that I had to go to the hospital immediately because I had diabetic ketoacidosis. According to her I still had Type 2 diabetes.

The endocrinologist who appeared in my hospital room promptly announced that I had Type 1 diabetes, not Type 2, and transferred me to the Intensive Care Unit where I stayed for four days.

I was misdiagnosed but it didn't even take 12 hours for someone to figure it out. I was on insulin in no time and feeling better by the minute as my blood sugar went down for the first time in...weeks? I never really think much of that day other than to use it in presentations when I tell my diagnosis story.

Then I read that blog post yesterday. I read other people's stories, one after the other. I read about people who were judged for not being able to get their blood sugar down on their own. People who didn't find out for months and months what the problem really was and who came dangerously close to death before they do.

We. Don't. Make. Insulin.

No amount of encouragement, berating, pill prescriptions and exercise regimes will help.

Without insulin. We. Will. Die.

I was down to a vial and a half of insulin in my fridge on the weekend. Enough to get me through almost two weeks as long as I didn't gorge on baklava for breakfast. Enough to certainly survive one statutory holiday. And yet a tiny part of me was freaked out at how low my supply was.

What. If. Something. Happens?

I have come to expect that people who have no experience with something, be it Type 1 diabetes, disabilities or whatever, will often have preconceived notions that can be quite far off from reality. I do my best to help clear those up but I try not to judge people for not knowing when there is really no way they could have known.

Reading about how many people with Type 1 have been misdiagnosed by doctors (doctors!!) frightens me. Type 1, in the big scheme of medical conditions, is not a very hard one to diagnose. Take a blood test. Check for insulin sensitivity. Ask a few questions. Bingo.

And yet when you combine the fact that many more adults are being diagnosed with Type 2 AND Type 1 has that 'juvenile' label attached to it and suddenly it's a problem.

From the sounds of it, it's a big one.

What Does That Mean Anyway?

"Are you in control?"

Four little words that have the power to make me cringe.

Especially when asked by a medical professional.

Latest example:

I went to my GP's office a few days ago for my physical and to get a few prescriptions refilled.

Before I saw the doctor I had to meet with a young lady (a nurse?) who goes through the usual things. She checks my weight, my height, my blood pressure and asks what medications I'm taking.

Then she asks the dreaded questions:
"Do you check your blood sugar every day?" and "Are you in control?"

"Do you check your blood sugar every day?"

I forced my face into my best impression of a pleasant/patient smile and responded in my calmest voice "I have Type 1 diabetes. Of course I check my blood sugar every day".

(I wanted to add - I check it 10 times a day AND I have a continuous glucose monitor - but I didn't. I also wanted to say - even if I didn't, how are you going to know if I'm lying? - but I didn't.)

"Are you in control?"

Again, using a picture-perfect look of patience, I responded "I have Type 1 diabetes. It's impossible to be 'in control'. My blood sugar is constantly going up and down. I just do my best to limit those ups and downs. My A1C was good though if that is what you're asking."

"Great!" was her response. End of discussion.

Seriously though - I don't get it. When someone in the medical profession asks "Are you in control?" I always wonder what they are really asking.

Is my blood sugar between 5 and 7 all the time? Of course not.

Do I have lows? Of course I do.

Do I have highs? Of course I do.

I have an A1C of 6.5, my diabetes team is pleased with everything I do but every day, and I mean every single day, my Dexter graph looks like a roller coaster. Sometimes I stay between 4-10 all day long. Other times it's a bit wilder and I go from 3-18. But it's always always always up and down and up and down.

So what does 'in control' mean?

I really don't know what they are asking but I never ever answer that question with a yes or a no. I always answer it with some version of "I have type 1 diabetes, there is no way to keep my blood sugars 'in control'.".

That usually either ends the discussion then and there or, as in the case of my optometrist last year, starts a conversation about my idea of control versus hers. I had no hope of convincing her that I could have highs and lows and still get a gold star from my doctor. She was extremely concerned when she heard that, of course I have lows and of course I have highs, and cautioned me on all the awful things that will happen if I let that craziness continue.

You can imagine how hard it was to keep my 'patient' look going that day.

"Are you in control?" feels a lot like greeting people with "hi, how are you?" We don't really truly want a long drawn-out answer to that question. We just want them to say 'fine thanks, and you?' so that we can get on to the real stuff we want to talk about.

"Are you in control" is supposed to be answered with a simple "yes".

I refuse.

Because I feel that it is important to gently teach people that questions like that are silly. And useless. And insulting. And, in my opinion anyway, tells me that the person asking the question does not really understand what Type 1 diabetes is anyway.

Supplement Overload

Remember a few months ago when I went to see a naturopath?

And he sent me for all sorts of blood tests that confirmed that I was NOT low in iron or B12?

And then he sent me home with a list of vitamins, digestive enzymes and fish oil to add to my diet?

Well, I added them. As instructed.

I even worked out a vitamin schedule to fit them all in without overlapping the things that should not be overlapped.

- one digestive enzyme tablet and a vitamin D with breakfast, along with a teaspoon of fish oil in my breakfast shake
- vitamin C (sometimes with iron) around 10:30am
- digestive enzymes, a calcium and a K2/D3 gel at lunch
- vitamin C in the afternoon
- digestive enzymes with dinner,
- and a multivitamin before bed.

I've been doing that since October. Every day.

I'm getting kinda sick of all the pills I have to take. I'm also getting kinda nervous because the supply I bought when I started this whole thing will be running low within a few weeks and the cost of replenishing is making me nauseous.

On top of all that, there have been a rash of articles lately in the newspapers and magazines as well as CBC interviews with people talking about the amount of money we waste on vitamins and other supplements that are often unnecessary and sometimes downright harmful.

I don't feel any different since I've started taking them. I'm not sure if I'm supposed to or not but I don't. No more energetic. No 'healthier'. I don't sleep better. My blood sugar doesn't behave any differently whether I take digestive enzymes before a meal or not. The only thing I've noticed is that I have not yet been sick this year. Considering the amount of cold germs I'm exposed to every day, that is a pleasant surprise.

Still though I'm beginning to doubt my regimen. And beginning to wonder if I really need to be taking all that I'm taking.

My diabetes doctor put me on vitamin D years ago. My naturopath agreed.

My family doctor put me on calcium late last fall after getting the results of my bone density scan back. My naturopath agreed.

The other stuff? My naturopath put me on it all and no one else has had any input to agree or disagree. So I don't know what they would say if I asked but I can guess they would tell me that most of it is unnecessary.

Does that mean they are right?

Why should I give one doctor's opinion more weight than another's.

Argh!

So I continue to take what I've been taking. Until they run out. And then I decide whether or not to get more. At this point, I'm leaning rather heavily towards not getting any more of any of it - except vitamin D and calcium.

We'll see.

Admitting is the First Step

I was driving home yesterday afternoon and listening, as always, to CBC Radio One.

It's a rare day when I'm am not fascinated by what they are talking about.

I missed the beginning of the interview and didn't catch who exactly they were interviewing. Whoever it was was talking about the growing number of people out there who are using some form of alternative therapy. My ears perked up when she said ''naturopath".

The speaker did not have any problem with naturopaths but she did say that many traditional family doctors do.

Because of that, many patients keep that information from their family doctor. They also, often, refrain from mentioning that they are taking fish oil. Or Coenzyme Q10. Or any other non-traditional supplement which, according to the speaker, can interact with pharmaceutical drugs in unexpected ways.

The message was not to stop taking supplements. Nor was it to stop taking pharmaceuticals.

It was to be open with everyone about who you are going to see, what you are taking, and why.

It's interesting.

When I went to the naturopath last week, they asked me to fill out a form with all the medications I was taking and the doses. I didn't hesitate and put every little pill down. I even put down the Vega powder I put in my breakfast shake because it's pretty high in a lot of things and I didn't want them recommending something that might lead to my taking too much.

On the other hand, when I go to my family doctor and they ask what I'm taking, I have no problem listing all the medications that they, or my diabetes doctor, prescribed. I do, however, refrain from mentioning my Vega powder. Or my iron pills.

I haven't seen my GP since I saw my naturopath but I'll be there early in the new year. I already know I'm going to think several times before 'admitting' that I'm taking a teaspoon of fish oil in my breakfast and digestive enzymes before meals.

Because I'm pretty darn sure I'm going to get a sigh and a polite lecture.

I also know that I'm going to think twice about telling my diabetes doctor because I've asked her several times about supplements for people with type 1 and she has always insisted that I only need Vitamin D and nothing else.

I'm not sure what the problem is exactly. I'm a firm believer that I am responsible for my own health and that the doctors, nurses and dieticians I see are there to help me make good choices and understand my options. They are not my bosses and they don't have the right to tell me what to do or not do. They can make recommendations and provide information to help me make my own choices.

And yet I am not thrilled at the idea of telling them about the naturopath in my life and the fact that I'm giving their advice as much weight as everyone else's. I won't do everything they recommend either but I'll certainly consider it seriously.

I have a few months before my next 'traditional' appointment which should give me enough time to get used to the idea that I'm going to have to look my doctor in the eye and say 'yes, I'm taking fish oil and enzymes'.

Do we have a problem?

Two Doctors and One Looney Tunes Nurse

Yesterday I had two different medical appointments.

Back to back.

I had my annual eye exam at 9am followed by a visit with my GP at 10:15am. The appointments were in different cities, 30 minutes apart. I was a little worried about time - not a lot but a little. I didn't want the first appointment to run late and I didn't want to wait too long for my GP because I had a busy day at work. I figured, best case, I'd be back at my desk within three hours.

First stop: eye doctor. This was my second visit with her, having switched after my regular doctor retired. She greeted me with a handshake and asked me the regular questions about eye injuries, issues, concerns, current medications.

"Are your blood sugars stable?" she asked.

I smiled, cocked my head and replied "I have type 1 diabetes. My blood sugars will never be 'stable'."

"Well, do they fluctuate very much?"

"I have Type 1 diabetes" I repeated gently. "My blood sugars can go down to 2.0 and up to the high 20s."

"Well, how often do they do that? What's an 'typical' blood sugar number for you?"

"Are you asking for my A1C? If so, that's 6.6. But please realize that, no matter how hard I try, I won't be able to stop the highs and the lows. That's kinda how Type 1 diabetes works." She smiled kindly and gave me a gentle lecture on the importance of keeping my blood sugars well managed and under control in order to avoid complications. I smiled kindly back and said I would do my best.

The rest of the appointment went very well. I have no diabetes damage, no cataracts forming, no glaucoma, no nothing. And my prescription is stable. Good news all around.

The entire appointment lasted 20 minutes so I was able to drive to my GP's office and make it in time to stop at the bank en route.

I walked in to a packed waiting room. In fact, it was so packed that I took the last seat - right next to the freezing cold air conditioner vent that was running full blast. Fabulous. I pulled out my iPad to read, vowing to move to the first available chair before my feet went numb. The door opened, the nurse came out, "Céline?" she said. I looked around, discovered I was the only "Céline" in town and walked in past a sea of frowning faces.

"Are you Céline" the nurse asked as she sat down at the computer. "Yes." I replied, wondering if she thought I was stealing Céline's spot in line or something.

"And you're a newly diagnosed diabetic" she stated. "No, I've had diabetes for almost 11 years" I replied. "Oh, ok" she said.

"It says here that you take glucagon and insulin. Is that correct?"

"Well, I don't take glucagon. That's like an epi pen for diabetes emergencies. I take insulin though."

"Oh, ok" she replied.

"Do you want to know my other meds?" I prompted.

"No, that's fine. When is the last time you saw your eye doctor?"

"This morning at 9am" I said. "Do you want to know the results?"

"No, that's fine. Can you stand on the scale please?"

I stood up, walked three feet to the scale and stepped on...just in time to watch her walk out the door. Um? Hello? I stood there, with my nose almost touching the wall, wondering what to do. She came back in a minute or two later. "Sorry. So you weigh 163 pounds. Does that sound right?" I nodded. She walked three steps over to the desk and sat down. "We said 160 pounds right?". I nodded again. No point in fighting the woman who thinks I take glucagon with my breakfast.

"Let me check your sugar!". She grabbed my finger, swabbed it with alcohol and pricked it. A drop of blood formed and immediately spread out in the still wet alcohol on my finger. She turned to the computer and frowned. "You're Céline right?" she asked. "Yep, I haven't changed since the last time you asked" I replied sweetly, sitting there with a drying puddle of blood on my finger. "Oh right!" she said and grabbed a test strip. "Where did all the blood go?" she asked frowning as she squeezed the now healed finger.

"Blood pressure!!" she announced after managing to milk enough blood out of my finder. My blood pressure, not surprisingly, was the highest I have ever seen it at 136/84. I don't usually stress at medical appointments but I think this lady was becoming a little much.

Thankfully, she left and my GP came in moments later. I asked for a few prescription refills and I asked for the results of my bone density test. Apparently my T-score (new to me) was -1.4. Anything under 0.0 indicates some bone loss but osteoporosis isn't diagnosed until you hit -2.5. So apparently I've lost some but not enough to do anything other than take calcium and vitamin D. My doctor said that the bone loss is most likely due to diabetes (dammit!) although osteoporosis does run in my family so it's not that surprising.

Two appointments, enough bizarre moments to be able to write a blog about them and I was back at my desk in under two hours, in spite of the hour drive to and from appointments.

Another day in the life of a T1 superhero.

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.