Monday, January 11, 2010

Endo says too Low - with Snow . . .

Goofy rhyming post title aside, there are two things I dislike.  Snow and endo appointments.  Well actually, there are a lot of things I dislike - mashed potatoes, my creepy neighbor, using public bathrooms, the Diabetes Police  . . . I could go on and on.  But for today's purposes let's just focus on the snow and the endo.

I woke up Friday morning to see that vile white stuff floating down and thinking of the endo appointment I had that afternoon.  Don't get me wrong, snow is pretty - but it's also cold and wet and slippery and messy and I haven't really liked it since I hit my teenage years.  And my endo?  Well, he's nice and supportive and smart and really really great.  I just hate that I stress myself out over what my test results will show and I imagine how he'll be disappointed in me and then get all judgmental - even though he never, ever has.  It's really more my "internal endo" that I have an issue with, not my real endo.

So anyway, we ended up only getting about an inch of snow and the roads were well plowed by the time I got behind the wheel to drive to my appointment.

Once at Dr. F's office, I did the most painful part of any endo visit - paid my $40 co-pay. Ouch.  I barely had time to start a game of Guess My A1C on Twitter before I was called in for my appointment.  The first thing Dr. F said to me was "So, have you been having a lot of lows?"  At that point, I knew my A1C must rock - in fact, I think I said those words to him exactly.  And yes, at 5.9 I now have a lower A1C than I ever dreamed I could achieve.  But as it turns out, lower is not always better.  Dr. F had some reservations about how often I find myself below 40.  And although I really hate highs more than lows, I suppose I have to agree with him.

We talked about better managing my work-outs so I don't bottom out half-way through.  We looked for patterns where basal tweaks might be needed.  We talked about keeping my A1C under 6.5, but not necessarily under 6.0.  Especially at the cost of having daily readings in the 30s and 40s.  Then we went over the rest of my labs.  I always breathe a sigh of relief when all of the kidney and liver tests are passed with flying colors.  I'm happy that my cholesterol is playing nice.  The only problem is my Vitamin D stores, which are far too low and don't seem to want to come up.  (Note to Self: You have to get out in the sun more!!  All day inside with a laptop is no good!!)  I left with a prescription for a higher dose of Vitamin D and a lab slip for a blood draw in four months, before my next appointment.  (At least there won't be any snow that day.  And hopefully no mashed potatoes either!)

I also left with a bit of a crestfallen feeling.  In the past couple of years, I've worked so hard to wrangle my A1C down below 7 when that barely seemed possible.  It was quite a triumph to get under 6.5.  So to fall to 5.9 but know it's because of unsafe lows leaves me quite conflicted.  I feel like I want to celebrate for getting my A1C lower than I ever dreamed.  But at the same time, I feel the need to scold myself for allowing all those lows that made the 5.9 happen.

Am I happy?  Am I upset?  I just don't know.  Diabetes, you sure know how to screw with my head!!


  1. Karen:

    I hear you on this one. My A1c has historically been Off-The-Charts-Too-High in my pre-pumping years, and though I got it down to a fantabulous 6.1 in my first year of pumping it gradually slid back up into the 9s. I hover about 8.8 now, and am striving to hit the 7-level in the coming months. But I've often felt conflicted: do I want to allow those Severe Lows just to get the A1c lower? What are the consequences? Ultimately, I don't want to sacrifice my daily well-being and sanity for the sake of a better, half-baked picture at the three-month marks. I'd rather be safe now, and still work it down in the long-run. We strive for consistency, not rollercoasters. That's what I try to remember, in avoiding not only the Highs but also the Lows.

  2. While I know that lows are no fun and hope you get a handle on them I want to be the voice of optimism and say CONGRATULATIONS on a completely rockin' A1C!!!

    I know it doesn't seem like the all-pros and no-cons situation that you wanted for your A1C, it's still an awesome number, which I'm sure will continue to be awesome once you've beaten those lows! Rock on! :-D

  3. You are aware and taking care of you, that is what matters. I would like to not see so many lows for your overall health. You will figure this out.

    And the Vitamin D levels, seems to be common amongst PWDs. I spoke to my Endo about it, the whole "get more sun" -- studies done, no benefit from those seeing it everyday compared to, uh, where I live. Ha. I am taking a dose of it daily too. No worries in that department. :-)

  4. There must be a shift in thinking on A1C, at my last appointment my PCP (not an endo) was actually *happy* I clocked in at 6.9, way up from 5.9 six months prior. I left really shaken. Yes, it's still under 7 and yes, no complications (yet) here either...but I still beat myself up for all the post-meal 200s and 300s and actually wished I'd had more lows. And then I tried to remember how tough it is to be a pancreas 24/7/365. I guess the answer is, there is no answer, just another day to put in the 'good' column.

    Hang in there! (Preferably in the sunshine)

  5. I totally agree with Crystal. You are aware of the pros and cons and you will figure it out.
    I haven't had my A1c checked in over a year because with all my highs and lows and no way of controlling them, my doctor feels the number will mean nothing. I guess he's right, still being a PWD I am always obsessed with that number. I think that if you are able to get the lows under control you won't see a huge up in the number. I know how sucky lows are, so I am rooting for you.

  6. My CDE has warned me about trying to get the A1C too low, too. Definitely a weird feeling.

    After my last round of bloodwork (during which my Vitamin D levels were found to be stupidly low), I got a prescription, too. 50,000 IUs!

  7. Ugh, the lows. That's exactly why my A1C dropped so fast the first month I was pregnant, because the lows sucked my averages into the trenches. A good A1C, but I don't blame you for worrying about how it gets so low. :(

    However, you are still rockin' a great number and with no complications to boot! Keep on fighting the good fight, Karen! (And kisses to K.C.!)

  8. It never ends. I'm just beginning to realize that.
    I didn't know you could get a prescription for vitamin D.
    This diabetes thing seems to have it's tentacles over every part of my body....crap!

  9. Mashed potatoes on your dislike list you say??? That's on my dislike list lol. Glad you got an overall report from the endo. There is nothing more relieving than that! But hopefully the lows will decrease & put your mind at ease some.

  10. I'm part of the low-D club too. I mean, you'd think to look at my sparkly white complexion, that guy spends all day in the sun, but it's just not true. I was on the prescription stuff for a while, but my levels didn't really improved until I started taking 2 of of the "maximum strength" over-the-counter pills every day. Because, you know, I just wasn't spending enough money at the pharmacy already. Sigh.

  11. Just stumbled upon your blog.

    I too am a Type One Diabetic. My lowest A1C was 5.3 throughout the pregnancy of my daughter last year.

    Now I am back up to 6.7 but thinking back now- oh the daily (hourly) almost lows drove me crazy!!

    GREAT blog! I'll be sure to come back and visit more :)

    p.s- I hate the ENDOs too. I've cancelled my last appointment and have yet to rebook.


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