Delicate Balance . . . . .

Friday morning I headed to my endo appointment.  I have a really great endo, but I’m still a bundle of nerves as my appointment approaches.  What if I’m not doing as well as I think I am?  What if something comes back floopy in my labs?  Even though my appointments have been going great for a while now, I find myself always waiting for the day I get a really bad surprise.  And I’ve decided I’m okay with the nerves, because it means I still care.  And caring about diabetes is a big part of the battle.

I love the bright open waiting room at my endo’s office.

So there I was, weight and blood pressure taken (both are higher than I’d like) and pump information uploaded.  Paperwork for a new 530G with Enlite filled out.  A new script for my blood pressure medication electronically sent.  We turned to my labs results and pump reports.  Liver and kidney tests are perfect.  Cholesterol is excellent.  Vitamin D is finally in a good range.  And then . . . . . my A1C . . . ..  hmmmmmm.  We take a look at the blood sugar graphs from the pump and CGM.  Hmmmmmmm.  Mostly good.  We discuss some of the big spikes and both agree that they don’t warrant any basal changes - just some tighter carb counting and acknowledgement that hormones throw my overnight numbers out of whack for a few days every month.  We agree that those highs aren’t too much of a problem.  The real concern during this appointment is the lows.  Lots of lows, especially between 2 a.m. and 4 a.m.

This all leads to a sentence I never ever though I’d type.  My A1C is too low.  Sounds impossible, right?  Sounds like a fantasy.  It’s not.  After decades of beating myself up for having a high A1C, of working so hard to bring it down and feeling like I always failed, I now have to worry because it’s too low.  And it feels like just as big a failure as my too high A1Cs.  It means I spend way too much time with hypoglycemic blood sugars.  It means my health is at risk - perhaps not from the complications I was threatened with during those years of highs, but with the fact that lows can stress my body, specifically my heart.

So here I go again.  Instead of working to bring down the highs, I need to focus on avoiding lows.  I’ll be honest - it’s completely frustrating.  It feels like no matter how hard I try, it’s never enough.  I’m chasing a delicate balance I’m not sure I can ever achieve.  I still care and I’ll still work hard, but my goodness it is exhausting.

Wordless Wednesday - That Time Again . . .

Getting ready for Friday’s endo appointment.

Wordless(ish) Wednesday - Labs

Ah the fun of fasting blood work . . . .

So when does it get easier??

For years and years I struggled with my A1C.  It was always too high.  No matter what I did, no matter what my endo and I tried, no matter what I couldn’t get it where I wanted it to be.

So, before I go any further, let me clarify that I am not saying an insulin pump is the answer for everyone, nor do I believe everyone should pump.  We are all different.  What works for one doesn’t work for everyone.  Let me also say I am not trying to brag about my A1C at all.  Okay, but, for me the pump has been kind of magic.  Since going on the pump about three and a half year ago, my A1C has been right where my endo and I have wanted it to be.  Sound the bells, strike up the band, everything is great, right?

Well, not quite.  I think back to when I was working so hard and not getting any results.  I think about how much I dreaded each endo appointment.  I remember wishing I could just get my A1C in line because then all of the stress and fear would be gone!!!

And I did.  My A1C has been in line since August of 2008.  Each and every lab slip comes back with nothing but the numbers we've been shooting for.  But guess what?  The stress and fear, the dread before each endo appointment?  They are just as strong.  What . . . the . . . . fructose??

I see my endo on Wednesday.  I procrastinated getting my blood drawn at the lab until today.  I secretly toy with the idea of coming up with some excuse to push back my appointment.  I’ve had several dreams about being in that tiny exam room and finding out that my A1C is HORRID.  I am convinced I am doing terribly - even though when I download and analyze my numbers they are right where they should be.  It's not just the average that is good (because to paraphrase my friend Rachel Y, a 210 and a 30 on the meter work out to a perfectly acceptable 120 average.)  The numbers, the pie charts, the standard deviation- they all check out just fine.  And yes, I pour over the numbers from both my CGM and my meter, never really believing that either of them are telling the true story.

All of those years I spent wishing I could get my A1C where I needed it to be, sure that once I did I could stop worrying neurotically over each number and appointment, seem kind of like a waste.   Because I’m finally there . . . . yet I am still just as neurotic.  Why can’t I relax?  Why can’t I trust that I’m dong well?  Why am I sure I’m gong to get blindsided by a sky-high A1C, even when everything points to that not happening?  Why am I so afraid of letting myself, and my endo, down?  Why did I think that once I got my A1C to a certain number all of my diabetes problems would be solved?  And when, oh goodness when, does it get easier?

Awesome Things & Blünt Lancet

Today's post topic is the most awesome thing you’ve done because of diabetes.  Obviously that’s a no-brainer for me. (Which is good, considering my brain is feeling pretty fried right about now.)  I mean really . . . . what awesome thing have I done because of diabetes . . . .gee, I don’t know . . . .  .maybe . . . .

DIABETES BLOG WEEK!!!!

I’ve had so much fun organizing DBlog Week for the past two years.  I’m excited to read all of the posts and get to know my fellow bloggers better.  I hope it not only bonds our community but also teaches a thing or two to those OUTSIDE the D-OC.  Yup, Diabetes Blog Week is by far the most awesome thing I’ve done because of diabetes!

Since today’s post was so easy , I thought I’d tackle one of the Wild Card topics - particularly D-Myths:

 * D-Myths: I’m not talking about D-Myths like “people with diabetes can’t eat sugar” or “you get diabetes from being lazy” - we work to disprove those every day.  Today lets PROVE some fun d-myths like #dprom (the prom for diabetics around the world), Sprinkles (the glittery unicorn of advocacy), or Blünt Lancet (the diabetic heroes of rock)!  Choose one of these “d-myths” (or create one yourself) and take it someplace creative!  You might write about the time Sprinkles visited you to spread the advocacy love - hopefully he / she/ IT?? brought you a cupcake too!!  You could compose a new song for Blünt Lancet’s next album.  Or you might give us every details of the night you went to #dprom.  Write about any "myth" or story-line you can dream up!  Let’s bring those “myths” to life!

So there’s been a rumor going around that Blünt Lancet is getting ready to go out on tour.  And that they’ll be covering the popular Police song “Don’t Stand So Close To Me”.

Mmmm, Sting. *ahem*  Anyway, I hear that although the lyrics to this song are quite fabulous, they’ve been updated for the upcoming tour.  My sources even slid me a sneak preview!!  (I thought about Stepping Outside The Box and singing this song on a vlog - but I love you all too much to subject you to that.  And apparently just THINKING about singing on my blog was enough to crash Blogger for more than a day!)

"Don't Judge My A1C”

Lab-work time, the subject
Of of lots of stress for me,
What I want so badly
Is one great A1C
Inside me there's longing
I’m just an open page
Appointment - it’s so close now
My nerves begin to rage

Don't judge, don't judge my
Don't judge my A1C

I have tried so hard now
You know how tough things get
Sometimes it's not so easy
And there ‘aint no cure yet
Temptation, frustration
So bad it makes me cry
Huge cupcake, will’s fading
Can’t eat just one french fry

Don't judge, don't judge my
Don't judge my A1C

I wish you understood
You know I try and try
Strong words are just no good
The accusations fly
It's no use, please listen
Or else you’ll piss me off
Just like my last endo
Who got a quick sendoff

Don't judge, don't judge my
Don't judge my A1C
Don't judge, don't judge my
Don't judge my A1C

Please don't judge my A1C

Don’t forget to add your post to the Awesome things-Friday 5/13 Link List.  Please enter YOUR BLOG’S NAME in the field marked Your Name and the link to YOUR SPECIFIC POST in the field marked Your URL.

Higher isn’t always bad . . .

For as long as I can remember, I’ve been working and working (and working) to get my A1C lower.  Lower has always been the goal.  Higher was always bad.

Until this week.  On Tuesday I had my endo appointment.

The waiting room at my endo's office - as part of the Waiting with Diabetes project.

I always hold my breath as we go over my lab results.  I’m worried for my liver and kidneys.  But most of all, I’m worried about what that A1C number will be.  Of course, the A1C is always at the end of the report - thanks a lot, lab-report-guys.

So, we went though each and every item on the lab report.  What the recommended range for each item is and where my numbers fall.  (Yes, my endo take the time to explain each item.  Love him!!)  Everything was in the AWESOME range (my words, not my endo’s, but whatever).  Then we got to the A1C.  And it has gone up . . . . just by .3 . . . but still up.  And higher is always bad, right?

Well, not always.  This time both my endo and I were actually happy to see a rise in my A1C.  For the past six months, my A1C has been 5.9.  A great number, yes, but a number that was the result of way too many scary-lows.  With my new Revel pump and the predictive alerts for the CGM, I’m catching more lows before they hit the scary-low range.  (No, not all, but more . . . )  So we were both thrilled that my A1C has risen to 6.2.

I've spent so many years, decades even, struggling for a lower A1C.  Celebrating a higher one feels crazy.  But then again, I never said I wasn’t crazy!!

Nerves . . .

It happens like clockwork . . . every few months.  The nerves set in.  The butterflies make a nest in my stomach.  Anxiety overload.  What is the trigger?  An upcoming endo appointment.

Next Friday it's time for me to go back to Dr. F.  On Monday I'll go to the lab to get my blood work done.  I'm nervous about that.  It's not the actual needle that I stress over - I'm an old pro at that by now.  It's what my blood will show - more specifically what my A1C and blood glucose numbers will be.  I must confess, if my fasting number is not in range on Monday, chances are I'll delay my blood draw until Tuesday.  I know this is silly.  My pump downloads and A1C will help show if that out-of-range reading was an exception or the norm.  But still, I can't help wanting the fasting number the lab prints on my test results to be "perfect".

The nerves don't stop once the blood work is drawn.  I have a full week of anxiety ahead of me.  It's stupid, really.  Even when I was on MDIs and my A1C was way above a healthy range, Dr. F never once lectured or blamed me.  Instead, we discussed what was going on and he gave me new things to try.  A new type of insulin that might work better for my body.  The splitting of my Lantus dose in the hopes of providing more even coverage.  A gentle suggestion that pumping might help me, but the freedom and time to come around to the idea of pumping on my own.  The statement that no matter what, there will always be some highs and lows and that I shouldn't beat myself up over them.

And since going on the pump, my A1Cs have been consistently under 6.5.  The only problems my other lab work has ever shown have been easily fixable - things like low iron stores or low Vitamin D levels.  Sure, I do breathe a sigh of relief each time he reports that my liver and kidney function results are awesome - who wouldn't?  But for the most part, he reports that everything looks good, he looks at my pump downloads and we discuss anything that might need tweaking, he asks me if I have any questions, and then he tells me how great I'm doing and says he'll see me in 3 - 4 (or sometimes even 5 - 6) months.  I head out the door with a huge smile on my face and the weight of the world lifted off my shoulders.  And I wonder why I spent the past week all stressed out.

Until a week before my next appointment.  When the cycle starts all over again . . .

And so the fight begins . . .

"In this corner, weighing it at " . . . okay, wait a minute.  I'm not about to broadcast my weight on the internet, so I guess this little boxing metaphor will have to stop before it even gets started.

So, to put it plainly, my fight for CGMS approval has begun.  Earlier today I had my endo appointment.  I have to confess, as I printed out my blood sugar readings I was sickened.  I saw some very scary lows, but I also saw tons and tons of readings between 200 and 300.  The amount of time I have spend high concerned me, and I was prepared to say good-bye to my hard earned 6.3 A1C.

I did say good-bye to it.  In fact, I was shocked to find that my new A1C was 6.2.  After looking over my blood sugar results, my endo agreed that there must be a bunch of lows I'm not feeling and not catching.  That's scary enough to counteract any joy I should feel at having a lower A1C.

This afternoon I was on the phone with Minimed.  The hardest part of the process so far was figuring out what Caller Option I needed from the main switchboard.  Once I got to the right department, things went very smoothly.  My request is in, and someone should be contacting my insurance company tomorrow.  According to the information in their files, I easily meet Anthem's requirements for CGMS coverage.  Hopefully I will have good news by Monday or Tuesday.

And if I don't, I'm prepared to move on to Round 2 of the fight.

My AIC results are in!

Actually, they were in on Friday morning at my endo visit - I just haven't had a chance to post until now.  But first, a bit of background . . .

When I worked at my old job, my A1C was in the low 7's.  After I quit, I got it down to my all-time low of 6.4 -but it was back up three months later and has never been anywhere near that since.  In the past year, I've been stuck between 7.0 and 6.7, unable to do any better.

I've been on the pump for about 4 1/2 months.    My current A1C . . .

6.3!!!

I'm stunned!!  I'm thrilled!!  I'm excited!!  I'm overjoyed to know my decision to start pumping was absolutely the right one for me.  And I'm inspired to keep up with the hard work it took me to get here.

High Expectations . . . .

So, yesterday was my second follow-up visit with my endo after going on the pump in mid-April. It was also time for my next A1C test. For once, I was excited about this. When last tested, in February, I was at 6.8. I couldn't wait to see what the lab had to say this time. Maybe I would finally have fallen below 6.5!!!

Well, I was quite disappointed when the doctor told me my A1C came back at . . . . 6.7. I only went down one lousy 10th of a point!

However, my endo was quite pleased. According to him, many people find their A1C goes up right after switching to the pump - due to all of the adjustments and the learning process and getting everything set. He was happy to see me actually being 1/10th of a point lower.

I admitted to him that as much as I love the pump, I notice it has caused me to put even more pressure on myself to be perfect. I expect each and every reading to be in the 80 - 120 range, and am disappointed in myself when they aren't. He reminded me that everything is NEVER going to be perfect. That's just not realistic. We can make them better than they were, but we can't make them PERFECT.

I left his office with praise from him and a vote of confidence that I will do just great in the three months until my next appointment. He reminded me to call if things start to go wacky and we need to tweak again. But he is thrilled with how I've handled things so far.

So why do I still feel I should have done better? Do you put unreasonably high expectations on yourself too?