Last week I posted some ‘points of interest’ that I wanted to address at my most recent endo appointment. My dr. is really great about giving me time to bring up things of concern/things that are on my mind — so I actually got to cover all 5 topics. I’ll debrief a little bit of what she said — but please note that this is my interpretation of what she said, it’s not medical advice (IT’S NOT MEDICAL ADVICE), your diabetes may vary, yada yada yada.
Duke charges each appointment as hospital based services. I’m still paying off over $1,000 in medical bills. I can’t keep accumulating this much medical debt.
OK, first of all, she said she wanted to keep me as a patient (I was touched!!) and I agree – I want to do anything I can to keep this endo. She also said that she understands I need to do what’s necessary to take care of myself diabetes-wise and otherwise. She set me up to speak with a Financial Care Counselor within the department (immediately — I met with her right after my appointment) who felt very confident that with my recent insurance switch, I’d be much happier with my out of pocket costs. My husband I agreed that we would wait until we get the latest Explanation of Benefits from this visit and go from there. If it’s not ridiculously expensive, we’ll stay — we both agree that good care is worth it.
I was sure that my basal rates would need to go down during the middle of the night, and I was right. She also advised me to lower my insulin:carbohydrate ratio at dinner time. In the past, I’ve tended to spike a bit after dinner (if consuming much more than 30g carbs) and then I’d get low while sleeping. Hopefully with a 1:9 ratio at dinner, I’ll cut out any postprandial spike (ha.ha.) and the lower nighttime basal with help with overnight lows.
Alcohol. Two beers makes me plummet. Never happened in college.
“You have no reserve!” she said. I guess because my control is a lot tighter than when I was in college — when the alcohol makes me dip, I’m going from 120 to 60 instead of from 200 to 140 (college was not a great time for my diabetes). New plan (not medical advice) try to go for red wine instead of beer (beer makes me spike, so naturally I try to bolus for it, then I get low. I’m not willing to give up IPA’s altogether, though. By all means, I’ll work hard to learn how to bolus for a Bell’s Two Hearted, holla if ya hear me.) Also, am going to be certain to have a snack before bed unless I’m extremely high, and I’ll set an alarm to check in the middle of the night. I sound like I drink all the time — I don’t, but I was experiencing some pretty scary lows when I was simply trying to enjoy some drinks with friends. Diabetes will not make me afraid. Diabetes will not hold me back. (Sorry so many parentheses).
Going to start setting a temp basal thirty minutes before exercise. Not sure of the percentage — will need to play around with that. I’ll also work hard to make sure I can exercise without diabetes getting in the way. See aforementioned statements about not being afraid or held back.
Ketones (Had ketones on Monday with a steady 180 all morning. I had exercised. Maybe it was my insulin.)
Not uncommon, she said. That surprised me. I guess I normally don’t check ketones when I’m 180 — but I was feeling particularly crappy that morning. I think she called them diet ketones, and told me I probably hadn’t consumed enough carbs that day. She recommended drinking a glass of milk in the mornings if I’m having a low carb breakfast.
Have any of you ever experienced any of the issues that have been on my radar as of lately? Any and all advice is always appreciated!