Monthly Archives: August 2013

endo appoinment – (that’s) what she said.

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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.

Basal Rates
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).

Excercise Tips
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!

 

being proud.

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Yesterday’s post was all about how nervous I was to go to my quarterly endo appointment (answers to my list of questions coming soon). I’ve been feeling really unorganized as far as my diabetes was concerned, and I just knew my a1c would show it. I’ve worked REALLY hard the past couple of years to finally get my a1c to stay in the 7’s and then in the 6’s. Last appointment I went from 6.1 to 6.3, and I was OK with that. What I didn’t want to happen at yesterday’s appointment was to feel like all of my previous work was for nothing. I didn’t want to see an a1c in the 7’s again — NOT because an a1c in the 7’s is bad, by all means, pat yourself on the freakin’ back if you’re there — but because I would have felt like I was starting all over again on the ‘i’m going to lower my a1c to below 7’ train.

(Let me say it again. You should be so proud if you have an a1c in the 7’s. You should be so proud if you are happy with your a1c number. You should be so proud if you are working on a number you are not happy with. You are working on YOU every day, and YOU SHOULD BE PROUD OF THAT. Each day is a new day. Each test is a new test. My personal mantra is that we are all doing the best we can, with what we have, at any given time. YOUR a1c DOES NOT DEFINE YOU, please never let it. One unit at a time, kay?)

So, when my wonderful, fabulous, amazing endo walked in to the appointment room and asked me how I was doing, I replied with a monotone “I’m OK.”

“Five-nine?” She said.

OK. Is she stating my current blood sugar in mmol? Did the nurse write my height as 5’9″ instead of 5’0″?

I sat there for a minute, probably with my mouth open – and she pointed at the computer screen. “I’m not reading that wrong, am I? It says a1c = 5.9%, right? Are you upset?”

I’m still in shock. And not totally convinced that I’m not anemic and therefore producing a false result (she assured me it’s correct and I’m not anemic). But holy crap, I’m going to let myself me proud of that.

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endo appointment – points of interest.

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Word for word, these are my notes/questions/points of interest I’m bringing to my endo appointment this afternoon. I’ve also put together 4 or 5 different Dexcom reports. I’m trying to be extra organized because I’ve felt SO not-on-top-of-things recently. And if I don’t organize myself, I’ll probably just cry happy or sad tears, for whatever reason (& that can be awkward). Wish me luck!

Endo Appt
August 21, 2013

  1.  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.
    1. Any chance in charging as office based services?
    2. New endo? 😦
    3. Do lab tests outside of Duke to keep it cheaper?
  2. Basal Rates
    1. Feel like I’m having too many nighttime lows, Dexcom doesn’t really reflect that though.
    2. Alcohol. Two beers makes me plummet. Never happened in college.
  3. Dexcom Graphs – take last week with a grain of salt. Was in my thigh and about 30 points off at any given time.
  4. Exercise Tips
    1. When to set lower basal rate
    2. Anything else
  5. Ketones
    1. Had ketones on Monday with a steady 180 all morning. I had exercised. Maybe it was my insulin. 

frittata.

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Frittata. Such a funny word. I’ve been seeing recipes for frittatas all over the place, so I finally decided to try it (read: was forced to try it because I had nothing else that resembled dinner in the fridge last week). Turned out it was dee-lish-ous, and probably will be a regular fridge cleaner-upper.

What I used (you can use ANYTHING that you have around, though!):
10 eggs
1 potato
goat cheese (whole bunch)
1 red pepper
some spicy spices. probably crushed red pepper.
some onion
BACON (because everything needs bacon)

Dice up the potato, put in skillet with a little olive oil (make sure you coat your pan pretty well — you’ll cook your eggs in this pan later). Cook up the bacon. Chop the red pepper and onion and throw that in with the potato. Tear up the bacon into small pieces and put it in the skillet with everything else.

Crack all of the eggs in a bowl and whisk. Then, pour them in the skillet over the potato/pepper/bacon/onion mixture. I think I had my heat turned down too low at this point, so you’ll just have to experiment. Don’t scramble — just let the eggs cook. This is when I added some goat cheese and spices on top. Once the eggs are pretty firm but not too firm (very scientific) – stick it in the oven on broil for 3 or so minutes. It browns the top just a bit, and voila! Before serving, at some more goat cheese. Just cause.

I didn’t take pictures during the cooking process because I didn’t expect for it to be so yummy. It was a pretty low carb meal, though – I only had to bolus for a portion of a potato. End result:

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have you ever been tested for diabetes?

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My work decided to switch our insurance companies in July. I can’t shouldn’t complain too much, but I will anyways. With my previous insurance company, my Durable Medical Equipment (so, most of my diabetes supplies) was covered at 100%. ONE HUNDRED PERCENT!! Now I’m paying 20% out of pocket for everything (with higher co-pays for scripts). I know, I know. I’m happy for the time I had with 100% coverage, I’m super happy I still have insurance, and I’m so lucky that my employer pays my insurance premiums.

With this new insurance company, there is some sort of convoluted way that I am able to get my deductible waved for my diabetes supplies. That’s a plus! The first thing I had to do to make this happen was have a bio metric screening — I fasted and they tested all of my vitals, cholesterol, BMI, and yes, blood sugar. I was 150 mg/dl at the time of the test. And there was no spot for the CNA who was performing the test to write down that I already know I have type one diabetes.

So yesterday, I get a call from my insurance company. The lady wanted to enroll me in a “Condition Care Program” to help me understand my condition (and also, I think, a step in getting my deductible waved). But then, she asked me if I’d ever been tested for diabetes. Poor, innocent lady (to have been talking to a sarcastic PWD like me) – but I couldn’t help but laugh at her. I was then asked questions such as: Have you experienced symptoms of low blood sugar in the past week? (Yes.) Have you experienced symptoms of high blood sugar in the past week? (Yes.) Oh, wow, OK — do you normally experience both multiple times in a week, or has this been a stressful week? (Feel sugar creeping up out of frustration. No ma’am, I have type one diabetes, my blood sugars are never just 80-120). Do you follow a diabetic diet? (Ma’am, I don’t know what that is. Apparently it’s when you don’t eat white food or many carbs. Hmm.)

Why do I get so frustrated with things like this? The people I talked to don’t seem to understand diabetes at all. Some of their questions seem absolutely absurd, but I’m sure they’re meant to figure out how individuals deal with diabetes/what they know about their condition/what kind of assistance they might benefit from. But I can’t ever see myself willingly talking to one of these nurses in the future, I guess because I already have a diabetes care team that I love. Who knows, though. I hope I’m wrong. I hope that I utilize this possibly amazing tool to its fullest extent and my a1c drops a half point. I’ll need to convince them first, though, that it’s not that weird to feel both high *and* low in one week.