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


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!



5 responses »

  1. HOLLA! Bells Two Hearted is the best, but I pretty much gave up beer and am now exclusively white or red wine (the dryer the better) and clear alcohols (gin and vodka). Also, I’ve read that following a low carb diet can result in some ketones, but it’s not the “bad diabetes” type of ketones. At least, that’s how I interpreted it. I eat low carb all the time (less than 60 carbs per day) and I never check for ketones unless I’m over 250 and feel this poo.

    • Yes! I don’t do beer too much — if we have alcohol at the house it’s red wine. I can’t do liquor lol. I toootally meant to put the part about them not being the bad kind — the doc did say that I didn’t really need to worry about them much, maybe just drink some milk. I eat pretty low carb too, actually probably about the same as you on average — so I wonder if I have ketones more than I realize!

  2. holla indeed 🙂 nor am I an alcoholic but I hear you when I consume 2 (or more?) beers on a lazy summer’s afternoon… I drink Bud lite Platinum beer (slightly gross but 4.4 g carbs/U can’t be beat and nor can the 6% alcohol content) and don’t bolus for it at all. Night-time snacks are a must then, esp. if exercise of sorts was involved during that day…

    re: ketones – makes sense! if a “normal” – shall we say “type zero?” individual is very hungry or starving, they will have ketones. Ketones are a byproduct of fat metabolism, which occurs when there is not enough of a carb. source for the cells, so they break down fat for energy 🙂 I’ve even found that I’m better off bolusing extra and eating when *(slightly) high in the morning than bolusing to correct and not eating at all…

    also – I looove parenthesis! (I believe I once referred to myself as “the queen on parentheses” on my blog [http://walkthedragon88.blogspot.com/] – I may or may not have consumed alcohol when saying that) 😉

  3. I saw your post about the questions so I was looking forward to the answers. It’s interesting about the beer because she made a good point-I was the same way in college so it makes sense alcohol affects us more now that our blood sugars are under better control although I haven’t noticed as much a drop as you do.

    Thanks for sharing!

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