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Pick Up the Pieces.

Keep calm and carry a clipboard?Heading into my endocrinologist appointment a few weeks ago, my expectations were non-existent.  My diabetes management has been consistent, quiet, and the last thing on my mind lately. 

My endo and I did a rundown of what's been going on since I'd last seen any member of my diabetes team.  The last few months have been especially challenging, as my family has been dealing with some health issues outside of the regular roll and tumble of diabetes.  Thankfully, we've all three emerged intact, and are more than on the mend.  But there was a lot of stress.  And anxiety.  (And stressandanxiety, which is the compounded version, when the two emotions butt heads, mush together, and produce cortisol, which has a less-than-calming effect on my blood sugars.)

I've been on autopilot for so many things, while we dealt with the health issues at home.  Work was still due and travel was still scheduled, but I was going through the motions.  Somehow, diabetes fell into the same category.  I didn't stop taking care of myself.  Instead, test strips and carb counting became part of the chaotic blur.  (I think it was partly because I've become accustomed to testing regularly, logging, etc. and partly because I needed my health to be as optimal as possible in order to deal with what was going on at home. Slacking of any kind wasn't an option.)

Before my appointment, they ran lab work, and my doctor and I reviewed the results in her office.  When my A1C result came back in good form, I was pleasantly surprised.  Actually, all of my lab work came back good, from A1C to cholesterol to thyroid to microalbumin. 

"That's good.  This is all good."  My endocrinologist said, checking through all of the results, but then reading the expression on my face.  "Why aren't we celebrating this?"

"I don't know.  I think I feel like that A1C result isn't reflective of my actual control.  My standard deviation is much tighter and my overall control is steadier, but I'm having a lot of 160s and 180s.  And very few lows."  I paused.  "Not that I want to have lows. I'm terrified of lows, honestly.  I just feel like that A1C boasts control better than what I actually have.  It's been a crummy few months."

My endocrinologist is fantastic, because she really understands that diabetes control isn't simply a matter of "following the rules."  She helps me find the underlying issues sometimes, when I'm so mired in the forest that the trees become a blur.

"You keep mentioning lows.  Was there a low in particular?" she asked.

I thought about January, when I had a low blood sugar episode that frightened me worse than any other I've had in recent memory.  And I thought about how much I never, ever wanted to experience that feeling again, because I felt so helpless and lost and too close to a point I couldn't return from.

"There was one.  I was traveling. I was by myself.  And I was completely out of it, worse than I've ever been that I can remember.  Coupled with all the health stuff going on outside of diabetes, I have been really wary of running on the low side.  Honestly, I avoid it."

"Your blood sugar goal, in your pump, is 100 mg/dL.  That's what we were shooting for when you were pregnant, and I don't think we ever changed it.  Maybe that's not the right goal for right now, especially since you're dealing with some things that make you very concerned about low blood sugars.  Let's update your pump to reflect a goal of 140 mg/dL.  Would that work for you?"

"Definitely.  I like where my A1C is now, but I'd like it to be a little lower, without toeing the line of wicked hypoglycemia.  You think this would help?"

"I do.  You've had more than the usual going on this last round, and I think a small change like this could help you feel more comfortable, less vulnerable to hypos.  Your progress has been really, really good these last few months.  I just want you to keep doing what you're doing, and feel safe.  And to be able to take care of your family."

"Got it.  It feels like a really small change, but it could make a big difference."

My A1C is close to where I want it to be, but I'm not elated.  Or frustrated.  I don't want to lament this number, or post it on my fridge in celebration.  It's just a number.  No emotions assigned to it this time, which kind of feels good.  Freeing. 

I just want to pick up the pieces of the last few months, be thankful for the good health of my loved ones, and keep doing what I'm doing.


The best part about this whole thing is that your doctor actually asked you what you wanted. That is a fantastic doctor.

I agree that your doctor is fantastic. The best appointments for me are the ones where we tweak just one little thing. It makes me feel more empowered than when they suggest a whole mess of adjustments - which always says to me that we're grasping at straws.

I am so sorry that you're dealing with this. I hate the medical super-poop-storm that hits every so often. Going through one of my own at the moment and it sucks.

I have recently just discovered the diabetes blogging world, what a magical discovery. I never knew there were people that had been going through the same hard times I have been for most of my life (Type 1 for 15 years). Keep up the great posts and I hope to be a blogging contributor some day

I love how eloquently you put into text the emotions I feel all the time. Diabetes control is a lot more than “following the rules.” There is no truer statement. Thank you for this post!

First of all, your endo seems AWESOME!!! Second of all, I love how you say about the numbers, how they are just that, numbers. You are an amazing writer Kerri. Even a simple post like this can move me to the verge of tears, because I know that people go through what I am going through, and LIVE.

Hey Kerri, I had a scary hypo in Jaunary too. On the 13th no less! I wasn't on my own, but I ended up hallucinating and screaming at my husband, who had no hope of getting a glucagon into me, that there were people in the house. I thought we were being attacked. An ambulance was called and the neighbours came running because of the screams.

It was the closest I ever came to losing my mind. .

It's only now, 6 months on that the 5s and 6s (100s) don't scare me anymore.

Good luck and keep at it. 140 is awesome x x

I love this. Makes me realize that there are so many others with the same issues and concerns that I have. Sometimes I feel like my numbers "aren't good enough" in comparison to others, but this just reassures me that one person's "good" isn't necessarily my "good." Sometimes we just need that change to put our mind at ease.

I know where you are coming from. I get a fear of low blood sugar before working out. So much so that sometimes I eat extra thinking I'd rather be a bit high than have a low mid-workout.

Thank you for sharing Kerri, especially about your relationship with your endocrinologist. I think these conversations are ones we often don't read or hear about.

Isn't it amazing how safety trumps a number? It does for me, and always has, but it is very personal to each individual.

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