My New Endo - The Mostly Good, Some Bad and A Bit Of Ugly

As I had mentioned in a previous post, I made the decision to change to a new Endo and diabetic team.  I would say the main reason for this is my desire to go on an insulin pump.  My local specialist does not deal with pump therapy and so I made the decision to move to the Grey Nuns.  I really do want to go on a pump sooner rather than later and know that I will need the support of a good team to do so.  As talked about in my previous post, I met with the diabetic nurse and dietitian already and they were just awesome.  I was scheduled to see my new Endo on the Friday before leaving for my holiday and I was nervous!  Since diabetic management is very self controlled I was nervous about what he would have to say on the job I am doing so far.

From the minute I met him I was relaxed.  He insisted that I call him Greg off the bat and he had obviously read all of my medical notes prior to the appointment.  He started off by telling me I was a very luck lady to still be here.  He said that in all of his years of dealing with diabetics he had never seen someone with such a high A1C on diagnosis.  We talked a lot about what went on before I was diagnosed and all of the symptoms I had that continued to go undiagnosed.  He wanted to know what I had experienced between being diagnosed and the present date.  I told him all about the issues with my nerves and my eyes and he was very educated on the topic of insulin neuritis.  He said that it was extremely rare to suffer to such an extent and was happy to see me come out on the other side intact.  He delved a bit deeper into how my high blood sugars had been dealt with while I was in the hospital.  I told him that they had started me on insulin right away and had brought my sugars down quite quickly.  I explained how terrible it had made me feel and described the symptoms of extreme head pain, confusion, vision issues, swelling, nausea and inability to sleep for the first while.  

Here is where the ugly comes in.  Greg was flabbergasted that they had brought my sugars down at such a rapid rate.  He said that considering how high they were, they should have knocked me down very slowly over the course of quite a few weeks in order that my body could adjust.  He was quite frank with me and said that I was lucky that I had not suffered brain damage or heart damage as a result.  He said that it completely explained why I had suffered with insulin neuritis to such a degree and explained the cataracts in both eyes.  He sincerely apologized that I had to go through what I did.  I was somewhat teary by this point as the thought of what could have happened scares me to my core.  I know that I cannot think about the what ifs, but it is human nature to do so.  Even now when I think about it I am filled with dread.  I feel very lucky indeed to be where I am today.

Now for the little bit of bad.  Greg did the usual vibration test on my feet and found that I did have some sensory damage in both of my big toes.  He said that at this point it should not worsen as long as I continue with my good control and exercise habits.  He will continue to check them each year and I am to let him know if I see any change whatsoever.  I felt a bit saddened, but heck, considering he had told me moments prior that I could have been brain damaged, at this point it did not feel like a very big deal.  The only other bit of bad was the fact that my cholesterol is higher than it should be, which unfortunately often goes hand in hand with Type 1 diabetes.  Since my blood pressure and weight are good and in view of my active lifestyle, he decided that we would hold off on any medication at this point.  We will continue to monitor it.

There was mostly a lot of good.  Greg took a look through my blood sugar log and was very happy with what he saw.  He said that I obviously was taking this very serious and was determined to keep the best control I could.  He said that it is not uncommon for newly diagnosed Type 1's to barely test and to be in denial.  I said that was simply not an option for me, I wanted to be able to live as healthy of a life I could.  We went over my carb to insulin ratios and changed my breakfast ratio to a 1:10 as I often experience spikes after breakfast, which apparently is not uncommon.  We talked about how I manage my lows and highs and he was happy to listen to my frustrations about the entire thing.  He said that I will have these frustrations through life so it is good to talk about it.  He asked me about whether I planned to have children one day and I said that it was a possibility, that I had not ruled it out.  He talked to me about the fact that if I did every wish to conceive it would have to be planned as they need to monitor you quite closely.  I felt happy with that and said that I would keep him informed :)

We then talked extensively about insulin pump therapy.  He wanted to know my reasons for going on the pump and I explained that I felt it would give me more freedom and the ability to return to my long distance running and dreams of triathlons.  I told him about how I struggled with any run over an hour as I would go low and was having troubles knowing how to adjust.  We talked about the fact that once I have injected my basal insulin that is it, you cannot take it away and the option is to eat more carbs before and during exercise and to know how much to reduce my meal time insulin's by etc.  I said that the freedom and flexibility around meal times would be great and altogether I feel it would just make my management that much better.  He was happy with my reasons and he said that he felt I was a great candidate for a pump. He has no hesitation in writing the request for one.  

The only stumbling block in my way is funding.  The Alberta government does not provide funding for the pump and unfortunately my benefits through work do not either.  Luckily my pump supplies would be covered as they would be treated as a prescription, so I would get 80% coverage there.  When the PC government was elected in April, 2012 they made the promise that they would cover the cost of pumps for Albertans, however it is not known when this will happen.  It could be as early as next spring or it could be years down the road.  I have emailed my MLA but have not heard back.  To be honest I don't want to wait.  I desperately want one now.  I was happy to hear that the pump companies are very flexible and often offer payment plans.  I have emailed both Animas and Medtronic to see what they can offer and hope to hear back soon.  If possible I would like to be able to attend the pre-pump classes held in November and be on one by the end of November.  Fingers crossed!!

All in all I walked about from my appointment very happy with my decision to move to this new clinic.  The people make me feel confident in managing this disease.  I try not to think about how worse things could have been, and I mean they already were pretty bad!  I can only move forward from here.

Camping and Diabetes

I just got back yesterday from a wonderful two weeks off, a lot of which was spent camping.  Ryan and I spent three days in Slave Lake with the dogs enjoying the sunshine and a lot of time swimming in the lake.  The dogs thought it was the best time of their life and us humans had fun too.  After a few days at home and an appointment with my new Endo (post to follow), we headed off to British Columbia for nine days of camping.  Spent the first two nights just outside of Revelstoke and spent our time relaxing, staying up too late, mini-hikes and a great canoe trip on the Columbia River.  Our next stop was Vernon and we stayed at a Provincial Park on Lake Okanagan.  I just love this area, it is too beautiful for words.  The weather was hot!!  We spent our days hiking, swimming, suntanning, playing tennis, Ryan went golfing, cooking delicious campfire food, visiting Kelowna, having picnics and of course going to some wineries.  Every morning we were up at a good time and had lots to do.  On the way home we stopped in Radium for two nights and Ryan went golfing while I hit the spa for a massage and salt scrub.  Sleeping in a tent trailer for eight nights takes a toll on the body!

Preparing for a long camping trip can be quite time intensive.  You have to pack clothes for all kinds of weather, food and so on.  Then you add diabetic supplies into the mix.  Since I knew the weather was going to be hot, I made sure I kept my insulin in the cooler as much as possible to keep it from spoiling.  I brought along extra insulin pens and a whole stack of needles and strips, just in case.  I was armed with glucose and granola bars in case of lows and had my waterproof medical ID bracelet with me.  Although it took a bit of extra planning, it really was not a big deal and I managed to keep all my supplies safe.

I have to say that my blood sugars loved being on vacation.  My sugars were perfect the entire time.  I had one high of 14 when I had misjudged the carbs in a meal, but other than that they stayed happily in range.  I experienced a few mild lows, but nothing too serious at all.  I ate healthy so I am sure that helped, but I did indulge in some drinks and suffered no ill effect.  I put it down to being stress free and relatively active most of the time.  Now if only I could find out a way to be on vacation all the time!  We already have out next one booked, San Francisco in September :)

Heat and blood sugars

The last couple of days have been hot here in Alberta.  I mean hot!  Yesterday got up to 29 and today hit 32 (not sure what the humidex has been), tomorrow is going to be 33.  This may not sound super hot for a lot of people, but for us here in Edmonton that is hot.  I have had a cold and at first was sure that was the reason my blood sugars have been running higher than normal.  Not super high, but higher than they usually do.  I have been eating less due to not feeling well, however have found that I have had to adjust my insulin to carb ratio quite significantly.  Usually my ration is 1:10 for breakfast and then 1:15 for the rest of the day.  The last couple of days during this heat wave I have had to adjust it to 1:10 for every meal and even then have had to make some adjustments through the day (which I really do not enjoy as that just means more injections).  After doing some reading on the net, I have found that a lot of Type 1's find that their blood sugars run higher during spells of hot weather.  I take comfort in this as I hate to see high numbers.  As I have said before (and will be the topic of another post), the numbers on that meter really can make you feel great or extremely disappointed in yourself.  I am hesitant to bolus too much of a correction as this has been known to bite me in the ass in the middle of the night.  I will just continue with my adjusted carb ratio, keep cool and not get to down on the numbers.

I love my pharmacy

I have learnt that having a good pharmacy is an integral part of my diabetic care.  My pharmacy is a chain, Shoppers Drug Mart, however the pharmacists and pharmacy assistants have been invaluable to me.  About an hour after I had left my doctor office with the diagnosis of Type 1 diabetes, and before I got the call that I needed to go to emergency, I found myself standing in my pharmacy with a prescription for a years worth of diabetic supplies.  I was in a daze and still in shock.  From the moment they found out I had just been diagnosed up until now they have gone above and beyond to help me.  For the first few months I was in the pharmacy every couple of days.  My doctors were trying me on different medications for my feet and I was also trying to figure out how many supplies to order at once.  One day I would be getting pen needles only to remember that I needed to get more strips.  It did not take long before they all knew my name and each and every one of them has always taken the time to find out how I am doing and they have answered my bazillion questions.  They truly have made the transition to my new lifestyle as smooth as possible.

The last couple of days are a great example of why having a great pharmacy can help ease the stress of managing a chronic disease.  I called in on Thursday to order a supply of Lantus, Novo-rapid and test strips.   I requested more strips than usual as I am off on holidays for the next couple of weeks and want to make sure I have back up supplies while away from home and out of the province.  My heart sunk when they told me that my insurance company had been in touch with them and were contesting the amount of test strips I was using.  They felt that I was testing too much and that I should be limiting myself to 6 times a day.  Before I could reply the pharmacy assistant let me know that it was ridiculous that they felt 6 times per day was enough for a Type 1 to test and she had faxed my doctor that morning requesting that she confirm in writing that it was reasonable for me to be testing 12-14 times per day.  I was so grateful for how proactive they had been.  We went over my testing schedule which they felt was extremely reasonable and were happy to hear that my control was good. When I went to collect my prescriptions this afternoon they confirmed that my doctor had responded and confirmed that I did need to test as much as I was.  Therefore insurance will cover.  I was over the moon as I do not want to cut back on testing, however at $98 for 100 strips I am not sure how long I could have covered this!  I thanked my pharmacist and assistant and they said that they were just happy to help.

So that is why folks having a good pharmacy team is awesome!!!

*If you are interested, a regular day of testing for me goes something like this.  Test first thing in the morning before I get out of bed.  Test before breakfast to dose my insulin and then again two hours after breakfast.  Test before lunch, two hours after and then before supper and two hours after that.  I test before bed as well to ensure that my sugars are good to make it through the night.  As I exercise every day at quite an intense level, I also test before exercise to ensure I am good to go, during the activity to see if I need any carbs and then right after to see how it has affected me.  That takes us to 11 times per day.  I usually wake up once in the night to pee and I often check then as well, which my doctor told me is a good idea.  This is all without taking into account whether I have suffered a low or high blood sugar which also requires testing.  I don't feel I test too much, just a reasonable amount to keep myself safe, active and in control.