Friday 27 July 2012

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.

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