Sunday, November 11, 2012

Week 35, part two: Beta Cells are Complicated!

Okay, so this post is coming a couple days later than it ought to have been put up - but with good reason.  It's been gorgeous here and I've been trying to soak up all of the warm sunny vibes from the world around me to balance the completely diabetes-world rocking appointment I had on Friday with my new (and might I add fabulous) Endocrinologist.  But before we get into the nitty-gritty details of what happened there, indulge me with a quick recap of the the second week 35 Baby check up...

As of Friday morning, Baby was incredibly active in her non-stress test (I credit HB for that since he sang to her) and her amniotic fluid index reading was slightly elevated but still within normal limits at just over 19.  "My doctor" was the only one of the four from the practice to be at the office rather than at the hospital testing center, so he had me see the nurse practitioner, Laura, for my check up.  With nothing earth shattering to report she ran the group-B strep test and checked for any effacement -- I hear back about the strep Tuesday at my first week 36 appointment and once again I've received compliments on my solid cervix (which I have to admit, I'm getting kind of tired of).  So she patted me on my head and sent me on my way... by far the least eventful and non-dramatic perinatal check up I've had in ages. 

So we go get lunch in Old Fairfax City while waiting for my endocrinology appointment to start, but when we eventually got there... oh my goodness, people... it was the nicest doctors office I've been in in ages AND they have the good sense to decorate with gorgeous photos of mountains (I'm a native Rocky Mountains girl, so mountains are a quick quick way to my heart).   With a 72 page chart faxed over from my old doc at UMW and a stack of freshly filled out new patient forms, the receptionist warmly welcomed me to their practice as if they'd been waiting for me for to grace them with my (albiet sickly) presence. Considering my first endo kinda dropped me on my head when we moved (we hadn't planned to change providers, but she insisted because of the "distance" ) and my second one was seriously incompetent, I think the look on my face at this woman's kindness must have been one of a deer in the head lights. What a pleasure.

Within minutes, a nurse was checking my vitals, taking blood for a HgA1C test and running through a basic history of my current diabetes status.  A few minutes later the door to the exam room opened and in walked this glowing angel of diabetes know how, Dr. Suzanne Rogacz.

Taking her time to look through my chart, to get a detailed verbal history of my life with diabetes and to talk through my current blood sugar roller coaster ride, she listened to what I said and responded to how I feel better than any specialist I've ever seen.  She didn't reprogram my pump - at all - or even ask me to take it off to verify it's settings.  She didn't ask for justification of my blood sugar logs and she confirmed that while the lows are concerning, the post-meal highs are more critical for this point in pregnancy because of the impact they have on Baby.  HALLELUJAH! After the ambivelance my last endocrinologist showed to those post prandial numbers, this was amazing to hear a licensed medical professional say something I expected!!

I'm seriously in love with her.

But, what is a good story without a twist right?  So we're going along through this appointment without surprises when WHAM! Out of the clear blue, Dr. Rogacz turns the tables and suggests that I reintroduce amylin to system ... In the two years that I've been an aggressive type 1 diabetic, I have never heard of it, I have never read about it, and I most certainly have never been told that I am missing it!!

Reading the look of confusion on my face, Dr. Rogacz explained that amylin is a hormone that is co-secreted with insulin by the beta cells of the pancreas to help regulate blood glucose.  Since my body destroyed those beta cells and made me externally dependent on synthetic resources, I'm not only naturally lacking insulin, I am also failing to self-produce amylin as well. She explained that it's not essential to "healthy living" like insulin is and that very few diabetic patients are selected to be put on amylin supplementation because it's a sensitive hormone that requires acute self-care to deal with the nuances of taking it (sever hypoglycemia becomes far more likely on amylin than just insulin by itself) and aggressive diabetes goals that are (unfortunately) uncommon with most diabetics, regardless of type.  But seeing as the hormone, which is only available in "Symlin" pen injection form, would smooth out my blood sugar patterns - making the peaks less high and the lows less low - she thinks that it could take me to the next level of blood glucose control that I am currently unable to do with an agressive insulin regimine alone.   Which, hypothetically speaking, is exactly what I need right now and what I want out of life in general --  the closer I can make my blood sugar resemble a non-diabetic's the healthier I can be for my husband and my kids.

Sooooooo... with little persuasion and a vote of confidence from a doctor I trust, we called the shot (haha) and I'm now injecting amylin at least three times a day in addition to wearing my 24/7/365 pocket-buddy of an insulin pump.  I'll admit that it's hard to get back into the routine of doing an injection whenever I want to eat anything more than 250 calories or 30 grams of carbs, but I'll fall into a routine one of these days and it'll eventually be old hat:  sit down evaluate the meal, input carbs into the pump and bolus insulin.  Pull out an alcohol wipe, clean off the symlin pen tip and abdominal injection site, attach the needle, set and stab. 

Simple enough, right?

We'll see how this goes.  I go back to see her again next Friday for another prenatal+endo check up.  I'm relieved to be working with someone who gets my goals and the factors that play in my individual case... she's supportive of my family planning, she's understanding of my physical goals and my running addiction, she is eager to help balance breast feeding and blood sugars... she's everything I could have asked for in an endocrinologist all wrapped up with a pretty bow. 

Merry early Christmas to me!

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