Friday, December 12, 2014

Week 29 Endo Appt

While the changes with Baby over the next two months transition my perinatal appointments from every four weeks to every two weeks and soon to be twice per week, I take comfort in the clockwork predictability of my pancreas and the resulting routine schedule I have for my endocrinology appointments: when pregnant, I see my doctor every four weeks and when not, every three months.   Seeing as there are still at least eight weeks to go with this pregnancy in the best case scenario, I find myself regularly annoying the receptionists at NOVA Endocrinology with my requests for non-existent appointments in my doctor's overly-booked schedule.  Always tacking me on to the tail end of my doctor's Friday afternoon schedule, I have plenty of time to mull over her suggestions and feedback as we fight our way through the I-95 traffic leaving Washington DC at rush hour - which, thank God, wasn't too bad today. 
 
After the last three weeks of vitamins and omelets, I anticipated that my HgA1C, like my weight, would be lower today than it'd been at my last appointment on November 12.  But while the scale did indicate that my weight is down, my HgA1C remained stagnant at 5.5 despite my drastic reduction of insulin from roughly 55 units per day down to between 30-35 units daily.  Inquiring about my glucose trends, I then presented the doctor with my latest CGM logs...
 
 
Finding my post-breakfast hyperglycemia to be still of concern, she asked if I'd continued the 30 unit injections of symlin with my breakfasts since swapping over to my monotonous diet.  Given that my omelets sometimes include a skosh of milk and sometimes not, I told her no, but seeing as I continue to struggle with post-prandial highs and insulin resistance kicks in to full swing during the third trimester of pregnancy due to the wonderful world of hormones she instructed me to start back up on my morning needle to the stomach routine for better numbers.  Moving on to inquire about my basal rates, I rattled off the nine (yes, you read that correctly: NINE) settings I have programmed throughout the day:
 
1)  12:00 AM to 1:30 AM:  0.450 Units
2)  1:30 AM to 4:30 AM: 0.625 Units
3)  4:30 AM to 6:00 AM: 0.950 Units
4)  6:00 AM to 7:00 AM: 2.50 Units
5)  7:00 AM to 8:30 AM: 0.875 Units
6)  8:30 AM to 4:00 PM: 1.45 Units
7)  4:00 PM to 7:30 PM: 1.75 Units
8)  7:30 PM to 9:00 PM: 1.25 Units
9)  9:00 PM to 12:00 AM: 0.475 Units
Grand total: 28.075 Units
 
Recording this with some annoyance (apparently this kind of nuancing of basal rates isn't terribly common at her office), she honed in on the one number that stood out in it's oddity: 2.5 units from 6:00 AM to 7:00 AM.  Otherwise surrounded by practically negligent doses, this "high" dose demonstrates my sensitivity to the body's natural rhythm of hormone production that happens between 2:00 AM and 8:00 AM that is commonly referred to as the dawn phenomenon.  As the knock on effects of this phenomenon haven't been something I've necessarily struggled with previously (maybe I did and just didn't notice), my doctor explained that at some point my honeymoon phase as a new type one diabetic will end and my insulin requirements will plateau to some degree of predictability.  As I've only been a diabetic for three (almost four... golly...) years, she doubts that my pancreas has fully given up the ghost and she thinks this new found requirement for additional insulin for one specific hour each morning may actually be a step closer to life post-honeymoon with my ball-and-chain pancreas.  

In coming out of today's appointment and having the traffic jam to think about it, I'm torn in to two emotions: frustration with my HgA1C remaining stagnant despite my concerted efforts and shock, I guess, that something may be progressing with my diabetes separately from the pregnancy.  I've become so accustomed to think of my medical situation as a high risk pregnancy due to diabetes that my diabetes just being my diabetes is odd... I'm probably putting too much thought into it and overanalyzing the whole thing, but being diabetic is so... normal... for me now that the thought of being considered as "newly diagnosed" floors me.  I understand that there are men and women out there who have had type 1 diabetes since their childhoods and at my age they are likely settled into their insulin routines with a decade or two of experience under their belt, but I feel so settled and so diabetic in my own skin that the comparison takes active consideration rather than passing acknowledgement to register.  

Well, for better or for worse, my diagnosis anniversary is just around the corner on January 25 and, if we're going with traditional gift choices, that means my pancreas and I should exchange either flowers or fruit to mark the date... we'll see how my next endocrinology appointment goes on January 9th, but I have a feeling we'll be skipping the carbs and going straight for the floral arrangements since that, at least, wont mess with me and Baby ;)

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