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THE NUMBERS GAME
11 December 2012
I don't think I've ever written here about diabetes, but it's time. I was diagnosed with Type II Diabetes over 10 years and 3 doctors ago. Actually it was me who requested testing. I asked my then-doctor (who, for obvious reasons, is no longer my doctor!) if he didn't think I should be tested. My father had Type II diabetes, I said, and I pointed out that I was morbidly obese (weighing over 300 lbs at that time), and it seemed to me I should be tested. The doctor looked kind of surprised and actually opened my file to check my weight to see if I was, indeed, morbidly obese. Good grief...was he blind?
Anyway, surprise, surprise, the A1C came back showing that yes, I was not just pre-diabetic, but actually full blown Type II diabetic. In all honesty, I can't remember getting any instruction from him other than to watch my eating and exercise more. I was very dissatisfied with him as a primary care physician and when John, who had been a Sutter doctor and whose Internal Medicine office had been next to mine when I was managing Women's Health, joined the Kaiser staff, I requested a switch to him and promised to be a 100% compliant patient.
And I was. John had me taking classes to learn about diabetes and I went to Weight Watchers and lost buckets of weight. I took up biking. I don't remember doing a lot of glucose testing, and I don't think John had me on any medication, but apparently I was doing all right. I was working for Dr. G at the time and he told me if he were my doctor, he would have had me on insulin, but he could see that I was doing all the right things.
Well, John left Kaiser and started a high priced weight loss/obesity clinic and I was assigned another doctor.
In all honesty, I'm kind of neutral about this doctor, though she has been my doctor for years now. She really knows very little about me and it seems to me that I am just a bunch of numbers to her. She has never asked anything about my personal life (she has no idea I have two dead children, for example, compared to my gynecologist, who takes time to chat and ask me how things are going and who is well aware of Paul and David). Dr. A and I never "chat," but she just checks the numbers and tries to get the medication, which she has put me on, dosage right. But, to be fair, I haven't kept up my end of the bargain either. I rarely followed through when she requested lab tests because I knew they were going to be bad. I went for a few years without taking the meds at all, and doing no testing. I lived in blissful ignorance.
But I had a scare recently (which turned out to be just a bladder infection) and it was kind of a wake up call. I decided it was time to try to take charge of this diabetes thing.
I went home from the appointment and did glucose testing for the first time in a few years. You know what a slot machine looks like when you hit the jackpot? All the lights go off and things to round and round and bells ring? If my glucose meter had sound and lights, that was what it would have looked like. My blood sugar was so high (over 400) that the meter apparently didn't go up that high. I just got a dire warning to see my doctor NOW.
I started getting serious about the medication. Within a couple of weeks, I had brought my numbers down to the low 200s, which, while still way too high, was at least heading in the right direction. As for diet, well, some days were better than others, but more "less good" than "better."
By the time I saw the doctor again, All of my numbers were starting to look much better. My cholesterol was OK, but the HDL (bad kind) was still too high. My A1C, which measures the bood sugar over the past 3 months, which should be 7 and which had been 13 the last time it was measured, was now 8, still not where it should be, but definitely going in the right direction. Of course Dr. A never gives me positive (or negative) reinforcement. She just notices the numbers and suggests action, without editorial comment.
Dr. A set me up with Heather, who teaches a diabetes class. There were only two of us in the class and one thing I learned was that each doctor has his or her own diabetes rep and that Heather was my doctor's rep, while the other woman had another rep, so at the end of the class, she gave the other woman the name of her rep and let her go, while she kept me another 30 minutes and I had a personal one-on-one session.
Heather has changed my life. The answer? Technology! She reminded me that my glucose meter can be hooked up to my computer, which will download all the readings and put them in a graph form to help me see patterns and adjust diet accordingly. As I told her, I may have difficulty sticking with a program, but give me a computer thing and I'm there, Baby. I ordered the cord that allowed me to connect with my computer.
I'm now testing my sugars several times a day...before breakfast, sometimes after breakfast, sometimes before lunch, always before dinner, and before bedtime (unless I forget). The before dinner number is a great help because if it's high, I eat less. My target range should be between 90 and 150.
I learned my lesson on the day when I woke up feeling so good because my sugar was 119, but then I snacked on Cheetos and when I tested before dinner, it was 277, the highest it's been since I got below 200! I had a small dinner and brought it down to 156 by bedtime and then starting afresh at 113 the next morning. Good me. That day was so good my sugar was 116 at dinner and low at 73 before bedtime. I had 1/2 cup of orange juice and brought it up to 93 before going to sleep. This morning it was a nice respectable 110.
For breakfast I had 1/2 cup of Grapenuts and 1/2 cup of blackberries with a bit of Splenda. I tested an hour after eating and it was 234! WTF?
I wrote to Heather, who explained that testing 1 hour after meals (though somewhere I read that was recommended) is too soon, because food is still digesting, so she recommends only testing before meals to get a more accurate reading. It's just great having someone available to answer questions more or less instantly.
I feel like my life has become numbers but, you know what? It's
actually fun figuring this all out. It's a painless way to finally take control of
my diabetes. If I can begin to make sense of the pattern of what is causing the
highs and lows!
I'd love it if you'd leave a comment!
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