Clash of the Titans

It’s been a while since I mentioned Not House (for some, with good reason). Two days ago I strolled into his office looking to have a heart to heart about all of the things I’ve been complaining about here: the Lantus, the overnight lows, the part where he told me it’s ok to adjust things on my own (that last one I know for sure didn’t happen). I got a little lucky and managed to make an appointment for the next day (January 6) at 3pm. If you follow me on twitter I was being a little cryptic about all of that. I was nervous, it happens.I’m still mulling over exactly how to proceed with the future of my Diabetes management so the rest of this post might be a bit disjointed and may jump around a bit. I’m sorry in advance.

The big target yesterday was the Lantus. As initially prescribed, I was due 21 units nightly. As I became more and more aware of my numbers in an effort to find control, I became more and more aware that 21 units was far too much. I tried dropping down to 17 at the beginning of November to see how that would fly. Over the past 2 months it has become evident that 17 units also requires too high of a target blood glucose a bedtime to ensure I don’t wake up in the middle with Bart Allen greeting me with a 50. Despite the demands of 17 units (somewhere between 200-220 at midnight), my morning fasting numbers have been surprisingly awesome. I’m going to baby step my way to a more appropriate Lantus dosage. If I can find some consistency with my bedtime-ish numbers that will help me figure out what will work moving forward.

Part of the issue with my bed time-ish numbers is pretty much anything involved with Diabetes after 12:30 pm. Going into lunch it doesn’t look like I have too many problems. Likely a result of my mornings suffering from Groundhog’s Day; It’s a lot easier to keep things consistent when the routine pretty much stays the same. From lunch on, I am having some issues. I suppose this is part of the growing pains of becoming an educated Diabetic. I suppose there’s more that I could learn from Not House assuming a) I knew the right questions to ask and 2) it didn’t feel like I had to work to get information out of him. At the top of my “to learn” list: I need to figure out what my insulin/carb ratios are. Clearly I need more insulin during lunch and dinner, the numbers don’t lie. How much is a big, fat TBD.

I’m going to start to take more detailed records of each meal to help my Reaganomics. For the past 2 months I have only been keeping track of blood glucose and time of test. Now I need to include insulin injected and a solid estimate of carbs consumed. Yes, I’m going “old school” with this pencil and paper nonsense, but Bart Allen isn’t exactly the most advanced meter in the world. Sure, there are other meters that would keep track of insulin dose, carbohydrates, blood sugar and time of all this for me but I think the manual process will help me focus on what I’m trying to accomplish. I know the carb counting will probably take the most work to figure out. And yes, I am considering seeing a CDE, probably sooner than later but there is a difference between education and application of said education. I still have work to do. As the numbers start to roll in, I hope I’ll be able to become a more informed patient when I discuss these things with my doctor and more importantly more informed with how all of this stuff will affect me, Diabetically speaking.

My next proper appointment with Not House is March 3. That should be plenty of time for the corresponding A1c to reflect some hopefully improved overnight numbers. Granted, there will probably be a bit of a “learning curve” as I start to adjust my Lantus and ironically that will likely negatively impact my A1c. Baby steps, right? Assuming the averages from my recorded numbers are accurate, my “potential” A1c looks like it will be a shade over 7, not quite under the ADA recommendation. Looking at my averages, if I can safely reduce my overnight numbers to something around 180, that will have a tremendous impact on my A1c and ultimately my health. Combine that with a more finely tuned lunch and dinner bolus and I just might resemble a healthy Diabetic. It will take a lot work and patience. I’m sure I will be venting here a lot more often. But it’s all for a good cause, right?

It feels like I’m at a crossroads. While this meeting did give me some answers, there were moments that felt like I was pulling teeth. I used the phrase “team” when I spoke with him because we are supposed to be part of a larger team. He’s the doctor, I’m the patient. Work together to figure out what works for me and everyone win, right? I know that there are some aspects of my Diabetes that I have to figure out on my own, your Diabetes may vary and all that. But there needs to be more there. This is a crucial step in becoming a more informed patient: engaging in an active dialog with my doctor so I can figure this out. If I know what I need to talk about, then will the information flow more freely?

Quite frankly, part of me went into this meeting prepared to never see that office again. If I can get the hang of this Lantus crap and open my mind up being more flexible with my insulin when I eat then maybe this is just a bump in the road. But I need more support through all of this, and not just through the DOC (although I do love you guys). I believe I’m asking the right questions when it comes to my management, now the hard part is accepting that maybe Not House is not the answer.

I’m going to work through this for now, but if I am not pleased with how things go in our next appointment then that might be it for our relationship. Maybe there’s a local endocrinologist that looks like Hugh Laurie. #irony

Oh, one more thing. I had mentioned that Not House’s office is right next to the hospital where I was diagnosed. After our talk I decided to see if I could pick up my medical records from my diagnosis. I was surprised how easy it was – a quick form and a picture ID. She didn’t even charge me for the copies.

I have to admit, I was a little surprised at the numbers. The only thing I couldn’t find was my weight when I arrived. But I digress, let’s get to the good parts.

(And I quote)

Christopher Snider is an 18-year-old college student who was sent to the emergency room by Dr. S with hyperglycemia.

Christopher Snider is a student at Virginia Tech. For the past one month, he has been experiencing polydipsia and polyuria. The patient subsequently went to see Dr. S and was found to have a high blood sugar and sent to the emergency room. In the ER, his blood sugar was 844. The patient was given IV insulin and started on an insulin drip. The patient was admitted to the PCU for further management.

(blah blah blah)

This is an 18-year-old male with new onset of diabetes mellitus with markedly high glucose levels. The patient will be maintained on IV insulin drip until his blood sugar is less than 200 and then will switch him to Accu-Cheks insulin coverage….The patient will start on diabetic teaching. Will obtain endocrinology consultation.

10/19/02

(end quote)