Endocrinology Visits Can Have Their Highs and Lows

“Can I see your pump?” my endocrinologist asked when I went for my visit last Thursday. I had a new insulin pump — a Tandem t:slim — which has recently hit the market, and not many people have had a chance to see one yet.

I disconnected, handed it to him, told him how to wake it up, and said, “have fun.”

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He was like a man with a new smartphone, which is what a t:slim looks like. It was “how do you do this?” and “how do you get to this place?” and “what do I do next?” and so on. He was even willing to change one of my basal rates by himself. I was surprised he gave it back to me when the visit was over! He’d never touched any of my previous four pumps.

Also during my appointment, there were people coming in and out of the examining room, also wanting to see the t:slim. They especially liked that it gives you instructions on what to do as you go along. I like that, too: It’s the first pump I’ve had where I haven’t had to carry the instruction manual around with me for the first month or two.

For the most part, it was a good appointment. I’d lost weight, my labs were good (except for my Vitamin D level, which was still low but not as low as earlier), my blood pressure was good, and my HbA1c was down to 6.2% (from 7.9%).

I say “for the most part” because one of the people filtering in and out was a certified diabetes educator (CDE) who was — at least in my mind — chastising me for letting my blood glucose go below 70 mg/dl. It was unsafe, it was all my fault, and I shouldn’t be doing that.

In my mind, she was shaking her finger in my face.

Do I know low BGs are dangerous? Yes, I do. Witness two friends who have failed to wake up in the morning, apparently due to dangerously low blood glucose levels (and I don’t mean in the 60s). One was a very good friend. A friend whose house was my house. A friend I still pick up the phone to call once in a while before I remember I can never talk to or see her again except in my heart.

I don’t feel lows unless I’ve been very low — say, in the 30s — for a while, which is why I wear a continuous glucose monitor (CGM). The problem is, I can’t find the transmitter for my CGM, so I haven’t had that tool. The next generation of the Dexcom CGM is now available, so I need to order one and get back on track.

There’s also a problem with hearing the “low” alarm when I’m asleep. I got a seismometer app for my iPhone, since the CGM also vibrates, and I put the CGM on top of the phone so I’d get the earthquake alarm from the app. But I can’t figure out how to turn the app on! That may be one to turn over to my grandson or –daughter.

I can lower my basal rates and change my insulin-to-carbohydrate ratio, but that doesn’t happen overnight.

How am I supposed to keep my HbA1c down, maintain tight control, and never go low? Can I never mess up on matching carbs and insulin, even when I’m giving my best guess to the amount of carbs I’m ingesting? Can I never mess up on committing math?

To quote Yul Brynner in The King and I, “it’s a puzzlement.”

The CDE wasn’t telling me how to avoid going under 70. Just that it was a bad thing to do. Maybe she needs to tell me in a different way, like: “I see you’re going low. Would you like to go over some ways to try and avoid that?”

It’s good to read books and articles about the dangers of going low. I think it’s quite a different thing to avoid doing it in real life.

I have heard that if you run high for a while, the symptoms of lows return. It’s never worked for me.

Anybody out there have any ideas?

To end this on a high note, my birthday was yesterday. My best gift wasn’t an object: It was words; words from my grandson, my granddaughter, and my granddaughter’s best friend.

“I can always count on you to be a stable part of my life.” Grandson

“You’ve been there for me when I need you and I’ll never be able to pay you back.” Granddaughter (and I think she just did)

“I’ve said it before and I’ll say it again, thank you for treating me like part of the family.” Best Friend

Can’t ask for anything better.

  • Deb

    Happy Birthday, Jan. And congrats on the A1c!

  • jim snell

    Jan: Happy Birthday and congrats on A1c reading.

    Glad to hear some things seem to be going better. Column does great job of covering a broad spectrum of issues and actions.

    Good Luck and best wishes for better health.

  • Kim

    I always enjoy reading your articles. REAL diabetic living. Having diabetes is like a roller coaster, its good to read your real living articles. You explained it perfectly about the nurse practitioner’s or CDE that make you feel worse rather than encourage.

  • riva greenberg

    We all do better when we are praised for what we do well and asked to think through how we can do a little better where we need to. Berating anyone about anything doesn’t help, and often hurts.

    Jan, I’ve had type 1 diabetes for 40 years and had plenty of lows. What helps me is checking my blood sugar often, carrying glucose tabs or SweeTarts in all my bags and pockets, eating pretty routinely to know how much insulin I need to cover what I eat, and not eating many refined carbs which throws you on that roller coaster of blood sugars.

    Grab any of those tips if they work for you. And experiment with your own ideas of what you think will work. That’s the best way to learn and grow.

  • Kathy

    I am glad you like the new T-Slim Insulin Pump.
    It will be interesting to see how you like the new Dexcom as well.
    I agree with you about the CDE not being more positive and giving you some ideas on how to avoid those pesky lows.
    But you know I also enjoying reading your blogs. You always make me smile and I so am glad for your new A1C, etc. Congratulations
    Kathy

  • jim snell

    Riva captured it well I am T2 over 30 years and up doing pretty much what she was doing.

    thank you and best wishes.