Diabetes Self-Management Blog

Two weeks ago, I made a prediction. I said that I guessed my HbA1c at this month’s endocrinologist’s visit would be 6.4%.

This past Tuesday, I had my appointment with the doctor, and as much as I’ve always enjoyed going to see my endocrinologist, if you reread or remember my entry two weeks ago, as well as last week’s entry on "Recognizing the Need to Tweak Thought," you may be able to predict where I’m going this week.

I wasn’t looking forward to my trip this time around. I arrived at the doctor’s office 15 minutes early and entered into the usual routine: I checked in with the receptionist, dropped my insulin pump into a plastic bag (the pump contains my blood glucose monitor, so I give them the whole thing), and received an ID sticker from the receptionist to put on the specimen jar.

After the always-wonderful experience of peeing in a cup and putting a sealed container of my urine in a two-way cabinet in the wall, I sat in the waiting area and, well…

Waited.

When the nurse mispronounced my last name, I said it was me and followed her in to the weigh-in, fingerprick, and blood-pressure-checking section of the clinic. My weight, as I could have guessed, has gone up some in the past three months. I’ve gained less than 10 pounds, and while I have a few dozen rationalizations about why — including avoiding the gym, blaming the holidays and weeks of cold cold weather — I can’t use them for much longer.

Besides, if I keep this incremental weight-gain up for a few more years, it won’t be a pretty thing. So, mental note to get back into the spinning mode.

My blood pressure was fine, 114/67 mm Hg. And my blood glucose at the time of my visit, 126 mg/dl . Blood glucose, when at the clinic, doesn’t matter; I’m sure they don’t care either, they just don’t want me passing out or going into DKA or something while I’m on the premises.

I was led into Room 5, asked to take off my shoes and socks, and given some kind of foot Kleenex on which to rest my bare feet so that I didn’t have to put them on the floor where, prior to foot-Kleenex implementation, hundreds and hundreds of other people had also rested their bare feet.

And then I waited some more.

Finally, the endocrinologist’s resident (I’m assuming that’s who it was) came in to perform the exam. He asked me how things were going, looked at my blood glucose readings from the pump, asked me about my weight gain of eight pounds, and then looked at my feet, my infusion sites, and so on.

I had to ask him what my HbA1c was, and he told me. He wanted to know if I had any further questions. I said no. He left.

Ten minutes later, he returned, this time with my endocrinologist, who pulled over a chair and picked up a conversation from where we left off three months ago.

I’ve mentioned my endo before, how much I like him, and it was nice to have him in the room to talk to. I asked him many of the questions I didn’t really feel comfortable asking the other doctor, even though he was in the room (that’s a topic for another blog entry, or entries, at some point).

I commented on my HbA1c. Or, rather, I was just about to, when my doctor interrupted me and told me I was doing great. This time of year, people often show an increase in their HbA1c — the holidays, all of that. He also said that even if I had gone up a tenth of a percentage point or two higher on my HbA1c, he wouldn’t have been concerned.

Studies show — and I’m paraphrasing now — that years of tight control and then a sudden jump does not lead to complications the way people might have previously thought. What I’d done for almost two years was bank good blood glucose control, and now I was cashing just a little of it in.

And, of course, it wasn’t a bad HbA1c. I was at 6.9%. Still in the acceptable range.

Yet my HbA1C was higher. My weight had increased. It was hard to discern a pattern in my blood glucose control.

This visit reinforced what I already knew, and the things I’d been avoiding hit home thanks to hard data. I’d veered slightly off my self-management track, and while I don’t need to make major corrections to how I live my life, I will need to shift back into what it was that got me into the good places to begin with.

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Comments
  1. I’m finding out all sorts of interesting things with my CGM beamed in to my pump. The exact metabolic nature of proteins and fats on my body, relative to exercise, time of day, etc. Carb combinations, etc. etc. Facinating. It would have taken me years to come to this otherwise, tho I am not the brightest penny in the nickle roll.

    I am hoping I can establish a life at, say, A1C 6.4 without havin gto be slavish or spartan. We’ll see. Last A1C, taken before I started CGM, was 7.3, which is unacceptable. But when my endo told me it was unacceptable, it irked me because well, you try it buddy.

    Posted by Peter Mead |
  2. Eric, This message was very helpful. I also was thinking my A1C would be higher at my Jan. 9th appt. To my surprise it was lower - 6.3% BUT - the month of January has not been good so far. It is time to get back on track - another New Year’s resolution!! Thanks for sharing your story. Tighten control MOST of the time - will possibly excuse us ONCE IN A WHILE - but should not be a regular lifestyle! We must get back to watching what we are doing - exercise, eating less, and being conscious of our life choices!

    Posted by Krone |
  3. Dear Eric.

    Lowering the A1c results form 6.9% is relatively easy loosing 10 lb is a totally different story. I made a very good plan to loose 10 lb over 68 days. I thought that the body would not notice such a slow rate of loss. Well at 11 lb loss all hell broke loose my body was convinced that master was starving it to death and went into a similar eat mode as during a low. Not only did I regain the 10 lb but another 10 to prepare for the next starvation period.

    At a very stable 250 lb and not enjoying it, I am pondering what to do? All out war: extremely low carb diet, calorie reduced diet, adding metformin to the insulin which makes me sick and spending 1/2 of each and every day exercising. May be best all 4 combined. Any other ideas?

    I dont understand why the body likes being so overweight even his furriness eats a bit of dog food and stops. Not sure that his self control would extend to Costco barbeque chicken. May be this is the solution. Make new dogma where everything but sauerkraut is taboo.

    Posted by CalgaryDiabetic |
  4. Dear Eric.

    Just to make you feel better my HA1c also went up from 6.2 to 6.5 overChristmas. Even worst my weight up also a lot. It is bad to have suppers where you have no idea to the closest 1000 calories of how much you have eaten.

    Posted by CalgaryDiabetic |

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