Doctors are the bane of my existence. I don't believe in them. I don't trust them. I'm not afraid to completely disregard their advice and instructions. I have a rebellious soul. That being said, I do like my current endocrinologist. Maybe because the letters MD don't follow her name. I think the letters are ARNP.
We're on a first name basis because she goes by her first name. She looks like she's fresh out of college. Probably not, but it's obvious that her education is still at the front of her mind. I love looking at her face as she studies my graphs and numbers. She looks like she has just been handed a difficult case study and she is determined to find the right answer.
Most MD's (acronym for Major Dork because I shouldn't use the word I was thinking!) immediately start lecturing me after seeing my numbers. Some are passive aggressive and say things like, "You know what you should be doing. I can't make you. At the end of the day I go home but you're still diabetic." Soul sucking. Little wonder so many people with diabetes let their A1C's determine their self-esteem. But my ARNP (acronym for A Really Nice Person) loves solving problems. She does is it without making me feel bad.
Right away she noticed my crazy overnight lows. Thankfully they are being pushed out later and later. I was up at 4:40 this morning with a low alert. An hour later I woke up on my own and saw my blood sugar was trending down again so I had more to eat. It didn't work and Patrick wanted a number to make sure the sensor was correct. That was at 6:30. I finally got up around 7:00 to just eat breakfast already. This is my new normal.
My doctor asked if I could change my blood sugar target for that time of day. Neither of us really knew but it sounded like an idea crazy enough it just might work. She has been to trainings and has talked to the Medtronic people to learn how the pump works. I have watched videos obviously created for new pumpers. I have worked with a diabetes nurse educator and have made several phone calls to Medtronic call center people to understand my pump. She made educated guesses to help me navigate to the set targets. From 3:30 - 6:00 am the target was changed from 130 to 150. That is a valuable piece of information I had forgotten about! I thought the pump always tried to keep my blood sugar around 120. I didn't remember that the nurse had me put in slightly different targets throughout the day. This could work well for me. I'm not above tweaking the time range either if needed.
She also added an extra half hour to my active insulin time. Most diabetics have a shorter window for active insulin. I know my insulin patiently lies in wait ready to pounce and drop my blood sugar hours beyond expectation.
They are small changes but they just might make all the difference. My A1C was lower but not as low as I was expecting considering the number of hypoglycemic events I endure on a daily basis. The doctor was still happy for me. I love that. I had a doctor once rain on my parade by saying, "Yeah your A1C is 6.0 but that's because you are low more often than you are high, so you're still not healthy." Thanks doc! I get my A1C below 7 as recommended and you just take the win away in one mean statement.
The one question I wanted to make sure I asked was about what to eat to treat lows. For years I have had doctors tell me that I overtreat my lows. They condescendingly remind me to eat 15 grams of carbs, wait 15 minutes and test again. Rinse, lather, repeat until I'm in range. I learned as a teenager that is a waste of time. It is rare for 15 grams of carbs to be enough. I almost always have to do more. It takes about 90 minutes to recover from a low with the 15 rule.
My doctor looked me in the eye and said, "Some people need more than 15 grams to treat a low." She also suggested I try to make half a peanut butter sandwich. As soon as she made the suggestion, she admitted that would be a pain in the middle of the night. She never landed on any other idea. I'm just grateful she gets it. I'm a real person who doesn't always respond as the textbook suggests.