When I made the appointment with a general practitioner, I suspected that I had diabetes. I had all the classic symptoms: extreme thirst, weight loss without trying, insatiable hunger, etc.  I was also getting recurring yeast infections and my fingernails were doing weird things.

When the doctor told me he suspected I was diabetic, I wasn’t surprised.  What did surprise me was his “treatment” idea.  The appointment was on a Friday afternoon.  The doctor (I can’t even remember his name) told me to fast all weekend.  NO FOOD FOR TWO DAYS.  He said that sometimes, doing this can “jump start” a person’s body and stop diabetes.  He made a follow-up appointment for Monday morning.

Knowing what I do now, I know that this was complete and total bullshit.  But back then, I didn’t know much about diabetes; I only knew the symptoms. 

So, I did what I was told.  I didn’t eat anything all weekend.  I drank gallons of water because my thirst didn’t go away, and I struggled with headaches, nausea, and dizziness the entire time.

When I got back to his office on Monday morning, he tested by BG.  I don’t remember the exact number, but it was somewhere around 400 mg/dl – even higher than it had been on Friday.

Instead of reaching the logical disgnosis of Type 1 diabetes, he accused me of cheating.  When I made it clear that I hadn’t had anything except water, he didn’t attempt to hide his doubt.  He declared me a Type 2 diabetic and gave me a prescription for Glyburide. 

For two weeks, I took the pills, and had significant success.  However, I had some horrible lows, as well.  Looking back, I know I was very insulin sensitive at that time, and the Glyburide just made my pancreas work harder while it was dying.  I’m convinced that those few short weeks I was on the drug hastened the near complete destruction of my beta cells.

I stopped taking the pills because the extreme highs and lows were impossible to manage.  I made an appointment with a new PCP, who prescribed Metformin.  I started off in small doses, but with each follow-up appointment, and no improvements, he increased my dose.  Met made me very, very sick.  I think I vomited at least three times per week while taking it.  And my BG stayed high.

After being hospitalized several times for near DKA (I never actually got to the critical point), I was referred to an endo. 

The rest of the story starts here.

My appointment with Dr. S. started well enough.  Traffic into downtown Baltimore was brutal, but I gave myself plenty of time.  The drive from my office (just on the edge of the city) to the hospital where Dr. S. maintains an office is well, interesting.  It takes me through some of Baltimore’s toughest neighborhoods, which can be a little intimidating. 

Baltimore is a rough city.  Riddled with drugs, crime, corruption, and poverty, the inner city has become something of a battle ground.  Rarely does a day pass when there hasn’t been a murder, nevermind the two or three that seem to be the “norm.”  And it’s getting worse.

As I drove through the streets of Baltimore, at 1pm, I was struck by the number of people just . . . hanging out.  These people were not at work in the middle of the day; they were just sitting on their stoops shooting the breeze.  Doesn’t anyone work?  Seriously, there were hundreds of people just hanging around.  I saw at least two drug deals go down (where are the cops?!?)  Anyway, I am digressing a bit from my original purpose for this post (must focus my short attention span better). 

So, after the enlightening drive in, I arrived 20 minutes early for my appointment.  The first thing that I noticed was the very busy waiting room.  Normally, when I go to Dr. S.’s office, it’s pretty empty.  Yesterday, there were at least six people waiting.  I signed in, paid my co-pay, and took a seat. 

A few minutes later, the medical assistant person (one I’d never seen before) called my name (actually, she called Ms. Burnadette – why is it so difficult to pronounce a name that is so freaking easy?). 

She weighed me (SCARY!!!), took my BP (slightly elevated, but not surprising given the aforementioned drive in), pulse (also slightly elevated), and BG (120 mg/dl).  Then, and this is why I’m still reeling, she began to enter my info into the computer.  At one point, she was clearly frustrated. 

She said, “This is so messed up.  It has two different diagnoses for you.  One is Type 1, and the other is Type 1 Adult Onset.” 

Hoping to help her out, I told her that I am a Type 1 who was diagnosed in my twenties.  She then asked if I take “pills” for my diabetes.  I told her that no, as a Type 1, I need insulin to control my blood sugar. 

She said (and this is where I nearly lost it), “I don’t even know the difference between Type 1 and Type 2!”

WHAT?!? She works in an endocrinologist’s office and she doesn’t know the basics of diabetes!

I calmly attempted to explain the difference, but once she heard “beta cells in the pancreas,” her eyes glazed over and she stopped listening (must find less technical ways of describing diabetes).  I gave up and returned to the waiting area. 

Here’s something I really like about Dr. S.: *he* comes to the waiting room and escorts patients to his office.  Most doctors have their office set up so that you (the patient) are escorted to an exam room by a medical assistant.  Then, you sit in that room until the doctor comes in.  Dr. S. does the talky part of the appointment first, then the exam after that.  It’s really nice.

Here’s the other thing I really like about him: he actually apologizes to patients when he keeps them waiting.  My appointment was at 2:00, but I didn’t see him until 2:40.  Most doctors would just act as though their time is far more valuable than yours. Dr. S. doesn’t do that, and I respect him more for it.

He escorted me back to his office, and we talked about what’s been going on.  Telling him about Lisa was especially hard, but I managed to do it without sobbing, so score one for me!  We also talked about the failed IUIs and other infertility stuff. 

Then, I started babbling about my weight and how unhappy I am.  I told him about my new low-carb resolve (today is day three and I haven’t cheated once!) and asked for his thoughts on Metformin.  His answer surprised me.  He didn’t feel that the potential benefits (Met is weight neutral, meaning that it doesn’t cause weight gain OR weight loss) were worth the potential risks.  When I said that I needed something to help get a handle on my weight, he said that because I’m TTC, I have very limited options.  His exact words were:  “yeah, it sucks.”

I can go back on Symlin during the times when there’s no chance of pregnancy: like now, thank you ovarian cysts, or the time from when I get my period until IUI day.  But it’s not really worth it if I can’t ever adjust to the drug long enough to avoid the horrible nausea.  Besides, I’m not eating enough carbs to take Symlin.

When I left his office, we had made no changes to my treatment plan.  I felt somewhat defeated, but I recognize that there is no magic pill for weight loss.  I’ve got to stick to my new way of eating and get some exercise.  It can work; I just have to stay focused.

So, that’s the (not-so) skinny on my appointment with Dr. S.  I see him again in three months (I can’t believe November is three months away!), and I’m hopeful that I’ll have lost a decent amount of weight by then. 

Or that I’m pregnant – that would rock, too.

Tomorrow, I see Dr. S.  Yep, it’s time for a visit to the principal’s office.

I have mixed feelings about this.  I am looking forward to and dreading this appointment at the same time.   There will be no lab results; no A1c.  As always, I’ll be weighed (dreaded moment #1), BP checked (this shouldn’t be bad, but who knows?), and BG tested on their dinosaur meter, whose results are ALWAYS vastly different from mine.

We’re going to review my Dexcom reports (dreaded moment #2) and see what, if any, chances need to be made.

We will be making changes.  I have to make some changes.

I know he’s going to ask me about my weight gain (dreaded moment #3).  I have some good reasons for this: my sister’s death, fertility drugs, blah, blah, blah.  They’re all just bullshit excuses.  I’ve gained weight because I’ve been eating like crap and not exercising.  PERIOD.  

But, I feel so deep in this hole that I have no idea how to get out.  I was doing so well on Symlin, but it’s not safe during pregnancy, so I had to stop.  And it pisses me off because so many of the things I’m doing (or not doing) because they’re unsafe for pregnancy are probably for nothing. 

I have a point; I promise.

Starting today and for the foreseeable future, I’m going to be eating only low-carb foods.  No more pasta; no more fries.  I will not eat any of that stuff because it is my own personal kryptonite.  I’m going to stick to protein, fat, and veggies (of the uncooked variety – I loathe cooked vegetables)

I’m also going to ask Dr. S. about Metformin.  This is a big fear because Met is one of the meds I was given during my misdiagnosis fiasco. It did nothing for me except make me sick.  But, I’ve read that the XR version is much easier to tolerate, and at this point, I’m willing to try.  It’s also a pregnancy category B drug, which means that it’s probably safe (nothing is category A).

One of my biggest problems right now is my insulin intake.  I’ve definitely got some resistance happening, and it’s leading to much higher doses of insulin to cover basal and bolus needs, which is leading to more fat storage, which is leading to greater insulin needs, etc. It’s an endless cycle.

There’s got to be an easier way!

I have made no secret of my struggle with diabulimia. And there is this big voice in my head that’s telling me to just stop taking so much insulin.  Just take a small shot here and there to avoid DKA.  My weight would drop so quickly, and I’d feel great.  That’s the thing that makes it so appealing.  When I was restricting insulin, I felt fantastic.  Most of the time, I had no idea how high I really was, but it didn’t matter – I had tons of energy.  Now, I struggle just to get out of bed in the morning.

But, I won’t do it.  I’ve spent the past three years trying to maintain a decent A1c so that I can have a baby.  I’m not going to throw that all away now for a quick fix to my weight issues.  I want to.  But I won’t.

I have a plan, and I’m going to do my best to stick with it:

1. Eat low-carb
2. Take Metformin
3. Exercise

If anyone has any suggestions or words of wisdom, please, please share!

Let me back up.  Yesterday, I had my usual quarterly appointment with Dr. S.  I was feeling fairly pessimistic about the results of my labs, and I was afraid he’d not be on board with the whole fertility thing (more on that later).

So, when the first words out of his mouth were “your labs look great,” I was relieved.  And, frankly, shocked.  After my last A1c disaster, I was expecting a decline, but certainly not as much as it really was. 

“Your A1c is 6.7%.” 

<side note> On the same day that I had my A1c done, I used one of those Bayer At-Home A1c kits.  The result from the Bayer test was 7.2%, which tells me that these at-home tests are not as accurate as we need them to be. </side note>

“Your kidney function is great, and your cholesterol is only slightly elevated.”  This is significant because I’ve been off of Lipitor for a few months.  “Overall, everything looks great.” 

Next, we reviewed my Dexcom reports (I always bring my netbook with me so that he can choose which reports he wants to see).  Other than some possible basal tweaking at bedtime, we agreed that my insulin usage is pretty good.  But, then we talked about my propensity for SWAGing.  He reiterated that I need to count carbs more accurately, which I’ve known for, well, ever.  “It’s just a discipline thing,” I told him.  Just like logging, measuring food and counting carbs accurately is a chore, but one that must be done.

He asked me if I thought I should see the CDE to get some carb counting lessons, and while I think I might need it, I told him that I wanted to wait until the next appointment to see if I’ve improved on my own.  He agreed.

Next, we started talking about the fertility craziness.  I told him that I was having an IUI done this cycle, and that, if all goes well, I’ll be pregnant the next time he sees me.  I told him about the disastrous appointment with the high-risk OB.  He actually offered to write a letter explaining that achieving a BG of 60-80 is a recipe for disaster for a T1.  He said that it often comes down to an education thing with other doctors – they assume that T1s are the same as T2s and gestational patients.  Obviously, they’re not. 

Then, he started talking about things like “what to do with my pump during delivery” and “my insulin needs increasing throughout the pregnancy.”  I joked that I’d wear my Omnipod AND Minimed pumps at the same time to handle the insulin needs.  He laughed, but started to think it was actually a novel idea.  It was so great that he not only gave me the green light to move forward with the IUI (not that he would have stopped me), but also that he was talking as if becoming pregnant was a foregone conclusion.  It suddenly felt very real.

Basically, he bottom-lined it for me: “You know what you need to do, Shannon.  You’ve got all the tools you need and the education to use them properly.”  He’s right, of course.  I do know what I need to do, and now that I’ve got a solid pre-conception A1c, I’m going to do it.  I feel oddly energized and optimistic about my D-life. 

So, he wants to see me in two months; sooner if the IUI works.  Although he’s booked solid through late August, he’s promised to squeeze me in if I get pregnant.  As I wrote above, I love my endo!

Symlin works by replacing the natural Amylin that, in non-Type 1 diabetics, is secreted by the beta cells of the pancreas.  It works by delaying stomach emptying, which helps you digest slower.  It’s also that little voice in your head that tells you when you’re full.  Since I am beta cell challenged, my body doesn’t make Amylin, which is why I often feel hungry even after a satisfying meal (= weight gain).  It’s also why my BG can easily spike to 300+ after I eat, which = more insulin, which = weight gain, which = insulin resistance, which = weight gain, which = well . . . you get the point. 

As it happened, George (a.k.a. Ninjabetic) also decided to start Symlin again.  He and I had very similar beginnings with Symlin, and we were both reluctant to try it again.  So, it’s really nice to be doing this with someone else who knows what it’s like. 

As you know, I started on Tuesday night at just 15mcg (the absolute minimum for a Type 1).  Yesterday morning, I skipped breakfast, so no Symlin.  Truthfully, I was feeling a little nauseated, and I wasn’t sure if it was from the Symlin or just general morning crappiness.  I was super-busy at work, which meant that lunch was upon me pretty quickly.  Knowing that I had a meeting at 1pm, and feeling the desperate need to get a home pregnancy test because my period is still MIA, I quickly ran to the drugstore for the test and Chick-fil-A for a salad. 

Back at the office, I peed on the stick.  Negative, which was no big surprise, considering . . .  Even still, I was disappointed and relieved at the same time.  After all, I’m taking meds that are not pregnancy safe (Lisinopril and now Symlin).  Still, it sucks to see that one lonely line on a pregnancy test time after time. 

Anyway, back at my desk, I dialed up 15mcg of Symlin and ate my lunch.  I programmed a 60-minute square wave bolus on the pod and watched Dex like a hawk.  Sadly, my BG began to spike within 30 minutes, and it went high (like mid-200s high).  Then the nausea hit.  I felt like complete shit.  It was weird because it was more severe than the night before.  As George, Scott, and I were discussing last night on Twitter, it feels like you’ve got food stuck at the very bottom of your throat.  I don’t know how else to explain it.  Whatever.  I wasn’t going to let this nausea screw with the potential benefits of using Symlin.

So, last night before dinner, I decided to up the ante.  I dialed up 30mcg on the pen and bravely took the shot (it stung, too!).  I ate my dinner (about ½ of my typical portion size) and waited for the nausea.

It didn’t come.  As soon as I finished eating, I got up and started cleaning.  Keeping busy really seemed to help.  My BG remained steady and under 150 mg/dl before dropping slightly.  I tested before going to bed and was 145 mg/dl.  Hearing Dr. S.’s voice in my head (he wants me under 100 mg/dl in the morning), I did a small correction bolus and went to sleep.

Sometime around 11pm, I heard a low BG alarm.  I grabbed Dex from my nightstand and saw that I had dipped just below 70 mg/dl.  However, a finger stick showed me at 75 mg/dl, so I didn’t treat and went back to sleep.

At 1:30am, Brian’s stupid on-call phone for work rang.  I woke up instantly.  A quick peek at Dex showed me still hovering in the low 60s.  A finger stick confirmed, so I decided to drink a very small glass of milk.  This was definitely the right thing to do.  I woke up this morning at 99 mg/dl (hey, it’s under 100, right?), and Dex showed a nice flat line all night.  I felt pretty good, although tired because of the phone call. 

I got to work, dialed a 30mcg dose of Symlin for my modest breakfast (45g of carbs).  I programmed a 30-minute square wave bolus this time to prevent any spikes. 

That was an hour and a half ago.  My current BG is 157 mg/dl, but it looks like I’m rising fast.  I’m going to keep trying different ways to get the most out of Symlin.  I am anxious to get up to the 60mcg dose, which has more weight-loss benefits.  But, as it is, I’m eating much less than I was, so that’s good.  I’ve read that some Type 1s are able to tolerate the 120mcg dose, which offers the highest weight loss benefits.  I’m going to shoot for that, but I’m prepared to stick with 60mcg if necessary.

Overall, this experience with Symlin has been significantly more positive than my last attempt.  It’s something I’m determined to stick with, so I’m not going to let a little nausea derail me.  I’m committed to losing this weight, dammit!

I admit that I rebelled a bit.  I also got lazy.  I was just so tired of the tight control and limitations.  I went a little nuts.  I have the weight gain and lousy A1c to show for it. 

All other tests were good.  BP was “excellent” according to Dr. S.  He also said that I’d *lost* two pounds since my last appointment.  This just doesn’t seem right, but I wasn’t about to argue.  He gave me a list of group meetings and events (read: support groups) for Type 1s and encourage me to attend.  I don’t know if I will – I admit that it would be nice to meet some other Type 1s in person, though. 

As I mentioned yesterday, I wanted to talk to Dr. S. about Symlin.  After looking at my A1c, Dex graphs, and logbook, his initial feeling was to further increase my basals.  Since I had decided that I was not going to let that happen, I needed to find an alternative.  See, *I* think my basals are too high as it is.  The highs I’m experiencing aren’t the result of too-low basal settings; it’s because I’ve been eating like shit for months and, more often than not, SWAG bolusing.  So, I’m high because I didn’t count carbs correctly.  Sure, I correct, but once I’m high, it’s so hard to get back down. 

Which, once again, led me to the Symlin talk.  I’d tried it once before and gave up after a few days.  I was told that it is not indicated for pregnant women, and since we were actively trying at that point (and blissfully unaware of our fertility issues), I decided that it was best to stop.  To be honest, I was not heartbroken to lose the awful nausea that accompanied it.  But, the thing is, I never really gave it a chance. 

In preparation for my appointment, I did a bunch of research.  I learned that the nausea goes away pretty quickly and that the key is to stick with it.  I learned that some people have lost huge amounts of weight thanks to it.  I learned that most decrease their boluses by at least half.  All of these facts solidified my resolve to give it another shot.

So, just before dinner last night, I dialed up the minimum 15mcg and gave myself the shot.  I ate my meal slowly (I did notice that I got fuller faster) and waited.  I carefully calculated the carbs in what I ate (49 grams total), and programmed a 60-minute extended bolus.  And I waited. 

Sure, I felt a little nauseated, but nothing too extreme (I definitely didn’t feel like I was going to puke or anything).  I wasn’t hungry either, which was nice.  I often feel hungry even after eating a decent meal.  Dex showed almost no movement in my BG for over an hour.  Since I was super exhausted yesterday, I went to bed early. 

At 11:53pm, Dex beeped.  The dreaded low alarm.  I looked at the screen: 68 mg/dl.  Not too bad, but I did a finger stick to confirm:  66 mg/dl.  Since Dex indicated a downward trend, I decided to drink a juice box.  Then, I did something really stupid.  I programmed a temp basal of 50%.  I was spooked; I admit it.  I didn’t want to have a horrible low that would be difficult to treat because of the Symlin (I’d read that this happens).  I wanted to play it safe. 

Just as any sane person would expect, a few hours later, my BG started to climb.  Nothing drastic – I was sitting at 150ish.  Then my usual Dawn Phenomenon kicked in (I have a basal rate that is more than two times greater during the hours of 5am-8am).  A temp basal of 50% was not going to make a dent in that train wreck.  After my shower, I was sitting at 180 mg/dl and climbing. 

Since the pod was due for a change, I swapped it out and canceled that stupid temp basal.  Now, as I write this at 9:16am, I am at 189 mg/dl.  This is despite two decent correction boluses.  I know the crash is coming, and I’m ready for it.  I’m just pissed off at myself for giving in to the fear.  It’s the fear of lows that gives me a 7.5% A1c.  It’s unacceptable.

Ugh, diabetes, I hate you.

**UPDATE**

As I wrote this post, I got a call from the fertility doc’s office.  They wanted to tell me that they’d received a copy of my A1c (which the nurse described as “elevated”), and that for conception, they want it to be under 6%.  As if I didn’t already feel shitty enough.

Today, I see Dr. S.  I’m not looking forward to getting my A1c because I know it’s going to be higher than last time.  I just hope it’s under 7% so that the baby progress can continue.  I’m strongly considering going back on Symlin.  I took it once before and had awful nausea, but I didn’t really give it a chance.  I stopped after a few days – mostly because we decided to start “actively trying to conceive,” which meant no Symlin.  Frankly, I wasn’t sorry to see it go. 

But now, I’m really trying to lose weight.  It’s my primary goal and I feel like I’m fighting a losing battle.  I’ve got HUGE genetic factors working against me.  On my father’s side, which is the side I take after, there is not a single person under 200lbs.  I’ve always had to fight my body’s natural inclination to be heavy, but now I need a little extra help. 

The other benefit of Symlin is that it will help to reduce those spikes I get after meals AND reduce my TDD.  So, if I can handle a couple of weeks of nausea, I think it would probably help me.  I’m not looking forward to a form of MDI again, but I’ll deal.

************************************************************************************

Next, I want to talk about Roddy Pippin.  We had some good news in our fight last week.  The Warden of the Jester III prison granted Roddy a few considerations:

1. He would be allowed to attend Sunday worship services – something he’s been denied since December.
2. He would have access to a telephone.
3. He would be allowed to change channels on the television in the infirmary (this one isn’t all that big of a deal since Roddy isn’t a TV watcher).

Unfortunately, these considerations were short-lived.  The prison P.A. said No more – “No more worship service for Pippin!  And no recreation, no law library, etc.”  The P.A. also said “Pippin is NOT allowed to leave the prison solitary confinement for the next 3 years and 8 months!”  This is not a disciplinary case issue.  So, we know that the prison P.A. is in cahoots with the D.A., but the question I have is this:  Does the P.A. have more power than the Warden?  Evidently, she does. 

There was a recent AP article done on Roddy.  While I initially liked the tone of the article, I don’t like what various publications did with it.  One, in particular, was the Dallas Morning News.  They created a headline that was not at all relevant to the article.  They did this to incite anger in their readers, and they succeeded.  I spent some time trying to respond to the nasty comments that followed the article, but most people were content believing a bunch of lies and exaggerations.  I’ve learned that it’s a losing battle with the press.  Unless/until the story breaks out of Texas journalism, it will never be told truthfully.

************************************************************************************

Last, I want to talk about the unbelievable liar my body is making me out to be.  I sat in Dr. T.’s office last week (ironically the day my period was due) and told her how “regular” I am.  Hell, I am more reliable than a calendar.  Until this month.  I am now officially one week late.  I’m not-so-patiently waiting to have all of these tests done, which are dependent on my period.  But my period is MIA.  It’s so frustrating.

The scene

The players:  Me, Phlebotomist (herein referred to as “Moron”), and a Supervisor

The Time:  9:14am

As part of my recent fertility consultation, I was instructed to have a blood test to determine if I carried the gene for Cystic Fibrosis.  Since I am due for my regular A1c draw, I figured I’d kill two birds with one stone (I hate that expression – who actually kills a bird with a stone?).

I walked into the lab, signed in, and sat down.  I always dread having blood drawn because I know that the inevitable battle will begin. 

<digression> Since my very first blood draw (that I can remember), I’d pass out.  Faint.  Hit-the-deck.  A few years ago, I had a very nice phlebotomist tell me that I have extremely small veins and that when having my blood drawn, I should always request a butterfly.  From that moment on, I never passed out again (as long as a butterfly is used).  I know some of you will think that this is a psychological problem, but I can prove that it’s not. 

Once, I requested a butterfly, and the phlebotomist agreed to use it.  Since I never watch the actual blood draw, I assumed that the prick I felt was the agreed-upon butterfly.  After a few seconds, I started to get that feeling.  The one where you see little black dots, begin sweating, and feeling very, very tired.  The next thing I knew, I was waking up on the floor.  She helped me back into the chair.  I apologized for fainting and said how strange it was because I NEVER faint when a butterfly is used.  She shrugged and turned away.

That’s when I saw it.  She didn’t use a butterfly.  When I asked her about it, she claimed to have “forgotten” that I requested one.  Bitch. </digression>

Anyway, back to today.

After 15 minutes, my name was finally called.  I handed moron the lab slips and my insurance card.  She instructed me to have a seat in Room 2 across the hall.  I did.  She came into the room and began entering all of the required information into her computer.  I waited.  Finally, she spoke:

Moron:  Oh, I see it was your birthday.  Happy belated birthday.

Me:  Thanks! (thinking this draw is going to be cake!  She’s actually nice)

Me:  As you can see, I’ve got two different lab slips from two different doctors.  Is it possible to send the results of my A1c to both doctors?

Moron:  (grabbing a clipboard with a release form) Sure.  You just have to sign this release, and we can send it to anyone.

Me:  Great, thanks.  I also have one more request.  When you draw my blood, can you please use a butterfly?  Otherwise, I’ll pass out.

Moron:  (looking at me like *I’m* a moron) I’ll need to look at your arm first because we don’t use butterflies on everyone.  What’s the big deal, anyway?  A needle is a needle.

Me:  Look, I’m not afraid of needles.  I’m a type 1 diabetic, so I’m pretty used to needles.  My issue is that my veins are really small, and with the bigger needle, the blood comes out too fast and causes my blood pressure to drop until I pass out.  Every time I’ve had my blood drawn here, they’ve used a butterfly.

Moron:  Well, I’ll have to look at your arms first. (indicating that she wasn’t going to use a butterfly unless hell froze over first)

Me: (really pissed off) Fine, but don’t be surprised when I pass out.

Moron spent the next 35 minutes trying to get the paperwork straightened out.  I repeated my original instructions that Dr. T. also gets a copy of my A1c.  Moron set up the paperwork to give Dr. S. the results of the CF screen.  Hence, the moniker, moron.

Finally, she wraps the rubber band around my arm and tells me to make a fist.  She pokes my veins to find her target.  Knowing what’s coming, I look away.  I felt the needle prick, and, at first, I felt ok.  I thought that maybe she’d listened to me and used a butterfly.  But, I started to feel that all-too-familiar sensation.  The last thing I heard was her clicking off the first vial and grabbing another. 

I came to on the floor.  Moron had called for backup.  They helped me back into the chair, gave me some juice, and waited.  After 10 minutes, Moron came back into the room with Supervisor. 

Supervisor: (taking one look at my arm) Her veins are tiny.  You should have used a butterfly on her.

Me:  I asked for a butterfly, but she refused.

Supervisor:  I’ll take it from here.  Unfortunately, she wasn’t able to get both vials before you passed out, so I’m going to have to prick you again.

Me:  You can prick me all day as long as you use a butterfly.  I wasn’t being a baby – this is just how it is. 

Supervisor: (after the blood draw was done) You’re all set.  You can wait here for a few minutes if you need to. 

Me:  (having already spent over an hour in the lab) I’m fine.  I really need to get to work.  I would appreciate it if you’d have a talk with moron about listening to patients.  This entire scenario could have been avoided if she’d just listened to me.

Supervisor:  I intend to.  We don’t like it when you faint any more than you do.

Me:  Thanks.

I figure it will start with the not-so-good news that my A1c has gone up since last time.  I know this is going to happen.  Then, we’ll take a look at my Dexcom reports, which will clearly show how horribly I’m slacking.  Dr. S. will ask me what’s going on.  He won’t be critical, he’ll just want to know if there’s some reason for my shitty numbers and weight gain.  He’ll talk about basals and boluses, but that’s not the problem.  The problem is that I’ve been in such a funk that I really haven’t cared as much about diabetes.  My numbers aren’t crazy; they’re just not as good as they have been.

This is when I’ll probably lose it.  I’ll have to tell him that I really don’t feel the need or desire to work so hard since there’s zero chance of me getting pregnant accidentally.  I’ll say sure, put me on whatever meds you want (Symlin, Lisinopril, etc.) because it really doesn’t matter which pregnancy category they are.  And, I’ll cry.  I know I will.  I’ll probably make him very uncomfortable – he’s an endocrinologist not a psychiatrist, after all.  He’s also got two beautiful children.  So, I’ll sit there blubbering about the unfair hand Brian and I have been dealt. 

He’ll probably attempt to get the appointment back on track by moving on to the physical exam.  I’ll sit there like a good patient, breathing in and out on cue.  He’ll declare me “healthy,” and that will be that.  We’ll go back to his office where he’ll write prescriptions, talk about what I can do to improve, and schedule our next appointment. 

So, life goes on.  On the outside, nothing has changed.  I continue to breathe in and out on cue.

I liked Humalog.  I was able to keep my TDD low, and I seemed to respond well to its peaks and duration.  At some point, I don’t even know when, I was switched over to Novolog.  It might have been for insurance purposes or maybe it was when I moved to insulin pump therapy.  I honestly can’t remember.

I have a point (I’m just getting there slowly, like everything else I’m doing today).  Since using Novolog, my TDD has slowly been creeping up.  Is it insulin resistance because I’m a lazy putz who doesn’t want to exercise?  Possibly.  But, it could also be that Novolog’s peak time and duration have so totally screwed up my dosing that I’m taking more and more correction boluses for foods that shouldn’t require a correction.  I’ve had to tweak my basals more, too.

So, not liking the fact that I’m taking so much more insulin than I used to, I did some research.  I know, I know, you’re all shocked and amazed.  What I learned is that Novolog has a reputation for being the slowest acting of the three rapid insulins (Novolog, Humalog, and Apidra).  What most people say is that Apidra is the fastest.  Some people have even cut down their TDD with Apidra. 

While I’m not expecting miracles, I do think it’s time to make a change.  So, first thing this morning, I dialed up Dr. S’s office to see about making the switch.  I know he must think I’m a complete pain in the ass at this point (first the switch from MM CGM to Dexcom, then from MM 722 to Omnipod, and now from Novolog to Apidra), but my goal is to achieve better numbers, so that should be commended, right.  I’m still a pain in the ass, though.  I know it, and I’m ok with it.

So, I’ve tried Humalog (and liked it), I’m using Novolog (not happily), and I now I’m switching to Apidra. 

I’m also starting an exercise schedule and eating more healthier (yes, I know that’s not grammatically correct, but I like it, so deal).