First Pump Clinic, HBA1C Wins and Questionable Doctors

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Thursday was a big day for me because it was my first diabetic clinic as a pump user and therefore at a pump clinic. I didn’t know which doctors would be there or if I would know any of them. I knew in advance that because the number of pump users is smaller the clinic doesn’t need all the docs. They appear after lunch to handle the teenage MDI users on a Thursday. It turned out I was right and I didn’t know either doctor. Yes, either as in two. It was the smallest clinic I have ever been part of and I’m pretty sure they only saw around 10 patients overall. It was such a more relaxed atmosphere than I am used to. Usually there are 30 or so patients going through a morning or afternoon clinic maybe? I am guessing but there are many many more than there were on Thursday that is for sure!

The nurses seem far less harassed which was nice and for once there was no awkward chitchat. I don’t like being spoken to while you vampire it up in my arm ok? I get that for some it relaxes them but I just don’t like it and I don’t know why they didn’t feel like chatting this time but I liked it.  I know they need to be fast so I’m pretty good and stripping from the moment I leave my seat in the waiting room and having my arm out to be stabbed by the time by butt is in their chair. Another bonus was the nurse asked if I wanted a plaster and I was able to say I am allergic and get cotton wool and tape instead without  having to do the NUUU DUNT thing I usually do when they come at me with plasters.  I was then sent on my way with questionnaires. I had the usual anxiety and depression sheet which I filled out and then another about my general insulin doses and stuff. I had never seen one of these before but I guess it is a generic clinic thing in Scotland now because it talked about doses at lunch and dinner, ratios and basal rates but the basal had 2 options. Lol…I have 6 different basal rates during the course of 24 hours. It also asked about tablets being taken so it seemed a very general diabetic thing but proved interesting because pumps appeared from all sorts of places while people checked all their basal rates. That was fun. What was infuriating though was when I was summoned to the doctor she didn’t look at the sheet, but asked me all those questions personally to fill out her own sheets.

My weight remained about the same, I didn’t have to do the walk of shame to the bathroom with a bottle to pee in as I remembered a sample, and I got sent out of the second room with booklets. One is about hypos.  I will never stop smiling at getting a booklet on hypos. They give me one every time I go. I have been diabetic nearly 16 years. I think I know what a hypo is by now. I try to refuse because hey, those booklets cost money to print but they insist they MUST be handed out.  The other was about what is expected at a clinic and what is tested with your blood and urine samples and why. More importantly there is a chart of what these numbers SHOULD be so when I get my biochemistry letter in a few weeks I know whether the results are good, bad or indifferent.  I have been waiting years for such a thing. I think if some vampire is going to do a runner with two tubes of my blood and a tube of my widdle the least they can do is explain why.

There was no feet checking person. There hardly ever is to be honest. Part of me is angry because there should be but in all honesty another part of me is relieved. I always fear that I will jerk my feet away because they are so ticklish and screw up my tendinitis in my foot.

Anyway, the doctor. She very much struck me as the sort that had a textbook and I had to fit into it. I was last in and I felt like she was eager to get finished up you know? I didn’t feel comfortable. She asked for my meter, didn’t look at my sheets with all my basals and insulin and ya know, information but purely judged what my meter threw up on the screen and looked puzzled. I immediately said I eat a lot of meals close together so often I know my insulin is still active as demonstrated on the diasend (info from my pump including what my bloods were and what insulin I had and when and what carbohydrates) uploads I had sent the hospital and the worksheets. These are all the things I am asked to do and don’t WANT to do so people like HER can USE IT and UNDERSTAND IT and not make mistakes like look at my blood meter results and think ‘hey that doesn’t fit her HBA1C’. Seriously unimpressed.

She accepted my explanation but I feel I should not have had to make it. A doctor should realise that diabetes is never as simple as what my blood kit throws up on her screen. I hate the sheets they make me fill in. I can’t follow them. I find it much easier to use my uploads on the computer to see patterns and change things but the ‘doctors’ want the sheets. Apparently not.

The reason my results puzzled her is my HBA1C is 53/7.0% or perfect and exactly what my target is. I am sure eventually they will ask it to drop a little but for now it was my target. My blood results are stable, predictable, freakily like clockwork actually. Ideally, there would be less of a peak after my meals. I see a lot of 10s two hours post meal and my nurse is yet to crack that rise but they always return to target. My dawn phenomenon is gone. (well no, it is controlled) I now feel like death with a blood of 14.5 when before my pump that was actually a decent reading. I nearly started crying in the office. This HBA1C feels real. It isn’t fake. It isn’t crashing lows and soaring highs averaging out a reading that keeps me from life but stops me losing my feet. It is real, balanced, and healthy. If the doctor had bothered to look at the sheets I was given at the clinic to fill in, the diary I was asked by them to keep or the uploads send in for them I feel she would have realised that a lot sooner. Plus, frankly, if they had all been 11s and my HBA1C was higher I would have been happy at that too because those numbers are STABLE. Any diabetic who has swung a lot knows how exhausting it is and how it impacts so much of our lives. Stable was all I wanted and it turns out I have kicked more ass than I thought. Brilliant.

She did note one pattern, and that is I am still fiddling with my post lunch basal rate but I explained it had taken me a while to notice it after changing my basals in general because of my mental health slump. She took that as my results being impacted and so refused to change anything and told me to see my nurse in a few weeks. Now I had said because I had, had as in past tense as in I would like to fix it now but she wasn’t having it. So what was the point of going? She seemed more interesting in putting details into the new system than listening to anything I had to say or asking any questions. In fact the thing she took most time over was making sure she had a note of what birth control I am taking for my endometriosis. Depo injections themselves are not an option to tick but injected birth control is but that took a few minutes to work out.

The Doctor totalled up the anxiety and depression scores while on hold on the phone trying to see if I could just go over to medical photography and get my eyes checked. She then didn’t mention them or bring them up at all despite my anxiety flagging as extreme (I added up the scores before I went in. What?)  Whether she knows that I am diagnosed or not (she did), she should still ask about that! Every doctor asks about that! They offer help if they can. They ask if my diabetes is a factor. They do, ya know, their job. But nope, she just added up the number and jotted it down.  She did a lot of jotting things down. I felt like a box being ticked. I didn’t feel engaged with at all. That is not how a diabetic should feel upon leaving their clinic appointment.

I would say I would give her a second chance but frankly with my health I don’t do that. I am ruthless because diabetes is ruthless and I cannot afford to have an endocrinologist that is not with me 150%. I will be asking for a note to go on my notes each time asking for a doctor that is not her. If that means sitting an extra hour waiting then I will read a book. I’d rather wait and get help than walk out early confused and a little hurt.

So in conclusion, having the chance to be in a smaller clinic feels a lot more relaxed and I enjoyed it. I am ridiculously proud of my work with my diabetes and the progress I have slaved over. I will not be seeing that doctor again. I do now feel my diabetes is stable and I can continue working with my anxiety, depression and fatigue in order to return to university in the New Year. I feel less panic about it all and more hope. All the midnight, two am, four am, six am, eight am and repeat tests were worth it . Maybe being stuck to a machine for the rest of my life doesn’t have to be so bad after all.

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