Wednesday, February 28, 2007

40,000 mile checkup

Yesterday I had the 40,000 mile physical with my Primary Care Physician. It's actually the first time I've had a real appointment with her in years, since most often I'm seeing either the endocrinologist for the diabetes care, an urgent care doctor for infection/accident, or one of the nurse practitioners for check-in and vaccines. No signs of complications so far, still need to see the results of the EKG (last one was 12 years ago as a baseline in the first year of diagnosis). The mammogram has been scheduled (first appointments mid-May?).

We had a nice chat about the CGMS, which she hadn't seen. It's five months today since I first started on it. I had thought the big deal would be it going bing at my if I go out of range, but I find what has been a bigger change is my sense of what is a high BG that needs to be addressed. I'm going from photo snapshots (fingersticks) every few hours to constant video (trend shows right on the pump) if that 's a good analogy. Yes, the number is a 120 mg/dl, is that rising, falling, been there for hours?

Imaging managing a checking account for more than just yourself. You can have a general sense of income and outflow, and you have a general sense of patterns of use by each account member (this one spends $150 every Tuesday, that one spends $10 each day, and there are irregular purchases and likewise on the income side) and keep a reasonable balance going, but making sure there isn't too much in there (that should be invested instead) nor too little (no checks bouncing!). Imaging doing this with a balance report once a week and no notice of what's been cashed or even checks outstanding other than what the users might report, versus on-line banking with hourly updates of transactions. Big difference.

Queer Joe had a post recently about their vacation trip with horrible delays on the tarmac and the plane running out of food. He mentioned an "alleged diabetic" raising a fuss about there being no food by the time they got to her. He thinks she was lying, and maybe someone was pulling the D-card to try to get better treatment. On the other hand, it reminds me how different I am from the normals and how compelled I feel to make sure all bases are covered in order to feel basic safety. I'm not sure how I would have handled that situation, even if I had tried my best to be prepared. I hate being reminded how fragile my nicely BG-controlled world really is.

I haven't been reading much which I now recognize is a symptom when I need to get my prescription changed (new glasses are on the way). Cheating Destiny by James Hirsch is a good book that got my attention. I'm still working my way through it, but he's got the credentials and skills to write this and he did it well. He's a writer already (many diabetes authors aren't), he's Type I, his brother is Type I and his son is Type I and his description of the diabetic culture and mindset (at least from a Type I perspective) pretty much matches my own experience. He addresses the (lack of) effective care for Type II's who are the majority of the population, gets into the history of treatment, philosophies of "control" and the treatment vs. cure controversy (I'm not sure we'll ever see cure because there is just so much money in treatment, but we are seeing much better treatment in recent years). There are parts that are too emotionally close to deal with at first reading, so I've skipped the description of helping someone do a lab blood draw on his three year old the night of the kid's diagnosis (but I've been there seeing the number too high for the home meter to read and just knowing what has come) and his mindset before his own car crash from a low (Mom did that one, good thing it was a low speed crash only into a tree). Good book if you're interested in the topic.

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