Since the initial learning curve, I have been the foremost expert on my own diabetes. I’m very comfortable looking at the data from my diabetes devices, noticing patterns (with or without a download!), making changes to my basal rates, insulin:carb ratios, and correction factors, then doing the necessary paying-attention to see how those changes are working to solve the issue.
My last endo practice has been in upheaval for several years and closed at the end of 2014. The last CDE I worked with there left the practice at least 5 years ago and so it’s been about that long since I worked with an educator. My last endo would review downloads with me and ask me if I wanted to change anything, but she was pretty laid back and happy to let me steer. In fact, her laid-back approach certainly enabled my increasing patterns of hypoglycemia. She would say, we don’t really know – for some people a blood sugar of 60 might be perfectly normal. This both sounded strange to me (never having heard any endocrinologist, CDE, or PWD say that hypoglycemia was still up for debate), and fit my inclinations to run low rather than run high (as if those are the only two choices!) so I didn’t challenge it. She just wasn’t that interested… I was managing more capably than a lot of her other patients so I must be fine.
Cut to the present. New endo practice and I saw the endocrinologist last October. I liked her approach, her attention to detail, and the time she took to ask me questions and actually listen to my answers. We looked over my downloads and made a couple of small changes. She clearly was picking up on my hesitation to do anything that would cause highs – or even make me fear that we would be causing highs – and when she suggested a change, asked me if that was something I could feel good about or if we should negotiate it.
3 months later (this week), I went to see the APRN. [I thought I was going to see a CDE, but I had misunderstood] I liked her too. Also found her to be an attentive and perceptive listener. We spent much more time looking at downloaded data and really talking about how the standard calculations compared to my actual settings, where the gap between them seemed to be lining up with patterns of low bgs, and where certain aspects of my settings (time spent in one basal rate setting for example) might actually be working against what I was trying to achieve. We ended up changing all of my insulin to carb ratios and simplifying my basal rate profile (from 8 time periods to 4 or 5). That’s a lot of changes based on a provider’s recommendations for me. It has been a long time since I trusted what a provider was suggesting as far as settings go. She also came up with a genius suggestion for the alert settings on my CGM that have been causing real problems overnight. A totally simple, sensible suggestion and one I never thought of even though what I have been doing is no less effort/work with poor results.
Long story, short: This appointment was a great reminder for me that even though I know my own diabetes/body better than anyone, that doesn’t mean that a fresh set of eyes/perspective, along with training, education, experience, can’t help me find solutions that I haven’t found on my own.
The past two days have already had fewer low bgs. And, I just changed 2 of my i:c ratios tonight because I can see that the changes we made weren’t quite enough. If the APRN had suggested the bigger change at the appointment I know I would have balked. But starting out with a small change helped me to see some success and helped me trust that we are heading in the right direction.
It’s nice to be able to say “we” in relation to diabetes management again.