Thursday, December 10, 2009

Thanks for calling me fat!

Of all my responsibilities as a diabetic, my favorite is to visit my imbecile endocrinologist.

First of all, I have to get a babysitter. I hate asking for help.

Then I have to drive. On the freeway. I hate driving and I have mini panic attacks on the freeway.

I park my behemoth of a van centimeters away from the large vehicles on either side of me. Are we just bad at parking? No, the parking lot is just tiny with tiny spots I think even my husband would have trouble parking his Mini Cooper in. And his car is so cute and little it fits in your pocket!

I walk into the office that is the size of my living room. I’m talking the whole thing, patient rooms included, is roughly the size of my living room. There is a sign on the tall counter stating that HEPA laws require people to have a seat and wait if someone is being helped at the desk. Even if people whisper I know every word they are saying. It’s a miniature waiting room with acoustical hardwood floors. Who are we kidding with the sign?

Nobody is at the counter except me. I check in and sit in one of eight chairs behind the coffee table filled with an assortment of outdated tabloid and medical magazines. Then I wait. And wait. When I’m done waiting, I wait some more. I wait an entire 45 minutes before the nurse calls me back.

She has me drop off my things in a room. Then she makes me stand on the scale so we both have concrete evidence that I am 30 lbs overweight. She never says anything about it. She’s skinny as can be but after all, she is a woman and knows what a sensitive subject weight and BMI’s are. I like the nurse although she talks faster than I do when I’m hyper and my blood sugar is dropping low. It’s hard to keep up with her small talk sometimes.

She takes my pump to download all the data for the doctor. Not that he looks at much more than the data from the continuous glucose monitor sensor and how often I change my infusion set sites. I hate my doctor but I’ll get to that in a minute. I love that every time the nurse gives my pump back she also hands me an alcohol prep to clean the quick release before I reconnect it to the rest of the tubing. I know she is being conscientious of germs and whatever. She is a nurse. It’s her job. But what I see her do with my pump is put it on a shelf next to the CPU and shut the door while she pulls up the Pro Link program. Unless she’s breathing into the quick release, I can’t imagine what germs could have touched it. I can’t really get the alcohol prep in there anyway.

Then I sit in the room rereading every poster I memorized early this year. I wait for another 15 to 20 minutes. That’s right. I have been waiting for over an hour beyond my scheduled appointment time. I’m so glad they can read my mind and know how much I love wasting time, not to mention my friend’s time while she takes care of my kids for me. Remind me to send the office a holiday card thanking them for the exorbitant amount of my time they have wasted this year!

Finally the Wizard of Oz himself opens the door and graces the room with his presence. My mind starts racing. What do I ask for today? A heart? Courage? A brain? I shouldn’t ask for a brain. Since he is in desperate need of one I think it’s safe to assume brains are in short supply.

His face is impossible to read. His tone of voice stays even. He asks how I am doing. I never know if he’s going through the motions of a traditional greeting or if he thinks my response will give him some clue as to what’s going on. I have answered both ways. The one time I told him I was doing crappy he spent the next 8 minutes (since I only get to see him in the flesh for 10 minutes, if even that. Some days it’s only five minutes) telling me that I’m being too hard on myself. It’s too early to tell if I don’t like the CGM (continuous glucose monitor). His whole attitude was that of a kind handyman. We can fix this. Don’t cry!

Today I wasn’t even nervous to see him. I knew what to expect. Increases in my basal rates at the exact times of day I tell him I experience a lot of lows. Why infuse personality in my voice? I know my fate. So I answered as dead pan as he greeted me.

Then the unanswerable questions. Why does it look worse this time? I don’t know, you tell me. We increased all your basal rates last time! I know. This is worse. I know. It’s too early for an A1C . . . you know it will be higher right? I know. Well, your vitamin D levels came back up. (There is a whole pharmacy story about that but I won’t get into it right now.) Good.

At one point I told him some days are better than others and cited an example. On December 3rd my blood sugar was over 200 for 12+ hours before I could get it to come and stay down. I sobbed myself to sleep that night after Hubby gave me a priesthood blessing. Obviously I didn’t tell him that last part! Then I told him that since that day I am low all morning. I eat at least three times before lunch.

He looked at the graph in front of him. The graph that only shows the data from the CGM sensor. Data I think is not a true reflection of reality since I am constantly having to calibrate the sensor when it is so off. Data that never reflects my lows. The sensor can be trending down but I have classic low blood sugar signs, test, and see I’m 33 or something ridiculously low like that. I can’t calibrate when it’s already trending in the right direction. Plus, I can’t calibrate when there are arrows on the screen showing that my blood sugar is dropping quickly. All I can do is wait for it to catch up. He looked at the graph in front of him and said, “I’m not seeing that . . . let’s increase your basal rates starting at midnight.”

He increased everything from midnight to 2 pm. The very time of day that for the last week I have not even bolused for the food I eat. I wake up in the middle of the night with a reading in the 30’s or 40’s. I eat a bowl of cereal. I am low again around 7 am. I have another breakfast. I am low again at 9 or 10 am. I eat another 30 or 40 grams of carbs. I am low again at noon. Too low to even bolus for my lunch. So I have to guess how much I should take for lunch since the bolus wizard on my pump won’t help until my blood sugar comes up. I know if I don’t bolus for lunch I will be crazy high in the afternoon.

Thanks for listening doc! You’re fantastic! I don’t need to sleep. Who needs sleep? I should eat my weight in carbs all night and all morning. Works for me. I don’t have kids or anything else to need to take care of. Bring on the insulin! Hook me up.

He never said anything. He just stood there with his arms folded across his chest. Then he offered to let me try Symlin. I told him I never heard of it. He told me it’s an injectable drug that curbs appetite. It causes me to use less insulin. People lose weight on it and that’s why they like it. Would I like to try this drug that I would inject three times a day? I said, “No, do I really have to do this?” He said, “No, you don’t . . . we could just play around with your pump . . .”

Everything in his manner implied that I was a liar. That I clearly eat too much or I wouldn’t be fat and I lie about all the cheating I do with my diet. I haven’t sworn in so long I can’t even remember all the good words! But my mind is full of the most hateful names to call this imbecile.

Tears started streaming down my face as soon as I walked out into the cold, rainy parking lot. I sobbed the entire way home. Then sobbed some more to my friends when I picked up my kids. The one whose house it was, led all the kids outside to jump on the trampoline while I sobbed shaking sobs in the arms of my other friend, who is a nurse.

I will be finding a new endocrinologist. Maybe the third time will be the charm. Maybe I can find one who won’t say, “At the end of the day I go home and live my life. You are still diabetic. What you decide to do is up to you. It doesn’t affect me.” Yeah. He said that. This one I have now is a word I am not going to use since my mother in law reads my blog.

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