The Principal's Office

Every three months I see my endocrinologist.  Usually it's just a recap of what's been going on, a review of my labs, discussion of medication needs, and quick exam (feet, glands, etc.).  Sometimes it feels more like a trip to the principal's office - I know I've done something wrong, but I don't know what the punishment will be.  

Last Tuesday I drove to my appointment with a feeling of excited anticipation.  Based on my CGMS data, I should have an A1c of ~5.8.  This is amazing to me since I've been trying to get below 6.0 for over a year (in preparation for pregnancy).  I walked into my doctor's office with an almost smug expression, waiting for him to deliver the good news.

"Well, Shannon, your A1c is quite good," Dr. S. proudly says.

"Sweet!  What is it?" 

"You're right at 6.8%."

"What the hell?"

After explaining that I was expected a much lower result, we review my CGMS data together (via Minimed's CareLink website).  He agrees that my average BG is much lower than the A1c indicates.  He then explained that he was becoming less confident in the accuracy of A1c readings.  Feeling quite a bit better, we move on to the rest of labs.

Dr. S.:  "Your cholesterol sucks."

Me:  "What is it?"

Dr. S.:  "It's 215 total, but your LDL is 140.  As a diabetic, your LDL should be under 100."

He then starts going on about statistics and how the LDL guidelines for diabetics may go even lower.  Being a diabetic is (apparently) the same as being someone who has had a heart attack. Everything must be lower than what a "normal" person has.  We discuss medications, fax off a quick Rx to my pharmacy, and talk about other things I can do to improve my overall health.

He indicates that as we get older, we have to pay more attention to these things.  He wishes me a belated happy birthday while I groan about turning 35.  He jokes that reaching that age as a doctor is a much happier experience - he's taken more seriously.  He tells me that he just turned 35 last week.  WTF? I'm older than my doctor? How did that happen?  

We move on to the rest of my labs.  Fortunately, everything else is great.  So far, I've had no complications of being a diabetic.  Hopefully, that will continue for another 10 years.

Finally, we cap off our visit with a discussion of my basal rates.  He doesn't want to change anything.  He suggests I review my patterns and makes changes myself.  For whatever reason, I'm still in the mindset of waiting for my doctor to change my basals.  Must come from having a complete control freak of an endo for my first 7 years as a diabetic.  Any unauthorized changes in basals were forbidden under penalty of prescription refill denials.  Perhaps this is why I feel like the endo = principal's office.

I left feeling like a bad pupil once more.  I really want a good report card next time.