A diabetic goldfish and needless pictorial filler, yesterday
Yesterday, six months had rolled around again and it was back to the Royal Infirmary for my bi-annual check up (odd word ‘bi-annual’, does it mean twice a year or once every two years? One to ponder. Or not.)
The very familiar waiting room was the same as always and the goldfish in the remarkable well maintained fish tank were looking very spruce. I idly wondered if they were diabetic fish – the waiting room of a hospital diabetes clinic would after all be the best place for them – and, if so, how their daily injections would be administered. But then I abandoned that train of thought, mainly on the grounds that it was silly.
I also amused myself with the usual waiting room game of “Type One / Type Two?” Using inaccurate and crass diabetes stereotypes I use the formula “younger and slimmer = type one”, “older and fatter = type two”. I also played the variant of the same game “Newly diagnosed diabetic / Diagnosed for years diabetic” which usually uses the formula “looking stressed and bewildered = newly diagnosed”, “relaxed and reading a good book = diagnosed sometime in the dawn of time”. This easily filled a good 90 seconds and I spent the rest of my wait reading the BBC news on my phone.
Anyway, eventually off we went to have blood pressure taken, to be weighed (very heavy boots) and to have a finger-full of blood extracted – all accompanied by the usual chat about the weather and holidays.
We then reconvened and, as I’m part of the pump clinic, I now get to see not only a consultant, but also my DSN, in addition to the dietician and – this time – a student nurse. Four against one.
My DSN did mention that some people thought that one diabetic versus four staff might be a bit intimidating for some. However, I said it wasn’t intimidating enough and suggested they should adopt an Apprentice-style boardroom, with huge throne-like chairs for the doctors and tiny, rickety stools for the patients. Sounds good to me – it would add much-needed drama to check ups!
Anyway, we went through a few bits and bobs – my pump settings, the fact that I just can’t get my temporary basal rates right while exercising, dry skin caused by high blood glucose levels (eugh, I know) and the intricacies of the dual wave bolus.
One quick foot check later and we were ready for my A1C results – 7.3, down from 7.4 six months ago.
I’m happy enough with this but it’s not as low as it was when I was on MDI, where I hovered around the mid-sixes. I know the pump has allowed me to have considerably better control than MDI and my levels are much more consistent. I suspect my A1C is higher because I’m having far, far, far, far fewer hypos.
So I’m not sure that the A1C is the best method of measuring the “success” of one’s control – it’s just far too crude by itself. We need something involving more blood glucose readings and standard deviation or something like that. But my basic arithmetic is so poor that such heightened mathematics are far beyond my ken. Ho hum.
Downwards is always good.
I’m sure you knew this already but.. biannual is twice a year, biennial is every two years. 🙂
I think the error in the results means it’s pretty much statistically the same anyway. Ho hum 🙂 And re: the biannual / biennial controversy (I don’t think I’m over-egging it by calling it a “controversy”) I should have thought of my Latin roots or something.
Oh, and fans of meaningless milestones will be pleased to hear that @seasiderdave‘s comment was the 4,000th on the blog. This, of course, doesn’t take account of the 500 or so comments we lost in the Blog Meltdown of 2009(TM) – which is why the oldest articles don’t appear to have any comments on them, even though they had quite a few. By the way, we do regular backups now.
To solve the controversy, it has been suggested that rather than bi-annual you should use semiannual. Which is just silly.
Downwards (or even the same) is, as @seasiderdave says, good. Better than up.
And fewer hypos is also good.
I always see all the different bods at my clinic seperately. Which is (a) good because its not intimidating (although I was told by my DSN that I was fairly intimidating myself – good) but (b) bad because what one says isnt always passed on to another, so my DSN will say one thing then the consultant will say another, and I dont know which I’m supposed to do/believe/whatever. (But I tend to do my own thing anyway, so it doesnt matter too much.)
Standard Deviations are the way to go…(Okay, I know, I’m spawn of the devil, I like maths and spreadsheets and stuff.) 😛
SO FED UP with Drs looking at my results and saying, hmm, 7.2, very good. And me saying but it’s an average, I’m high half the time and low half the time. Yes, but 7.2 is very good. New Consultant did this very thing to me last week. Can’t recall the actual amount. Didn’t even listen. No point.
AAAAAAAAARRRRRRRRRRRRRRRGGGGGGGGGGGGHHHHHHHHHHHHHHHHHH!
I’d much rather be 7.4 without hypos than 6.4 with. HbA1c is seen as the be all and end all, but to me its just a useful indicator to look at alongside everything else. I hate it when people make judgements on HbA1c numbers – you need to see the full story to see what they mean – if all past HbA1c’s have been 10, then 8 is excellent progress. If you’re 6.5 but hypo 5 times a day, that’s not a great way to live. I agree with @Annette: standard deviation is the way to go, but unless you have CGM that too can miss huge chunks of data eg if you’re spending 4 hours in the middle of the night as a 14 but because you’re asleep you don’t know, your standard deviation may be good because you didn’t know about it, but your HbAlc will still reflect it.
It’s almost like Drs need to look at the whole picture of what’s going on rather than jumping to conclusions based on one test result. Who’d have thought it?
Why not just say twice yearly or 6 monthly, that solves all the confusion?
Oh God no standard deviation please remind me what it is its years since I’ve been at school.
A better picture can only be achieved by either CGM or hard work by the team and yourself. My team down here has been great I can down load my results from the pump and meter then email them. I then receive an email back with suggestions of what to try. I can also go and see the lovely team or phone (the latter can be difficult at times).
My only problem is the fasting …is it me or does the day I always want to fast seems to be a day when the infusion site needs changing/ dog needs walking or I hypo because of xyz which doesn’t usually reflect why I’m doing the fasting in the first place!
At the moment dare I say it seems to be going o…..k eeek Diabetic Gods angered now! I’ve managed to reduce my basal by 4units over night and I’ve had two days of no hypo’s. It is hard work and I am no saint at all but I know it will pay off. I think the problem lies sometimes in the Diab teams who haven’t really got the time to consider your lifestyle when looking at your results.
actually I’ve reduced by 2 units not 4 slight exaggeration!
I’m clearly shocked & appalled by @tims use of a mobile phone in a hospital.
The bans clearly there for health reasons & not so that a hospital service provider makes a mint from charging for phone calls & the internet!
Clearly all this exotic insulin you’ve been getting for free has gone to your head 😉
With an HbA1c of 8.3 (0.1 up on the previous test) a couple of weeks ago, I was relatively satisfied. I agree with the First Lady of Diabetic Blogs though, a higher average due to fewer lows has to be a good thing for T1s. For us T2s the lows are immaterial, a reduction in the average reflects a reduction in highs, so I think it’s more representative. A chart of my blood tests looks like a cross section of the Himalayas, so averages are the only way to be sure what’s happening.
Talking about dry skin though, I didn’t know that that was a side effect of high blood glucose, but it does explain why I’m turning into a lizard!
I think it’s more to do with the diabetic diet which is too low in fat.
When I took up a low carb diet with fat in, my eczema entirely cleared up. I don’t eat loads of fat, but i don’t avoid it either… fats are crucial to the skin.
Ah, but I don’t have a “diabetic” diet – I eat the same old rubbish that I ate before I was diagnosed. I’ve changed nothing…
You mean – butter? Are you really sure your diet is bad enough?
I only ever use real butter, whole milk too, I can’t be done with these spreads and such. I’m taking statins, but my cholesterol has never been a concern, despite the fact my body is not a temple, but a rotunda!
By the way, I’ve decided that the problems with my body have nothing to do with old age, just 65 years of benign neglect. 😆