As I started to write about yesterday's endocrinologist visit the words felt familiar. I looked back and found a post (which you can read below) from 2013. The only difference between the old story and yesterday's visit was the added visual aid of a Dexcom graph which showed that the average range of blood sugars was about 40 points higher than we'd like it to be. "This whole graph just needs to move down an inch or two," was our doctor's assessment of the issue. The rest of the conversation was about the same as this one four years ago:
We visited the endocrinologist this week.
In the weeks leading up to a visit, I am usually motivated to keep a more detailed log and to scan through the meter's averages and graphs. I try to identify any major issues we need to discuss. Sometimes I am able to fix a few things or at least narrow down the issues to a few really tricky ones. I do this so that we can spend our endocrinologist time on issues I really need help with.
This time I tried to think about it. I really tried to weed through all of those numbers and find the places we needed to change things. I didn't know where to begin. I gave up. It turns out my confusion was warranted. The doctor's initial impression?
"She needs more insulin...like most of the day."
Her A1C was up, only by .3, but after going down a couple of times in a row it wasn't great news. It wasn't surprising either.
Many things had changed since our last visit. She'd added height. She'd added weight. Yet she was missing a sufficient quantity of a key ingredient.
So we added insulin to almost every basal rate. We added insulin to almost every carb ratio. We added insulin to the correction factor.
We've been doing diabetes for ten and a half years. I'm able to tweak a basal rate here and there, or recognize when the correction factor is no longer correcting. I'm a person who, given sufficient knowledge, tries to solve problems on my own before asking for help.
Yet once in a while, particularly with a growing child with diabetes, the time comes for a major overhaul. In many ways, it was freeing to hand that whole pile of 'undesirable' numbers over to the endo and say, 'please fix this.' Now we'll watch and see if he did, and hope he at least got close enough that I can trouble-shoot the rest from there.
I don't imagine all of yesterday's adjustments will work perfectly. We'll be following up with more tweaking in the weeks to come. But I'm grateful for yesterday's major overhaul so that we can get back on track, an inch or two lower on that Dexcom graph.