Saturday, November 6, 2010

Check Up Check List

Saturday, November 6

Check Up Check List – Very few people enjoy doctor appointments, but if you have diabetes, you’ve probably had your share of these! Share your doctor appointment stories – funny, frustrating, embarrassing or inspiring – or what appointments you need to catch up on.

Since I'm relatively newly diagnosed, I haven't had a whole lot of Diabetes-related appointments just yet.  I saw one of the local doctors twice in the week I was diagnosed, and it was another month before I was able to see my endocrinologist for the first time.  My next appointment with him is in late December, a few days after Christmas.  I'm anxious to see what my hemoglobin A1c will be this visit because it will be the first time we'll get to see what effect my management has had on my blood glucose numbers. 

For those of you who don't already know, the hemoglobin A1c is a blood test that provides a measure of your blood glucose average over the past few (2-3) months.  You'll also find this lab test referred to as HbA1c, glycosylated hemoglobin, or glycated hemoglobin.  Essentially, when you have excess glucose in your blood, hemoglobin (a protein that transports oxygen to the cells throughout your body) attaches (or glycates, hence the term glycated or glycosylated hemoglobin) to those glucose molecules.  The HbA1c test measures the percentage of the hemoglobin in your blood that has become glycosylated in the lifetime of the red blood cell (120 days*), and therefore gives a good picture of your blood glucose control over the preceding few months.

In a person without Diabetes, a normal A1c is 4-6%(*).  For good control, my CDE (Certified Diabtes Educator) recommended an A1c of 6.5% or lower.  At my first visit with the endocrinologist, my A1c was at 6.4%, meaning that I'm already below the recommended level, but still high by normal standards.  For pregnancy, most doctors will recommend achieving an A1c of 6% or below before conception...In other words, the same level as someone without Diabetes. 

One reason I'm anxious to see what my A1c is in December is that I want to know how much farther I'll have to bring it down before we can safely decide to have kids...Because despite my endocrinologist's assurances that I would be "fine" during pregnancy, I want to give our future baby the best possible chance of being healthy.  I would  have a hard time forgiving myself if there was something wrong with our baby that could have been prevented had I just had better control over my Diabetes.  For this reason, I also want to discuss going on insulin to obtain tighter control of my blood glucose levels before we decide to conceive, whenever that may be.  My CDE recommended my BG levels be between 70-120 before meals and not over 140 after meals prior to pregnancy, but nothing over 120 during pregnancy.  I honestly think that for that level of control to be possible and consistent, I will have to be on insulin.  Also, it's worth noting that women who are on insulin prior to pregnancy will double or even triple their insulin needs by the end of their pregnancy, while those who were not on insulin previously will likely have to be in the later trimesters. I would like to begin injecting insulin prior to conception simply because I would rather learn then than later, when the stresses of pregnancy are already under way.

Next week, I'll be seeing my eye doctor for my annual eye exam, which I was actually due for during the summer.  Incidentally, then, this will be my baseline eye exam for my Diabetes treatment as well.  Un-or poor-controlled Diabetes affects many of the body's organs and systems, and retinopathy of the eyes is one of its well-known long-term complications.  It's important to see your eye doctor regularly (current standards recommend an annual dilated eye exam) because retinopathy can easily be treated with laser surgery if found soon enough.  The earlier your eye doctor can detect these changes to the eye, the earlier you can get the treatment you need and prevent vision loss.

The day after my eye exam, I'll be going to a free all-day Diabetes education course offered at the same hospital (a couple of hours away) where I saw my CDE.  My endocrinologist provided me with a referral to this program because it offers information on various aspects of Diabetes, from diet & exercise to emotional health.  I'm looking forward to learning more from the experience, and hope that it will give me even more confidence in dealing with my disease.  The following day, the same hospital is also holding a Diabetes health fair open to the public, where various vendors for Diabetes-related products will be set up and free lab tests will be offered.  We're thinking of staying overnight so we can kill both of these birds with one stone, but I suppose we'll have to see what happens!

A person with Diabetes definitely has more doctors' appointments than the average person:
--Endocrinologist/Primary Doctor/Other Diabetes Specialist (At LEAST 2x/yr to check A1c; mine is every 3 months)
--Eye doctor (1x/yr)
--Dentist (Exam & cleaning, ideally 2x/yr)
--For women, a gynecological exam & PAP smear (1x/yr)
Other Possible Members of the Diabetes Health Care Team:
--Registered Dietitian
--Social Worker
--Psychologist/Psychiatrist/Other Therapist
--Exercise Trainer
For those with complications from Diabetes, still more doctors/specialists may be necessary:
--Nephrologist (kidney specialist)
--Podiatrist (foot/leg specialist)
--Physical Therapist

As you can see from this list, Diabetes is an expensive disease to manage simply due to the sheer number of doctors visits it entails, whether or not you have insurance. (For further discussion on this subject, see my post "Election Day",  All of these extra appointments can certainly add stress to an already stressful disease, but they're also very, very necessary to successfully managing Diabetes.


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