The Good, The Bad, and The Gray

Today I had and Endocrinology appointment. I was nervous for one reason only. You see, I usually have access to my lab results before I see my doctor. I’ve worked it this way by getting my labs done soon enough that the 14 day California regulatory withholding period for patient access goes by, and I am able to see my lab results before I see my doctor.  I like it this way so I can have questions available before the appointment.  You know how often you are in the doctor’s office, get news, and then after you are on your way home and have had time to think it through…then you think up a bunch of questions!  I hate that; I want to be prepared before the visit.

This time I was unable to get my lab results ahead of time, so I felt so very unprepared.

Anyway, I went through the normal pre-doctor routine; weight (I’ve gained 8lbs in the last four months!), BP (120/74). Then I followed the nurse to the consult room and waited nervously for the doctor (Diabetes Educator, actually). Several minutes passed and then she came in and greeted me happily. Then we got down to business.

“Congratulations! Your A1c is down to 7.7. That’s a great improvement from the past.”

“Yay! I’m so happy!” I smiled big.

“So, the CGM is helping you a lot…”

“Yes, I love it!”

We went over my other lab results. My liver is good, my cholesterol is great. Then she told me my kidneys are showing signs of trouble. Not bad, but something to keep an eye on.  I explained that my kidney function has been stuck at this exact place for quite a few years. She said that that is confirmation of mild kidney disease and it probably will never get better but the fact that I am doing so well and getting my blood sugars under control will help to keep it from getting worse.

Next we talked a bit about my PCOS. I told her that the Metformin and birth control seem to be doing something, but I have yet to see any real results; but I’ve only been on it for a couple months.

I told her my major concern right now is that I am doing so well at getting my BG’s under control, eating healthy, getting as much exercise as I can push myself to do everyday before I crumble into pain and tears (neuropathy)…I’m doing everything right to be healthy and lose weight, but instead I am gaining?!

She looked over my labs and meds, and took everything I had just told her into consideration and after pointing out that weight gain is a possible side effect of Gabapentin… she concluded that I am probably gaining weight because my blood sugars are under better control.

Really?!  There’s never a happy ending for a diabetic!

You see, when my blood sugars were chronically sky high, my body spilled all the excess sugar through my urine. A side effect of this is weight-loss.  Now that my blood sugars are much lower, my body uses the sugar it needs, and stores the excess as FAT!

Fuck you, body!

She suggested a few weight-loss drugs that might help me. She also suggested I join the weight-loss program they offer at this office.  She gave me brochures for both suggestions.IMAG0838

I asked her if maybe the Humalog and Lantus I started on back in February (just a few weeks before I started ballooning up) might be partially to blame for the weight gain.  She doubted it.

I asked her about going on a pump.  She was all for this idea and suggested the Animas Vibe because I already have a Dexcom CGM and the Animas links with it.  I was all for that and she said she would contact the rep and get the ball rolling. She also gave me a booklet for the Animas Vibe.

“A pump may help with weight-loss as well, because you’ll use less insulin.” She pointed out. IMAG0839

The conversation soon turned to my foot issue. She actually remembered my injury from February, which pleasantly surprised me. I asked her what might be causing the continued discoloration. She examined it while I explained the entire situation.  She then told me it looked like it was still in the healing process.  This is very slow healing probably because of my poor circulation due mainly because of the vein they took from this leg for my heart. She assured me it was OK, no worries.

Finally, she gave me a lab slip for my future labs before my next visit in three months. I asked for refills on some prescriptions, and then we said our goodbyes.

The only thing I forgot to ask her was if it might be beneficial (especially for weight-loss) for me to up my Metformin dose. I guess I’ll just have to call or e-mail…or maybe I’ll just hold off until my next visit and see what happens in the meantime.

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Author: Tamra K. Garcia

Stephen King says to "Write what you know." I know diabetes, I know me; so this is what I write about.

3 thoughts on “The Good, The Bad, and The Gray”

  1. Insulin causes weight gain. Insulin, while fantastic for lowering blood sugar, is your body’s natural fat-storage hormone. The less, the better. The trick to to find the sweet spot where your carb intake is low enough that you need a bare minimum of insulin to keep glucose in a good range – that’s the way to avoid weight gain with insulin use.

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  2. I can confirm: When I got on the pump, the daily total of insulin went down from something like 60 IU down to 45-50.

    Aaaand gone were 10 pounds within three months, without more exercise, or any change in diet.

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