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Joslin: I'm So There.

Thumbs up for, um, blood!I'm driving my little Honda up to Boston today for my endocrinologist appointment.  I spent part of last night printing my blood sugar logs from the end of March and the bulk of April (I have been keeping up with The Log Book, as promised - many blue stars on my chart).  I noticed that while I've been feeling like my control has been relatively good, I've had some zinger highs and a few trenches in the last 90 days. 

For whatever reason, I'm not dreading this appointment.  Oddly enough, I'm looking forward to spending the day in Boston, even if I will be at a hospital for much of the day.  Going to Joslin forces my brain to realign, and it always makes me feel hopeful.  I've been a patient there for over twenty two years, and it feels oddly like home.

They'll take an A1C, and I hope it's finally ringing in at NHB Range.  But my doctor has expressed more interest in having my numbers stable, instead of "good" as a result of averaged highs and lows.  She'd rather see me holding strong at a 140 mg/d as opposed to pinging from 300 mg/dl to 40 mg/dl. 

I'm not sure how I feel about an A1C result being the definitive measure of my diabetes control.  (Apparently Lindsey at Blogabetes has had the same thoughts.)  Is this a state of mind I've decided upon as a result of a result over 7%?  People talk about the estimated average glucose (here is a dizzying article including lots of math and here is an online calculator that keeps the math hidden where it belongs), but is it a true indicator of how I'm running?  And what is this fructosamine test I keep reading about?  What is the best way to tell if my body is healthy?

I'll have these tests today and I'll run through my list of questions (including, but not limited to, what can I do about this relentless tendonitis, is my blood pressure well-controlled enough for pregnancy, and do I really need to cut out ALL the coffee from my diet as I move forward here?)  I feel like I'm in excellent hands at Joslin, and I'm ready for whatever today has to throw at me.

(In the meantime, this had me mesmerized for quite some time yesterday.  I wanted to dive into the middle of that couch and snuggle every last one of those furry messes.)

Comments

Unless you want a baby that is up all night and sleeps during the day, you'll want to give up the coffee. Trust me on this one.

hmm...i'm about 0.9 away from that magical 6. but then again, that's because my bg's swing like tarzan: 260+ one hour, down to 40 three hours later. NOT cool.

i need to push myself to log too...i started last night because i don't want my new endo to yell at me. =X

Good luck, Kerri! Hope it's a productive & good day!

22 years at the same place?!?! amazing. Good luck with your appointment. I agree with you on the A1C. Funny thing is, my NP at my Endo's office would rather see stable bg's as well. I thought he was crazy! I thought about of later on, it made sense.
As far as the caff goes...if you have to give it up for 9 months it'll be worth it.

Best of luck to you with your day at the hospital. I personally do feel like an A1C is a very important indicator of diabetic health. It is not the ONLY factor we should be looking at ... but there is no question that your average blood sugars indicate what you are doing on a daily basis as far as control. Funny you should mention it, but in my experience, those with higher A1C's seem to tend to downplay their importance. I've got a father with an A1C of 10% and a daughter with an A1C of 6%. My father thinks nothing of it, is extremely unhealthy and never feels good. My daughter takes things seriously, feels fantastic and will live a long healthy life.

Too bad there wasn't a little more sun for your drive and romp in Boston (although I suppose you'll be inside most of the day). I hope everything goes even better than you could hope for.

And now, your post has me missing Boston so much. :)

I'm not an endo by any means and I'm not a scientist, but I know that Ian feels better when his bg isn't bouncing around. So I think your dr is onto something - that holding a nice steady 140 is probably better than a LOW a1c that happens due to many lows peppered with many highs.

the body feels good for a reason when bg's are not hopping around.

Fructosamine is a measure of intermediate-term bg control -- the past 2-3 weeks. One could argue that since the A1C, though it usually covers three months, is heavily weighted to the most recent month, suffices, a disparity between fructosamine and A1C can indicate somebody "paying attention to have good numbers at the doctors and then going hog-wild afterwards".

A number of folk active in the DOC and/or D-socnets try to measure the stdevs of their bg excursions (how close am I to being "within range", how much of the time?). It's a pretty good idea in that it washes out the real outliers (one or two readings that are "way out there" over, say, a three month period) while it still gives an idea of how "controlled" you are.

Of course that is still limited by when we test, and that using a standard glucometer, we are only getting spot readings.

If your CGM can give you readings to do stdev analysis, that would add a level or two of confidence to the A1c and fructosamine results.

As far as pregnancy's concerned, your A1C can only tell you so much. Of course 6 and lower is much better than 8 or higher, but if that 6 is coming with a lot of lows, that's less healthy for the baby than an average but reasonably sugar in the mid-100's.

I've gone down as low as 5.3, when I was being a super-fanatic a few years back, but I was low at least twice a day. Now I'm in the upper 5's, but I still go into the 50's--and into the lower 200's--every other day or so, so I'm not sure how good of a test that is of my control. It's the best test they have, but logbook results are much more meaningful.

I too love my coffee. But I gladly gave it up when I became pregnant. I developed a horrible aversion to it in my first trimester. Maybe you'll be lucky enough to have the same aversion!! Fingers crossed...

They're not real, that's Pixers latets CGI adaptation!

As Ive mentioned before, a bit higher a1C with good even BG's, is better than low a1C and fluctuating BG, at least as far as what new research is alluding too, safety and same view as my endo's. He thinks a1C in the 5's for T1 is not at all good, and generally aims for high 6's.

I tried to Twitter you and wish you luck but it was all screwed up yesterday. Anyway, glad to hear it went well. I hope your a1c is good. I always dread hearing the number and I hate how it impacts me. Is my diabetes really just a single number? I don't think so.....

My endo at our local Joslin says that it is a thinking now that its way better to have a consistant a1C [mine are always in the low to mid 7 range]. When I try to get and stay in the 6's I go low 2 or 3 times a day. Being consistant seems to work for me .. will enter into my 52nd year with J.D. in a couple of weeks!!
I had two babies many moons ago and neither are diabetic. :)
I got a call from Boston Joslin Monday.. there will be 50 of us who have lived over 50 years with JD at the Medalist Event in May!
It will be super to finally meet others that have had 'it' as long as me!!
Just do the best you can to get where we are :)
~Annette~

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