Which seems a little surprising-- given the number handwritten in black ink on that sheet of paper sitting on her desk.
"Joseph, you've gotten so big!" she says enthusiastically, "I wonder if you can you see over my head now?"
Immediately, my son leaps out of his chair.
Standing directly in front of her, it's clear that Joseph is now several inches taller than his endocrinologist.
"Oh my!" she says, red-faced and laughing. "I think we can safely say you've begun the adolescent growth spurt."
With these words, Joseph throws his arms around his endo -- giving her a huge bear hug -- then, grinning, returns to the seat next to mine.
He's growing. That's the most important thing.
I tell myself this over and over while smiling at the two of them.
But then my eyes wander back to that sheet of paper.
To that number.
"Yes," she says with a nod, "we did see an increase in the A1c."
Joseph's head snaps up.
"From 8 to 8.5."
And now the only one smiling is Joseph's doctor.
"I'm not worried about this," she says, noting our somber expressions.
"A number of things are going on here. First, it's obvious that Joseph saw periods of rapid growth since his last appointment. This is probably the most significant factor."
She pauses a moment, thumbs through Joseph logbook, and then continues.
"Now, according to the log, you had a problem several weeks ago with a leaking cartridge..."
"That's right," I say, remembering that awful night.
Blood sugars in the 400s, followed by corrections that had no effect-- injections, a site change...
And finally, the anger and shock at finding his meal and corrective insulin clinging to the sides of a soaking wet, almost empty pump cartridge.
Our son hit a diabetes milestone that night-- moderate ketones.
"Keep in mind," the doctor continues, "blood glucose over the last month will have a greater impact on the A1c-- so this 8.5 is partly due to that incident."
Joseph says nothing, but listens intently.
"So what can we do?" I ask.
"You increased Joseph's basal rates three weeks ago-- and those new rates worked well for a while, but the highs are returning. So I've raised them again-- overnight and early in the morning. That should help."
She hands me the sheet of paper with Joseph's new rates-- and his A1c.
"Understand," the endo goes on, "you're probably going to need to increase his basals every two weeks."
And now my head snaps up.
"Don't be afraid. You need to do this, Sandra."
"But every two weeks- "
"He's going to need a lot more insulin now that it's clear he's entered puberty in earnest. And the amount he'll need is going to keep changing as he grows."
I know she's right.
The ridiculously frequent, insulin-resistant highs we've seen over the last three months made that perfectly clear.
Walking out of the clinic an hour later, carrying his new basal rates -- and the weight of that number -- I can still hear her voice.
"Don't be afraid."
But, I am afraid.
Not of making changes, nor of working harder.
I'm afraid of that damn number.
I'm afraid of what it means might be happening inside my son's body.
I'm afraid that -- no matter how hard we try -- it won't be enough.
Wednesday, March 12, 2008