Wednesday, May 28, 2008

Three Months Later

Sitting next to Joseph on a bench painted like a black and white spotted cow, my mind is racing.

We've worked so hard... the testing, adjusting, the basal rate changes... so many long nights...

It has to have come down.

A knock at the door, and into the exam room steps a young woman with wavy blond hair and a slightly nervous smile.

A resident.

"Hello, Dr. C wanted me to meet with you before she comes in."

The resident takes a seat in the swivel chair opposite us and stares for a few moments at Joseph's file.

"Let's start with the basal rates-- what are they right now?"

Joseph leans back a little, pulls out his pump and gives her the numbers.

"Now," she continues, "do you correct a high blood sugar?"

Joseph and I look at each other.

"Umm, yes-- usually we do," I tell her. "Joseph's insulin sensitivity factor is 1:175-- we use that as a starting point and then adjust depending on activity level, insulin on board... "

The resident looks puzzled.

"What I mean is-- " she begins, shaking her head, "most families will do a correction starting at a blood glucose of 200, and then give a certain amount of insulin for every 50 points above that. So how much do you give him in that situation?"

And now I'm confused.

"It sounds like you're talking about a sliding scale-- we don't really use one. One unit of insulin typically brings his blood sugar down 175 points. So we calculate his correction based on that formula... "

I pause a moment-- suddenly annoyed by the woman's blank stare.

" ... but again, we only use this as a general guide, while taking many other factors into account-- like food, activity, insulin on board, and so on."

"Well, but you always correct a blood glucose over 200, right?"

"Again-- it depends. For example, if an hour earlier he was 300, then he's coming down pretty fast. In a situation like that, no-- we wouldn't do a correction. I guess what I'm trying to say is that there are no hard and fast rules here-- there are just too many factors."

She pauses, clearly frustrated with my answers.

"Do you have diabetes?" Joseph asks her.

I shoot him a look.

"Uh, no-- no, I don't."

After taking a cursory look at Joseph's sites, she finally leaves the room.

"Well that was weird," Joseph says. "Why do they send in people who don't really know what they're talking about?"

Stifling my own frustration, I take a breath before answering.

"Well, Bud-- I'm sure that's why they do it. It's probably the best way for new doctors to learn."

Just then, there's another knock at the door, and in walks Joseph's endocrinologist.

For a split second, my stomach is a mad frenzy of butterflies.

"I am so pleased," she says with a broad smile.

"Joseph you're doing beautifully. You're growth is perfect. You're all doing a wonderful job!"

I look at her, hopefully-- willing her to go on.

As if reading my mind, she nods-- still smiling.

" ... and yes, the A1c fell-- from 8.5 to 7.9."

With those words, Joseph jumps up and flings his arms around his endo.

Sitting still, so relieved-- I watch the two of them celebrate.

No more butterflies.

Just a huge lump at the back of my throat, and two eyes clouded with tears.


Nicole P said...

Yay!!!! :D I'm celebrating with you. Lots of love, N

Shannon said...

What a relief!! Your hard work certainly paid off. That's a great difference.

That resident has to realize that you guys are the experts ;)

Araby62 said...

Sounds like the resident has a lot to learn about type 1 diabetes. Good on Joseph for asking if she had it herself, and well done on the A1C :)

Allison said...

I remember the first time my A1C went from the 8s to the 7s. It was like Christmas.

Congratulations you two. ::hugs::

George said...

This made me cry. Congrats!

Jeff said...

Cause for celebration!! (blank stares notwithstanding.)

Jillian said...

Yay!!!! I'll do a little happy dancing for you guys today!
I'm with Shannon. The day to day of this disease is in our hands so we usually know more, and it's obvious that Joseph senses that too. The resident has a lot to learn.

Donna said...

Congratulations on the A1c!

Minnesota Nice said...

Oh Sandra.. The investment in the numbers continues (for all of us).
So pleased that you guys got an improved result.
And, I suppose Joseph is old enought to be exposed to stupid doctors and realize that there are plenty of them out there. QUESTION AUTHORITY is my motto.

Malyssa said...

Congrats on the A1c. I had an endo appt. this past friday and my A1c went from a 10 down to a 7.8! Keep up the great work!!!

Colleen said...

I LOVE that Joseph calmly asked his question. Talk about taking control. Tell him we're proud of him.
And I can't believe I had to read the whole thing to get to the GREAT A1C news - wowee!!!!!

Paige said...

That's fantastic!

(I almost feel that our permission should be asked before we meet with a resident like that. It can really seem like such a waste of time, though I think you make a good point about how doctors learn.)

Carey said...

Sandra: Fantastic A1c news! I'm very happy for you guys. Great job!

Molly said...

Great job on the A1c.
Ah, residents. (and most doctors for that matter...) I'm glad that Joseph remembered, and was assertive, that you guys know more than that person.

Anonymous said...

Thanks so much for sharing the news. Both about the 8.5 and the 7.9 -- it's inspirational to those of us struggling daily. That things can be improved. Congratulations!! - Stellasmom

Val said...

Congrats on that a1c. And tell Joseph his comment to the clueless dr was perfect!

Scott K. Johnson said...

Alright!!!! Way to go you two!

I too got a kick out of Joseph's comment to the clueless wannabe doc.

I think you handled yourself perfectly too Sandra.

Nice job!

Sandra Miller said...


Thanks. :-)

Just getting that number below 8 felt so huge...


A relief indeed.

And I agree about that resident-- she just looked at us as if we were speaking a foreign language... but worse, didn't seem to want to understand what we were saying.

Very strange.


Oh yes, I thought Joseph's question was both appropriate and well-timed.

I was very proud of my boy. :-)


It was like Christmas.:-)


By the time I finished writing this post, I was bawling all over again. :-)


Yes!! (and LOL!)


Since our appointment, I've found myself spontaneously breaking out into happy dancing of my own... :-)


Thanks. :-)


I like your motto.

By the looks of things, so does my son. ;)


Wow!! Amazing improvement!



I'll tell him. :-)

And I couldn't believe we had to go thru that whole exchange with the resident before finally getting the good news!


I think so too. :-)




I'm glad, too. Makes me all the more confident in his ability to handle this stuff when he's grown...



(If you'd ever like to get together for coffee and unload about some of this stuff, just let me know... )


I've told him already-- but I'll let him know that you all think so, too. :-)



(And I got a kick out of that comment, too. :-)

Anonymous said...

I know how hard it is to get that number down. Great job!

Jamie said...

Awesome! Congrats to both of you on your hard work :)

You two ARE the experts and you know how it works for Joseph - this latest a1c proves that :D

Malyssa said...

Thank you, and yes, it helps very much!! I tried the cgm from Minimed, and I didnt like it. The insertion needle is HUGE! And it flopped around a lot. I really do like the Animas pump a lot, especially compared to the Minimed. I think it will definately be worth the wait until dexcom and Animas are integrated in my opinion. But everyone is different. And I understand about the lows...I rarely feel them anymore. If I didnt wake myself up at 2am to check every night, I probaby wouldnt catch most of them. And this brings me back to this past Sunday. I tested before dinner and I was 43. I didnt feel a thing, and I actually felt very normal. Scary stuff.


p.s. Thanks for adding a link, and for the welcome!!! Hope to hear from you soon! =)

Bernard said...

Sorry I'm late in offering my warm congrats.

Excellent job.

What was that resident taking? I want to stay away from it.

Lisa said...

Congratulations! We are working on our A1C too.

Tag! You're it. Here are the rules:

Once you’ve been tagged, you have to write a blog with 10 weird, random, facts, habits or goals about yourself. At the end, choose 6 people to be tagged, list their names & why you tagged them. Don’t forget to leave them a comment saying “You’re it!” & to go read your blog. You cannot tag the person that tagged you, so since you’re not allowed to tag me back; let me know when you are done so I can go read YOUR weird, random, facts, habits and goals. Have fun!

Ashley said...

WHOO! that's AWESOME! congratulations, you guys!

Anonymous said...

I thought this was a wonderful post. Any mother, whether of a child with diabetes or not, can relate to doctors/nurses/admin saying ridiculous things. I loved your description of the event and Joseph's response. Great writing. I would put this in our magazine if you're interested. You can contact me through our website. Cheers!

Kristin Lund,
Managing Editor
Diabetes Health Magazine