Posted in Diabetes

A Difficult Appointment with my Dietitian/DE

Today, I had an appointment with my new dietitian/diabetes educator at the same clinic I have been going to see my diabetes educator nurse. The first time we met to get my medical history he said he would be able to help me with balancing my insulin and food (so the peaks of both match and I don’t end up too high or too low afterwards, etc).

Well, the appointment was a huge bust today. First, he was concerned that my two hour blood glucose numbers were “too low” and thinks I am probably taking too much insulin for what I am eating. Well, the reason I keep them low is because my blood glucose keeps going up after the mealtime insulin stops working so if I am high two hours after a meal, I’ll be even higher three hours after a meal and I will essentially be spending all day long in the “high” zone rather than in the lower numbers where I should be. I tried keeping my numbers higher for a while and I just didn’t feel good (even though the numbers were in ranges that were considered “normal” for diabetics). It was not working for me so I keep them lower now. There is an extremely small window of blood glucose numbers where my body feels comfortable and that’s where I try to keep my numbers (a much as possible).

In addition to thinking my 2 hour post-prandial meal numbers were low, he also thought I have been going to bed too low. I personally cannot eat right before bed (unless I have a low and have to correct it). My stomach feels full and I can’t sleep very well. Plus, I wake up feeling exhausted, probably because I’m spiking my blood glucose while I sleep. Even if I just eat a piece of protein, which technically shouldn’t cause a spike (like a small piece of cheese) I still don’t feel good. Digesting food and sleeping just doesn’t work for me.

Finally, he was also concerned about the way I am eating right now. He thought it wasn’t sustainable because I eat pretty much the same thing every day. I know it’s not sustainable to eat exactly the same thing every day, at the same time, for the rest of my life. The reason I eat the same thing is because I have a huge problem with not feeling well after eating in general. This is why I alway stick to my “safe” foods. Whenever I try something different, I always end up feeling bad, which is why I end up going back to the same thing.

I didn’t say much throughout the whole appointment because I didn’t really bring my full blood glucose log (I only had pre-meal, post-meal, and bedtime numbers with me and not the other times I have tested when feeling weird, etc). I did not bring my food diary and physical activity log either as I tend to just “log” everything in my head. I understand he was concerned and just wants to help me. But honestly, I just don’t have any hope anymore that anyone will be able to help me with my diabetes. I feel terrible regardless of what I eat or don’t eat. And it’s not just that I feel terrible for a little bit, it’s the physical symptoms I get as well that scare me. Before being diagnosed with diabetes, I had gone through a period of severe chronic pain that no physical therapy, medication, or anything really had helped with very much. After I was diagnosed with diabetes and I worked hard to bring my blood glucose down, I felt so much better. Some days, even when my blood glucose is not high, I start feeling those sensations again and it scares the heck out of me. Therefore, I worry that keeping my numbers a bit too high for me (even though they are considered “ok” numbers for diabetics) will bring back all the pains again. That period of chronic pain was one of the most awful times of my life and I really do not want to end up back there again. It was one of the periods in my life where I felt I had reached “rock bottom” and there was never going to be a way out of my despair.

I left the appointment angry at him, angry at myself, and angry at my body for not being normal. I cried in the bathroom before heading off to work as the appointment just made me feel like I wasn’t putting in enough effort (plus I haven’t had a very good couple of days so that did not help my mood today). I’m also just exhausted of never really feeling well. I wish I could be one of those people that can eat anything and feel fine even if their blood glucose numbers are a bit higher, I really do. But unfortunately, that’s not me. My body is very sensitive to spikes and to high blood glucose in general and I feel this is just the way it’s going to be my entire life. I will log everything (food ,exercise, times I ate everything, insulin dosages, times I have felt weird and blood sugars at those times, etc) for our next appointment and I really hope he can help me as he has been working with diabetics specifically for a long time. However, something tells me that, as usual, my issues are unique to me and I’m the only one that can find a solution. I have gotten to the point where I don’t know what to try anymore though so I’m hoping that bringing all my data to him next time will give me some new insight.

The tone of the appointment felt a bit harsh, but I’m hoping that maybe it’s the kick in the behind I need to really dig deeper into my numbers and see if my feelings of malaise are because the peaks of blood sugars and insulin aren’t matching quite right (or maybe my dosages aren’t quite right). I think the reason I have been a little bit lax on figuring it out is because previously the only variables I had to worry about and analyze were diet and exercise, which made problem solving much easier. Now I have diet and exercise, the two new insulins and their interactions (Lantus and Novolog), plus whatever insulin my own body is producing while I’m “honeymooning”(by the way, this is NOT a happy honeymoon). The more variables are added in the equation, the more complex the situation becomes, which makes it more difficult to understand my diabetes and find trends. As a research analyst and statistician,  I know it’s going to take a heck of a lot of work to figure this out (even more work than I had previously been doing), which becomes a bit overwhelming to even think about as I have already been putting a ton of work and thought into my diabetes management since I was diagnosed last year (and have gotten a bit burned out a couple of times).

Diabetes management with insulin is new territory to me so I will really have to put in the work to collect as much data as I can to get some useful insight from my dietitian/DE. I really will need to trust his experience on this one and learn as much as I can. He suggested I start focusing on breakfast for a week so I will start testing every hour or so until lunchtime to see what happens. I doubt I go low as he thinks may be happening, but I need to collect the data to prove it. We’ll see what the data reveals.

20160706_073142
Just started the process of logging everything I eat, activity, insulin dosages, blood glucose levels, times when I don’t feel well and blood glucose at those times, etc so I can bring it all in to my next appointment with my dietitian/DE. I hate to have to spend even more time thinking about my diabetes, but hopefully the collected data will be worth it in the long run and will get me closer to figuring out what I can do to feel better.
Advertisements

Author:

Hi all! This blog is a space to share my journey and day-to-day experiences with managing diabetes. Please note, I am not a doctor or nutritionist, just a patient that lives with the condition.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s