Originally posted 04-06-2104

My reason for writing this particular blog is because if I don’t write it down I will forget the details.

I went for my endo appointment eager to hear my hba1c result & fasting cholesterol result (first time I’ve ever had a fasting blood test since my diagnosis 11 years ago).
I arrived, booked in, took a seat in the waiting area. About a minute later I got called through to be weighed by a nurse, this speed is very rare and I ‘thought this is off to a good start’. I had forgotten the water sample, not such a good start. I said that I’d provide one now, I was told not to worry & she said it had to be a ‘first of the morning’ sample, I was a little surprised as in the passed I’ve just been sent off with a bottle in the direction of the ladies. Off I went to sit in the next waiting area.
Within a few minutes I was called by another nurse to have my BG done, blood pressure checked and the bottoms of my feet looked at, again I’ve never experienced this speed. I was thinking “yay I’m going to be out of here in no time today”, this was actually a minute or two before my appointment time and never happened before. It’s a given that you never go in on time!
I sat down in a room with the nurse and I watched as she set up the monitor, scanned all the different barcodes as she went. When she was ready I offered my right hand for her to stab a finger, I wasn’t too impressed as she went for the pad of my finger & it hurt, I huffed under my breath thinking I never hurt myself as much as that! Also was a bit narked at the amount of blood squeezed out when the machine obviously only needs a very small amount of blood going by the amount left on my finger. “Oh 3.7! Do you have anything for it?” she said, to which I replied “yes”. Whilst retrieving 2 Jelly Babies from the front pocket of my handbag and shoving them in my mouth the nurse then said to me “Jelly Babies? We would normally get you to eat 5 glucose tablets to which I nearly choked as I knew that would send me sky high, to which I replied “it’s ok I’ve been dealing with it for 11 years!”(Yes I felt awful later for that). The poor nurse then said that they had a protocol to follow & that she needed to inform someone and dashed out of the room.
She came back shortly after with a bright orange hypo box and a small record book, saying that it was ok & that she would need to check my BG again in 15 minutes. Whilst we were waiting the 15 minutes to go by she continued with her checks, my BP & the bottom of my feet. I was asked about a water sample, I explained what had happened with the first nurse I had come into contact with, she explained why & when a first morning one was needed but for the purpose of just checking for protein there & then, would I provide a sample? It was also noticed in my notes that it had been just over a year since my last retinopathy test. Boy doesn’t time go quickly? I hadn’t realised it had been that long & I promised that I’d chase it up as I hadn’t received a letter yet offering me an appointment.
She then explained to me that it is their protocol to give 5 glucose tabs and that because that hadn’t happened she would have to write it up in a record book. I said that glucose tabs taste like chewing a stick of chalk, she did smile. She said that I should go and buy a sandwich to keep me going, I said “well maybe just half” knowing that if I ate that I would definitely go high, I know me. I was then also asked about my hypo warning signs. I explained about mine and said being irritable was one of them (BG obviously rising by now but hypo feelings had really kicked in), and then I apologised for snapping at her, to which she was completely fine about. By now I was wishing I’d checked myself upon arrival & presuming I hadn’t noticed it as I’d been sat in a car for the 30min journey & then sat in the hospital.  Anyway the 15 minutes passed and BG check done again showing a reading of 4.9 and the nurse saying “oh you were right then with the 2 Jelly Babies”. She then let me out to sit in the next waiting room to see the doctor.
There’s usually 2 endos in clinic & I noticed that my usual gentleman wasn’t there. So I was more apprehensive about going in especially as this time I went armed with data from my monitor and questions, some sparked by my contact with the #doc (Diabetic Online Community) on Twitter. I wanted to ask the person I was familiar with. Things had started good at this appointment but now it seemed to be going downhill.
Whilst waiting to see the doctor I tested a few times, a 5.3 then 5.7.
The nurse came passed a few times, smiled every time & obviously she hadn’t held it against me. She also informed me where I was on the list.
Finally I got called into see the doctor. Now I can’t remember the order all this happened but there was a lot to take in. I was thankful I’d asked my husband to come in with me this time.
She apologised that my usual endo wasn’t there as he’d been called away. We started with the usual of checking which insulins I use, how much basal & bolus carb/insulin ratio & wrote it all down. She pulled up my hba1c on the computer & instantly I could see by the graph that it had come down. I was celebrating inside. She turned the screen around for my husband to see as well. She was concerned that it had come down due to hypos, I sank a little thinking of the hard work of trying to keep as close to “within range” as possible. But anyway I thought “It is good news, I know what I’ve been doing”.
Next was my notes on my recent overnight stay in hospital due to rapid heart beat, dizziness. I explained the whole situation starting with the fact that at first I thought I was either hypo or heading that way, this had actually woken me during the night several times. But after testing all day to check & monitor if I was, I wasn’t. There were no other hypo symptoms and my husband (a retired paramedic) checking my blood pressure which kept dropping and my pulse where he noticed the odd skipped beat, I decided to visit the doctor the next morning. To cut a long story short two days later I ended up in hospital for overnight heart monitoring. By the time I was eventually seen & monitored on the ward things seemed to have calmed right down. A heart murmur was found by two different people a doctor & a consultant. I was told I’d be sent for a heart scan, which I am still waiting for the results of. Sorry gone off a bit here, let’s back to today’s appointment.
After explaining about this she did wonder if it was due to hypos. I repeated that I really didn’t think so due to the ECG read out & the heart murmur (and my BG monitor not showing this either). But she did say that “we” shouldn’t always put things down to diabetes, good point I thought.
Next she wanted to check my blood pressure, but this time it was to be the difference between sitting and standing. There was no change in the readings which there should have been. I was asked questions about dizziness and if I get dizzy when I stand up. I do sometimes but just put it down to standing up too quickly & that may be all it is. She said she wanted me to have my adrenal gland (another organ in the endocrine system, like the pancreas – for my non-D readers) checked out & explained what that was about & that it would mean a daytime stay in hospital attached to a drip that puts “stuff” (that’s my technical term not hers) in to me that would force the adrenal gland to “put out” what it does so that it’s function can be tested. It’ll probably be a few months before that appointment comes through.  (UPDATE – 2nd March 2015 , Blood pressure was monitored at my GP’s and it behaved as it should have so the hospital stay wasn’t necessary)
Again I was asked about hypos, warnings, when they occur & how often. Apart from warnings, you can’t exactly explain when they occur or how often. I know some occur when I’ve been particularly busy in work or like last weekend when I’ve been shifting furniture but sometimes they happen out of the blue. Then I remembered the data that was tucked away in my bag. She was thrilled with all this information, anyone would have thought it was Christmas morning!! Straight away she spotted a night trend in my hypos, and higher readings after my evening meal. She asked if she could keep the print off to go in my notes which I was fine with. We talked about different ratios of insulin to carbs for my evening meals. Which was one of the questions I had written down to ask about. She explained that my basal only actually lasts approximately 20 hours not 24 so I would not have any background insulin for those missing four hours. I can either give two separate doses, one at night and one in the morning or change to an insulin that lasts 30 hours (UPDATE 2nd March 2015 – I have since split my dose in two). She then told me that she wants me to use a blind CGM (Continuos Glucose Monitor) for 3 days to track my highs & lows and then take things from there. I will be contacted by the DSN about that.
Next I told her that I’ve been having trouble with my ankles being stiff if I’ve not walked about for a bit or upon waking in the morning, once I’ve got up & walked about they’re fine until I sit for a while. She checked them, poked and prodded then got out the vibrating fork to check that I could feel it. That was all ok, so she asked me did I get much sun. I wanted to say “well I do live in Wales” but I resisted the temptation & said “no, not much really”. I was advised to take vitamin D, she explained why. Again not always related to diabetes. She did say that if I was still having problems by my next appointment to feel free to remind them.
I was diagnosed with early menopause last year so asked a few questions that I’d been meaning to ask for some time but always left without asking as I forgot. This is why this time I wrote questions down. By now so much had been discussed, looked at, etc that I think my memory went into meltdown and I can’t remember all of the details. She wasn’t sure if the menopause was causing a problem or if the diabetes had caused early menopause.
The final thing that I had written down was that I needed a new injection pen as I was having trouble reading the numbers on the dial up of my old pen especially if there wasn’t direct light on it. That was sorted without a hitch by the DSN. The BG nurse also offered to show me the way to the DSN’s office, as she’d had to leave clinic for a previously arranged appointment, chatting pleasantly all the way.
My spare meter also needed setting up, I couldn’t do it because only the nurses have the code to enable them to put in the necessary information. The DSN was very helpful and sorted that out for me too.
Overall, by the time I came away I felt that it was the best appointment that I had ever had in the 11 years since my diagnosis. A lot of things were looked at. My questions were answered and things were explained to me, not only why but how. So my apprehension about a different endo was unfounded. The question I have asked myself now is “Was my appointment so much better because I had information and questions to bring to the table too?”
Only problems, with everything else being talked about I forgot to get my fasting cholesterol results, check that my next appointment was in six months and get a bloods form for my next hba1c. Doh!! Think I’m going to have to make a phone call.

Oh and the appointment was the longest one I’ve ever had and I didn’t get out of there quickly like I thought I was going to.