Letting The Dust Settle.

I once heard someone note that when you have a baby, "your life just kind of explodes". I'd like to add to that thought and remark that when you have a baby AND you have diabetes, your life just kind of explodes but then all of those fragments proceed to land on their self-destruct buttons. Life post-baby seems to resemble some sort of Michael Bay-directed cinematic adventure (with the addition of an adorable infant).

The total takeover of mind, energy and heart that a child brings has been... intense. But after a few months, I'm feeling that we're adjusting okay to this new version of normal. Our mornings look a little different, and not just because we're up waaaay earlier now - there exists a whole new set of activities that run in tandem with ours in order to get another human ready for the day. But I'm finding that I don't even mind all that, because that first grin of the morning - the one where the dimple in her right cheek surfaces; where her eyes widen, then light up with recognition when we lock stares; where she kicks her legs jubilantly and, with clenched fists, swings her chubby arms around - sets the tone for everything else. No matter what else may happen throughout the day, this daily treat remains the highlight. The joy in that moment fills up my heart, and I continue to be astounded at how this perfect little person could have been made by me.

Sorry, I'm baby gushing. I do that now.

While I may be adjusting to the shift in schedules and priorities, my relationship with my health has become more tumultuous. Diabetes is running alongside me like the child, arms flailing with panic, whose school bus drove right by them but never slowed down: "Hey! HEY!!! Stop the bus! You forgot me!!" I see you, diabetes - I just don't have the time to come to a complete stop for you. Don't throw yourself in front of me, okay? And no angry calls from your parents.

Where I once might have seen patterns and predictability, I now just see a jumbled mess... but maybe it's not as bad as I think it is, because I'm comparing it to the super-intensive routine I had during pregnancy. I saw my endocrinologist a few weeks back and after studying my CGM and insulin pump downloads for a bit, the corners of her mouth began to turn up.

"You know...." she paused, shuffling papers twice, and then three times, looking back to double (and triple) check herself, still smirking. "I'm actually really happy with where you're at." The tone of her voice indicated that even she couldn't believe she was saying that.

Pause. "I'm sorry... you're what?"

Laughter. "I mean, with most new moms, the baby comes and diabetes goes out the window. But I can see that you're still testing. And you're bolusing! I mean you're not entering carbs most of the time, but you're remembering to take insulin... at all. I can be happy with that if you are."

Well, that was true. And when we checked my A1C, she and I were both pleasantly surprised when I clocked in at 6.5.

"If you're okay with it, I really don't think we should make any changes yet. Let's let the dust settle a bit more before we start changing things - you already have enough to adjust to right now."

I'm okay with it.

I think.

Breakfast Woes.

"I think that's too many carbs for you right now."

My endo and I were reviewing several days' worth of Dexcom graphs, and it was glaringly obvious where my most consistent challenge lies: breakfast.

Overnight? Coasting beautifully. After lunch? No problemo. Dinner? Even that's not too bad. But breakfast? Breakfast is a jerk. Breakfast is a bastard who steals my lunch money and throws spitballs at the back of my head all morning. We hates it. We hates it forever.

"So what kind of stuff are you eating then?", my doctor asked. Every single day for the past handful of days, I'm soaring above 200 after my daily oatmeal, raisins, and glass of milk. It's a breakfast I switched to a couple of weeks ago as I had gotten tired of my usual egg casserole, and oatmeal is a breakfast I can eat while driving to work super easy and quick to make during my morning rush. I'm also trying to balance the whole "you're supposed to eat more whole grains and fiber and the baby needs carbs so quit low-carbing it at breakfast" thing, so I had thought oatmeal might be a good substitute.

It is not.

I explained, "I've been trying a different strategy pretty much every morning for the past week, without messing with my basal rates. Bolus early? High. Use an extended bolus? High. Up my insulin to carb ratio? High. Think about oatmeal? High."

"Maybe try something with some more protein? And let's increase your I:C ratio at breakfast, as well as inch up your basal rate a bit", she said, while I imagined her waving a magic wand.

And you know what? If improvement can be measured over just one day (it can't, but indulge me), she's right.

What's also encouraging is that my blood pressure measured lower than it has in years, my thyroid levels came back "perfect", my A1C result clocked in at a number my doctor and I were both pleased with, and I can't even get mad about gaining a few pounds since the last appointment because, hello, pregnant ladies do that.

I'm clutching to this moment where I feel full of win, and I'm running with it as far as it will let me go.

(Also, Baby Girl is moving around like crazy right now. She says "hi".) :)

Relief.

Some of the kindest words
this diabetic could hear:

"Your eyes look beautiful.

Nothing's changed from last year."

Nobody Panic; The Coffee Is Safe.

A small list of things, because that's how I'm rolling today:

• Blog stats tell me that the search term "pictures of awesome" frequently brings people here. I do post a lot of Billy pictures (and may have tried to put glasses on him last night to see what would happen - he wasn't okay with it), so I guess that makes sense.
• The building I work in is going to be experiencing some construction for the next two months - actually, it will all be happening on my floor, specifically. They're building a wall and a new door (with a swipey badge thing - technical terms, people) to close off my area, but this also means that we won't be able to access our break room for that time. My first thought upon hearing this might have been, "But how will I get to the coffeemaker???" Rest assured - they're relocating that, too. We're safe.
• In pancreas-related news, I saw my doctor again last week. I didn't realize we were checking my A1C until she told me what the result was. Although it's higher than I want it to be (7.1), it is unchanged from last time - and I'm counting that as a good thing. I can be okay with consistency. Onward!
• I can't believe I'm thinking about Christmas already. WHAT.

I also saw something on Twitter about diabetes flash mobs? Color me intrigued. And blue. ;)

I'm A Jumper.

"Nope, nope... that doesn't have anything to do with diabetes. It's just a normal thing some people have."

Whew.

For the last several months, I've noticed an occasional floater in my field of vision. It isn't always there, nor is it always there in any particular situation.

The only times I see it are at work; specifically, sometimes when I'm looking at my computer screen. But, not always then. It's just this bean-shaped blob that moves around with what I'm looking at.

Frankly, I'd been a bit scared about it.

My opthalmologist had seen a couple of microaneurysms in each eye shortly before I started using a CGM, which would have been in 2009. The technical term is mild non-proliferative retinopathy. In subsequent visits, he's told me that they've been healing/shrinking/running away scared, which is super, but it still scared the crap out of me that something was happening to my eyes. That I wasn't somehow immune to complications, after all.

I know it's a mild complication, but it had felt very major to me.

When I started seeing this floater, my mind understandably went to Worst Case Scenario - that 25 years of diabetes had finally started to take its toll. That my recent not-as-tight-as-before control was to blame. That I was to blame.

But I also told myself - if this was diabetes-related, wouldn't I be seeing it all the time? I guess that's the line of thinking that had me keeping my original yearly exam date, instead of scheduling the appointment for much earlier.

I didn't mind putting off the answer. If it was bad, I didn't want to hear it quite yet. (Yeah, I know.)

So when Dr. D asked me if I'd had any changes in my vision, I told him. I described what had been happening, and when. He took a look.

"Oh, no. No, your eyes look great. Actually, it looks like they're still getting better. That thing isn't diabetes-related. Some people just get those from time to time; you get just the right lighting or look a certain direction, and they show up for a little bit. Nothing to worry about."

Their opthalmologist must use
really strong dilation drops.

I drove home with my anime eyes, wanting to believe those last four words so much. But it's hard to put six months of worry into reverse so quickly.

And as for the title of this post - something must have been written down in my file, because when we got to the part where the thing touches your eye (I'm very technical with my terminology here), he had an assistant come in to hold my cranium against the head holster. Seriously; she applied force so that I couldn't react! (She was very nice and gentle with me, though. No rough-housing.)

I'm a jumper, apparently.

* * * * *

The winner of this week's Hope Paige Medical giveaway is....

Life as an Empty Nester!

Please send an email to textingmypancreas (at) gmail (dot) com with your name, phone number and email, so I can get you in contact with Hope Paige Medical!

Thanks to everyone who entered the giveaway - we'll do this again in two weeks.

(Comments were numbered chronologically, and I used random.org; a random number generator; to determine the winning number.)

The Power of Encouragement.

I had an appointment yesterday with D, my Fabulous P.A. (For those who don't know - she's who I see in lieu of an endocrinologist. It's a long story, that you can read about here.) She's the one who has high-fived me over A1C scores, helped me get a Dexcom, has been totally supportive of my blogging and DOC involvement, and has probably been the most emotionally supportive doctor I've ever had. She's totally worth the 45-minute waits. I'd also like to mention that her opening line to me at this appointment was, "So are you still 'texting your pancreas'?", said with a big grin. (I think she was asking if I'm still blogging? It was kinda cute, in any event.)

It was a by-week for A1C testing, but we did test my thyroid and other blood-dwelling numbers. "How's your pep? Are you feeling energetic? Because your thyroid looks perfect!", she told me. "All of these numbers look beautiful! Your blood pressure is back down, too. (118/80!) Let's take a look at your Dexcom print-outs."

Things looked pretty good there, pattern-wise. I'm running higher in the evenings, and I know I need to make some adjustments there to curb that.

"Are you still planning to do the half-marathon again this year?", asked D.

"Yep! I got a late start on my "training", but I'm getting out and walking lately. I've already logged 6 miles this week, and I plan to go out again a couple more times."

"That's so awesome! What a great role model you are. And you had your trip to DC, right? How did that go?"

(Editor's note: can you see why I love her, yet?)

I told her a shortened version of what went down, and how valuable and FUN that experience was. And then she asked me, "So what other questions do you have for me?"

"Well - I'm not really happy with my weight. I mean, I don't think my portion sizes are that out of whack, and I get a moderate amount of exercise... sometimes. It just feels like whatever I do, it never 'sticks'. And no matter how much I try, the weight doesn't come off as quickly as I think it should, you know?"

"That's something we could work on - although, you're still wanting to be pregnant soon, right?"

"Right."

"So, here's my view on that: while yes, it will benefit you to lose some weight, I don't think that should be our priority for the near future. (I love that she said "our", by the way.) Weight is something we can definitely work on, but right now I want you to keep eating healthy and focusing on getting your mind and body ready for pregnancy. Losing weight would be good, but when you become pregnant, your way of eating and exercising is going to change up - so I don't think that's something we want to focus on right now."

Or something like that. I don't recall exactly how she phrased it.

"All of your bloodwork looks great, so the weight isn't something we NEED to focus on, for the short term. But keep training for that half-marathon, and I want to hear all about it in June!"

We also discussed, for probably 20 minutes, her upcoming wedding (less than 2 weeks!), and how weird it will be for her to have a day off while she's healthy. I assured her that it will be a vacation well-deserved. And she told me that every time she hears about wedding pictures, she thinks of me.

I love that I have a doctor I can chit-chat with; that acknowledges the power of PWDs connecting with each other; that takes the time to know me as a person, as well as a person with diabetes.

Appointments with her don't have the leading-up-to-it anxiety that I used to feel. Time with her feels comfortable, and I know that even when I struggle, she gets that diabetes is hard work, and that I'm doing the best I can. She's there to jump in when I need it, and back off when I don't. She cheers me on, and cheers me up when I'm being hard on myself.

In short? She rocks. :)

D'oh.

I realized on my way in to work today that I forgot to do something very important.

My "endo" visit with my P.A. is today, and I don't have anything printed off or downloaded to hand her - no CGM data, no pump settings, no blood sugar logs.

"Awesome".

Then, as I was downing my morning coffee and getting signed into everything at work, I realized I hadn't bolused for that coffee (and loads of creamer). And so, I tweeted about it.

Five minutes later, I remembered:  I still hadn't bolused for that coffee.

Can I go home, go back to bed, and start today over? Please?

(At least I remembered to refill my pump before leaving the house today... something tells me that the two units I woke up with wouldn't have cut it.)

Rules.

One of my friends on Twitter, Sarah, was having a rough morning, BG-wise and ketones-wise.  I sent her some reassurance, and the whole situation got me thinking that we need some ground rules on what to do when diabetes is being naughty.  We need to know what is allowed, and what is encouraged.  I came up with a few Diabetes Rules... That I Just Made Up.  Please feel free to add your own in the comments section.  :)

• You are allowed to yell at your blood glucose meter.  You can do this when you think it's wrong, when you don't like what it's telling you, or when it's Tuesday.  This is especially appropriate when that jerk tries to be all friendly and chipper, with a greeting like "HI".
• Calories consumed while overtreating a Holy Crap! Low do not count. 
• If your hand is shaking so badly due to hypoglycemia that you can’t hold a mirror still, maybe it’s a good day to skip mascara.
• Shutting down an annoying and inaccurate CGM receiver is totally legit.  I mean, that little guy probably needed a nap anyway.
• When you are at your endocrinologist's office, you need to have them celebrate your accomplishments with you.  A1C under 7?  High five.  Under 6.5?  Exploding fist bump.  Under 6?  Free puppy!
• When you hit 300 mg/dL, cursing is not only allowed, but encouraged.  I’m pretty sure it helps flush out ketones, too.

Is It Just Me?

"Wilson - surely, you must also have atypical
basal insulin needs."

I've been doing what I've been doing so long, that I sometimes forget it's not "typical". 

My P.A. and I have been tweaking my basal rates for several months, and finally have things to a point where I'm not consistently running low or high anywhere; i.e. I'm at the basal rate I should be for that time of day and will mostly have in-range, predictable numbers, SWAGing notwithstanding.

It didn't occur to me that my basal insulin needs were out of the ordinary until I saw a CDE last week.  Since I haven't been to an endocrinologist for two years, I haven't had access to a CDE, either.  I've pretty much been winging it, and the numbers seem to suggest that it's been working well for me.  It's a very detailed system, and took months to figure it out, but it works.  And I'm okay with that.

The CDE, however, was not okay with that.  And now I'm wondering if I should still be okay with that, too.

This CDE knows her stuff.  It turns out that she was actually the one who trained me and worked with me on my first insulin pump at Dr. B's office (which she doesn't work at anymore).  She's very knowledgeable, and given our track record, I'm comfortable with her.  She knows what she's doing, and I mostly trust her.  (I say mostly, because when it really comes down to it - I know my body best.  I've been living with this for 24 years, and I know what will work for me specifically, and what won't, in most cases.  I reserve Veto Power.)

Here's the deal:  I have a lot of basal rate changes Monday - Friday.  Twelve different rates, to be exact - which is also the maximum amount that the Ping will let me program for one pattern.  I didn't think this was weird - I mean, they give you up to 12 because some people will use that many, right?  I have scheduled exercise twice a day, and instead of eating a snack, I have a reduced basal rate programmed in there to accommodate that exercise.

Once the CDE and I had gone through my pump settings, and she had everything written down, she sat back.  She looked at the paper she had just written all over, and said, "Wow.  Um... wow.  This is going to be challenging." 

Her thoughts were that I was working with too many variables.  That, if I could get myself down to no more than 6 rates during those weekdays, life would be easier, because adjustments could be made more easily.  The "less is more" approach.

I can see where she's coming from, and part of me can agree with that.  But, I also look at the side that says, "But this is working for me right now!  I don't want to mess it up!"

I will hopefully be seeing my P.A. on Thursday of this week, and I'll see what her thoughts are.  The CDE said she'd call my P.A. and talk through what she told me, so at least I don't have to go in and explain what she's talking about.

So...  I'm wondering, from my fellow pump users - how many pre-programmed basal rates do you use on a typical day?  Does anyone else go into the double digits, or is it just me?

(P.S.  You may be asking why I went to the CDE in the first place - if it isn't broke, don't fix it, right?  Well, maybe I'll have more of an explanation on that another day.  Cliffhanger!)

Victory Is Mine!

Today was the Big Day.

At least, to me, every time I get my A1C checked, it's a Big Day.

As I've discussed before, I have mixed feelings about the amount of importance we place on A1C results as the sole indicator of control.  I've worked so, so hard on keeping my numbers as close to "normal" as I could in the last three months, but I know that my A1C doesn't mean I was "good" or "bad" - it's supposed to be viewed as just another number to help me determine which way to go from here.  However, I still can't keep myself from feeling like I'm getting a report card - and when I get a report card this great, I can't help but show it off to a few friends.  (That's you!)

6.5!

This is huge!  For those unfamiliar with A1C testing, here is a brief explanation, courtesy of the CDC's website:

[An A1C test is] A test that sums up how much glucose has been sticking to part of the hemoglobin during the past 3–4 months. Hemoglobin is a substance in the red blood cells that supplies oxygen to the cells of the body. The AIC goal for patients in general is an AIC goal of less than 7%. The AIC goal for the individual patient is an AIC as close to 6% as possible without a considerable amount of low blood glucose.

So, I'm finally in range.  I haven't had an A1C this low in a long, long time.  In fact, my P.A. printed off for me every A1C I've had while in their care, and they've usually been in the lower 8's.  In April, I had a 7.1, which I thought was GREAT - and now, I've graduated to the 6's.  It's a great feeling.  You know what else is a great feeling?  Getting high fives, congratulations, and "We're proud of you!"s from your medical team.  :)

My Insulin Pump Story, Part One: How A Tiny Robot Threatened My Mad Ninja Skillz.

I orginally intended to do one long post about my process of accepting an insulin pump into my life, and how I wear it.  But, like usual, that got me going on other semi-related points, and before I knew it, it was going to be a small novel...  soooo...  I'm breaking it into two parts, spread out over two days.  You're welcome.

******************************************************************

Prior to actually wearing one, insulin pumping was never something I was all that, er, "pumped" about.  (HA! I love D-humor.)   

The idea of me actually wearing an insulin pump was first brought up to me in 2004, by a new endocrinologist I started seeing (Doctor B).  He was all about technology, and I was very comfortable with my injections, thank you.  Even making the move to insulin pens from syringes and vials had taken some coaxing.  I mean – this would be a big step.  And one I didn’t feel prepared to take.  The only times I’d seen someone wearing one, they had it clipped to the outside of the waist of their pants, and I really didn’t like how that looked.  Not very subtle, right?  I dreaded the idea of having to have it “on display” all the time.

As I’ve said before, sometimes I like to be discreet about my D.  A diabetic ninja, if you will.  I don’t necessarily want my robot parts to be the first thing someone notices about me – I’d like to have the say-so in who knows and when, in some situations.  Job interviews, or meeting new people for the first time, for example.

Another reason I had for putting off getting a pump was dating.  It sounds ludicrous to me now, but I thought any guy who saw that a machine was attached to me at all times (albeit, a small, life-saving machine) would be turned off.  I was scared that no one would want to date me while I was wearing that thing.  I made a deal with myself that once I was in a stable relationship, I’d give the insulin pump idea another look – but not until then.  I really wasn't giving myself enough credit - or looking at it from a logical standpoint.  Because, really:  anyone who doesn't want to date you solely based on the fact that you wear a piece of equipment that helps you stay healthy isn't worth dating in the first place.  Would I really want to be with someone like that for the long haul?  Would I really want to live the rest of my life with someone who values appearance over health?  That would be a long, hard road to walk with someone.

Destiny spoke in 2005.  I started dating my now-husband, A, in January of that year, and our relationship might be the only good thing to ever come out of MySpace.  I was browsing through my friends' friends one day, and came across a picture of a guy with a huge beard who was playing bass guitar (and seemed to be having a lot of fun doing so).  I thought "Hey, this guy looks like fun.  And he's cute.  And he plays guitar.  Friend request!"  A and I chatted online for a week or so, and got along really well.  He invited me to come see his band play, I did, and we were inseperable from pretty much that moment on.  He has an infallible knack for getting me to burst into giggles, he's the most patient and easy-going person I've probably ever met, and he gives one heck of a great hug.  How could you not love this man?

By the end of that first year, I finally started thinking that an insulin pump might be kind-of okayish.  I knew that my A1C needed improvement (I had been consistently hanging out in the 8's and 9's), and I was told that a pump could help me with that.  I still didn't like the idea of being attached to something at all times, but I knew the benefits would probably outweigh the inconveniences.  On a few occasions, I’d brought up the idea to A, and he always said that “If it means you’ll be healthier, I think you should do it”.  (That's how you know you have a keeper!) 

I worried about what others would think of it.  Would I get stares?  Would people even know I was wearing one?  Was I being too paranoid about this?  (In most cases, the answer to that last question is "yes" for me, but I still think it's a valid concern.)  I didn't have anyone else to talk to at the time, to ask real-life questions of.  Having someone like that to talk to probably would have coaxed me into trying an insulin pump sooner, but that's just how it went.  I finally caved, my doctor did the footwork required, and I had my Deltec Cozmo insulin pump.

My next issue was... where the heck do I wear this thing?

Choices In Care.

I'm interested to hear what other T1s do for their care - do you see an endocrinologist, or someone else for your diabetic care?

To my understanding, most diabetics (type 1, at least) see an endocrinologist for their primary care.  (Endocrinologists specialize in the diagnosis and treatment of conditions affecting the endocrine system.  The endocrine system is made up of glands that secrete hormones which regulate the body, through the blood stream.  Insulin is one of those hormones, and because diabetes - type 1, type 2, LADA, gestational - is such a prevalent thing, their focus tends to be on diabetic care.) 

It makes sense to do this.  They are the doctors most likely to be up-to-speed on the technologies we have available to us.  They should have plenty of experience to draw upon, and be able to keep an eye open for other auto-immune diseases.  They are supposed to be the experts.

Everyone has to decide what the right decision is for them, for their own particular situation, when it comes to who you see and how often.  I've been through 6 (I think) endocrinologists in the 24 years I've been diabetic - and some were great.  I am especially appreciative of the one who finally caught onto my hypothryoidism - he really saved my life, quite literally.  My childhood endocrinologist was good, as well - I don't remember much about him, but I do remember him being a friendly, kind man. 

On the flipside of that, however, are a couple of endos who didn't quite cut it.  They missed important red flags.  They were derogatory and sometimes downright mean.  I got to the point where getting to and leaving appointments with one doctor in particular caused me extreme anxiety and stress.  (How does any of that, in any way, help my overall health?)  I won't name names - their reputations are consistent and easy to locate.  Anyone who lives around where I live will be able to find their names, if they so desire.  The inability of either one to provide quality, considerate, and meaningful care was the catalyst for me to find another way.

Doctor A failed to diagnose (or maybe even think to test for) my thryoid condition.  In addition to Type 1 diabetes, I also have Hypothyroidism, which basically means my thyroid gland is underactive.  It's an auto-immune disease, just as type 1 diabetes is.  The two aren't technically related, but it seems to be that once you have one auto-immune disease, you're more prone to developing others.  Anyway - I digress.  The thyroid thing should have been an easy diagnosis - and yet A never caught it.  I experienced a large shift in personality, became depressed, my hair thinned out, I'd get ridiculous muscle cramps, and I could never sleep enough.  All of the classic symptoms.  No bells rang, apparently.  I also got reprimanded by A, though I will admit that my care (or lack of it) was asking for it.  I can recall getting an A1C result of close to 13.  That means my average blood sugar was almost 340.  The only memory I have of this doctor is being asked the question "Are you trying to kill yourself?  Because you're doing a pretty good job so far."  While I can now appreciate what she meant by that, Former Kim didn't want to hear that. 

Doctor B was my the last endocrinologist I saw.  B was very educated and proactive.  B is the endo who finally got me on an insulin pump five years ago, even if B didn't let me choose which one I could get.  I had been reading about the Minimed pump, and decided that was the one I wanted, but when I brought it up in my next appointment, B told me I had to get the Deltec Cozmo, because that's the pump they were familiar with.  (But, won't I be the one who has to live with and operate it every day?  And you'll only see it every 3 months?  Oh, I guess that doesn't matter.)  B also found the right combination of thyroid medication to get me feeling energetic again - so I am always thankful for that.  However, B had horrible manners.  Not the normal pleasantries - those were there - but the way B worded things.  B also never really taught me anything.  My insulin pump would get whisked away, reprogrammed, and handed back to me.  I'd hand B my blood sugar results for the past two weeks (all hand-written, on the ridiculously annoying forms B had self-designed, because they were "easier" to read.  My insulin pump had software that made everything downloadable and printable, but B didn't want to see any of that.), B would make adjustments, write them all down, and send me on my way.  No excess amount of time was ever spent on me.  I'd wait for 45 minutes past my appointment time, only to get maybe 10 minutes of B's time.  One of the last straws was when B told me I was "obese", and suggested I go on the South Beach diet.  While that may have been true under the clinical definition of the word, there's no reason to use that particular word.  You know what?  I realize I weigh more than I should.  I have a mirror, and I can see the sizes of clothes I buy.  I don't need you telling me any of that; it's not helpful.  Why couldn't I say that to his face?  And why, if that was his opinion, couldn't he set me up with a nutritionist or CDE to set up a food plan, instead of just telling me to "go buy a South Beach diet book"?

Okay, enough rambling.  My point is that my other way, instead of seeing an endo, is seeing an internist and a P.A.  The internist and P.A. are in the same office, and work with each other on my care.  I see the internist once a year, and the P.A. every 6 - 8 weeks.  And it's GREAT.  Really, I've never been so happy to go to doctor appointments.  Both of them have such great attitudes, and are willing to listen to me and what I know about my condition.  They accept feedback and suggestions from me on my care.  It is just absolutely a breath of fresh air, after years with B.

An unintended consequence of not seeing an endo is that I am now more educated and up-to-date on diabetes care than I ever have been.  I have to be - while they do have other T1 patients, they don't specialize in diabetic care.  As a child and even into my teens, my mom was the go-to person who shouldered much of the burden with doctor appointments and dosage decisions.  (Mom, correct me if I'm wrong.)  As a college student and for a bit beyond that, no one shouldered it.  I simply lived as though injections and sporadic blood tests would do the job - which makes it no surprise that I saw that really high A1C I mentioned before.  So, the past few years with this new medical team has been a brand new experience.  There are even some cases where I'm more knowledgable on a particular topic than they are!  For example, the Dexcom CGM I got was the first Dexcom that office had seen.  I actually have gotten to teach a few people on my medical team about how it works and what it's capable of, which I think is kind of fun.  When I wanted a new insulin pump, and explained the benefits to them of the particular one I wanted, they were more than willing to do the footwork to get me one. 

Switching to an internist was really the best decision, for me, that I could have made.  It's forced me to take more responsibility for my own care, and I wish I could have jumped on that bandwagon long ago.  I guess it just wasn't my time yet to do so.