Endo Notes

A1c

The A1c technician had scrubs in a lovely shade of orchid. We appreciate solid color scrubs in pediatric medicine. In the hospital we encountered Spongebob Scrubs, which made the whole scene feel like a really tedious birthday party BUT WITH IVs.

Yesterday = quarterly Endo appointment.

As usual, sift through scrawl after appointment, try remember new tips re How to Be.

Rate of Digestion

He seems to digest his food slowly—it seems like it takes more than two hours. (Do you mean the insulin peaks after more than two hours?) No, I mean the food continues to affect him for more than two hours. But that could be good. It could mean he is not eating a lot of junk food…

BUBS: I love junk food!

…because you know, we’ve learned that high fiber foods stay with you longer, provide a more sustained energy source.

What to make of Bubs’s allegedly slow digestion? Seems normal digestion for Bigfoot science because food/insulin both last approx-but-longer-than 2 hours. Was this some endocrinological mutterings or was information for use? And if latter, what use?

4′ 9.25″/ 77.8 lbs.

Hmmh. He has grown taller, but has not gained any weight since last time; and that time he had lost some weight since the previous appointment. (And is that ok?) Yeah, it’s fine. He’s probably just very active. You might want to try to give him more to eat, but look at him: he is not skin and bones. Well, maybe try to feed him more but don’t worry about it. His BMI is still normal.

Again: this A Thing? This mean maybe not enough insulin for body store new muscles/fat? Seemed more like casual front-porch musings than actual directive.

Thyroid

Yup, thyroid’s still there. No need for any hormone replacement yet.

Damn! Should have asked if allegedly slow digestion is thyroid clue. But then would gain weight—like Oprah.

extreme close-up of FINGERS

extreme close-up (FINGERS)

Callouses

Dexcom buzz w. blood drop icon while in appointment, Bubs test for callibration. Endo notice Bubs’s Fasclix method of click-click-click instead of just one click at deeper setting. Bubs likes setting 2.5, even though takes multiple tries. Bigfoot use 3.5 @night, just one pop & DONE. Endo agog: Bubs, you should not have to poke yourself that many times! Doesn’t it hurt? (Bubs shrugs not really. That’s just how I like to do it.)

Then endo examine fingers. Did you know that you should never be ashamed of your callouses? They’re what makes it possible for you to get pokes that don’t usually hurt. Then this: See this? He’s getting too close to the center. Bubs, you shouldn’t be poking here. Go more toward the fingernail, stay to the outside. There are so many nerves at the center of your fingertips and you don’t want to create nerve damage.

Well, shoot. Everyone know that. Learn in hospital. But sure enough, examine Bubs’s fingers up close, callouses creeping toward center. Sorry. Maybe some benefit if become classical guitar player?

Dexcom G4 Platinum

Apparently Bubs this endo’s 1st patient w. DG4P. Marvel at size. Report transmitter much larger than Medtroinc’s transmitter. Does it bother you at all?

BUBS: No!

ENDO: Not even when you’re sleeping?

BUBS: Nuh-uh

ENDO: Do you wear it all of the time?

BUBS: Yup.

ENDO: Doesn’t hurt?

BUBS: No

ENDO: Does it hurt going in?

BUBS: Nope

ENDO: It is kind of a pain having to carry another device?

BUBS: I don’t care

ENDO: You have to carry it like a necklace?

BUBS: Or on my Spibelt with my pump

ENDO: Do you ever feel like you could do it like some kids wear it for three days and then take a break for a month?

BUBS: No, I like it.

While underway, questions seem kind of geared toward DG4P disillusionment, but afterward realize maybe questions are for help Endo know what tell other parents/kids. Tell them like Macklemore: This is hmm-hmm awesome.

Bolus Insulin/Basal Insulin

Vaguely remember ideal is maybe keep amounts pretty even? Like…if 9 total units basal/day, should bolus 9 units/day. That even true? But as Endo delve into unknown areas pump, notice bolus much more than basal. One day he bolused 22 units! So make some adjustments: oomph up morning basal, decrease breakfast insulin. Also decrease dinner insulin from 1:15 –> 1:18. Like that.

Sites

His sites look great. Perfect. You can keep using just your bum. That’s fine.

A1c

6.1. That tiny peep higher than last time. Probably insignificant.

They Just Keep Coming

On way out, endo call in next patient. Sweet little mocha cream puff of girl dressed in hydrangea shorts-tank top, foldover ankle socks, sneakers/dark circles-eyes mom/actively weeping abuela clutching crumpled tissue wad.

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10 responses to “Endo Notes

  1. Yeah, they (whoever “they” is) say that the daily bolus and basal totals should be about equal. On most days, my total bolus is double my basal amount. On some days, it’s triple. It’s been that way for years.

    So deal with that, so-called-experts. It works for me, and since it works I’m not changing it.

    (Oh, and I tried folding a tablecloth the other day, and you could HEAR my fingertip-callouses scratching along the fabric. Sort of like fingernails on a chalkboard – I thought I was going to rip the thing. Not sure what my point is, but I just figured I’d mention it).

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  2. Karen

    Had similar experience with basal/bolus at our endo last month. Increased basals a good bit. Result? Lots of lows. Rarely highs…if highs, they are very short-lived. How do I feel about this? With Dexcom G4 and me homeschooling her we can do this. Otherwise, wouldn’t work..would have to decrease basals. Also…even less sleep for mom as Dexcom alarm a lot some nights..not all though. Some nights very pretty parallel line close to the 80 line. Also, full disclosure..we are still in the adjustment phase of her meds after hypothyroid dx at December appt. So that could have something (a good bit, possibly) to do with it. ALSO, we use the one touch Delica lancets because of their super-fineness. I HATE the lancet device. It is awkward and cheap-feeling and if dropped on hard tile floor the twist off part will no longer stay twisted on. (luckily I had 2). BUT…we continue to use because after we started using them her fingertips improved dramatically. And she no longer wants to use anything else..because they feel that much better to her. Just and idea, of course, 🙂 (YDMV and all:))

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  3. We love cgm too…everyday….and 6.1 is AWESOME!

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  4. Ella’s basal to bolus ratio is 40 to 60% if she eats normal and more like 25 to 75% if she eats a lot of carbs. It works for us. If I increased her basal she’d go low in between meals. So take that, experts.

    Ella rocks the double click with the fast clix! Her left middle, ring & pinky fingers were getting really bad so I wrapped them in polysporin and bandaids and told her to give her right hand some love. I also slather her hands at night with polysporin and make her sleep in gloves. Have no clue if it works but it makes me feel better.

    I told Mr. Nurse the other day that her callouses will help her become an awesome guitar player when he gave her a lecture about not testing on the middle. She’ll also give one heck of a back scratch. Who needs to fingertips to feel, anyhow. She hates the sides – says they hurt more? It’s her fingers. If she chooses the middle, so be it.

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  5. Oh my God, if my doctor ever told me to prick a different part of my finger I’d probably lose it on her. Honestly, of ALL the things one has to do to live with diabetes we’re going to talk about poking placement? I’m sure it was all said with good intentions, but I wouldn’t lose any sleep over where Bubs tests.

    BTW – I’m suddenly obsessed with pre-bolusing based on Melissa’s post today. http://www.sweetlyvoiced.com/2013/04/tidbits-and-tricks.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+SweetlyVoiced+%28Sweetly+Voiced%29 Do you guys pre-bolus a lot?

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  6. My basal is way less than my bolus,but I eat a lot (too many) carbs. More carbs = more bolus insulin, right?

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  7. Karen

    This post and it’s comments are very informative…Thanks!! the DOC is AWESOME!!!!:):):)

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  8. Julia

    A1c is awesome! Your son has no problem accepting wearing two sites. That’s excellent. If endos would start pump and Dexcom together or soon after each other I believe most kids would wear both. Unfortunately our DD was pumping for years before Dex came out and fights wearing two sites. And, no, not because it hurts…. just because she psychologically does not want to wear two sites. I’m hoping this will change once she is out of the teen years. Once young children wear both they will accept it as a matter of course, I believe.

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