My hubby asked how my visit went today and my summary was, "Well...we did a lot of 'discussing' (you know, 'nice' arguing)...the kind when two people both have something to say and both know they are right." :)
Here's what we "discussed"...
Let me say, however, that I would not have been able to handle working with him either 1) before I recovered from my eating disorder and all the emotional issues that went with it; 2) early on in my raw food journey; or 3) early on in my fruit-based raw journey. He is so convinced that his way of doing things is right and that the fruit-based diet can't be, that his words and demeanor could easily "crush the spirits" of someone not as confident and experienced in it as I am.
I have a very strong spirit (aka "stubborness"), which I am sure has greatly aided in my ability to persevere in this lifestyle despite nay-saying from so many people, especially my diabetes doctors. Despite this, I still cried today...though not for the whole visit, as I did in years past with diabetes doctors.
There was a lot of "chatter" in my head as I left the visit, reviewing what had happened in there. The predominating thought was, "He has NO IDEA how hard I work at health & diabetes control. Absolutely NO IDEA." He thinks I eat a lot of carbs because...why? Because I can't control myself? No way. Eating the diet that most of his patients eat would be WAY easier and WAY cheaper; it requires way less discipline to eat the animal-product & cooked food diet I have eaten my whole life. I work my butt off to eat a fruit-based raw food diet, and I do it for my health.
I have no resentment or ill feelings toward my doctor, and I didn't have any the whole time I was there. I don't fault him; it is his training in the medical community. He honestly thinks he is doing and saying the right thing and looking out for my best interests. He really is a good doctor. He was even smiling and friendly when he walked in the room today. :)
He never was unfriendly. I could tell he was just frustrated. Probably frustrated because I didn't seem to be listening to him. The problem was, I was listening, and what he was saying was the opposite of what he said the last time I was there. Here's how it went down...
Doc came in, greeted me, asked about any recent problems, and how I liked the new Dexcom G4. (The medical assistant had already told me that it downloads WAY faster, so they like it better.) I shared my thoughts and we had nice surface chatter. :)
He told me my A1c was fantastic (5.9). He doesn't like them to be much under 6 because that tends to mean a lot of hypoglycemia. (I personally would like it to be lower, since I am now aiming to get it ultra-low in order to get rid of my diabetic retinopathy. However, I was happy with a reading under 6, and was not surprised that it was .3 higher than last time's 5.6, because these three months have been newly dealing with added fat--thus higher blood sugars--in my diet.)
I then asked about my other lab results, and he handed me a printout (that was nice, since I usually ask for it and he gets me a copy as I am going out the door, so he thought ahead of time to print me a copy). :) The main thing I was looking for was the cholesterol results...which I was so excited to see! We had a short conversation about that, which I will cover in another blog post.
He did the routine shine-the light-in-my-eye and breathing/stethoscope checks, then we looked at the CGMS results printout.
I had switched over to the new CGMS only 9 days prior, so the printout had only 9 days' worth of info on it. I asked him to please look at the info from my other CGMS, because I did not believe the last week was representative of the last 3 months. I told him that I had eaten 3 fatty meals in the past 9 days that I normally wouldn't, and that affects my blood sugars for 3 days.
He didn't really want to, since they were having to charge my old CGMS (since it hadn't been used/charged in so long) and it would take an extremely long time to download (just how the older CGMS works). But he agreed to, so I just sat and waited while he saw another patient--she was in and out quite quickly. Hahahaha. :)
We had the same discussion while looking at the 9-day printout as we did while looking at the printout with more readings. It turned out that the last 9 days had actually looked pretty similar to the previous 3-month and 1-month printouts. I guess that's actually a good thing! That means that I handled the extra-fat days well, by just not taking my EFA supplements for a couple of days following, until blood sugars evened out. So if I want to deviate and have a high-fat meal once in a while, it's really okay--I handled it well, according to the printouts. :)
What was apparent from the CGMS printouts was that my average blood glucose was 146. My doctor was pretty happy with that. I was not. He said that my last 3-month printout had an average reading of 116...which I liked much better.
He said it looked like I hadn't been dropping low as much (which he liked, because he doesn't want me to risk death by hypoglycemia). True. I have been running higher with the fats in my diet, because they slow blood sugar rise and slow blood sugar drops. When I am high, I am high for a longer period of time. But true, I don't get the high spikes and quick drops that I did without the fats.
He noted that I am consistently high during the nighttime, and I agreed. We had a lot of back and forth about what he thought I should do, what he thought the cause was, and me clarifying. I am sure he sees a lot of patients, which is probably why he didn't remember things we have talked about in the past...the same discussions.
Perhaps it was frustrating to me because, since he (like me) is also stubborn and "knows he is right", the discussions get long (thus my long visits). It is fine; I don't mind. It is just that I had hoped he would remember what we had talked about regarding this....I mean, I'm not exactly his average patient so I would think it would stand out and be memorable. So we had the same long discussion as we had last time.
I again told him about how fats affect me for days, how they keep my blood sugars higher longer, how I am more sensitive to insulin with less fat, how eating large amounts of carbs don't digest all at once, and with the inexact science of estimating carbs in varying fruits, I can get high blood sugars a couple hours after eating (when I have fats in my system).
While awake, I can keep an eye on this, but once I go to sleep (if I have eaten close to bedtime), my blood sugar will rise over the next few hours. Preferring to have uninterrupted sleep, rather than have my CGMS wake me up as it is rising, I let it rise until I wake up between sleep cycles to pee, and then do a correction bolus.
He wanted me to raise my basals, and again carried on about how my levels were probably too low overall, and I again explained in detail how the levels he thought would be right for me were too much, that I had done fasting and lots of testing to figure out the correct basals, sensitivity, and insulin:carb ratios. He didn't believe me because he couldn't believe they could be right.
I told him, during both discussions of the matter, that last time he wanted me to correct these high blood sugar tendencies in my bolus settings, not in basal. I tried to point out that he was telling me the exact opposite of what he had said last time, which was why I was raising objections.
I think he finally heard what I was getting at. He said that, well, because of that tendency which seems consistent, that he thinks I should raise my basals even though the high is being caused by carbs, not by insufficient basals.
I reminded him that at my last visit, I had been just starting adding some fats in to my diet. (I did not go into the essential fatty acid deficiency thing, which he had poo-pooed last time.) I explained that my HbA1c was higher, my blood sugars were out of target more often, and I got meal rises a few hours afterward due to the addition of the fats. I told him I had to do it for health, but I was still trying to get the blood sugar management perfected.
I think he remembered this when I brought it up. I told him this is what I have been trying to figure out, and why I am getting the nighttime highs. I mentioned that this has been hard to figure out by accounting for it with boluses, but I have been doing my best. So I asked again if he really thought I should account for the effect of carbs by adjusting basal, not bolus, and he said, yes, in this case.
I asked if any other of his patients (which he had reminded me, none of them eat anywhere near the amount of carbs I do) account for the effect of fats with increased basal, and he said no. He said that if I insist on eating this way, which he does not think is the right thing to do, then I should do that. He did say again that for how many carbs I eat, I have remarkably good control--that I somehow make it work, but he doesn't like my eating choice at all.
He started to give his opinions about how ridiculous it is for me to be eating 450-600g of carb per day. He said if I asked any other type 1 diabetic, they would think I was crazy, and there's probably nobody else doing this. I said, "Yes, they do think I am crazy; and yes, even though there are a few of us doing this, we are rare."
He said (paraphrased), "Well you are finding a way to get basically good control with doing it, but why do you insist on it? Eating lots of carbs is not at all the right way to be managing diabetes." I told him that yes, it is harder, but I am seeing other healing in my body from eating a fruit-based raw food diet, so it is worth it to me.
He said, "Other healing? Like what?" I told him about the fact that I am off my epilepsy medication now and no longer have seizures with low blood sugars. He said, "Well, you probably aren't having as low of blood sugars as you had before." I told him my blood sugars are running lower than before! And that I always kept my blood sugars high before because I didn't want to risk having a seizure, but that now I am taking the risk, and despite having very low blood sugars at times, I am not having seizures. He said, "Well that's great that you aren't having seizures any more, but I doubt it is due to diet. The brain changes." Mm-hmm.
He brought up the "there are no big studies" thing and the "one person's story doesn't make something true thing...you can't just listen to what people say out there. Again, I don't fault him for his perspective; that is how he has been trained.
Then we got back to talking about the overnight highs, and he asked about my middle of the night corrections--how much insulin I did--and I told him, well, I do 1 unit to bring me down 100mg/dl, so whatever that amounts to for my blood sugar. He said, "Oh yeah, you are really sensitive to insulin; that's right."
We again covered the ground of the insulin:carb ratio, his recommendations, me trying that, it being too much insulin for me, causing me to drop low, doing lots of testing & analyzing, and coming to the levels I have now. I told him that without the fats, my insulin:carb ratio was 1:22 and now with the fats, it is 1:18. He slowly started to believe me. I think I probably should have mentioned that my insulin:carb ratio used to be 1:10. I was not always sensitive to insulin; it happened on the fruit-based diet.
He then did the prescriptions stuff and I thanked him for his feedback and said I would think about it, and he said that all he would ask of me. I am supposed to see him again in 3 months...the time period he uses between visits for patients who are in poor control. :) I like going every 3 months, though...keeps me aware of what is going on with my diabetes management, and keeps me on my toes and working toward better and better readings.
So now my homework is to try some experimentation with overnight basals. I did tell him I had been doing temporary raised basals on the high-fat days. So I guess I will play around with it some more...which means I will need to get back into my EFA morning routine, which has been off lately, due to the high-fat meals I have eaten here and there.
So, overall, it was a good visit. My lab results were ALL within range. My HbA1c was good (though not as good as I would want). My average readings were not bad. I got productive feedback on what I can do to improve my control. And I got to challenge some of my doctor's views by exposing him to a little more of the raw food world.
Of course, I wouldn't ask for the angst parts. But, I feel I am doing my part to speak truth, and to do the hard (and right) thing for me, whatever that means for interpersonal and doctor relations. And he really is a good, smart, experienced doc that I very much appreciate.
So, on the whole, I am happy with the visit. :)