Recap: Virtual Endo Consult

Originally posted December 2007...here it is again, for your viewing pleasure. Especially relevant after a humongous T-Day meal.

Press "1" if you're experiencing a health question or concern.

Press "2" if you'd like to speak with a nurse(sometime in the next month.)

Press "3" if you'd like to schedule an appointment.


1. Hello, this is your virtual endo speaking, how can I help you today?

-My blood sugars are whacky.(A)

-I have another D concern.(B)

-I'd like to know the results of my latest & greatest
a1c test(C)

-I'm bored, and I just wanted to know if you would
tell me again if avoidance of that box of KK donuts
will absolutely add another 5 minutes to my life or
if I just go ahead and live it up.(D)

-How much is this consult going to cost me??(E)

2. You have reached the message box of EMT-B Heidi.Please leave your name,email,and credit card number + we'll get back to you asap.Thank you.Sorry if you expected to reach a real doctor,that ain't happening. But if it makes you feel better,someday I will be a nurse,if you plan on sticking around that long.

A. Press (!) if you're over 600 mg/dl
Press :-((((( if you're under 40 mg/dl
Press :) if you're perfect
B. Choose your concern:
A1. Complications
B1.Insurance Woes
C1.My Neighbors Cat
D1.Everything else.

C. ER, yes. Ok, now enter your Medic Alert number...

D.Dude, KK is ALWAYS worth it.That's not the ADA line,but its what you wanted to hear,right? So go ahead and bolus well,don't let D dictate your life.Just remember,all things in moderation.

E. It all depends.So far,$10 per word,or a measily $2000+. Keep reading.

(!) So you're high.Wayyy too high,as you well know.How long have you been this way?
!1 under 2 hours
!2 2:4 hours
!3 4 + hours

!1Check ketones..troubleshoot pump.Take injection immeadiently.Recheck ketones+ bg, in a couple hours.
Drink tons of fluids.

What are you now?
J1moderate ketones,250 mg/dl
J2trace ketones, 200 mg/dl
J3moderate ketones,300 mg/dl

J1 You're not out of the woods yet.Keep drinking fluids,sugared as well as plain,to replenish calories.Take additional boluses,as needed.

J2 You're fine. I don't care if your stomach is throbbing fit to beat the band,ketones are nasty little buggers + thats to be expected.You're out immenant danger. Plus,you probably just have a little stomach virus.(its always a stomach virus!)Nothing for us to waste our valuable time over.

J3 Take more insulin.NOW. Go back to !1


!2 Repeat J1,call if bg not coming down.
!3 Go to the ER(if ketones not coming down).That's assuming you're still conscious.

A1-B1. Worried about complications,yes,we feel your pain.America is eating itself to death,T2 and T1 is on the rise,and many people can't even afford basic meds.
Keep your chin up,and do the best you can, that's all we can say.

C1 So,your neighbors cat does its business all over your front bushes?It very likely may have diabetes.See if you can get a dipstick reading off it..and if its positive,you have your answer right there.

2C- 00000000000001
Your latest a1c was 7.6 Keep it up,you'll get there.

D1 I wasn't aware there were any,thought I'd covered it pretty well. Press "3" to schedule an appointment,we should obviously talk about this.

#3 Ok, you wish to make an appointment. How soon?
N.Today
O.Sometime in the next week
W.SOmetime in the next month

N.You're in luck!we have an appointment for you in 10 minutes.Would you like to accept this appointment?
Y or N
Yes-I can make it
No-That isn't enough time to get out of the house,much less to your office.

O. Sorry,nothing available.Switching to W...

W. Thank you, your appointment is scheduled for Dec.24 at 4:45 PM.Have a nice day,and we look forward to serving you!

A:-(((( Eat, eat,and eat.Call us back when you're able to hold a rational conversation(assuming hypos don't resolve) You should really reduce your basals by 0.2 h/hr and your bolus ratios to 1/20. And no, you're not having a second honeymoon.Nor are you turning into another Halle Berry.You're a type 1,and there's obviously a reason for this.

A:) Perfect, huh?Enjoy it while it lasts,because it won't. Please press "2" if you wish to share with the medical community your secrets for a persistantly euroglycemic state.We're all dying to know.

See,there's nothing to be an endo..very predictable.I know what they're going to say before they say it.I know what they should say&don't and vice versa.Even when you're down(bg wise)you're not really "down."(ketones)But its ceased to be a concern,since your bg is now fine..

Wipe(d) Out

Have a wonderful & safe Thanksgiving,everyone! Travel day today,which is why I'm utterly & completely too exausted to say anything else..witness the lamest post ever.I will do better the rest of the month, I promese. I just can barely remember my name at the moment,after a 3am wakeup,a cross country fligt(involving many delays)a carb overload(hello,300 mg/dl) & the traffic jam from heck at the final destination.(however,I love the 70 temps & totally would just like to stay here for the winter.It is bliss.) But I'm committed to NaPoBloMo,so here it is.

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Of TimTams and Pink Gloves

Australia's favorite cookie has now hit the States, en masse:(thank you,Pepperidge Farm)


Having never been to Australia, I've never tried them before but now I get to.( have known about them for years..via an Aussie Diabetes website. They look pretty good.(and if they aren't...I hope my husband will like them. It helps, being married to a non-D, he can eat the rest of the culinary temptations that really wreck havoc on my blood glucose and I need to exercise restraint with)

And if you haven't yet seen this video, you need to-it's awesome.

Rethinking the System

Last night I was getting caught up on my blog-reading, and came across this article. Read it, it will make you mad.(or it should)

Screaming Headline: Is Uncontrolled Diabetes a Reason for Divorce?

There are many,many blogs(some even in the OC, you know what I'm talking about) out there complaining about their spouses, significant others not taking care of their diabetes. About how they can't take it anymore,and are just so fed up they could leave tomorrow, etc. I'm not here to minimalize the fact that their spouses(as well as the blog writers) are acting like irresponsible jerks. That they should be more considerate.(we all can)

But it is not a diabetes issue. And pinning all this on the diabetes, because you can't believe that the person you married would EVER act like that,if they didn't have diabetes,is just plain stupid. People are complex creatures, & what governs their actions is not just one factor..it's many. If you're yelling at your spouse/mistreating the kids/etc. you have issues that go way,way,way beyond your chronic disease. And if you're not "taking care of it", the following speech will not improve your compliance. (quote)
"Diabetes is not a disease or blood sugar. It is a disease of blood vessels. If you can imagine everywhere blood vessels go (which is everywhere), diabetes will destroy that part of your body. It will lead to a horribly disabled and miserable existence. I described all aspects that she had to look forward to from uncontrolled diabetes

* Memory loss
* Stroke
* Blindness
* Heart attacks
* Arrhythmias
* Heart failure
* Gastroparesis
* Ischemic bowl
* Painful neuropathy
* Diabetic myopathy
* Claudication
* Amputations
* Frequent infections
* Life threatening illness with septic shock

The list can go on and on and on. I told her that 1halfof my hospitalized patients are likely there as a direct result of uncontrolled diabetes in one way or another. I told her about the life changing disability she was in for. I told her she presented with a high risk of death due to an acute illness within the next two years. Her admission now should be a wake up call for change." (unquote)

Telling people horror stories makes the exact opposite happen...it closes off their willingness to listen. I have been told horror stories,and I'm one of the ones who actually attempts management of this disease. I just wonder why, after 80+ years of T1 diabetes history and the hundreds of thousands of diabetics who have been preached at by their physicians(more so in the later part of this century) why the physicians haven't gotten a clue yet that said scare tactics don't work, 99.9% of the time. Despite that,it's a scene that repeats itself hourly, daily,all across America.(and the world)

I will tell you what a goes through the mind of someone with diabetes, when they hear something like that.

1."It won't happen to me." (It likely will-but they know that anyway,and you telling it to them won't do any good. They're in protection-denial mode)
2. "Might as well go out with a bang."(eat, drink, for tomorrow I might die)
3. "You have no clue what diabetics go through everyday. You don't HAVE diabetes,or you wouldn't be lecturing me like this. You don't know what its like to
swing madly, no matter what you do."
4. "Is it lunchtime yet?"

For a type 2 diabetic,it's likely to be so much harder to come to terms with diabetes. You feel fine(most of the time), and you'd rather not think of yourself as sick/needy in any way. I don't know what the solution is,but a positive outlook/support system is the first step. High blood sugars breed depression, both mentally and physically(they may say they aren't depressed but it's impossible not to be)

One thing I do know..for the millions of "non-compliant" PWD out there, there has to be a better way of reaching them then scaring them into an early grave.My heart bleeds for my 'betic brothers and sisters. I don't think anyone is unreachable, and I don't think anyone deserves the complications of diabetes.(compliant, or not)

Progress

On the cross-stitch front.



-- Posted from my iPhone

The Top Ten Other Jobs of Your Endocrinogist

1. Relative Geneticist- "Once upon a time,the top Two Beta Cells got together & threw a big bash, for all the other Beta Cells in PancreasLand. Unfortuantly,they got so sugared out that evening that they all died the next day & that's how you got diabetes."
2. "HEYYY NEIGHBOR!"
A friend of mine was singerally dismayed to find out she'd gone & moved next to an endocrinologist.Quite the friendly type,from her description. Well he came over,saw her pump,and offered to be HER endo. She politely declined,on the grounds that it would just be too weird...every time she threw a party he might think it was his responsibilty to provide the glucagon,question her bgs,etc.
Not deterred,he still offered his future services.
3. Statician-"Based on the range of your latest quantitative bg range-there's a 99.9% chance that your a1c will reach the mean average of a type-1-in-complete-denial squared.(divided by the number of times that you tested this year)
4. Mission Control-"Housten,we have a problem..Our pump cartidge just ran dry & I'm 77 miles from the nearest pharmacy with a bg of 488.Abort???"
5. Lawyer-Going to bat with the insurance companies.Not for the faint of heart.A good Endo stops at nothing,to get the best care for his patients.
6. Blood Brother-Your Endo also has diabetes,your bgs are simultaniously low..and they "get
it."
7. Tattoo Artist- As you watch your Endo frantically scribble notes at a mile a minute,(on the back of his arm) , it occurs to you that probably 20% of said records and 80% of it is guessing,that's why they call it "practicing" medicine.
8. Archiologist:
-Unearthing 2 month old bgs from the meter innards..
-Deciphering hieroglyphic scribbles(it's the night before the endo exam and you're frantically jotting down notes that no one can read the next day)
-Telling diabetic mummys-to-be that they're scaring you.
9. Mob Boss:
"Yo, bub.Time to cough up da dough,da moolah. You got me? This diabetes practice ain't cheap, I gotta keep up my standards of living. This is my team. Meet Joe Surgeon. Joe takes out the kidneys of anyone who crosses me.Don't mess with Joe. And this is Frieda Food Nazi-our resident dietician.She reports directly to me.Ciao-you'll meet the rest of the team next week."
10. Knight in Shining Armor-
You thought those days were a good 1,000 years in the past-until your new patient did a Carpe Carpum(Seize the Carpet) on their first appointment with you. As soon as they regain consciousness, your first question to them is not "Are you having any chest pain?" rather.. "What's your blood sugar?" Instant popularity points.(an Endo always thinks low bg first) The above account is,unfortuently,completely true.I was never so mortified at an appt. in my entire D-life.


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Naughty or Nice

For today's post, I refer you over to this medical blog for a really funny(and true) guide to the personality of your physician. I'm not quite sure where Endocrinologists fit in on that chart(Sane:hardworking: nice/or mean, there should also be a dumb/smart option) but it's fun imagining where they'd be.


Go check it out.