This is probably long and drawn out.. but I would appreciate feedback if anyone has anything to add.

So, ever since I went to see the endocrinologist and the physician's assistant, I am thinking more and more that I do not need to go to that office anymore.

First, the day after my appointment I called and asked if I could decrease my I:C ratio because the 1:20 was sending it sky high. The PA basically wound up telling me I was micromanaging and not to worry so much.

The CDE that I am seeing used to work at the same endo office and knows this PA. I told the CDE about what happened, and I said maybe the PA was having a bad day but it made me feel really bad when she suggested that I was micromanaging. My CDE told me that the PA's heart was probably in the right place, basically. So I decided to just let things simmer before making a decision.

The second incident occurred a week and a half later when I sent her my BG numbers. She actually e-mailed back and told me the following: "You are testing a lot and may want to reduce it a little. Be careful with over testing. I know you are curious but you don't want to burn out
with testing." I was really shocked by that, but let it be. I was testing on average 9-10 times a day; a couple days I did more than that when I was paranoid about my sugar dropping too low. Well, I just ignored that comment and let it be.

She has been asking me when I am going to make my pump appointment off on. I've tried to schedule it several times, but whoever was at the front desk the first time I tried had no idea what I was talking about. This week after I e-mailed her my numbers, she asked me yet again. I e-mailed her back and told her that I could not make an appointment because of my schedule- I am working 85 hours a week for 4 out of the next 6 weeks and the two weeks I could potentially go, they do not have any appointments.

I don't know why she keeps pushing me to make the appointment when they are booked solid for a month and a half.

She e-mailed me back with this "Sound like you are a little busy for the pump. So best to give it a little bit more time." I'm sorry, but that came off rude to me too. I keep thinking maybe she is just not a very good people person, but these interactions have totally turned me off of going back to that endo and PA.

I told the CDE I am seeing the first day that I am probably a little too intense and she responded immediately with "That's OK, I am too." And every interaction with her has been positive and helpful. She is very supportive and does not speak negatively to me about things; instead she is informative. The CDE does set some people up with pumps; but she told me on my last visit to go through the process at the endo because they are better set up for it.

I just don't want to. Is it unreasonable to ask my CDE if she would please go through the process with me because I am not wanting to go back to that endo office? It is the only endo office in the whole region, and quite frankly not worth it to me to keep going..

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Definitely worth asking the CDE. The worst that can happen is she'll say no. I expect she says you're micromanaging because she's not used to people like us, if you know what I mean LOL. She's maybe afraid you'll burn out - there seems to be a pervasive attitude that no one can maintain good management for any length of time.

You know yourself, you know your body, do what you know is right for you.

Thanks. I'll ask the CDE. The PA I've been seeing has a son with type 1. I guess I was expecting her to be more helpful instead of... Almost condescending?

How long have you had T1? I only ask because I really only use my endo to keep my pump scripts up to date. My PCP writes my insulin scrips. I find that I am a much better judge of my control than any doctor. I know my body and my way of dealing with things, so I can do a pretty good job. My A1C last week was 5.8, and my standard deviation is about 28, so I know I am on the right track. I adjust my basals (carefully), my I:C, etc. quite often, because things change so much. Even the warm weather we are having this week impacts my control. Oh, and I test 8 to 10 times per day on a good day--sometimes a lot more if I am having problems.

I had a really snotty PA once at my endos office and refused to deal with her. I told the doctor that I did not like the way she treated me (like a child, asking all kinds of silly, meaningless questions and implicating problems that do not exist) and he should assign me to someone else or take care of my needs himself. He did after that. I was amazed.

I find it is important to stand up for myself with doctors. I also find that they respect me for that, so it is a win win all the way around.

I was diagnosed February 10th. I was attempting to adjust things on my own before I even saw the endo. I tried to respect the PA's knowledge base by asking her what to do when the carb ratio she gave was ineffective.. and that apparently didn'tgo over well.

The CDE has been much better about helping me, including giving me handouts and copies of articles to read that she normally gives to the medical residents about adjusting doses..

I sort of feel like this is my body and I'll micromanage it if I please.

You will need the advice for a while, but I agree, it is your body, your T1, and you should manage it in a way that makes you comfortable. It has only been a month, so you will have lots to learn. Just one more word of advice: don't let it become the focus of everything! There is a lot more to your life than Diabetes!

I know that you are right about that. I guess initially my way of coping with the shock was to learn as much as I can. I actually had a vacation last week in New Orleans and Memphis; I definitely lived a little, but kept the diabetes aspect reasonably under control. It was nice and I felt like a normal human being. I even got over caring about testing or injecting in public.

It honestly puts me more on edge and anxious having someone be so negative towards me. It makes me feel as though I have done something wrong. My friend in vet school who made me initially go to the doctor because she was concerned read through the emails and was not really impressed either...

I'm not even sure about who is in what role at my endo's office, and whether the person I email or talk to on the phone is a CDE or a PA or a nurse or what. I know they are slow and like to tell them "oh, I already did that" on the (few) occasions they've made suggestions. There's a bigger, glitzier clinic in the town next door, although it's on the wrong side of my town from my office for me to be really motivated to move but sometimes, particularly during "insurance reboot season" every spring, when I think I ought to move to the bigger place.

I don't take "vibes" from staff personally, sometimes the PA may be doing what the doc or administrator tells her to do to? "don't make pump install appointments except at such-and-such a time as I don't want it to throw off whatever other elements of my schedule...", which makes the PA come across as more of a hard-ass than they may be? To me, I'd interpret "give it a little more time" as a bureaucrats way of saying "look, these are when we do these, if you can't make it, we can't help you". I'd probably find another clinic although, if the paperwork's all done, it may be more annoying to switch? Still, sort of "stock" reference to "burnout" seems a bit cheesy. If I were hearing that, I'd probably consider shopping around. I am SO lazy though!

I'd figure that if you were a vet, you'd be able to install it yourself though? Two of my high school buddies have a 3 year old who was dx'ed a couple of years ago and she's a vet and is very sharp. I like her notes in my copy of TLAP a lot!

I'd rather have appointments in the afternoon but have only been able to get one when something "interesting" (which, of course, it's my goal to avoid...) has happened, like once in the 3 years I've been there.

No paperwork is done yet. Dealing with that PA just makes me want to wait longer because I want to find a way to politely bow outwithout making huge waves. I think I would be fine dealing with setting up the pump with just my CDE.. but she may not want me to do that. I'm going to make an effort to get in touch with an endo who has a solo practice in a neighboring city. She used to see my sister and actually came to my sister's funeral when she passed away. My sister had her pituitary removed when she was 7 because of a tumor there and had to see that endo for the rest of her life.

Everyone comes to terms with their condition in different ways. Often, you will be diagnosed and your endo and doctors initially do essentially everything for you. They make all the adjustments. Often you wouldn't even be introduced to carb counting right away, you would just be given a fixed dose of insulin to take at every meal. And only over time does the patient learn how to do things and take over all those daily decisions.

But here you are. One month after diagnosis. Apparently you have already learned how to carb count and know the basics of adjusting your own insulin. You are an anomaly. I applaud you for leaping into the deepest end of the pool and coming to the surface swimming. But you may just be a little too much for your PA. Most patients are still clueless after only a month, unable to really tell whether a 200 mg/dl 2 hours after a meal is good or bad, let alone what to do about it.

I would just step back. Over time, you will emerge as the leader of your own destiny. You will make your own changes to your I:C ratio. And your endo and PA will feel more comfortable with your doing that. But today, one month after diagnosis, they are not ready for you to be where you are. But they will come around. And if they don't then you can look to changing endos. But I have to tell you, finding a good endo is difficult and many of us have had our share of bad experiences with doctors.

As to the pump, there is no rush. If you are really busy, then it actually might be better not to complicate your life with the transition to a pump. And if you get any more criticism about testing 9-10 times a day, you can remind them that you are testing that many times so that you can establish the appropriate testing patterns to be an effective pump user.

Thanks. They had me on that ridiculous sliding scale for the first couple weeks, and I got a little fed up with it because it wasn't doing anything useful at all. It was more of a pain in the rear to me to try to figure out how much of what I could eat based on the amount I was supposed to take. I told the GP it wasn't working at all, lol. Now that I look back, I see why they do that with everyone but yes, I am probably too much for some people. :/ I'm not following the PA's advice this week.. she told me to go up from 9u to 11u. I know with 10u I start having fairly low readings. I'm doing the 10, but woke up at midday today in a sweat and feeling crappy. Checked and was 67. Ate two tablespoons of peanut butter and woke up at three with a reading of 73.

Sorta feel like she didn't even look at my log to have suggested 11u.

I like BSC advice. Learn the Diabetes basics first. You need to know how to handle your diabetes without a pump first. When you understand how insulin reacts in your body with excercise, emotion, eating out and much much more then consider a pump. Changing your I:C ratio without doing it for a period of time can be a problem. If you make changes on your own, you may not realize how that change is actually effecting you. You may not even know if it is actually a basal change that needs changing. Your I:C can be crazy for no reason today, but perfect the next. You will have a better idea of how to react and if a change is actually needed. I would suggest managing your diabetes with MDI for a least a year, before considering going on a pump. I have been doing this for 40 years. Don't expect your diabetes to be perfect everyday. I am going to side with your CDE or Endo. Don't micromanage. Enjoy your life.

I'm enjoying my life. I just don't appreciate being talked down to.

The PA at the Endo office is the one pushing the pump. I have a very busy and active lifestyle as I am in my fourth year of veterinary school. I understand the pathophysiology behind diabetes and other related metabolic disorders in animals which has helped me to more quickly understand the same in my own body. We also use insulin in animals.. and glucometers. I mean, this is really not that different. It's easier in cats and dogs that eat the same diet because you don't have to worry about I:C ratios, but it's the same idea.

I know not to make more than one change at once. However, when you switch from weeks of a day rotation, to a week of vacation, to weeks of overnight shifts, changes must be made.

I appreciate your input on waiting on the pump for a year or more, but my micromanaging has already allowed me to fine tune things rather well in the last few weeks. My fastings are in the 70s to 80s and I rarely spike above 150. My micromanagement also allowed me to enjoy my vacation in New Orleans and Memphis quite a bit last week, without threat or fear of hypoglycemia or running high all the time.

While I realize I still have a lot to learn about how my own body reacts to things and that those of you who have been doing this for years and years know your bodies much better than I know mine right now... I'm going to be okay, even if I went on a pump tomorrow.




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