I have been going back and forth with the CDE at the Joslin clinic where I have been going for more than 10 years. I was angry that I had been stuck on a sliding scale for insulin and had been struggling with some devastating lows and bounce back highs. I sent some bitchy emails to her and pretty much got the same back. So I decided since you get more flies with honey, to try a new approach. Here is what I wrote:
When I read back over my emails to you yesterday I realize how incredibly bitchy I sound and I am sorry for that. My attitude is born more of frustration with myself but I don’t want to alienate someone who I know has my health and well being at heart.
So I read an interesting article last night about patient empowerment in diabetes self management and realized one of my problems with taking care of myself is I have no specific goals with regard to my diabetes and general health. So I have decided to set some goals and a time frame to achieve them. By December 6th which is my first appointment with Dr. X I intend to:
1. Maintain my A1C as close to 6.0 as I can without hypos, if I can’t do it without too many hypos then I will aim for 6.5 instead. I can check this by downloading my glucometer readings and watching not only the lows but also the coefficient of variance and try and keep that below 30%. But at the same time I will try not to look at a number as “bad” or “good” just as a number to guide the next shot or the next meal.
2. I will work as hard as I can on getting to be an expert on carb counting so that I can better match insulin doses with what I eat.
3. I will get my weight down to 150 pounds and maintain it there but I’ll qualify this with it will be on my scale in my bathroom. If I happen to go lower then fine, but I think a bmi of 23-24 is a good target for me.
4. I will attempt to get my blood pressure down by not sweating the small stuff, by eating right, and exercising.
5. I will stop being so hard on myself for past mistakes as I can’t change the past I can only work on myself now and into the future.
So I think these are realistic, achievable goals and I would appreciate it if you have any other goals to add, or you have a problem with any of my plans please let me know.
Thanks in advance,
Goals are great. Yesterday was an aaha moment for me on many levels especially when I pulled your record to see we had never met for education prior to the sensor. I believe when you emailed me I asked you your ratios and you weren't using any. I'm happy this is a new beginning for us all. I think you should see me though at least twice a yr. I'm happy to email in between visits but we do need to have a few formal visits for both of us as email tones can often be misunderstood. If you call for an appt. ask for an hour visit as I don't think a 30 minute follow up would be enough. Thanks and aim for 6.5. Lower is not always better based on research studies."
I will probably bring the article I read about brain shrinkage occurring with "high normal blood sugars". And I am not sure what research studies she is referring to, but I am really happy to start over as well.