Saturday, October 19, 2013

After the Endocrinologist

Okay. I feel so much better now.

I made a deal with my father on Friday on the way to the appt that he didn't get to be in there when I had my appt. To my shock, he agreed to leave when I discussed things I didn't want him to hear (everything?).

So my father's appt went first. It took all of five minutes. And then my endo kicked my father out and sat down in the chair next to me.

We talked a bit, then I told him I can't take Metformin anymore. He took my BP, then went to his computer and asked why. So I explained it to him. And he said I absolutely shouldn't take it anymore. When I brought up the B12 deficiency, he said he didn't even have to test me to know I have one. I asked him to test me anyway because I already have tingling issues and I want to make sure it's the B12, not those getting worse. He agreed. (His view is that as long as he's drawing blood, he might as well draw more.)

He offered me Precose, which I refused because I don't have a phase 1 insulin response (the initial, immediate surge of insulin you get when you eat. It lasts for about a half hour, until your pancreas makes more. I don't have this built-up store, and my body doesn't make enough insulin (or use it productively enough) to cover the rest of it. So I get stuck with a high blood sugar very quickly, and it doesn't go down for a while. Precose doesn't help this issue). He didn't argue with me, just thought.

I told him that I'm terrified of the other diabetes meds. Some, like the sulfonylureas, can cause beta cell burnout. His response was, "I wouldn't put you on a sulfonylurea--you'd be dead" (presumably of low blood sugar).

So he then said he had a brilliant idea and popped up to get me a sample. He came back with four bottles (21 pills each) of a drug called Cycloset. It's really used for pituitary tumors (to control the symptoms), but it's approved for T2 in low doses.

He explained that the working dose is 2-6 pills per day, all taken in the morning with breakfast. It has virtually no side effects (or at least none for me, since I'm not on any other meds), except for some mild nausea when first starting. I start with one pill, go up to two after a week, and then stay there for a couple of weeks and call him.

He gave me so much because he wants to make sure it works for me before he prescribes it. He knows that Metformin wasn't great at controlling my BG, anyway, so I think he's trying to circumvent that. (Actually, now that I think of it, he always gives me tons of samples. I guess he's worried that these things won't work for me.)

For the time being, I haven't had any real nausea (I had some this morning, but I really think that was because I was expecting to have it). The Metformin hasn't left my body yet, so I can't tell you if it works or not.

I then asked him if I really have insulin resistance. Based on my negative antibody tests and a couple of high c-peptides I had about a year ago, he said yes. He said that IR isn't based on body type nearly as much as the media makes it sound, and that in my case it's extremely genetic. (He also was shocked at my weight. He thinks I'm nearly 20 pounds lighter than the scale says I am. HA!) I asked because of my age, not my weight, but I guess I'll ask him about MODY when I talk to him about the Cycloset.

I asked him some other questions about my health, most notably the use of CoQ10 for my fibromyalgia (he said there's no reason why not), and why running helps my breathing so much. He said a pulmonologist should test my breathing before I run, and then again about a day later. Mine will never do that, but the one he gave me the name of might.

Overall, I'm very happy with how this appt went. He spent nearly a half hour with me (he's always willing to spend more time if necessary, but it's always nice when he does). He answered all of my questions honestly and in a completely straightforward way. He was kind, gentle, and listened. I think if I asked him to put me on insulin, he'd probably give me the same answer he gave me about sulfonylureas, but if Cycloset works, then I don't really care yet.

Now I just have to wait for the rheumatologist to get an opening earlier than the end of November. Yay?

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