I went to see the endo yesterday. And. I. Hate. Waiting! Not in his office, but for lab results.
I have a pretty great endo in that he takes the time to talk to me. Yesterday what happened was this: I arrived, I waited a little in the waiting room, I went in and got weighed (104 lb), asked the nurse if I could look through my file, she said she'd photocopy it for me. Then took a good look around the room. The endo came in, we crafted a letter of medical necessity together to try to convince insurance to pay for a CGMS, having a conversation in the process.
Then we talked about labwork: the TSH I really wanted and that was the primary point of the visit. The low creatinine that has been in most of my bloodwork, and which indicates hyperfiltration (more on that in a minute). How stomach aches really mess with my willingness to prebolus. Decided to measure vitamin D levels just because we haven't done it before and I'm curious and the endo thinks it's a good idea. Decided to run a lipid panel just because. Put in an A1c, and my guess of a 6.8. Talked about what lab values mean, reviewed the past. The blood draw itself was remarkably painless- I thought it especially special because I was pretty darned dehydrated, having woken up with a blood sugar of 358 (2010's high) and not really having gotten rehydrated since. Then I did a urine sample for microalbuminuria,traded it with the nurse for an envelope with my labworks for the last two years, and that was that. Afterwards I went to the downtown library, since I just so happened to be downtown, and picked out eleven lovely books.
From my conversation with the endo, a few things stick out.
Foremost is the creatinine. Two or three years ago I had a below normal creatinine and BUN, and pointed them out to the endo, and he said he hadn't seen that much and didn't know what it meant and don't worry. The next time, they came in normal and he told me that on the phone, relieved. But for the last year and half, about six readings, the serum creatinine has been low. With a normal range of 80-130, mine has been from 45-65. Sometimes the BUN is also low; sometimes not. I had looked this up myself and not found much, and I pointed it out again to my endo yesterday. Guess I have some great kidneys, huh? I said, knowing that that wasn't really great, not anymore than a hypoglycemic reading would be great on a diabetes screening.
And my endo then told me what I had already guessed: That the kidneys become overactive in a small percentage of type 1 diabetics, in a condition called hyperfiltration, and that this usually turns into the more classic form of chronic kidney disease. And I knew that, and at the immediate level that was a sort of a relief to hear him say what I had been suspecting. I left the meeting feeling really good and happy, actually. But at another level... I have kidney disease that shows up in bloodwork. I have blood pressure that is too low to make an ACE inhibitor seem like a good option, and I have had elevated microalbuminuria readings. I am afraid of what my future holds, and I am afraid of when my future might reveal itself.
My endo said he had to take a microalbuminuria reading because otherwise my insurance would send him a letter of admonition, and I said okay, but don't tell me the results unless there's something I can do about it. I don't want to know.
When I mentioned the hyperfiltration to my mother later, she said I should have asked if this could be the reason why I get stomach aches when I drink water. ???
I mentioned to the endo that I wanted my vitamin D levels checked and he said, "We haven't checked that before?" And then he gave me a mini-lecture (like a professor's lecture, not like a parental lecture) on new research regarding vitamin D. He told me about how, when vitamin D levels are low, parathyroid hormone levels go up, and looking at how much vitamin D it takes to keep the parathyroid less active is how the "normal" range for vitamin D got set at something that only 60% of the population fits into. I pointed out that my serum calcium levels have been a bit high the last year and a half, and said that I'd thought that was because of my thyroiditis (which led us onto a tangential look at ideopathic thyroiditis), and he said that while that is possible, it's also possible that was caused by a vitamin D deficiency. I asked him if the vitamin supplements were vegetarian and he said he didn't know, but that he thought they were synthetic. (My boss tells me that she and her husband get vitamin D supplements from a vegetarian vitamin company).
I've been reading a lot of books lately, happily, and it is driving me bonkers how in so many of them, people who ought to know better will say that they or their loved ones had "low blood sugar" or even "dangerously low blood sugar" when what they mean is that they were hungry. They did not check their blood sugar, they cannot say that they had low blood sugar, they definitely do not know that they had dangerously low blood sugar! This is one of my pet peeves.