Moments of Wonderful

…rather than a lifetime of nothing special. A diabetes blog.

Moments of Wonderful - …rather than a lifetime of nothing special. A diabetes blog.

Listen to me

Last week I had an appointment with my endocrinologist that was one of the most confusing and frustrating appointments I’ve experienced in my life with diabetes.

It had been a while since I’d seen my doctor due to some unusual circumstances. Before my last appointment, the endocrinologist had ordered some blood work and other tests to be completed. I got the tests done and anticipated finding out more about the results. A few weeks later, knowing my appointment was coming up but not remembering the exact date, I was thankful when I got the reminder phone call from the office. Or at least I thought it was the reminder call. It was actually to notify me that with barely 24 hours notice, the financial backers of the practice had removed their funding and the offices were closed.

Fast forward to last week, I finally made it back into the office. The previous office had an enormous waiting room with plenty of seating. The new office was a completely different experience.

When we finally went over the blood work from months ago, it was like the nurse practitioner was looking at each number individually without any thought of how they could fit together or the reasoning for any of them.

For example, I had lost about 20 pounds since the last time they saw me (remember this was last summer, so it was far from sudden or dramatic loss). She asked if I had done anything differently and I explained how I had made changes in my diet and overall felt so much better. She repeated that she worries when they see “unexplained weight loss.” If I offer an explanation right before you say that, I think that maybe you aren’t listening.

Next, the nurse came back in with my finger prick A1c result. I don’t trust those results on a good day, so I was already skeptical about the number. The only reason I let them draw it was because it had been so long since my last lab work. With me in the exam room was a full report with my meter download and a full Dexcom report. I use one meter and I wear my Dexcom 24/7/365. That is why I flat out told the nurse practitioner that the A1c result was wrong when it came back a full A1c point lower than my Dexcom average would suggest – which would be equivalent to about a 30-40 mg/dL difference in average BG results. That is a BIG difference!

Instead of questioning the A1c, she poured over my Dexcom reports finding lows to be fixed. Lows had to be artificially reducing my results, right?

It wasn’t until I was back in my car on my way to work that I was able to put the pieces together myself. One of my out of range lab results from months and months earlier indicated that I was anemic. If I have in fact been anemic for the entire time this A1c result was measuring, it isn’t took far of a stretch to assume that my A1c result would come back erroneously low, is it?

I have had good experience with this endocrinologist in the past; so at this point I am willing to let this go as a bad day in a busy “new” practice.

But I do think this was a perfect example of the many times when actually listening to a patient might be the best medical treatment available.

  • katy says:

    “unexplained weight loss” ha!

    I’m sorry this is like this.

    March 31, 2014 at 6:24 am
  • StephenS says:

    Sara, aren’t nurse practitioners (or anyone between you and the doctor) supposed to be actually, you know, good at listening so they can forward that information to the doctor? I’m worried that if something is lost in translation between you and the nurse practitioner, it will be even more lost after just one degree of separation. Hope it goes better next time.

    March 31, 2014 at 7:54 am
  • kelly2k says:

    I’m so sorry you had to deal with that – But WTG on the 20 pound weight loss!

    March 31, 2014 at 8:10 am
  • Scott E says:

    I totally agree with you on the fingerstick A1cs. While I think it’s fine for following trends, I think they tend to measure 0.5 to 1.0 lower than the go-to-lab/stab-your-vein type (either that, or my average BG got a lot worse when I switched endos, which is entirely believable).

    At my visits, I tend not to give much credit to the people I see BEFORE my endo. Usually, they’re the ones who check my height/weight/blood pressure/BG, etc, and ask the standard questions to update my chart, and it seems to be a different person each time, and they are just following steps in a checklist. Fortunately, the time doctor himself really spends time looking over my reports, so the visit is worthwhile.

    March 31, 2014 at 10:22 am
    • Sara says:

      This was not a “before endo” person. This was an “instead of endo” person. The nurse practitioner has her own patient load of which I never have been a part of and will choose not to be again.

      March 31, 2014 at 12:17 pm
  • Alecia says:

    This sounds an awful lot like some of my confusing appts over the past year. My most recent visit went MUCH better so hopefully you are dealing with a few hiccups before these appointments become much smoother sailing. Finger’s crossed and yes, I share your frustration. xo

    March 31, 2014 at 12:19 pm
  • Ginger Vieira says:

    AHHHH! That would’ve driven me bananas AND coo coo for cocoa puffs! Roar. But congrats on all the hard work it sounds like you’re putting into your health!

    March 31, 2014 at 2:27 pm
    • Sara says:

      “unexplained” hard work, right? :P

      March 31, 2014 at 5:42 pm
  • Natalie Serendipity says:

    A couple of years ago, I had the opportunity to go to AADE, and there were 2 different booths giving A1cs, one with a lab machine, and the other with a fingerstick device. My results were fairly close, but a friend had results that were a whole point off — instead of the 7.2 she got on the lab machine, it was a 6.2 on the fingerstick. That’s a serious difference. So I don’t trust those fingerstick devices at all, and would refuse to take it if my doc used them, which he doesn’t. I have enough trouble with having a naturally low A1c, and don’t want that little machine to goof it up even further.

    April 1, 2014 at 10:22 am
  • Karen says:

    Wow, unbelievable!! Here’s hoping you don’t ever get stuck seeing her again – it sounds like a complete waste of an office visit. :(

    April 1, 2014 at 12:10 pm
  • Need A Nap2 says:

    Ok, I had no idea the fingerstick a1c’s were different?! Now, I’m concerned about my daughter b/c all she does at her endo’s office is a fingerpoke then they take the blood and run some tests (one being a1c). Is this not accurate??!! We switched endo dr’s, staying in the same practice, b/c the one we had been seeing didn’t listen to me and wanted to change my daughter’s carb ratios to the same all day (which doesn’t work for her, she needs a “lower/higher” depending on how you look at it carb ratio in the morning, 1:6). Great job on losing 20 pounds!!

    April 12, 2014 at 12:49 pm

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