A trip to the Dark Ages...

I have been incredibly spoiled in my diabetes care. Right after my diagnosis at age 14, our PCP sent me to the Barbara Davis Clinic (BDC) because he recognized that my care there would be much more complete than what he could give. Thank you Dr. Chesley--it was the best referral you ever made.

The BDC is an amazing center for the research and treatment of insulin dependent diabetes. I have participated in several research studies there, and the treatment options are cutting edge technology. The blood test that measures average glucose levels (an A1C) is taken via a finger prick and the result is available within 4 minutes. The staff really understands TYPE I diabetes and do everything in their power to help you control blood glucose levels. There are dietitians, nurses, and diabetes educator on hand IF YOU NEED THEM. My doctor is superb and knows that what works in theory doesn't always work in a type I body. I never feel censured when, after trying my best, my numbers are not perfect. Quite frankly, I find myself running out of superlatives to describe my experience at the BDC.

I love the BDC so much that I have been flying back to Colorado every 3 months to attend my appointments. I have been searching for a good diabetes doctor here in San Diego, but
1. Most have waiting lists of 4-5 months
2. Most are not accepting new patients
3. Most have no clue about the fine details of Type I.

A quick delineation between the different kinds of diabetes. Most diabetics in the world have Type II, also called adult onset, which means that the body either 1. Doesn't produce ENOUGH insulin, 2. Doesn't USE the insulin the body produces efficiently, or 3. Both 1 and 2. Gestational diabetes is basically Type II while a woman in pregnant. Due to the hormonal roller coaster or pregnancy, 1-3 can occur.  The treatment of Type II diabetes focuses on helping your body "remember" how it is supposed to work: a healthy diet, exercise, etc. Occasionally oral medications are used to help the body use insulin more effectively, and in the end some patients will end up using insulin.

Type I (juvenile diabetes) is an autoimmune disease, which basically means that the body's immune system destroys some part of the body, in this case the insulin producing cells of the pancreas.  IMMEDIATELY upon diagnosis, someone with Type I MUST begin taking insulin. Without insulin, the body doesn't work...sugar from food, and naturally produced glucose from the body, clog up the kidneys, eyes, circulatory system, and the body doesn't have any fuel, since the glucose stays in the blood. AT this point, if I didn't take any insulin, I would be dead within a few days. Not to be melodramatic or anything. Only about 8% of all diabetics have Type I.

There are tons of treatment for type I, and I use an insulin pump combined with a continuous blood glucose monitoring system. I have two needles in me...one is attached to my pump via a tube and gives me insulin. The other senses my blood glucose level and sends a message to my pump so I can see what my blood glucose levels are.

So much for my "quick" explanation. At any rate, hopefully you can see that the differences between the kinds of diabetes.

AT the beginning of January I tried to get my foot in the door with an endocrinologist here in San Diego. Yesterday I finally had my appointment.

The doctor I went to knows about insulin pumps and continuous glucose monitoring systems, but is clearly used to dealing with the other 92% of people that have diabetes. He really wanted to focus on making diet and exercise changes so "I don't use so much insulin." Really? I exercise about 6 hours every week, and eat a fairly stringent diet. I have been dealing with my diabetic body and how it works (or actually, doesn't work!) for 18 years.

The doctor was pleasantly surprised that I "know exactly what I am talking about" in terms of what is happening with my body, and that my eye exam and kidney tests were current. He was a little shocked that I had just been in to see my endocrinologist in Denver in January, and was amazed that I go there every 3 months (which is the absolute recommendation for check-ups for Type I).

After spending 15 minutes with me, he said "Well, our time is up so next time we will cover some more issues at your next appointment." The kicker is that this doctor is so busy that his next opening for an appointment is at the END OF JULY. In the meantime, he will have a bevy of people calling me: the diabetes educator who "knows" about pumps, the dietitian, and a different diabetes educator. AT this point, I feel like I am a diabetes educator myself (quiz me on a carb value...any carb!) and DON'T NEED the calls. I need a knowledgeable doctor who can help me tweak some insulin rates and uncover hidden pitfalls I might not think about.
He sent me down to get a blood draw for my A1C value, where the line to GET said blood draw was over 45 minutes (keep in mind that my 16 month old was at a babysitter's house and I had already been gone for close to 2 hours) and then I would have to wait 3 days for the results. I went straight to my car, gently wept while driving to pick up the baby, and then got mad.

I feel like I was enjoying living in a sparkling house complete with remote controlled appliances and a bidet, and now I am thrust into a broken-down shack with an outhouse. I guess the commute will continue.