Endo Chooses Thyroid Over Diabetes

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Hi. My name is Eric. I have Type 1 diabetes. Two days ago I went to my endocrinologist for my quarterly checkup. We’re all supposed to have quarterly checkups. Are you getting your quarterly checkup for your diabetes?

The last time I went to the doctor specifically for my diabetes was in early October of 2009. At that time I visited not with my regular endocrinologist but with his spouse, who also happens to be an endocrinologist. (My endocrinologist was only working part-time last fall, thus the reason I met with someone else.)

It’s been about six months since I’ve spoken to Dr. Kumagai in person.

In the interim, in these past three months, I’ve been dealing with a diagnosis of papillary thyroid carcinoma. In that interim, I have felt as if I’ve gone a bit lax in my diabetes self-management. This self-critical mode of thinking isn’t atypical for me, of course. I liken it to expecting and believing beyond a doubt that you’ll fail the exam you’ve overprepared for, only to find out you got an A on it.

I found out about my thyroid cancer around Thanksgiving last year, and all of my self-medical focus shifted to worrying about, talking about, and educating myself about thyroid cancer. In December — oh December, such a month! — I had more high blood glucoses (in the 200’s mg/dl range) than I care to remember. I felt guilt, felt as if I was letting myself down (as well as my endocrinologist; those of you who really respect and like your doctors will know of what I speak), but for the most part my mental space for worrying was given over to the cancer.

Prior to my endo visit two days ago, I suspected that I would have a much higher HbA1c. I was certain that I would have gained weight, given my indulgences over the holidays. I suspected that there would be a number of diabetes areas that I’d neglected and for which I’d not so much be reprimanded about but at least reminded sternly by the medical team to pay closer attention to going forward.

All my fears were unfounded. Last fall my HbA1c was 6.8%. Tuesday it was at 7.0%. Sure, that’s in increase, but these are not (quote unquote) normal times in my diabetic lifestyle. So I’ll take the two-tenths uptick of my HbA1c without much consternation. The resident I met with prior to Dr. Kumagai’s entrance spent ten to fifteen minutes going over diabetes care, but then he shifted to concerns about my thyroidectomy and how I was doing in my recovery. That took another ten minutes or so.

When Dr. Kumagai came into the room, I honestly can’t recall much discussion of diabetes. He asked questions about my thyroidectomy (and by the way, from a doctor’s point of view, the incision in my throat is healing beautifully, the scar, according to the medical world, “looks beautiful”). Much of our discussion was about my voice, or the lack thereof. Yes, it’s been three weeks now since my surgery and I still cannot talk above a whisper. I’ll know more about what’s going on next week, however, because I’ve got an appointment with an otolaryngologist.

As someone who has diabetes and who’s only seen my endocrinologist for diabetes, I’ve sort of pigeonholed my doctor as a diabetes doctor. But he’s an endocrinologist, and the thyroid is also his business. Thus, while I was there for diabetes, the diabetes, yet again, was relegated to the backseat once it had been determined that there were no diabetes-related concerns.

I told Dr. Kumagai that I worried about how I’d been managing my diabetes, that I’d expected this visit would be one in which I’d receive a corrective in how I’d been handling things. He smiled and told me that I may not realize it, but my so-called “not paying attention” to my diabetes care was still above and beyond the normal levels, and that my months of “lapsed self-management” would be what many people would in fact consider obsessive self-management. In short, I had nothing to worry about.

Everything to do with my diabetes — my insulin pump settings, my ratios, any concerns with other numbers from blood work, etc. — are all to just kind of proceed as-is for the next three or four months. There’s nothing I’m to be concerned about, and the focus now is to maintain what I’ve been doing with my diabetes care. Then, once I’ve gone through the thyroid scan in early April, my endocrine team can work to get my synthetic thyroid hormone dosage regulated and we can return to looking at diabetes when I have my new normal.

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