Goiter!? Who said anything about a goiter?!

So i went to see the diabetic specialist doctor yesterday and all i can say is... I'm in love.

I was really nervous going to see him. I was afraid he'd have the same reactions to my want of getting off the injections as my family doctor, making me feel like I'm in a fantasy land with the thoughts that it's even possible, that I'd be destined to stick myself continually for the rest of my life. I had every possible scenario running through my head, ready to put up a fight in every respect and direction the conversation may head. I was never given a chance with the pills; the injections make me go too low; I'm not comfortable with them; they're hindering my need to get healthy; I'm having anxiety attacks; if you don't I'll find a doctor who will.

It felt like i was sitting in that waiting room for hours, even though it was only a few minutes, the whole time constantly picking and ripping off the skin around my fingernails (my ultimate nervous habit) until they were red and sore, breathing deeply trying to push back my fears and not have another anxiety attack. I was consoling myself, trying to give me strength to not cry explaining all my issues, trying to give me strength if he ultimately tells me the pills are not possible for me. I was giving myself pep talks, convincing myself the injections aren't that bad, there's worse things to have, so what if this is my life from now on. I've been through so much, what's one more thing to deal with, right? I can do it if need be. I can do it if that's my only choice. But i won't do it without a fight.

I was finally ushered into a room and sat there picking, breathing, eyes watering, until i heard him pull the chart out of the holder beside the door. He comes in, says hi, asks how I'm doing and i do my best impression of a happy calm person. He opens the folder, looks over it, and goes over our history - his first time seeing me was in the hospital, 2 months pregnant and starting an insulin treatment. He said he had been unclear on when i was actually diagnosed with type 2 diabetes and i told him it was in November, right before i ended up in my 3 day hospital stay. He told me about my blood tests whilst in hospital, the a1c test (the average blood glucose levels over a 3 month period) and at that time i was at 11%, which means my sugars on a daily basis were running between 12 and 20. (A healthy blood glucose level pre-meal is between 4 and 7, post-meal being between 5 and 10)

He asked me what medications and dosages I'm on now. I told him Novorapid 3 times a day before meals, between 9-11 units each meal. He looks up at me and asked about the lantus, how many units of that was i taking. I picked at my thumb while i confessed i stopped taking it, but quickly followed up with my explanation. I found alot of mornings i was drenched in sweat, and every one of those mornings i had higher numbers - in the 8's and 9's. The one night where i was woken up at 1230, sweating profusely and completely confused, i managed to make it downstairs and check my blood sugar and was at 2.3 - well below the safe point of 4. It scared the hell out of me. I told him i had called my family doctor the next day and expressed my concerns and his answer was "Well that happens sometimes, nothing to worry about" and when he heard that my average numbers in the morning were still between 6 and 8, mainly in the 7's, he said that was still too high and i needed to up the lantus. After hours of my own research, i learned that if you wake up with high numbers it means you're going too low in the middle of the night and your body compensates for the low numbers by creating more sugar. It scared me too much to think i could slip into a coma or have a seizure in the middle of the night from going so low, so i stopped taking it altogether.

He then told me i had every right to be concerned, he completely understands why i went off of it and was fine with the fact that i did. He explained that all the lantus *really* does is keep the morning numbers low. He asked what my numbers in the morning were like since i stopped taking it and i said "In all honesty, they've been the same, between 6 and 8, mainly 7's." He told me that those numbers are fine, they're not too high at all, perfectly acceptable. I fully exhaled for the first time that morning and i felt my body starting to calm. This doctor is listening. This doctor understands. This doctor will help me.

He then pulled out some paperwork and says we should go over all my blood test results - i assume he checked for pretty much everything given that i had somewhere around 7 vials taken last week, plus i had to pee in a cup. "Okay first, cholesterol" I suck in air through my teeth, expecting something bad, expecting my heart to be in poor health, expecting risks of heart attack. He noticed this and asked if this was a concern area, and i quickly mentioned my anxiety attacks due to thoughts of poor heart health, but tried to brush it off in fear he'd think i was some hypochondriacal crazy person. He looks back down at the sheet and says "Your cholesterol is *excellent*... your kidney function is excellent... all these blood tests confirm that you're a *very* healthy person, with the exception of being overweight, but your body is *really* healthy. And as for your a1c, as i said in the hospital last November you were at 11%. Now you're at 5.7% That's absolutely excellent! That's better than target for a diabetic. You're doing a great job! Now, let's check out your blood pressure." I take off my jacket and sweater, sit on the crinkly paper and breathe deeply. Now here's where the problems are going to be... Blood pressure is perfect. Heart sounds perfect. Lungs sound perfect. What was i worrying for again?



He then puts his fingers on my throat and asks me to swallow... well this is new. Of course now there's pressure - someones *telling* me to swallow, so of course it takes a few tries until i actually do! Then i hop off the table and he says he wants to discuss my plans. I've lost a baby at 9 months, another at 3, am i planning on trying to get pregnant again right away? I told him that i do want to get pregnant again, but i want to be really healthy first - lose as much weight as i can to reduce any risks during another pregnancy. Hopefully by the end of this year we'll be trying again. My goal right now is to get off the insulin injections - they're causing me too many problems - and get on the pills. I knew I'd have to inject every time i got pregnant and i was fine with that, but for right now I'd really like to give the pills a shot. I realized i had stopped fully breathing again, waiting for his answer. This was it.

"Okay well. Take your insulin tonight for dinner, and you'll never take it again as long as i can help it. Tomorrow you'll be starting on Metformin which you take 2 times a day, once with breakfast and once with dinner. In 10 days you'll be calling me to give me your numbers if you don't mind. Don't be surprised if your numbers are a bit high for a few days, it's natural for that to happen. And stop taking your blood sugar 2 hours after you eat like you were told to do, that's for type 1 diabetics. Take your numbers pre-meal, try to check it 2-3 times a day at first until we get things under control and see if we need to fiddle with the dosage. And as for having to inject again during pregnancy - it's not true. In the hospital that's what they tell you because there's no solid results to say the pills *don't* affect the baby, but there's no solid results that they *do* affect the baby. I've had tons of diabetic mothers that stay on the pills and there's been *no* adverse affects whatsoever. Some people just prefer to inject during pregnancy, but if you don't want to, you don't have to. What it comes down to is this - your medication and the way we treat you, needs to be comfortable for you. If you want to be on pills, I'll do everything in my power to *keep* you on pills."

It took everything in my power not to jump up and tackle him with hugs and kisses. I was so excited i felt like i was going to burst, but i remained seated calmly so as not to scare this nice man.

He smiles and says "There is one more thing"... Oh here we go.

"You have a goiter."

Excuse me? I have to admit, that when i think of a goiter, i picture this:




But don't worry - i don't look like that! So i ask... how is that affecting me? Well, i have an enlarged and inactive thyroid gland. Which pretty much means, my metabolism sucks. I need to go on thyroid medication, one pill a day first thing in the morning with no food. I'll start to notice it'll be alot easier to lose weight. And Metformin is known to promote weight loss. Therefore it's going to be quite easy to lose weight if i keep up with my diet and exercise.

Oh darn it. Damn that goiter. I have to take meds which will promote weight loss? Fuck, who wants that.

I have to admit, it's been a looong time since I've left a doctors office with an uncontrollable huge smile on my face. I smiled for the rest of the day.

And I've been smiling all morning.