Bright and early Monday morning, I met my new endocrinologist. I was pleasantly surprised to learn that his office was in the same building (right next door even!) to the office I visited throughout my pregnancy. (As a side note, I have had the best experience with the doctors and hospitals at UCSD Medical Center. It's great to take advantage of having all of my care centralized in one group. The communication between physicians is quite helpful for those of us with chronic conditions. Also, it's nice to cut down on the clerical busywork by using just one health care provider.)
Being the busy mom that I am, my logging records let much to be desired, as in, I hadn't logged a single blood sugar for nearly four months! I hastily jotted down a few days worth of numbers, just so we'd have something to discuss. After managing a diabetes pregnancy, with the incredibly tight control it demands, I was less than thrilled about the results I had to share with my new endocrinologist. I figured I could just use the "I'm burnt out on intense glucose control right now" approach, and hope that my past success would buy me time!
My new doc and I hit it off right away. He's young, enthusiastic, and very knowledgeable. What more could you ask for?! Also, he got off on the right foot with me by praising my last A1c result of 6.5%. Although that's significantly higher than my A1c numbers during pregnancy, it's right at the threshold doctors usually want their patients to reach. He also commented that my numbers looked good. It was difficult to find many patterns in only three days worth of data, but we discussed a few potential changes.
One big change my new doctor suggested was my potential use of a continuous glucose monitor. This is a device that I've contemplated several times. However, there are several reasons I've hesitated to start it:
First, I feel my lows extremely well. Thus, the advantage of "catching lows" before they get too low, isn't much of a factor for me.
Also, since I test at least 12 times per day, there are not many periods of time where I'm completely unaware of my blood sugar range. Obviously the CGM provides up to the minute blood glucose values. However, you are not supposed to take any therapeutic actions (i.e. deliver a correction bolus or eat carbohydrates) without verifying your blood sugar on a traditional meter. It's difficult for me to see a great benefit in the continuous monitor versus several standard blood sugar tests.
There's also the issue of wearing another invasive medical device all the time. I already have my insulin pump, and now I'm using a breast pump four or five times per day. A person can really start to feel like a robotic machine after awhile!
The biggest factor that's given me pause in embracing the continuous glucose monitor is the cost. Insurance coverage for these devices is still spotty. My doctor also pointed out that my history of good control would actually hurt my chances of getting insurance to cover a CGM. One would think that pregnancy would be a great time to use this technology, but in fact, many of the systems do not have FDA approval for use during pregnancy. Thus, insurance is not likely to cover them.