Thursday, May 12, 2011


Didn't post yesterday because I was taking Penny to her quarterly endocrinology checkup. Which turned out to be fantastic, for two big reasons.

Back in December, Penny's A1C (essentially, an average blood sugar over the previous six to eight weeks) was 7.4, but at the last visit, in February, it was up to 8.5, which is way over where they want it to be. (For scope, the maximum desired A1C for kids Penny's age is 8.0; for teenagers, it's 7.5, and for adults, it's 7.0; the average non-diabetic will generally have an A1C under 6.) So the doctor told us to work on it, and if it wasn't down at this visit, he'd put her on a continuous glucose monitor device for a few days so we could see when the spikes are occurring.

So we've been trying to stay on top of her blood sugars (without triggering lows) and it's been a real headache. A couple of weeks ago, she seemed to be spiking highs all the freaking time, and there wasn't anything we could do about them. She'd be in-range when we went to bed, but wake up a hundred points higher. We'd dose aggressively for food, but she'd still be high at the next meal. It was making us crazy. And of course it wasn't quite pattern-forming enough for us to feel comfortable adjusting her insulin dosages. But for the last couple of weeks, her numbers have been fantastic. Almost suspiciously good. But the A1C was definitely going to include those couple of weeks of craziness.

Which is why I was both surprised and relieved when yesterday's A1C came back as 7.5. She's more or less back to where she'd been in December, comfortably within her target range. Huzzah!

The other thing that's had Matt and I in a frenzy of worry is that we'd been notified, by both Matt's insurance and CHKD (the "local" children's hospital) that their contract with the insurance company was about up and that the insurance company was seriously considering dropping their coverage. Which means that any visits to CHKD would be considered "out of network" and correspondingly more expensive. Switching to my insurance wasn't an option, because it's the same company, just a different plan. (I have an e-friend who manages her son's diabetes without the benefit of medical insurance, but I swear I have no idea how!)

So Matt and I tried to find other pediatric endocrinologists who might be in-plan, but there aren't any in our area. At all. We were debating the choice between paying the out-of-network fees and taking Penny to a non-pediatric endocrinologist, who wouldn't be as conversant with the specific issues of a child diabetic, like growth and the effects of puberty. (And who would, let's face it, be far more familiar with type 2 diabetes than type 1.)

But while I was chatting with the nurse practitioner examining Penny yesterday, and bemoaning the hard choices ahead of us if our insurance drops CHKD, she corrected a misconception that Matt and I both had: the pediatric specialty group that we take Penny to for her checkups is affiliated with CHKD and keeps their primary office in the hospital, but is not actually part of the hospital, and their participation in our insurance is not going away, even if the hospital's does. So if our insurance drops CHKD, it'll mean that they have to send bloodwork to a different lab, and that if Penny is hospitalized and the Williamsburg hospital decides it's something they can't deal with and they need to send her to CHKD for pediatric specialty care, we'll have to pay the out-of-network premiums for that, but her regular checkups will still be covered.

Which, frankly, is a huge load off our minds. It's still somewhat of a concern (especially since hospitalization isn't cheap even in network) but that's not something that happens often, and we'll deal with it as it comes up.

We also talked about some other, more minor, concerns (the high dosage of insulin Penny requires in the mornings, and her weight issues). We made plans to attend a pump class in early June so we can start the process of turning my daughter into a cyborg. (She didn't think that was funny, either, but she still wants a pump. Since that will allow us much finer control over her dosages and give her more flexibility with regard to eating and make it easier for her to do things like go to a sleepover, I'm all for it.)

So it was a good checkup. It left Matt and I both feeling like weights had been lifted from our shoulders, and we're ready now to march onward. How often does that happen in the life of a diabetic's parent?


Matt said...

Penny was actually bragging about "becoming a cyborg" on the walk home with Ray yesterday once she gets her pump. I thought it was amusing. I guess she's coming around on that idea, too.

rachel said...

Yay! I am so happy for the good news :D I can't wait to see Penny's new pump!!