{"id":1911,"date":"2020-03-17T16:23:00","date_gmt":"2020-03-17T16:23:00","guid":{"rendered":"https:\/\/reversingdiabetes.xyz\/blog\/2020\/03\/my-first-endo-visit\/"},"modified":"2021-05-03T19:58:08","modified_gmt":"2021-05-03T23:58:08","slug":"my-first-endo-visit","status":"publish","type":"post","link":"https:\/\/reversingdiabetes.xyz\/blog\/my-first-endo-visit\/","title":{"rendered":"my first endo visit"},"content":{"rendered":"
<\/div>\n

At the end of August, after having completed my first fasts, then going on to eat a ketogenic diet, learning to Eat Like a Bear, I saw my endocrinologist.<\/p>\n

I hadn\u2019t seen her in a while; I missed my previous appointment in April due to being out of town, and this was the first appointment they could get me, so was missing some recent blood work.<\/p>\n

I told her about Dr. Fung and what I\u2019d learned about reducing liver fat to decrease insulin resistance coupled with reduced pancreatic fat to improve beta cell function. I expressed my newfound belief that it was possible for me to actually reverse my diabetes.<\/p>\n

I showed her my bG readings and much excitement ensued; she was nearly bouncing in her chair as we spoke. She had them do an in-office A1c since I hadn\u2019t had one recently and expressed a bit of disappointment that it was 8.3%, much higher than my bG readings indicated. I reminded her it had been as high as 11.9% over the past year and I\u2019d only been at this a few weeks and her excitement rebounded.<\/p>\n

She was somewhat concerned to discover I\u2019d quit carvedilol, lisinopril and then wound up weaning off lasix; she double-checked my BP and expressed wonderment at the 138\/76 reading on no meds. My hypertension, uncontrolled on all those meds, seemed to be gone.<\/p>\n

I told her about being able to feel my feet all the way down to my toes, being able to walk on uneven surfaces without a stick, that I\u2019d begun walking with kitties. She had me remove shoes and socks and tested me all over and could find no neuropathy.<\/p>\n

We were both pretty damned excited by now! I knew things had improved dramatically, but it was nice sharing it with someone who understood the magnitude of what I\u2019d accomplished.<\/p>\n

We also discussed a couple issues.<\/p>\n

First was insulin.<\/p>\n

I\u2019d been on a regimen of 40 u basal and 30 u bolus 2x\/day prior to my first fast, 100 u TDD, with pretty poor control; spot checks showed me usually over 200, sometimes even over 300.<\/p>\n

I\u2019d begun on 30 u basal only during the fast, and had fasting hypoglycemic bG readings (with absolutely no hypoglycemic symptoms), so had just kept reducing insulin until I was on none. I expressed a certain amount of bewilderment about what \u201cbasal\u201d actually means; it\u2019s the long-acting insulin, supposed to provide for insulin needs when not eating, but I\u2019d wound up needing none. She suggested that for my next fast, I just stop insulin entirely and if my bG went up too much, just take a bit of bolus to knock it down, which seemed a good plan.<\/p>\n

She also suggested I go back on metformin, a relatively low dose, 1000 mg\/day. I thought this might help me get off insulin, so I agreed.<\/p>\n

The second issue we discussed was my adrenal insufficiency. I noted that when I began eating again, I was using 200 mg\/dL as my cutoff for taking insulin, and after several days of experimenting, I wound up on 30 u TDD, which had been working well for over a week. But I had noted that besides 15 u basal and 10 u bolus for my RBS dinner, I also needed 5 u for my morning prednisone dose. Since my goal was getting off insulin, it seemed to me that prednisone stood between me and accomplishing that.<\/p>\n

Years previously, I had badly failed an ACTH-stim test and then did a diurnal saliva test; I was making nearly no cortisol. It wasn\u2019t bad enough to be frank Addison\u2019s disease, but was enough to leave me mostly bedridden for over a year until I went on steroids.<\/p>\n

I know I don\u2019t have late-onset congenital adrenal hyperplasia (suspected because my sister has it). CAH prevents production of cortisol and aldosterone, but I make aldosterone just fine; I have bloodwork that proves it, if many years of out-of-control hypertension hadn\u2019t.<\/p>\n

We don\u2019t know of anything actually *wrong* with my adrenal glands; I speculated that if reducing visceral fat improved liver and pancreas function, might it not improve adrenal function also?<\/p>\n

I had been on a physiological dose of steroids for years, first hydrocortisone, later dexamethasone, finally most recently on prednisone. My dose was 5 mg on waking and 2 mg at 2 PM. Given my history, I didn\u2019t think I\u2019d get off it entirely, but if I tried weaning, the worse that could happen was an \u201cadrenal crash\u201d and I had hydrocortisone on hand for any such emergency.<\/p>\n

She suggested I go from my 5\/2 dose to 5\/1, give it some time, then go to 5\/0. Then a month out, we\u2019d test morning cortisol (before my prednisone dose) to see if my adrenals were bouncing back before proceeding.<\/p>\n

Finally, when she was writing labs, she asked what else I wanted and I asked to test FT3 and rT3, with an eye to the future; the conversion from T4 -> T3 happens primarily in the liver; maybe I could wean that too eventually. She also wrote labs for PTH and vitamin D, neither of which I thought necessary. But hey, she writes the ones I want; I\u2019ll bleed for the ones she wants!<\/p>\n

And I asked for a Libre; poking my finger just wasn\u2019t good enough anymore. I wanted to closely examine my bG as I figured out what to do to get off insulin entirely.<\/p>\n

After I visited my endo, Pete came to visit me<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

At the end of August, after having completed my first fasts, then going on to eat a ketogenic diet, learning to Eat Like a Bear, I saw my endocrinologist. I hadn\u2019t seen her in a while; I missed my previous appointment in April due to being out of town, and this was the first appointment […]<\/p>\n","protected":false},"author":1,"featured_media":1912,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"0","ocean_second_sidebar":"0","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"0","ocean_custom_header_template":"0","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"0","ocean_menu_typo_font_family":"0","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"0","ocean_post_oembed":"","ocean_post_self_hosted_media":"","ocean_post_video_embed":"","ocean_link_format":"","ocean_link_format_target":"self","ocean_quote_format":"","ocean_quote_format_link":"post","ocean_gallery_link_images":"off","ocean_gallery_id":[],"footnotes":""},"categories":[66,60],"tags":[],"class_list":["post-1911","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-early-results","category-my-journey","entry","has-media"],"yoast_head":"\nmy first endo visit<\/title>\n<meta name=\"description\" content=\"My endo was incredibly excited when she saw my bG logs. 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