I had my annual review with my endo on Monday. I'll be honest, I was extremely nervous about getting my HbA1c result back. I normally run the usual 'having everyone guess' pool on Twitter, etc. But I didn't this time, because for once, I was actually scared about the result. With my several month run of extremely fruity scores, I was worried. I had prepared myself for a double figure score, knowing that whilst that would be a huge jump from my previous result of 7.1, if I prepared myself for the worst, then at least it wouldn't be too much of a shock.
As I was sitting in the waiting room, all sorts of things were going through my head - what if they took my pump off me? After all, it was supposed to help me bring my A1c down. Well, it turns out that whilst it had gone up, the damage wasn't as bad as I'd been expecting. It rolled in a 7.8%, which I know many people would bite my arm off for. So, Dr J. wasn't too worried about that. He told me that he knew I'd get it back down again, and he had absolutely no doubt about that. He also wasn't that concerned about what I've been calling my 'fruity' scores. His argument was that a) my honeymoon has clearly ended, and b) my body was still getting used to pumping - the two things together meant that the scores I'd been getting didn't surprise him. What surprised me, however, was what seemed to concern him. Which was my weight. Or more precisely, my BMI.
Now, I was pretty clued up to the fact that I'd most likely put on a few pounds, but it wasn't something that I was overly concerned about. I also dislike BMI as a form of measurement a) because for some reason, the hospital have measured my height as several inches shorter than I actually am, which skews things, and b) it just seems to make everyone feel bad about themselves. However, Dr J. seemed extremely concerned about it. Apparently my BMI was too high for someone with Type 1. He wanted to put me on Metformin. I did not want this. When I was in hospital after I was diagnosed, they weren't quite sure what type I was. This was despite the fact I had ketones that were (so I'm told) practically off the scale. Since I was out of adolescence, they gave me Metformin. It did not agree with me. I know for a fact it would most likely not agree with me now, for reasons I'll come on to shortly.
So it turns out that from about a year ago, I'd put on 5lb. This apparently had tipped things to a point where he wasn't comfortable with my weight, despite the fact that I'm still lighter than I was pre-diagnosis. I pointed out that my total daily dose was still coming in at under twenty units - I'm hardly insulin resistant, so I didn't really see the point in it. Then he asked me THE question, which has been rattling around in my head all week:
"Have you always been on the chubby side?"
Well, what do you say to that? Admittedly, I have always been heavier - I'm built that way, and even if I were to shed all excess weight, I'd still have a heavier build. I'm never going to be a size 8. That I've come to terms with. But I was slightly dumbfounded, and the best I could come out with was, "Uh, I guess so?".
The discussion went on for a while, and eventually I convinced him that I didn't want to take him up on the offer. That was fine, he told me, he didn't want to twist my arm and force me into anything I didn't want to do. I said if my weight was really a concern, then I would try and do something about it. We agreed that I would try to lose a stone by my next annual review. Ideally, I want to lose two, so that he really has nothing to complain about.
So the comments about my weight cut rather deeply. I've always had issues about my appearance, so having this put in front of me hasn't been exactly easy. It's upset me. I know he didn't mean it to, but it has. However, that's only 50% of what this post is about.
I said I had reasons for not wanting to go onto Metformin. I remember, from the couple of days that I was on it, that it did not agree with me. It caused many of the side effects that it's well known for - abdominal cramps and excessive gas being the ringleaders. You see, the thing is now, that I have issues with IBS. I don't talk about it much, particularly not on here, because well...it's not really very pleasant. You just don't talk about those sorts of things, do you? That leads me to ask, why not? I don't mean graphically (I promise I will never do that), but why is it such a taboo to talk about this? I asked out on twitter about whether any other Type 1's had Metformin suggested to them, and eventually discovered that I wasn't alone in dealing with both T1 and IBS. I suspect there are more people out there than just the two of us, as well. But it's not the sort of thing one sits around and chats about in polite company. But surely that's where problems, particularly those of feeling isolated, start? When we don't admit things, and we don't talk about them?
So this is me saying that I have IBS as well as T1. For me, my IBS is mostly stress induced, and I don't have it half as bad as other people I know. But it's there all the same. And for me, I didn't see the point of putting myself through the wringer of Metformin, in all probability exacerbating my symptoms, for the minimal payoff. So I'm going to try and get rid of this two stone the old fashioned way.
And if anyone else with IBS wants to say hi, please do - you're not on your own either.
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I either hate to love metformin or love to hate metformin, I haven't decided which. IBS symptoms most of the time since getting my first period (is that more taboo?).
I'm a month into my second try, which has gone a lot better than the first time around (June 2007 - April 2009). Mostly because I've actually seen a change in my blood sugars this time, which I never really saw the first time around.
Okay, I've not seen a ton of pictures of you, but you are not "chubby". :/ I'm overweight. I know it. My endo knows it. And I'm also slightly insulin resistant. But when I asked my endo about metformin, she told me that as long as I was doing okay on my A1c that she didn't want me using anything like that because the possible side effects weren't worth it. I day don't worry about it. Get your A1c to where you are comfortable with it and don't worry about the rest.
There was me thinking you looked like a normal 26 year old woman, but now your doctor has told me you're overweight I guess I'd better change my opinion. What a lot of nonsense; glad you will make up your own mind about what, if anything, to do next.
It never hurts to get a second opinion. Or at least insist that they remeasure your height and ask your doctor if he will do a body fat measurement. Maybe in composite all these data will show a different picture. Women - especially athletic or muscular women - can have a higher BMI even though they are at a good weight.
Other things I've recently read is that drs. don't usually worry if you are just overweight according to BMI, but do worry if you are obese. Maybe your current doc is just being cautious. But his bedside manner could be improved, IMO.