Inertia

When I was diagnosed, I was admitted to the children's ward at the hospital close to where I live. That is where I was designated my first (paediatric) diabetes team, and where I got my diabetes education. That is where I switched from Mixtard 30 (yuck!) to MDI of Lantus and Novolog, and that is where I made the transition from paediatric services to adult diabetes services. Then I switched from MDI to pumping Novolog, and from pumping Novolog to pumping Apidra.

My diabetes team are really supportive, and know that even though my a1C is in the high 7s I truly am doing the best I can. They know that I test 10-12 times per day and use a CGMS and run temp basals and adjust my basals every couple of days and bolus for everything I put in my mouth and spot patterns and do all that jazz. And they give me the credit for doing that, even though my a1C is considered sub-optimal (apparently I'm supposed to aim for below 6.5). They realise that my hypo-unawareness is something which waxes and wanes and doesn't seem curable simply by running high for a bit, and understand that my other illnesses can sometimes affect my diabetes control. They have even given me opportunities for public speaking, teaching doctors and nurses from my area about the insulin pump and continuous glucose monitor, which was great.

The problem is, I don't feel like I necessarily get much from them other than an ego-boost. They make me feel like I'm doing the best I can and that is lovely, but also fairly pointless. I may as well just be told my a1C in an email, because it seems that that is the primary result of my appointments (which are every 6 months and usually last less than 10 minutes). Because pumps are so uncommon in my area, they do not seem to know a lot about adjusting basal rates according to patterns, and they know almost nothing about CGMS (I was left to insert it myself according to the instruction manual, and they told me to disconnect the transmitter when I have a shower - bad idea!).

The clinic I could move to is in Cambridge, where I go to university. In terms of ease, it makes little difference to me (I spend roughly the same amount of time at university in Cambridge and at home in Essex). However, Addenbrookes hospital has an amazing reputation, particularly in diabetes care. There was recently an article published about regional variation in amputation rates, and the Cambridge area had the lowest rate, with where I live in Essex having the highest rate. Addenbrookes also have a good history of prescribing insulin pumps, which will become relevant to me soon, since I am coming up on 4 years of pumping and it will be time to prove yet again that I should get a new pump rather than going back to MDI.

However, I am still not sure whether or not I should move. As a person I tend to get stuck in the rut of what is comfortable, and it is certainly comfortable for me to keep going to the D clinic which I have always gone to, and be seen by the professionals who I know and who know me. I am worried that if I switch my team might be more judgemental about the fact that I am failing to reach the targets set, because they do not have a history with me. On the other hand, I know that those worries are kind of stupid - I mean, who cares if my doctor or nurse thinks that I am trying or not, as long as I know that I am? So I think that I will probably switch.

I just need to stop with the inertia and start actively trying to improve things. Now that is a challenge.