what happens at first 3-month checkup post-DX?

Hi all,

I have been lurking here for the past few months. First 3 month post-dx appointment is coming up fast and I am feeling a little (lot) nervous. Can anyone simply outline what we can expect? Will we meet with multiple team members or just endo? How long does it last, in your experience? When do they draw blood for A1C? I know we're all different, but any general ideas of what to expect would be most assuring. Thank you!

Also, how do I keep my child calm before/during the appointment? I haven't even informed her that this is taking place. Not sure how far in advance I should spring the news that we have to go to the endo (whose office in the hospital, which may stir bad memories -- it does for me!).

Anyway, sorry for all the questions! I have learned so much from this board already

 

Honestly, it varies so much from doctor to doctor that you're going to get wildly varying responses. Our early appointments lasted quite a bit longer than our current appointments do. I think they assume that you will have lots of questions for them. We do A1C at a separate lab, so it is not connected with our appointments at all. Some endos have a fingerstick machine in their office. It just depends.

How old is your child? We brought my father-in-law along to our first appointment so that he could watch Jack in the waiting area while my husband and I asked the endo questions. (He was 3 at the time, and not the sort of kid who would sit still for a lengthy appointment.)

There is no reason to be nervous. Can you explain what is making you feel anxious, and maybe we can reassure you.

 

We have a finger stick A1C done at each appointment and urine check with blood draws yearly. October 2014 was our 1 year anniversary and they drew for cholesterol (which was elevated and addressed at our last appointment in April, missed January due to bad weather). They also checked Thyroid and a few other things. They didn't check celiac because his one in the hospital was negative. We see a PA and the CDE. They download both his meter results (one for home and one for school) and can see his ranges over the past 3 months. He gets a basic physical and we can ask any questions we may have. They really aren't that bad. Try not to worry too much. I know it is easier said than done. Hang in there.

 

At 3 months:
They weighed him
They Measured his height
We met with a nutritionist
We met with a social worker
We met the endo
Fingerstick A1C
Prescriptions as necessary
Discussions about CGM
Questions/advice
Upcoming events for T1D parents and kids

they patted us on the rear, and said see you in three months.

 

It is probably different everywhere. For us it went like this.

Typical weight, measurement, blood pressure before the appointment.

Get in the room and the nurses take his meters to download them. Did a finger stick for the A1C test. They also asked us about total daily insulin - which I did not know so maybe be prepared for that one In full disclosure I have not once been prepared for that question, lol.

The nutritionist popped in to see if we had any questions. She hasn't been back since but we did not have any questions. We had an appointment at 2 weeks in which we met the entire team of people and that appointment lasted two hours. The 3mo appointment and all subsequent ones have been one hour or less.

The endo came in to talk to us (my son was 13yo at the time so he talked directly to him) and answer any questions that we had. I had a few that I had written down. Everyone's questions are different I imagine!

He gave us the A1C results.

Prescriptions were reviewed and re-ordered if needed.

That was it. It was very easy and pleasant and my son was not nervous about it at all so there wasn't anything I had to do to prepare him. Good luck!

 

I'm still nervous for every appointment almost a decade later and they're never bad. Even when things aren't going well I always leave feeling encouraged, not discouraged or judged. I always sulk my way into the office and practically skip out. I'm hoping it will be the same for you. I am sure not doctor will expect you to be an expert or have things perfectly even keeled three months in.

 

ours was about the same, we give everything to the receptionist, pump, meters, cgm and they download it for us. Then we get vitals and his fingerstick a1c done. They review how things have been going, encouraged us to ask questions, tells us how good we are doing and go over dosing, always ask us if we have enough supplies, due a basic physical and off we go. I found the first one longer due to having more questions.

 

Here's a quick description of what goes on to prepare for and what occurs at my appointments. I'm probably a lot older than your child, so some things might be a little bit different. A lot of stuff is similar from appointment to appointment unless major treatment strategies are changed (such as talking about switching from MDI to a pump).

My endo has me do lab work about 7-10 days before my appointment. It almost always includes a basic metabolic panel and A1C test, though I also have cholesterol, thyroid, vitamin D, and urine tests done at least once a year.

At the appointment...
-Have vitals taken. This includes height, weight, BP, temperature, pain, and BG. They also ask if I experience any symptoms that might point to diabetes complications or other health issues (numbness in feet, needing to urinate a ton, excess thirst, unusual pain, etc.)
-Have insulin pump uploaded to their computer and the reports printed out
-Analyze lab results and see if any new medication needs to be added or any tests repeated
-Analyze the BG data on the pump and make adjustment to insulin dosages
-Have endo/NP talk about the same old stuff they always have to discuss at every appointment. For my age group, this includes topics like alcohol/drugs, sex/pregnancy, driving, hypoglycemia/rule of 15, exercise, nutrition, etc.
-The endo/NP answers any questions I might have
-The endo/NP does a diabetic foot exam. They have a fine gauge filament and slide/poke it around the foot to assess for neuropathy.
-I'm free to go. I receive my labwork orders for the next appointment and schedule my next appointment

 

Write down your questions and bring stuff to take notes! At diagnosis you knew nothing and were just getting the basics; now you will learn more advanced tips and talk about additional technology like CGM etc. Lots to learn. We had several vials of blood drawn at diagnosis and were tested then for thyroid, celiac, etc. (which is repeated annually), so the only test done at the 3 month appointment was a fingerstick A1c. If you can get them your meter data ahead of time that might save some time - we use diasend.

 

^^^This. Also, write down what prescriptions you need-- it is MUCH easier to ask for prescriptions in person rather than over the phone. If you have concerns about running low on insulin or test strips ask for them to increase the prescription. It is pretty standard to get 300 strips a month (10 per day) and even if you don't test that much now it is always good to start building up a small stockpile. Also you can request a blood ketone meter and strips which will be helpful in the case of illness. If you want to start using a pump or CGM you can find out what the process is for that and get started. Other useful things include requesting extra meters and lancing devices since those have a tendency to go missing or get forgotten at school/home/playground. Your endo should have a closetful of extra meters to give away since the companies make money off the strips. I guess the last thing is if you have any insurance or financial concerns you should ask for help with that. Sometimes it is as simple as switching to a different brand of test strips to get a lower copay and some states have special programs for kids with diabetes and a social worker can get you sorted out with that. Good luck!