Walking on sunshine

Last Thursday, I  had my own personal judgement day – my endocrinologist appointment. After 3 months of 4-5 times a day finger sticking, pre-meal boluses, a drastically changed diet and a few more things thrown in for good measure, I was feeling pretty good about this visit.

I was still a little nervous, though. Deep breaths.

When my doctor knocked and entered the examination room, I took another deep breath. She looked at me, smiled and said “What have you done?”

I thought to myself “Oh no!” and then she handed me the paperwork that showed this:

  • Hemoglobin A1C: 6.9% (was 8.6%) [4.8-5.6%]
  • Serum Glucose Fasting: 73 mg/dL (was 229 mg/dL) [65-99 mg/dL]
  • BUN: 15mg/dL (was 17 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.70 mg/dL (was 0.83 mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.270uIU/mL (was 1.880 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 178 mg/dL (was 170 mg/dL) [100-199 mg/dL]
  • Triglycerides: 126 mg/dL (was 240 mg/dL) [0-149 mg/dL]
  • LDL Cholesterol: 90 mg/dL (was 70 mg/dL) [0-99 mg/dL]

That’s 8 out of 8, all in the desired ranges. (And lest you question the A1C, for diabetics, they want it to be <7.0%). I haven’t seen an A1C in the 6’s – and even the 7’s – in a long, long time.

That is a HUGE drop in my A1C in just 3 months, from an average BG of around 200 to 150. That is very significant and very hard to do (A1C can often lag).

And my triglycerides went down almost 50%, too!

What’s more, my liver function tests – which were out of whack last time – were also back in the normal range.

YEA!!!

I think I deserve a pat on the back.

patonback-400w

Needless to say, this news made both me and my doctor very, very happy.  It was so nice not to be scolded (even though she does it very nicely) and to talk about positive things instead – like how the changes I’ve made are working, low-carb recipes for Thanksgiving, participating in the Step Out Walk to Stop Diabetes and more.

As I left her office – and even now, a few days later – I am still walking on sunshine.  And it feels good!

I can do it! Week 3

3 weeks in, 76 days until I see my endocrinologist again. How I am doing?  Well…I’m still hanging in there, still trying really hard to do what I’m supposed to do.  Not perfect, but I would argue that perfect is impossible for a T1D.  In fact, my idea of a perfect T1D day is no numbers above 200, and I’ve had several of those since I’ve been testing more and eating much better (yea)!

Observations

  • I tested my BG an average of 4.4 times per day this week (last week it was 5.3).  It doesn’t help when you take an all-day road trip and leave your glucometer at home!
  • I had 3 readings above 200 this week (down from 4 last week).
  • My fasting BG averaged 106 (last week it averaged 105). Not as consistent as the previous week (a couple of lows with a couple of higher than I’d like for a fasting BG numbers).
  • I had 10 measured lows (<80) this week, some lasting for several hours.  I need to continue to tweak my basal rate (I lowered my middle of the night basal) and remember to set a temporary bolus BEFORE I start exercising (especially mowing the lawn in South Florida in August).
  • I’m doing much better with my diet (lower carbs, less fat, no wine on week days) but I  still feel like I’m living for that next meal or snack.
  • I have lost 4 pounds.  Wish that was a bigger number, but it’s a start.

On to week 4 – wish me luck!

August 16-August 22

Date

Time BG Pre-Bolus Carbs Bolus Correction

Comments

8/16

7:46a

142

         
 

11:43a

109 X 40g

6.6u

   
 

2:50p

132  

19g

     
 

6:08p

120 X 30g

5.0u

   
 

8:57p

74 X 30g

5.0u

   
               

8/17

7:35a

94

         
 

9:21a

  X 20g

3.3u

   
 

11:49a

125 X 40g

6.6u

   
 

2:40p

135

         
 

3:42p

  X 22g

3.6u

   
 

6:04p

92

         
 

9:41p

142      

0.1u

 
 

10:50p

  X 24g

4.0u

   
               

8/18

6:42a 76  

24g

     
 

10:09a

175      

1.0u

 
 

12:23p

  X 40g

6.6u

   
 

6:46p

212      

0.5u

 
 

7:30p

    45g 7.5u  

Pizza

 

9:47p

294      

3.3u

 
               

8/19

6:08a

132

        10 hour car trip (plus left glucometer at home)
 

9:07a

  X 35g

5.8u

   
 

1:56p

  X 45g

7.5u

   
 

8:30p

193 X 35g

7.3u

   
 

10:56p

232      

0.1u

 
               

8/20

9:41a

124

         
 

11:59a

  X 30g

5.0u

   
 

1:52p

65  

18g

     
 

3:47p

105 X 19g

3.1u

   
 

7:07p

  X 30g

5.0u

   
 

9:03p

104 X 25g

4.1u

   
               

8/21

6:52a 58  

22g

     
 

8:11a

  X 30g

5.0u

   
 

10:51a

52  

19g

    EXERCISE! Set Temp Basal to 0.7u for 1.5 hours
 

12:20p

  X 40g

6.6u

   
 

2:16p

93

         
 

4:13p

54  

16g

     
 

5:40p

  X 60g

10.0u

   
 

8:02p

53  

32g

     
               

8/22

7:52a

121

         
 

11:45a

  X 40g

6.6u

   
 

3:10p

122

         
 

5:38p

77  

19g

     
 

6:20p

  X 45g

7.5u

   
 

9:11p

75   20g

2.5u

   
 

10:45p

73  

22g

   

I can do it! Week 2

A couple days late, but here are my second week results (August 9-15).  I’m feeling pretty good about what I’m doing.

So here’s what I see:

  • I am testing my BG an average of 5.3 times per day (last week it was 4.5).  My poor fingers!
  • I had 4 readings above 200 this week (only 2 last week, but I did eat out a couple of times this week).
  • My fasting BG averaged 105 (last week it averaged 136). Much better!
  • I’m still having too many lows (<80) for my comfort.  These are very physically draining for me. I need to look at my data more closely, see if I can spot any trends and do some adjustments. (I need IBM Watson)!
  • Pre-bolusing seems to be working for me – and it is getting more instinctive each day.
  • I have not lost much weight (ugh).  As drastically as I think I have changed my eating and drinking habits, one would think (hope) that I’d see more of a change on the scale, too.  Ah, the frustrations of trying to lose weight when you’re over 50.

I sent two weeks of data to my endocrinologist a few days ago…still waiting on her insight (and dare I say a thumbs up).

Date

Time BG Pre-Bolus Carbs Bolus Correction

Comments

8/9

6:49a

134

11:25a 97 X 35g

5.7u

2:15p

191

0.5u

6:03p

144 X 35g

5.8u

8:25p

156

8/10

7:48a 65  

18g

8:24a

167

0.7u

11:23a

100 X 30g

5.0u

1:51p

114 X 16g

2.6u

3:54p

71  

34g

6:21p

197

0.3u

8/11

7:55a

94

8:56a

X 40g

6.6u

1:33p

111

3:19p

40g

6.6u

Late bolus (pump empty during pre-bolus)

4:13p

208

0.3u

6:50p

X 40g

6.6u

Ate out

9:24p

259

1.6u

8/12

6:05a

135

9:01a

X 30g

5.0u

10:42a

167

2:50p

55

        No lunch

3:50p

X 21g

2.2u

7:28p

128

8:26p

X 40g

6.6u

9:31p

220

1.0u

8/13

1:34a 54  

17g

1:59a

88

17g

8:13a

74

9:26a

X 30g

5.0u

10:39a

43

        EXERCISE!
 

11:46a

61

        EXERCISE!

1:04p

X 27g

4.5u

2:40p

89

3:33p

X 35g

3.6u

6:04p

X 50g

8.3u

7:48p

90

8:44a

X 35g

5.5u

8/14

8:09a

102

9:29a

X 35g

5.8u

11:37a

133

1:08p

X 45g

7.5u

3:51p

84

5:46p

X 45g

7.5u

7:14p

68  

18g

8/15

6:52a

130

11:05a

105 X 40g

2.9u

2:27p

263

3.2u

No idea!

5:38p

188

0.3u

6:02p

X 30g

5.0u

7:57p

170

0.3u

8:51p

X 22g

3.6u

10:32p

135

I can do it! Week 1

As promised in my last blog post, I’m going to share my progress and weekly data with you.  So…how am I doing?

ICanDoItScorecard-Week1

I think it’s a pretty good start – not perfect, but certainly much, much better than what I have been doing.

I’m not as insightful as IBM Watson, but here’s my take:

  • Testing my BG an average of 4.5 times per day is significantly higher than the (approximately) 2 times I have been doing.
  • Only two readings above 200 this entire week (and one was because my infusion set slipped off so I wasn’t getting insulin for a short time).
  • Fasting BG averaged 136 – I need to get that lower, but I am positive that is better than it has been.
  • A bit too many lows (<80) for my comfort.
  • I feel like I am living for my next meal.  I remember this feeling all to well, whenever I’ve followed the ‘diabetic diet’ (eat smaller meals several times during the day) in the past. At least I have something to look forward to every few hours!
  • I decided not to wear my CGM in these first few weeks, because I find that I let it do the work for me (as it is supposed to).  I want to establish good habits of testing my BG more regularly before I rely on technology to ‘do it for me.’

I’m going to send this data to my endocrinologist in a few days. Curious to hear what she says and if she’ll recommend any adjustments.

And here’s all the gory details:

Date

Time BG

Pre-Bolus

Carbs Bolus

Correction

8/1

6:33a 120

8:23a

X 30g 5.0u

10:35a

98

12:05p X 30g

5.0u

2:49p

77

5:29p

176 X 45g

7.5u

9:06p

142

8/2

6:26a

142

7:50a

X 30g

5.0u

9:53a

153

11:45a

X 30g

5.0u

1:58p

93

4:15p

108

7:28p

134

15g 2.5u

8/3

7:17a

113

8:27a

X 30g

5.0u

11:07a

153 35g

5.8u

1:08p

211

0.5u

2:43p

174

0.1u

6:48p

84 X 30g

4.5u

9:41p

133

8/4 7:58a 155 0.4u
12:02p 124 X 45g 7.4u
2:41p 243       1.2u
5:23p 190 0.5u
7:35p 61 45g 7.5u
9:59p 81 34g 5.1u
8/5 6:44a 90
7:50a X 30g 5.0u
9:55a 145
11:33a X 35g 5.8u
1:20p 193 0.3u
2:25p 73
4:09p 65
8:04p 70g 11.6u
8/6 1:00p X 75g 12.5u
3:52p 58
6:04p 45g 7.5u
9:53p 97 19g 3.1u
8/7 6:35a 119
8:50a X 30g 5.0u
11:16a 60g 10.0u
2:31p 283       2.5u
3:37p 60g 10.0u
8/8 6:09a 77 X 15g
10:24a 104
12:20p 77 X 35g 5.0u
3:20p 115
6:02p 35g 5.0u
8:07p 134 X 20g 3.3u

Mea culpa.

“I’m worried about you, Kim.”

Those were the words of my endocrinologist as she entered the examination room. Not the words of kudos that I was hoping for (if not somewhat expecting).  I had been using my CGM, I had been religious about taking my medication, and I had been testing my BGs more (not enough, but more).  I didn’t think they would much under 8, but I didn’t think they would go up, either!

And then she proceeded to go through the test results that were not in my favor – the good ol’ standbys and some new ones. Let me recap:

  • Hemoglobin A1C: 8.6% (was 8.3%) [4.8-5.6%]
  • Serum Glucose Fasting: 229 mg/dL (was 119 mg/dL) [65-99 mg/dL]
  • BUN: 17 mg/dL (was 14 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.83 mg/dL (was 0.79 mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.880 uIU/mL (was 1.330 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 170 mg/dL (was 226 mg/dL) [100-199 mg/dL]
  • Triglycerides: 240 mg/dL (was 165 mg/dL) [0-149 mg/dL]
  • LDL Cholesterol: 70 mg/dL (was 138 mg/dL) [0-99 mg/dL]

She was very concerned about the triglycerides (diabetes and heart disease are highly correlated). Note: My cardiologist wants his patients to keep their TRG levels < 100; for his diabetic patients, he wants it to be < 70.  240 is SERIOUSLY in the wrong direction.

And then she also mentioned elevated potassium and elevated liver enzymes. Potassium can be indicative of kidney and heart function.  Elevated liver enzymes can be indicative of liver function. Those have never been out of whack for me – and those are the big ones for diabetics.

Oh dear.

That’s when the rubber hit the road. Push came to shove. The you-know-what hit the fan.

And then came the tears.

You know, I knew this was coming. I have been skating through my diabetes management for the last few years, mostly focused on A1Cs. High sevens to high eights in the A1C department, with a nine something in there for (not so good) measure.

You can call it being lazy, stubborn, selfish, rebellious, whatever you want. I’m just going to call it stupid – and I’m not a stupid person. Mea culpa.

She asked me why I was tearing up, and I told her that I was disappointed in myself. And that I’ve been avoiding changing my diet and exercise routine. And that I know I have been lax (more accurately, lazy) in my self-management of my disease.

She said it was good for me to have this “aha” moment.  And that this was the first step in turning this around.

She was – and is – right.

She also encouraged me to send her my BG readings and other information at any time so she can help me, rather than waiting 3 months to address any issues. (I have the best endocrinologist).

I write this now, two weeks since the appointment.  I let myself feel sorry for myself for one day, I immediately made some changes to my diet, and I went on vacation.  I made these pledges to myself:

  • I will test my blood glucose before meals, not just after.   This will help me better determine how much insulin I should give myself with my meal.
  • I will bolus (give myself insulin) 15 minutes before I eat.  This “pre-bolus” gets the insulin into your system earlier (while you are eating) and should help reduce post-meal BG spikes.
  • I will visit a nutritionist and get back to a healthier diet. (Less carbs, less fat, smaller meals spread throughout the day…)
  • I will exercise more. (Duh).
  • I will stop drinking wine during the week and save it for weekends only. (Double Duh).

(BTW, I know all of these things. It’s not new news to me.  As I said earlier, I’ve been skating through my diabetes management for too long now).

So…

By writing this in my blog, I am pledging this not only to myself, but to you.  It’s in writing and in the public domain now.  I will also try to share my progress each week.  I figure if I make it public, I will have additional motivation to do better (as if my health was not enough). I can do this!

Anyway, thank you for listening.

And I WILL do this.

 

 

 

Keep on swimming, swimming, swimming…

Here we go again! At least I can say that my A1C is improving. Not quite where I’d hoped it would be this time, but getting there.

  • Hemoglobin A1C: 8.2% (was 8.8%) [4.8-5.6%]
  • Serum Glucose Fasting: 119 mg/dL (was 83 mg/dL) [65-99 mg/dL]
  • BUN: 14 mg/dL (was 14 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.79 mg/dL (was 0.66 mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.330 uIU/mL (was 1.330 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 226 mg/dL (was 213 mg/dL) [100-199 mg/dL]
  • Triglycerides: 129 mg/dL (was 137 mg/dL) [0-149 mg/dL]
  • LDL Cholesterol: 138 mg/dL (was 124 mg/dL) [0-99 mg/dL]

I really thought that my A1C might sneak in under 8.  I was so hoping for a number in the 7s (I knew it couldn’t possibly be less than 7, which is the ultimate goal for this T1D), but I would’ve been thrilled with a 7.9999 (smile).

[For those who may not know or have forgotten, the Hemoglobin A1C test is a diabetic’s touchstone into how they well they are managing their diabetes.  It measures glycated hemoglobin, or, simply put, your average blood glucose for the past 2 to 3 months].

So, my A1C was 8.2%, which means my average blood glucose for the last 2-3 months has been around 190. (Last go ’round, it was 8.8%, which is an average blood glucose of 200+.  And the time before that, it was 9.0%, which is an average blood glucose of 212).

Note that  a normal A1C is between 4.5 and 6. Most diabetics have a goal of <7%, which would indicate an average blood glucose of about 154.  That sounds like nirvana to me!

Anyway, my doctor and I looked at graphs of the last 3 weeks from my pump and CGM.  There were two clear trends:

  • My morning blood glucose is running too high (which means it has been running too high through the middle of the night too often) and it doesn’t seem to lower quickly enough (whether I eat or not).
  • My late afternoon blood glucose is dipping too low too often.

We made some adjustments to my basal rate and carbohydrate ratio at different points in the day. And she was happy that I am exercising more (so am I, although a bit frustrated that the scale moves down as slowly as my A1C).

I did mention that I am not sensing my lows like I used to (I’ve had several in the 40s recently where I barely knew I was low – this can be a bit scary).  She said that is a normal progression (neuropathy) for someone like me who has been diabetic for 30+ years.  We also discussed using a temporary basal when I exercise to (hopefully) prevent the lows that I seem to be having now that I am exercising more.

You might have noticed that my cholesterol inched up, even though I have been exercising more and eating better.  I realized a couple of weeks ago that I had not been taking my Crestor as regularly as I should (it is on a different refill schedule than my other meds, and I have another pill that looks very similar. Doh! So hopefully, with more rigor in taking my medication, that will improve, too).

Overall, a good appointment, and I am trying to focus on the good news. My initial reaction was to be disappointed and discouraged, but I told myself (and keep telling myself) that I am doing the right things, and it just takes time.  So I shall, like Dory, keep on swimming, swimming, swimming…and work towards that ever elusive <7% in June.

Thanks for listening!

 

You’ve got to look back to move forward

No, I did not publish my last test results (from October). I was, frankly, dismayed. Since I am going back to my endocrinologist on February 24th, and I have been trying, trying, trying…I am  hopeful that the numbers will be better.

For the sake of completeness and chronology, here were my results from October 2014:

  • Hemoglobin A1C: 8.8% (was 9.0%) [4.8-5.6%]
  • Serum Glucose Fasting: 84 mg/dL (was 114 mg/dL) [65-99 mg/dL]
  • BUN: 14 mg/dL (was 13 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.66 mg/dL (was 0.83mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.330 uIU/mL (was 1.390 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 213 mg/dL (was 201 mg/dL) [100-199 mg/dL]
  • Triglycerides: 137 mg/dL (was 167 mg/dL) [0-149 mg/dL]
  • LDL Cholesterol: 124 mg/dL (was 103 mg/dL) [0-99 mg/dL]

What is going on? Some things up, some things down. Overall, very disappointing. And yes, if I look at it, now 5 of the big 8 are in “normal” ranges, but:

  • My A1C inched down ever so slightly. That’s the right direction, but nowhere near where it should be.  I’ll take anything under 7%, to be honest. That would be MAJOR for me.
  • Both my cardiologist and my endocrinologist want my triglycerides to be under 100.  Looks like the Crestor is helping with that, but the rest of my cholesterol numbers are going up.  And my endocrinologist said I am maxed out on Crestor, and there is nothing else medication wise that she can do for me. So (and I knew this was coming), I am going to need to adjust my diet and increase my exercise.

My endocrinologist also showed me the Medtronic graphs of another patient who tests her blood sugars 4-5 times a day.  Her A1C was in the 6% range, and she didn’t have the fluctuations that I have. So…I promised myself that I would get back to testing more frequently (I was testing 1-2 times a day at best).

Plan of action:

  • Increase my exercise.
  • Test my blood sugar at least 3 times a day.
  • Eat better (less red meat, more vegetables, less carbs, less fat).
  • Take my medications every day.
  • Decrease my wine consumption.

Basic tactics that just about everyone should do (except #2).

I guess I’ll find out how well I’ve been doing in a couple of weeks.  Have I been perfect? Of course not! But I have tried. Anecdotally, I have lost 10 pounds since Christmas, I wear my Jawbone Up24 (my Christmas present) daily to track my steps and sleep, I’m eating less snacks, eating a lot more chicken and seafood, drinking wine spritzers instead of wine at night, and not missing my medication as much. I’ve also been wearing my CGM for the last several weeks, which MAKES me test my blood sugar more regularly.

With the increase in exercise, I am getting more lows…and some of those lows have hit me like an oncoming train! I’ve even had to adjust my basal rate down (less insulin is always a good thing).  I’m still experiencing more lows than I think I should, so there’s probably still some more adjusting to do.

Keep your fingers crossed for me! I don’t think my A1C will be under 7%, but I’m hoping for under 8% this time. Please.