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!

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.

 

Confessions of a tired T1D

I write this blog post, once again my diabetic head hanging in shame. And if not shame, in disappointment with myself.

I have been embarrassed to disclose my latest test results from June. Honestly, I really, truly thought my results would be better than last time, but no. (Heavy sigh).

Since the purpose of this blog is to motivate myself – and hopefully other diabetics – here goes:

  • Hemoglobin A1C: 9.0% (was 8.3%) [4.8-5.6%]
  • Serum Glucose Fasting: 114 mg/dL (was 147 mg/dL) [65-99 mg/dL]
  • BUN: 13 mg/dL (was 16 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.83 mg/dL (was 0.74mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.350 uIU/mL (was 2.090 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 201 mg/dL (was 185 mg/dL) [100-199 mg/dL]
  • Triglycerides: 167 mg/dL (was 133 mg/dL)  [0-149 mg/dL]
  • LDL Cholesterol: 103 mg/dL (was 92 mg/dL) [0-99 mg/dL]

Back to 4 of the big 8 being out of whack (even if 3 just inched up slightly). Can you see why I have been reluctant to share?

Hey, my fasting BG was 117 – yea! Save for small victories, I might be 5 out of 8 being on the wrong side of right.

So what happened?

  • I didn’t wear my CGM as often as I should.
  • I didn’t eat as well as I should.
  • I didn’t always bolus after I ate.
  • I didn’t exercise enough.
  • I didn’t test my blood sugar enough.
  • Sometimes I forgot to take my medications (even with one of those old people pill boxes sitting out on my counter).
  • Sometimes my pump reservoir became empty while I was sleeping and I waited several hours to refill it, so I’ve been without (new) insulin all that time.

There you have it. Confessions of a tired T1D.

Boo hoo, you’re probably saying. Get up off your blanking you-know-what and do something about it! And you’d be right.

So my next endo appointment is October 28. How can I ensure that I will be proud of my next set of test results?

  • I’ve been wearing my CGM more, but still not all the time. (I do get tired of being woken up at night to the alarms, and yes, I know that is the purpose of the alarms).
  • When I do wear my CGM, I am “forced” to test my blood sugar more times each day. (Kill two birds with one stone, you say? Another reason to wear it).
  • I have been exercising more. I have a puppy and I take him out for a walk 4-5 times a day at least. It may not be aerobic, but I am up off my blanking you-know-what and I’m sweating profusely in this South Florida summer heat. (I also mow my lawn each weekend, but I had a head cold and then sprained my ankle, so was out of commission for a while).
  • I have been eating better most of the time. Since my husband and I are now empty nesters, I’ve been cooking more vegetarian dinners. In fact, I got on the scale last week and was down 5 pounds.

Some other things I need to work on:

  • I am trying to take my medicine religiously, but I have missed a few days here and there.  That’s one I’ve got to figure out:  Why do I have a self-destructive attitude towards taking my medications? I pass by the pill box several times a day and don’t take them. I’ll leave my pill box empty without refilling it. Any suggestions for how I can stay on track with this one? (Perhaps recruit my husband to remind me? I’m sure I’ll handle that with grace and pleasantness).
  • I need to check my blood sugar and my pump reservoir before I go to bed each night.  It’s just stupid not to. One, if its high, I can correct and it shouldn’t be high all through the night. Two, if it’s low, I need to eat something. And three, if my reservoir is nearing empty, for goodness sake, get up off my blanking you-know-what and fill it.

Enough of being mad at myself, but sometimes me being mad or disappointed in myself is the best motivator.  (I wonder what that says about my psyche).

Anyway, thanks for being there.  I think I’ll press publish and head out to mow the back lawn. Oh, yes, and take my medications.

 

Coulda. Woulda. Shoulda.

It’s been a while since I’ve blogged, and I’m guessing that I was feeling subconsciously guilty because I didn’t do all the things I said I was going to do after my last visit with my endocrinologist.

Long story short, I am just very tired of dealing with diabetes. Poor excuse, I know. I honestly thought I had done better managing my BG the last 3 months, but, once again, it has crept up.

The news wasn’t all bad, though. My cholesterol is back to normal levels – YEA! The Crestor appears to be doing the job.

  • Hemoglobin A1C: 8.3% (was 7.9%) [4.8-5.6%]
  • Serum Glucose Fasting: 147 mg/dL (was 84 mg/dL) [65-99 mg/dL]
  • BUN: 16 mg/dL (was 14 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.74 mg/dL (was 0.69mg/dL) [0.57-1.00 mg/dL]
  • TSH: 2.090 uIU/mL (was 1.640 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 185 mg/dL (was 243 mg/dL) [100-199 mg/dL]
  • Triglycerides: 133 mg/dL (was 220 mg/dL)  [0-149 mg/dL]
  • LDL Cholesterol: 92 mg/dL (was 162 mg/dL) [0-99 mg/dL]

This time, 7 of the big 8 were in range. (Three months ago, it was 5 of 8; 6 months ago, it was 3 of 8). So the trend is definitely heading in the right direction.

My doctor had a very frank talk with me, and said that I am getting enough insulin – that I don’t need to increase my basal rate or my carb ratio. (Which was her diplomatic way of saying that I need to eat better and exercise more).  I knew that, but I didn’t want to face that. But it’s time to.

So here are my goals for the next 3 months:

  • Use my pedometer and walk more. She recommended getting 10,000 steps a day, regardless of how or when I get it. It doesn’t all have to be at one time during the day.
  • Eat better, portion wise and diabetes wise. Less carbs (duh!), leaner proteins, lots more vegetables. (I’m not a fruit fan, so we won’t even make those promises). Nothing I didn’t already know, but I take the easy (comforting) way out too often.
  • Use my CGM more. (I tend to test my BG more often during the days I am wearing my CGM, which will only help me manage everything better).
  • Blog more often so that I have accountability.

If I achieve all of these goals – even just most of the time – I believe my BG and A1C will reflect that, and I should even lose some weight (always a perk). And wouldn’t it be nice to go back in 3 months and have 9 of the 9 in range?

So…deep breaths, game face on, let’s do it!

Wish me luck.

Open Kim-ono

So today (and with each endocrinologist appointment from here on out), I’m going to post my A1C and other pertinent test results. I am not always proud of them, but I’m hoping this “open kimono” approach will inspire me to keep motivated and aggressive in managing my diabetes.

My latest blood work was done on August 16, 2013.  Here’s what it showed:

  • Hemoglobin A1C: 8.5% [4.8-5.6%]*
  • Serum Glucose (Fasting): 117 mg/dL [65-99 mg/dL]
  • BUN: 12 mg/dL [6-24 mg/dL]
  • Serum Creatinine: 0.73 mg/DL [0.57-1.00 mg/dL]
  • TSH: 1.640 uIU/mL [0.450-4.500 uIU/mL]
  • Total Cholesterol: 229 mg/dL [100-199 mg/dL]
  • Triglycerides: 220 mg/dL [0-149 mg/dL]
  • LDL Cholesterol: 131 mg/dL [0-99 mg/dL]

So, 5 of the big 8 were out of whack. BUT…the good news is that these values were all down significantly from the previous tests that were done in May.  This means I’m headed in the right direction, although not at goal. Encouraging, but I’ve still got work to do. [And, as a diabetic, that work never, ever, ever goes away].

An A1C of 8.5% means that my average blood sugar during the last 2-3 months was around 197, just shy of the big 200.  Not good, and I know I can do better.

As a side note, we do tend to focus on our A1C numbers every 3 months, but the other values are also very important, especially since the risk of heart disease and stroke is 2-4 times higher in diabetics than non-diabetics. They’re all interrelated. I’m pleased (relieved?) that my kidneys are still functioning well, my hypothyroidism is in check and my eyes aren’t showing signs of retinopathy (just middle age). Diabetes isn’t an isolated condition, it’s systemic. (It’s kind of like that old Whack a Mole game, where you get one mole and another pops up and then another one…)

My plan of action:

  • Get back to using my CGM more regularly, because it provides me with real-time data on which I can take action.
  • Exercise more!
  • In general, eat healthier (less red meat, more vegetables, smaller portions)…
  • My doctor increased the dosage of my cholesterol medication, so hopefully that will help get those numbers down.
  • I bought a S/M/T/W/Th/F/S pill box to make sure I take my medications every day. (I feel so old).

My next scheduled appointment is in December. The holidays are never a good time to have your blood work done (and get on the scale!), but you’ve just got to do it. My new mantra: Don’t be afraid of your A1C!

*Who are they kidding? For a diabetic, if I can get below 7.0%, my endocrinologist and I are thrilled! Time to celebrate (just not with food)!

The Lingo

If you overheard a conversation between a diabetic and his/her endocrinologist, you quite possibly might think they’re speaking in a foreign language. Here are some of the common terms that frequent a diabetic’s vocabulary and may pop up from time to time in this blog:

Note:  Thanks to the American Diabetes Association for official definitions. My interpretations are noted in […].

A1C
A test that measures a person’s average blood glucose level over the past 2 to 3 months.  Also called hemoglobin A1C or glycosylated hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood. [One of the best tools you have for managing your diabetes. Don’t be afraid of it!]

Basal
A steady trickle of low levels of insulin, such as that used in insulin pumps. [Not the herb]

Bolus
An extra amount of insulin taken to cover an expected rise in blood glucose, often related to a meal or snack. [You’d think by now I’d never forget to bolus, but…]

Blood Glucose
The main sugar found in the blood and the body’s main source of energy. [So it’s not necessarily a bad thing]

Blood Glucose Level
The amount of glucose in a given amount of blood. It is noted in milligrams in a deciliter, or mg/dL. The normal range is 80-120 mg/DL. [This is why I am literally sweeter than the next person]

Blood Glucose Meter
A small, portable machine used by people with diabetes to check their blood glucose levels. After pricking the skin with a lancet, one places a drop of blood on a test strip in the machine. The meter soon displays the blood glucose level as a number on the meter’s digital display. [Don’t leave home without it!]

BUN (Blood Urea Nitrogen)
A waste product in the blood from the breakdown of protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN levels increase. [Luckily, my BUNs have always been good]

Carbohydrate
One of the three main nutrients in food. Foods that provide carbohydrate are starches, vegetables, fruits, dairy products and sugars. [AKA carbs and no, eliminating carbs from my diet will not make my diabetes go away]

CGM
A Continuous Glucose Monitor (CGM) determines glucose levels on a continuous basis (every few minutes). A typical system consists of:

  • a disposable glucose sensor placed just under the skin, which is worn for a few days until replacement
  • a link from the sensor to a non-implanted transmitter which communicates to a radio receiver
  • an electronic receiver worn like a pager (or insulin pump) that displays glucose levels with nearly continuous updates, as well as monitors rising and falling trends

[I’m lucky enough to use both an insulin pump and a CGM]

Creatinine
A waste product from protein in the diet and from the muscles of the body. Creatinine is removed from the body by the kidneys; as kidney disease progresses, the level of creatinine in the blood increases. [Just wait ’til you get to do a 24-hour Creatine Clearance Test – fun, fun, fun!]

Diabetes Mellitus
A condition characterized by hyperglycemia resulting from the body’s inability to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly. [A diagnosis, not a character flaw]

Diabetic Coma
A reversible form of coma experienced by people with diabetes, most often caused by severe hypoglycemia or diabetic ketoacidosis.  It is a medical emergency. [Happy to report, no experience with this to date]

DKA
Diabetic Ketoacidosis is an emergency condition in which extremely high blood glucose levels, along with a severe lack of insulin, result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. Signs of DKA are nausea and vomiting, stomach pain, fruity breath odor and rapid breathing. Untreated DKA can lead to coma and death. [Again, no experience with this to date]

Endocrinologist
A doctor who treats people who have endocrine gland problems such as diabetes. [Your endocrinologist can be your biggest ally. Don’t be afraid of him/her!]

FBS 
Fasting Blood Sugar is a person’s blood glucose level after the person has not eaten for 8 to 12 hours (usually overnight). [The bane of my existence, as this, for me, is rarely in the normal range]

Hyperglycemia
Excessive blood glucose. Fasting hyperglycemia is blood glucose above a desirable level after a person has fasted for at least 8 hours. [Pretty much a constant for me].

Hypoglecemia
A condition that occurs when one’s blood glucose is lower than normal, usually less than 70 mg/dL. Signs include hunger, nervousness, shakiness, perspiration, dizziness or light-headedness, sleepiness, and confusion. If left untreated, hypoglycemia may lead to unconsciousness. [Did they mention extreme grouchiness as a sign?]

Insulin
A hormone that helps the body use glucose for energy. The beta cells of the pancreas make insulin. When the body cannot make enough insulin, it is taken by injection or through use of an insulin pump. [My drug of choice].

Insulin Pump
An insulin-delivering device about the size of a deck of cards that can be worn on a belt or kept in a pocket. An insulin pump connects to narrow, flexible plastic tubing that ends with a needle inserted just under the skin. Users set the pump to give a steady trickle or basal amount of insulin continuously throughout the day. Pumps release bolus doses of insulin (several units at a time) at meals and at times when blood glucose is too high, based on programming done by the user. [The pump + A CGM + My brain = My external pancreas]

Interstitial Glucose
The level of glucose in the interstitial fluid, which is liquid found between the cells of the body. A CGM measures the interstitial glucose level. [This is not the same as your blood glucose level, although can be very close. You still need to stick you fingers to confirm hypo- or hyperglycemia before taking any action.]

Ketone
A chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. High levels of ketones can lead to diabetic ketoacidosis and coma. [You check your ketone levels by checking your urine]

Lancet
A spring-loaded device used to prick the skin with a small needle to obtain a drop of blood for blood glucose monitoring. [The ouchie]

Postprandial Hyperglycemia
Blood glucose above a desirable level 1 to 2 hours after a person has eaten. [Another bane of my existence].

Retinopathy
An eye disease that is caused by damage to the small blood vessels in the retina and may result in loss of vision. [Preventing this is why I’m *supposed* to go to the opthalmologist once a year]

Type 1 Diabetes
A condition characterized by high blood glucose levels caused by a total lack of insulin. Occurs when the body’s immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. T1D develops most often in young people but can appear in adults. [That’s me!]

Type 1.5 Diabetes
Also known as Latent Autoimmune Diabetes in Adults (LADA), Type 1.5 Diabetes is a more slowly progressing variation of Type 1 diabetes and is often misdiagnosed as type 2. [In hindsight, this is most likely my original diagnosis, although it wasn’t identified until 1993 – and I was diagnosed in 1983]

Type 2 Diabetes
A condition characterized by high blood glucose levels caused by either a lack of insulin or the body’s inability to use insulin efficiently. T2D develops most often in middle-aged and older adults but can appear in young people. [I have moved on]