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.


I think I deserve a pat on the back.


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!


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.


If you ask how I am…

…then I won’t say inspired.*

So, it’s been a month since my last endocrinologist appointment, and I was so gung-ho about keeping up with my exercise, eating better and using all the great technology that I have…all with the hopes of getting my A1C below 7%.


I feel so unmotivated right now. I was doing pretty well until we went on our trip over the holidays. I don’t know if it was the fact that my BG was out of sorts and my CGM was waking me up constantly during the night, but I haven’t put my CGM on for almost 3 weeks now. And since I’m not wearing it, I’m not testing my BG as often as I should…so that means (if I keep on this trajectory) my A1C will most likely be higher than it should be. (I certainly haven’t had very many lows lately).

Grrrrrrrrrr…I get so mad at myself sometimes. It doesn’t take rocket science to know what you’re *supposed* to do.

<I’m going to pause now and get my CGM started>

There, that didn’t take very long…probably 3 minutes at most. Did I mention that I get so mad at myself sometimes?

I guess this is diabetes fatigue. I admire diabetics who can be so rigorous with the management of their condition for years and years. I go through stages. When I was pregnant with my 2 children, I was almost perfect. Lately, not so much.

Sometimes I just get so tired of thinking about every single thing I eat or drink, how exercise is going to make me feel, whether that tingling in my left arm is carpal tunnel or something else…after 30+ years of this, it does get old.  I call these episodes my “rebellious” times.

I know…WAH. WAH. WAH.

Sorry for being a downer, but it’s how I’m feeling right now, at least about how I’m handling my T1D.

I’m curious – how do you (or your diabetic loved ones) stay motivated? I’m very interested in learning some new strategies that may help me get through these rebellious times better.

Anyway, if nothing else, at least writing this blog post guilted me into getting my CGM going again. (smile)

*For those of you who know me, that’s a play on one of my favorite Elton John/Bernie Taupin lines (“If you ask how I am, then I’ll just say inspired”).

The types that bind

If you’ve read any of my other blog posts, you know that I have quite a history of diabetes in my family. (Beauty, intelligence, and, of course, wit, are also prevailing family traits).

I thought I’d document the history (but leave names out to protect the innocent):

My family history

My family history

The people within the circles have diabetes. I’m in the second row, #3 from the left (so 4 of 6 siblings are diabetic, 3 T1D, 1 T2D).

Of these 4 generations, 10 out of 21 relatives have diabetes. My nephew’s 20-month old son was just diagnosed T1D.

So what does this mean?

  • I fear that my children will be receive the dreaded diabetes diagnosis.
  • My family is really, really sweet.
  • It’s kind of funny when we all get together, all the paraphernalia we have to carry with us and use.
  • A family that’s diabetic together, (finger) sticks together?

I personally would like to understand the genetics of diabetes better. According to the ADA web site:

  • In most cases of T1D, people need to inherit risk factors from both parents. These factors must be more common in whites because whites have the highest rate of T1D.
  • T2D  has a stronger link to family history and lineage than type 1, although it too depends on environmental factors.
  • In general, if you are a man with T1D, the odds of your child developing diabetes are 1 in 17.
  • If you are a woman with T1D and your child was born before you were 25, your child’s risk is 1 in 25; if your child was born after you turned 25, your child’s risk is 1 in 100.

Both my children were born after I was 30, so hopefully that’s one positive factor in their favor.

Anyway, wouldn’t it be cool if IBM Watson chugged on and analyzed all the diabetic big data that I know is out there and help come up with a cure for this disease (or at least better ways to manage it). While we’re building that Smarter Planet, let’s build a Smarter Diabetic.

What’s your family history? Comment and let me know – I’d love to hear from you. Remember, we’re all in this together – we’re the “types” that bind.

Why does insulin smell like Band-Aids?

I’m sure you’re at the edge of your seat waiting to hear the answer to that question. (It has bugged me for many years, especially the day I broke not one, but two, vials of insulin on my tile floor).

Just today, the subject came up again. My husband walked into the kitchen from a completely different side of the house and said, “I smell insulin.” (I had just refilled my insulin pump – without spilling a single drop, I might add). To which I responded, “Then you smell Band-Aids.”

Which is when I decided it was about time to do some internet sleuthing (AKA googling), from which I discovered that it has to do with a chemical (meta-cresol) that is used in preserving and stabilizing many brands of insulin. (My drug of choice is Novolog). Meta-cresol is also used in many medical and antiseptic products. And…you got it – Band-Aids is one of them. Voilà!

Apparently, scotch also smells like Band-Aids…but I’ll leave that one to you.

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 […].

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!]

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

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]

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]

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]

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]

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]

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!]

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]

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].

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?]

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.]

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]

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].

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]