Good Eye, Bad Foot

Happy New Year! Since I last posted, two things have developed in my health life, one good and one bad. The good? Thursday I’m having Lasik eye surgery. The bad? I’ve barely had time to think about the surgery because I’ve been so preoccupied with the excruciating pain when I walk caused by achilles tendonitis in my right foot. Tendonitis sucks for anyone, but is especially bad here where I depend so much on my own two feet for transportation. The GP I saw on Tuesday said that if it didn’t improve after two weeks of ice, Aleve and as much rest as possible, that he would send me to a podiatrist. He mentioned that diabetics have a propensity towards tendon problems. “Even well-controlled diabetes?” I asked, and he replied “Yes”. Bummer.

So far after 5 days of ice and rest, it’s feeling about the same, but if I understand correctly, the Achilles tendon is one of those slow-healing things, so I’m trying to be patient. I did buy a nice, squishy pair of New Balance and can walk somewhat comfortably in those (as opposed to not at all/limping in any other shoe), so my goal is to walk as little as possible and only in the New Balance from now until it heals, which I hope and pray will be in time for my 30th birthday in February. I _will_ dance on my 30th birthday, darn it!

Wish me luck with the lasers on Thursday!

Numbers part II

Late last week I got my “real” lab results back from my doctor:

A1C: 5.4
Cholesterol:
hdl: 109
ldl: 79
total: 205

The doctor called my HDL “superlative” and says he’s never seen that high in a patient, ever. Thanks pecans, almonds and fish! I was a little suprised by the A1C but I think it just goes to show how much good all this walking is doing me.

It’s Numbers Time!

My latest round of labs arrived in the mail today from my Stanford Self-Management program 6-month check-in. Before I spill them, though, I have to confess that I accidentally left the little card that you drop your blood on out to dry for way longer than I was supposed to… about eight hours longer. Therefore I’m not very sure about the accuracy of these numbers, particularly the A1C, which came in at a surprising 5.2, which according to this chart puts my average blood sugars around 108 mg/dl.

On the cholesterol front, my HDL came in at 91 mg/dl, which is fine, but my LDL was a slightly disturbing 132 mg/dl, far above the target 100mg/dl or lower. My total cholesterol was 235 mg/dl, which is well above the target of 200 mg/dl or lower. I’m not freaking yet, though, because Thursday I finally took my fasting butt to a Quest Diagnostics for the large round of tests that my doctor ordered when I saw him well over a month ago. So sometime in the next week or should have a second set of numbers to compare these with and will then either keep on keeping on or make some adjustments.

Speaking of cholesterol, this New York Times article from August, Looking Past Blood Sugars to Survive with Diabetes, is a great read and raises a good question – are cholesterol levels that are OK for non-diabetics really OK for us diabetics?

Greetings from Brooklyn

Greetings from Brooklyn! After two months of working in the Big Apple and living in peaceful, green Brooklyn, I can report that this city is both a wonderful and a terrible place for my diabetes. Wonderful because you can’t even begin to imagine what a positive affect all the walking has on my blood sugars, but horrible for me because the hassle of cooking at home in a tiny apartment vs. the convenience of eating out has resulted in some very poor diet decisions. I hit a low this week by allowing myself to run out of test strips for the first time in months, but am picking up a refill tomorrow and will soon be back on track.

On top of my 3 mile average daily walks to and from the subway station and around the ‘hood, I joined a local gym but have only been making it there 2 times a week, 3 at most. I really miss working out at home. There were so fewer things to come between me and a workout when all I had to do was walk a few feet and pop in a DVD, but I like my downstairs neighbor too much to do Turbo Jam on her ceiling. Now it seems that anything can come between me and the gym – early meetings at work, long days at work, any social activities during the week, illness, etc. My immune system is taking quite a beating too: two colds and 1 food poisoning all in a two months span. I hope this is just my immune system adjusting to living in germ and virus mecca.

Yesterday morning I saw my new internist for the first time and am in love. He gave me an order for a whole slew of tests to take to a Qwest Diagnostic, including an A1C. We both acknowledged that the A1C probably wasn’t going to be very pretty, so the plan is for me to get a second A1C in February then go see him, and if it hasn’t improved he will refer me to an endocrinologist in the same office. For now I’m quite happy with the prospect of seeing him for my diabetes treatment – he was familiar with MODY, seemed up-to-date on his treatment knowledge, and was a very good listener.

So long for now – considering the workload at my (ver stressful) new job, I don’t know how regularly I’ll be able to check in, but I’m thinking about all of my D-friends and hope to catch up on all of your blogs soon!

Moving to the Big Apple

Well, there you have it – the reason for my present and short-term future lack of posting. My husband, dog and I are getting rid of most everything we own, renting out our house, and moving to Brooklyn in early August. To complicate things, we have a previously planned beach vacation smack in the middle of things, which is either going to be a great blessing or somewhat of a curse.

Despite the inordinate amount of stress, my blood sugars still look surprisingly good, likely because I’m still holding my diet and exercise routine together. Emotionally I’m not as stable as my blood sugars, but I guess you can’t have it all. I make one last visit to my PA in a couple of weeks, then sometime after I get settled, I’ll start the process of looking for MODY-friendly doctors up in NYC.

During our packing/sorting/trashing spree, I did find a couple of interesting pieces of my diabetic history. The first was the extremely high-carb, low fat and low-calorie meal plan that resulted from my very first trip to see a nutritionist, 10 or so years ago. The second was a sheet of paper that I found stashed in an old glucose meter. On it I’d logged my food and blood sugars for a couple of days prior to an endo visit about 4-5 years ago. (This was back in when I only tested before check-ups). I had to laugh at how bad my diet was: a whole everything bagel for breakfast, carrots and potato chips for lunch, etc, and I was waking up in the 120s and consistently in the 170s-200s during the day! My endo had written all over the paper suggestions of different things to eat (nuts, cheeses, veggies, spaghetti squash, etc) – it must have been the first time anyone suggested that I eat high-protein/low-carb.

This may be my last update for a while, so wish us lots of luck!

Type 2 and Parkinson’s gene linked

The following headline on the Diabetes Blog caught my eye this AM: Type 2 diabetes directly linked to one gene causing Parkinson’s. According to this article, the scientists concluded that biochemical changes brought on by diabetes can switch off functionality of a the PINK1 gene, causing Parkinson’s. I’d be interested to see the study itself to find out which biochemical changes they are referring to – are they the result of high blood sugars or perhaps related to insulin resistance? Is Type 2 only mentioned because there were no study participants with other kinds of diabetes? My father was diagnosed with Parkinsons shortly after I was diagnosed with diabetes, so this link gives me even more reasons to keep those sugars in tight check.

How is everyone? Things are good here – just chugging along with low-carbing and the occasional correction dose with insulin. Life is busy and I’ve fallen off the obsessive record-keeping and food-measuring wagon, but am still testing frequently and exercising. My numbers are looking good, save the occasional morning when I hover in the “helpless zone” of 130-140. 140 and above are fixable, but 130 is a tricky number for me because it’s too low to correct with the 1 unit minimum that my Humapen can do, but high enough that I want to do something about it. At my next appointment I plan to ask for a prescription for and a lesson on good old fashioned syringes and insulin vials. I love the convenience of the HumaPen, but now that I’m mostly using insulin for post-meal corrections, 1 unit doses are more often than not too large. Why Lilly would make a pen that allows half-unit increments only after the 1st unit is beyond me.

Strawberry Love

Did you know that a half cup of fresh strawberries has only 5.5 carbohydrates? That’s one of the many reasons I’ve been on a bit of a strawberry binge lately. I eat them at breakfast with cottage cheese, a bit of vanilla whey, and toasted pecans. My favorite afternoon snack is strawberries on top of sesame thin crackers with a slice of mozarella cheese. What is your favorite low-carb strawberry recipe?

Reunited

A chapter in my Insulin Experiment has come to a close. Over the long weekend, I ditched my mealtime insulin and returned to the safe arms of low-carbing and Starlix, and a funny thing happened: my post-prandials and fasting blood sugars magically returned to the 80-100 mg/dls. Amazed and relieved but still a bit nervous, I decided to finally take the time (something a mother of a MODY patient that I encountered on Dr. Bernstein’s forums suggested a month or so ago) to write a long email to the experts at Centre for Molecular Genetics at the Peninsula Medical School and Royal Devon and Exeter Hospital, Exeter, UK and ask them what they thought about insulin vs. sulfonylureas.

Professor Hattersley wrote me back with a world of information, and I learned that in his experience, staying on oral medications was the best long-term option for MODY patients. Turns out they have observed MODY patients actually deteriorate on insulin. Whoa! So I am finally submitting to what my doctor and PA told me all along, which was that the Starlix was not putting me at risk of prematurely burning out my beta cells. Professor Hattersley even suggested an option for the future that I had not considered, which was a long-acting insulin taken once a day with Starlix at mealtime, and confirmed what I’d experienced, even with the insulin, which was that a high-carb diet makes no sense for a MODY diabetic.

I still have a lot of info from Professor Hattersley to process, but for now I’m confident that I’m making the right decision: I will resume using Starlix at meals, and will use insulin for correction doses and to cover the occasional high-carb meal. Injected insulin was simply no match for my own insulin. Obviously I’ll need the insulin full-time when my husband and I decide to breed, but we’ll cross that bridge when we get to it.

In other insulin-related news, I know who I’m calling first thing tomorrow morning…

Anxiety Always

Gah! Another day of slightly elevated blood sugars. In order to simplify my troubleshooting, I think I’m going to have to stop using the I-Port for a week or so. I’m not happy about it but I’m more even less happy about waking up above 100 and having problems getting under 130 all day long. Other possibilities:

• hidden infection or impending illness (I feel fine though, gums and mouth fine, etc)
• insulin gone bad (I just changed my Humapen cardridge on Saturday)
• lingering repercussions from The Pizza (could one bad day really throw me for this long?)
• my meter is off (seems unlikely but I could make my newer backup meter my primary just in case)
• my strips are bad (am almost done with this vial so will be able to check that off in about two strips)
• hormones (possibly, but that usually happens on the 4th week of my birth control pill, not the 3rd)
• I’m developing insulin resistance and need to adjust my carb/insulin ratio

That last possibility scares me the most – is it possible that after only a month and a half of injecting less than 15 units of Humalog a day, I’m becoming resistant to it? Is a carb/insulin ratio of 1 unit per 8 carbs in the A.M. and 1 unit per 10 carbs in the P.M. excessive for someone under 115 pounds? Is it normal to have to increase your carb/insulin ratio after only a month and a half of usage? I always understood that MODYs were very sensitive to insulin, so of course this makes me wonder – what if I’m not MODY after all?

The other thing that has been worrying my lately is this constant anxiety surrounding losing my basal insulin production. Every morning when I wake up and test, I pray the number is under 100, and every time it isn’t, I think “well, this is the beginning of the end”. I know that sounds terribly melodramatic, but I realize just how lucky I’ve been to still make some insulin and make it in a consistent manner, and I am determined to preserve that functionality! Then today I was doing some googling on insulin resistance and MODY and came across this terrifying statement:

Except for MODY2, all types of MODY are characterized by glucose intolerance and progressive ß-cell failure and can lead to the long-term complications typical of diabetes.

Progressive beta cell failure?! My PA also seems to believe that my MODY will inevitably progress, but I still don’t want to believe it. What if the MODY patients they based that observation on destroyed their own beta cells with high blood sugars or oral medications?

All this makes me want to shell out for the genetic profile needed to determine once and for all what type of MODY I have… but what if I spend thousands of dollars just to find out I’m not even MODY? If I did turn out to be the “progressive” type, would I regret finding it out? Or would I benefit from having some time to come to grips with the fact that eventually I will have complete dependence on insulin? What if I have MODY2/glucokinase? Would I celebrate? What is it I really seek to gain from such a diagnosis? Judging by the tone of this post, the money would probably be better spent on a beach vacation or something else aimed at restoring my mental health.

Maybe there is more I can figure out on my own. The diagnosis flowchart on the Athena Diagnostic MODY page shows a path for Ketotic and Non-Ketotic. MODY falls under Non-Ketotic. I picked up some Ketone testing strips at Walgreens last week, so next time I’m above 200-250 I will test and see what happens.

Pizza hubris

I messed up big, big time last night. I thought I was ready to attempt to cover pizza with insulin, but my body thought otherwise and I payed the price – mentally, physically and in cash at the rate of the eight dollars worth of Freestyle test strips I used testing and re-testing on my backup meter. I struggled the rest of the night to get back down from the high 200s. I was injecting directly (no I-Port in the equation – I’d attempted an upper-backside install but it left me in tears so I threw it away) yet it was as if the insulin couldn’t keep up with the digesting pizza (or my lack of patience). It was getting late so I set my alarm to wake me up an hour and a half after I went to sleep so I could check and make sure I wasn’t still high or going too low too fast, and it was back down to 140, so I gave up and went back to sleep because I was too tired to change my suspect Humalog cartridge and I knew my own basal insulin would eventually take care of the rest anyway.

I woke up this morning with an elevated fasting of 108, but I was ready to start clean – clean diet, exercise, new insulin cartridge, new I-Port… but I can’t get my head in the right place. I’m mad at myself and don’t feel like doing anything productive, and I am dreading the blood sugar see-saw that I’ll likely experience today. Writing about my mistakes always helps me move on, so now that I’ve confessed, I’ll make myself go lift some weights and try to make up for whatever horrible things I did to my poor body with that (to borrow a word from Monday) insidious pizza last night – which, by the way, left even my non-diabetic husband at 130 mg/dl an hour and a half after! How did I stand a chance?