I Love New York

My six-month mail-in A1C results from the Stanford Healthier Living with Diabetes Self-Management Program arrived in the mail today. My HbA1c was a new personal record: 4.8! Of course I’ll want to get this one confirmed at a real lab, but last time the real lab number was only .2 points away from the mail-in result, so I guess I’ll go ahead and celebrate! w00! Thanks go out to Starlix for allowing me to eat, to New York City and Brooklyn for being so darn pedestrian friendly, to my usual low-carb (and more recently, Zone-favorable) diet for the obvious, and to Crossfit for kicking my ass left and right and keeping me coming back for more.

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!

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?

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?

The Insulin Experience: Week 2

As my second week of insulin comes to a close, I feel like I am no longer in control of my body. Blood sugars are still all over the place, including a few really unpleasant lows this weekend. I have put on 3-4 pounds in two weeks, all of which seems to have all gone straight to my abdomen because my waist measurement has increased by an inch and a half. I wouldn’t mind the weight gain if it was a) better distributed and b) wasn’t such an obvious side-effect of the insulin. My well-tuned sense of hunger also seems to be lost in the shuffle.

Today I made enough Mediterranean chicken salad to feed me lunch every day this week, so perhaps eating the exact same carefully weighed, mid-low carb meal for lunch and breakfast for the entire week will help shed some light on the situation. I haven’t yet decided what to do about my beloved breakfast - do I change it or give it one more week? I started eating my current breakfast when my breakfast of over 2 years (whole 7-grain bagel with cream cheese) suddenly wasn’t cutting it with Starlix. I cut the bagel in half (to about 2 oz), and added some protein in the form of salmon and 1 egg, 1 egg white scrambled, which comes to about 30-36g carbs depending on the weight of the bagel. Starlix could handle it fine - insulin not so much. The only luck I seem to have with it is by splitting my bolus up into half the dose before and half during or after, but even then I’m still lingering in the 130s all morning (and now have twice as many bruises ). Possible options: a) cut the bagel down to a quarter-bagel, b) ditch the beloved bagel all together or c) try cranking my A.M. carb/insulin ratio up to 7g carbohydrate per unit.

It’s hard for me to admit that this whole thing isn’t going as swimmingly as I’d hoped, but with a week and a half left before I see my PA, there is still plenty of time for things to turn around and for me to be back in control of this mortal vestibule.

I’m The Operator With My Elephant Calculator

Apologies for that last little bout of self-pity - sometimes you just have to get it out of your system. And, as my stepmom kindly reminded me, at least the bruises are not on my face.

In an effort to focus on the more positive aspects of diabetes, I’d like to start posting more about all the amazing foods I’ve discovered since switching to a lower-carb diet. Last night I took this recipe for Yellow Tail Snapper Baked in a Salt Crust and modified it for fillets by halving the ingredients for the stuffing, placing the stuffing on top of the filets, then folding them over and securing with a toothpick. I omitted the salt crust and instead topped with sea salt and additional fresh thyme, then baked for 10-12 minutes at 450. It was divine, incredibly aromatic, and of course low-carb (assuming you don’t eat all of the lemon slices). I can’t wait to try it again with whole snapper so we can do the salt crust.

Heard back from my PA today. She does not want to try a “regular” insulin, and said that most diabetics don’t cover proteins with additional units, but because I probably eat more protein than your average person, I can try covering any protein/meat over 3 oz, by counting it as 15 carbs per 3 oz equivalent. (Oh joy, more calculations!)

Speaking of calculations, my sweet husband bought me a calculator to keep in my kit. He didn’t even see this when he was buying it, but it has a lovely little splash of Engrish on it that says “Elephant: So Gentle, So Strong” which will surely make me smile every time I use it.

Allie Beatty of The Diabetes Blog posed an interesting question yesterday about whether eliminating the availability of pork insulin from the US was really in the best interest of diabetics. See C-Peptides and Pork insulin vs. Synthetic insulin and the follow-up Is Human Synthetic Insulin a Cock Block?.

Sink or swim

Back from a morning spent at the hospital visiting the dietician and my PA. I’m having a hard time capturing my current state of annoyance, confusion and disappointment into words, but I will try.

My one-on-one carbohydrate counting and meal planning session with the dietician was quite helpful. I don’t think meeting the amount of carbs that she wants me to eat at each meal is going to be as hard as I anticipated, and I’m certainly looking forward to being able to eat things like fruit again on a regular basis. I now have an idea of how many calories, carbohydrates, proteins and fats I should be aiming for every day, and I’ll see her again in a month for a follow-up and to see how the meal plan works with my insulin. I’d say it was a productive visit, and I wish I could say the same about the visit to my endocrinologist’s office that followed.

Mixed Emotions

Today I started an online diabetes management workshop. I haven’t mentioned it before because I’m not sure how much I’m allowed to discuss it while the workshop is going on, but I have to at least mention this: before the workshop started I had to send in some blood work for A1C and cholesterol but had forgotten about it. Today I found out my A1C result… 5.3. This is the second to lowest, if not lowest A1C I have ever had. Of course this only makes the little voice inside my head that all weekend has been asking “what the @#$@ are you thinking changing your diet and going on insulin when you are having the best blood sugars of your life?” even louder.

Languid Spring

Aaaah - spring in the South: the weather is beautiful, the skies are clear, the trees are in bloom, and pollen-induced lethargy has sent in. Even our Scottie is suffering - we took him to the vet today for relief for his goopy eyes and itchy, irritated skin, and he fell asleep sitting up at the exam table. I’m trying to scrape together the motivation to exercise -  something I haven’t had to force myself to do all month. I don’t think I could lift a weight if I tried, so I will reluctantly proceed to the freakishly hyper-energetic world of Turbo Jam for a little Cardio Party. I’d link that for you but the Turbo Jam site is the interweb version of a TV infomercial and therefore is quite high on the annoyance scale.

Oh yeah, the reason for this post (other than procrastination): how cool is this little Recipe Analyzer gadget at Calorie-Count.com ?

Two small victories

I know I sound way too excited about such small, predictable “victories”, but it is always exciting to find some way to make the foods you enjoy fit into your diabetic life.

The first: Overindulged by eating three fajitas at dinner two nights in a row, despite knowing two is my normal limit. Tuesday night it left me at 155 an hour after (ouch), but only at 94 on Wednesday. The difference? Wednesday evening I exercised! Which makes me wonder, how would I weather a typical low-carb dinner post-exercise without any Starlix at all? More thoughts on that later.

The second victory occurred at lunch today at my husband and I’s weekly lunch spot, which we have eaten at several times since I started on my A1C-lowering endeavor but until today just couldn’t seem to find the right combination of food at to not leave me with highs an hour later. Today I hit the jackpot: I took my Starlix 30 full minutes before eating. We ordered our usual cheese dip, but instead of eating out of the basket, I picked out 7 large chips and placed them on a napkin. Once they were gone I didn’t reach into the basket again. For my main course I ordered 1 brisket and one carnita taco, which I opened, ate the contents of, but left the tortillas untouched. I felt great afterwards and just couldn’t wait the hour to check my blood sugar and checked at the 30 minute point instead: 107, followed by 93 at the one hour mark! You all must think I’m crazy for wanting to ditch Starlix when it helps me eat the things I love, but I don’t see any reason why I couldn’t accomplish the same thing with a fast-acting insulin taken at the right time before a meal.