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.

I can see!

Thursday’s Lasik procedure went swimmingly. I’m hoping to post an edited-down version of the blow-by-blow I posted on my other personal journal, but it’ll have to wait until my eyes have recovered further and my tolerance for staring at the computer increases. So far I can say this is one of the best decisions I ever made - to be able to go from not being able to see 10 inches in front of your own face to seeing every little detail in this beautiful city with your naked eye is truly miraculous!

Nothing to report on my Achilles Tendonitis - even after 5 days of rest and almost two weeks of only wearing super-padded New Balance running shoes, I still can’t tolerate having any pressure (i.e. any shoe other than the New Balance) on the back of my right foot. Based on the lack of improvement from ice, massage, heat, rest and Aleve, I’m beginning to think it may be Haglund’s Deformity. I made an appointment with a podiatrist in February but tomorrow will be calling around to see if someone can see me earlier.

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…

Count to 20

Doesn’t it always happen this way: as soon as I mentally give up on something, things take a sudden turn for the better. After my terrible highs’n'lows weekend when ended with me going to bed in the 200s Sunday night, I woke up Monday morning with a normal fasting and have been sailing smoothly in the sweet 80s to 120s ever since. What changed? Counting 20 carbs per ounce of bread instead of 15. This did the trick on both my 1/2 whole wheat hamburger bun at dinner last night and for my 1/2 a bagel this morning. Insulin (and small amounts of whole-grain bread!) and I are friends again.

Looking forward to my body re-adjusting - right now I feel a bit hypoglycemic in the 80-90 range. It’s amazing and a bit scary how fast your body gets used to higher blood sugars.

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?.

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.

Back in the 5% Club

My visit with the PA went well. My A1C was not surprisingly down to 5.7, which is not exactly a dramatic improvement from the 6.0 of my last visit, but is still good and is still in the 5s. I discussed my concerns with Starlix potentially causing long-term damage to my beta cells with the PA. She said she is unsure that there is really anything we can do to stop the progression of my diabetes (BS!), so I asked her to explain the exact mechanism by which MODY diabetes progresses. She explained how type 1s progress but admitted she didn’t know how MODY progresses and agreed with me when I said that maybe the “progression” of diabetes in MODYs isn’t progression at all but the result of high blood sugars causing insuling resistance over the years, which would mean that the “progression” is completely preventable through tight control.

She commended me for being in control of my diet and blood sugars, but was also a bit critical of my low-carb diet (which is not even that restrictive or completely carb-free) and expressed concern over me being “too obsessive” with my diet and cutting out too many carbohydrates. She insisted that I need carbohydrates to be healthy, which I also questioned, so she is sending me to a dietician, something I haven’t done in 10 years.

She suggested three or four possible alternate treatment routes: insulin, Amaryl, Januvia and Byetta. She is unsure if the last two will work for my type of diabetes, but added it to the list of things to discuss with my doctor when he returns to the office. I told her that I was not very interested in going on any of the newer drugs (Januvia and Byetta) since I am considering having children in the next few years and don’t want to do anything risky to my body. Amaryl has been around for 10 years or so, so I will read up on it this week, but am still a little unsure about changing my treatment to a different drug when I’m going to have to go on insulin sometime in the next few years. I hope it didn’t sound like I was asking for insulin, because I’m not - I just want to do what is best for my body long-term.

She also ordered a C-peptide to get a sense of how much insulin I’m producing vs. the last time I had a C-peptide which was almost 5 years ago, so that should give us some guidance as far as what damage the Starlix might be doing. She also OK’d me trying a meal or two without the Starlix to see exactly what affect it has on me, but she is doubtful that we’ll be able to control my diabetes without any medication or insulin. So in the meantime, she’ll be discussing all of this with my doctor and doing some homework, and I will continue my current diet and treatment. Oh, and a CGM wouldn’t be covered by insurance unless I was on insulin and having problems with lows or if I was pregnant. So overall it was a good visit - I didn’t expect her to be able to answer all of my questions without consulting with my doctor, so I’m anxious to see what he has to say about it all.

10 Degrees South

Last night the Mr. and I went to 10 Degrees South for a belated South African birthday dinner. The food was quite delicious and diabetic-friendly and even brought back some fond memories of our trip to Cape Town many moons ago. We had the crab pastries (seasoned with peri-peri, a perfect spicy something I intend to look up and pursue for use in my own kitchen) and Boerewors to start, then Ostrich and Lamb for main courses. G. had a dinner roll then sent back the remaining bread, and I skipped the mashed potatoes and ate around the carrots in my vegetable side. The meat portions were large but not over-sized, and I left stuffed but not comatose. My blood sugar was 131 an hour after dinner, and probably would have been lower had I not had a two tiny bites of G’s chocolate dessert.

My mother just emailed me to “brag” that her BG after her breakfast of oatmeal and toast, which I suspected was too carb-y and have been nagging her to test after for at least two weeks now, was 90. I’m excited for her and maybe even a teeny bit jealous that her Januvia is allowing her to eat carbohydrates, but not too jealous because I think I’m adjusting to low-carb life just fine, thanks in a large part to G’s constant support. He reminds me to check my blood sugar, helps police what I eat without being overbearing, sends away bread at dinner, buys me tomes full of low-carb recipes, handles more than his share of errands so I’ll have time to exercise, and accepts huge changes his own diet without a single complaint. I feel incredibly lucky to have him. The first few days without carbohydrates were hard but once that scary “constantly hungry” feeling subsided (and the head cold passed), things started looking up.

Oh, and a special thanks to my friend out there who encouraged me to get some light cardio WHILE I was sick. It felt like torture for the first few minutes but afterwards I felt human again. My lungs especially are thanking me today - this is the first cold I’ve had in years that I haven’t been coughing up junk for days afterwards. Thanks E!

Twenty-nine

It’s been a lovely 29th birthday. My cold is still lingering, but blood sugars seem back to normal aside from a little hypoglycemic episode this afternoon that I’m going to attribute to the half a bottle of Vueve Clicquot I consumed late last night. What better way to end the weekend than with a BG of 122 mg/dl less than one hour after one of my favorite dinners in the world: buffalo and beef burger with caramelized onions on a whole wheat bun.