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.

Sausage Arms!

T-minus one day until my next Crossfit class and my arms still look like sausages… hello tendonitis! The pain is all but gone, and I can almost straighten them all the way, but my arms are still so puffy around the elbow that I had to changes sweaters twice this morning to find something with sleeves wide enough to accommodate them. I’ve been icing 2-3 times a day and taking aleve and don’t know what else I can do except NOT do pull ups tomorrow night.

Crossfit Foundations

Wednesday was the first of a six-class Foundations series that I signed up for in order to (safely!) learn the basic exercises and nutritional elements of Crossfit. We learned the movements and proper form for the basic Crossfit warmup, which consists of sit-ups, push-ups, pull-ups, squats and Sampson pose. I was able to do all of those exercises OK with the exception of the pull-up. To work towards a full pull-up on my own, I jump into the rings and focus on the descent, allowing my arms to reach full extension before touching my feet to the ground. After a few rounds of the warm-up exercises, we learned Cleans and Jerks, first with PVC then with bars. Afterwards I had a fun time standing around chatting with my new classmates, then went and watched the last few minutes of the group class’ WOD. I felt amazingly energized afterwards and all through the next day.

Unfortunately I think I’ve pulled the tendon in my right and possibly also my left arm. The day of class, no less than four friends told me “don’t hurt yourself!” so I aimed to ease into things, but now it appears I may have over did it on the pull-ups. Actually I probably would have been fine had I not tried to carry my extremely heavy bag of records to a gig last night (my husband had his hands full with our turntables). Thursday and Friday I went through the normal post-Crossfit soreness in muscles I never knew existed phases, but every day was feeling better… but then this morning I woke up unable to extend either arm fully, especially my right. Now my right biceps is swolen and stiff. I was hoping to go to Beginners class tomorrow morning, but I’m going to give myself some time to rest and heal completely before class on Wednesday. I hope this doesn’t become a constant cycle of Crossfit -> debilitating soreness -> injury -> no exercise for a week to heal -> Crossfit again.

Crossfit

Yesterday I accompanied a friend to my very first Crossfit group class in Brooklyn. My husband went a few months ago but I was sitting it out while rest and cortisone treatments via iontophoresis healed the inflammation around my Haglund’s Deformity. I was super-nervous about the class (fears of puking and hypoglycemia made me eat an unreasonable amount of carbs beforehand – oops) but managed to complete the warm-up (which was far more difficult in intensity than my normal workout) then in lieu of the Workout of the Day (35 cleans and jerks), worked on form and technique with the instructor. I’m in a whole new world of pain today, but hope to make this a regular part of my workout routine. I’ve been lamenting my lack of general/cardiovascular fitness lately, especially during my weight lifting routines where I felt like I wasn’t making much progress due to my lack of cardiovascular endurance. Friday at the gym I did an interval routine on the treadmill and felt fantastic afterwards. I think adding more running, buying a bike, and doing Crossfit at least once a week will be just the thing to move me towards better overall fitness. Plus how cool would it be to one day say I’m proficient at gymnastics and Olympic Weightlifting?

Any diabetic pals out there Crossfit junkies?

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.

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.

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.