Archive for March, 2007
Just got off the phone with my doctor’s office: one week and 4 days until my diabetes resource center visit and introduction to insulin! Still approaching the “big I” with enthusiasm and not fear, although an unsuccessful attempt to eat right while dining out for lunch yesterday did leave me a little nervous about the task of precisely calculating doses for meals consisting of food I don’t control. But hey, people do it all the time, right? This week I will try not to drive my insulin-dependent co-worker crazy with questions and will aim keep my mind occupied with non-diabetes-related things. I bet I don’t sleep a wink the night before!
P.S.: I removed my last post complaining about health insurance not covering all of my testing strips because I realized how whiny and ungrateful it must sound to those who are not lucky enough to have help paying for their supplies. I still don’t have strips and I feel “blind” not knowing what my sugars look like, even though I’m eating the same things I always eat! Will be going to pick some up at full price later today.
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.
Sometime soon I will be welcoming something I thought I’d never greet with open arms into my life: Insulin!
While waiting to hear back from the PA, I’ve been doing a little research on Amaryl and a lot of reading and re-reading of the Insulin chapters in my diabetes book. I asked my husband how he feels about me going on insulin and he said he just hated the idea of me having to lug it around everywhere. He asked if it would be possible to do insulin but still have the Starlix as a convenience. I thought that sounded like an excellent idea, so I thought on it for a few days and have come to the conclusion that now really is the right time for me to go ahead and learn how to use insulin. Work is stable, life is stable, my diet is stable, and I still have Starlix to fall back on should things change. Although this decision isn’t just about having kids, I think it will take a certain amount of pressure off us to “hurry up” if we don’t have the getting-on-insulin adjustment period to worry about.
I’m really excited about the idea of being able to do small corrections when needed rather than simply being at the mercy of my own insulin and Starlix, and am even thinking this will give me the freedom to safely try very low-carb meals without any medication or insulin at all because I’ll be able to correct afterwards if I mess up. I know it’s going to be difficult at times, particularly tracking and calculating doses, but I’m ready for the challenge.
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.
I finally got around to installing Health Engage on my laptop. It shows promise, but a few major issues:
- The user interface is awkward. The food input mechanism would probably get easier as time goes on, assuming you eat the same things frequently.
- It’s a memory hog. If I leave it running on my laptop for more than 12 hours, even if its just sitting there idle, it starts gobbling up virtual memory. 512MB for 2 days worth of data?
- My biggest complaint: the teeny-tiny, non-resizable viewing window. It’s fine for inputting data, but not for viewing reports.
Overall I’m not impressed. I’d be willing to give it a chance if and only if I can import data into it directly from my meter (Freestyle Flash), but I don’t have high hopes that this will be possible since I am still on a Power PC-based Powerbook. I’d be interested to know if any diabetic Mac users out there with Intel-based macs have had luck using PC-only software and data management products with either Boot Camp or Parallels.
Another online tool I took a look at this week was MyCalorieCounter.com. It showed promise, but I never returned to use it because the features that I really needed (nutritional totals per-meal and per-day) are only offered to paid users. How am I supposed to decide if I want to buy your product if I can’t at least have a trial of the features I’m paying for?
So for now I’m sticking with iCal and the occasional FitDay for looking up carbohydrate content. I have a few more tools and websites to try, but I’m losing steam already and will probably just stick with what works, with the exception of giving CalorieKing.com a try for carbohydrate look-ups, and possibly trying the (gasp!) analog Glucograf data sheets recommended by Dr. Bernstein.
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.
A large part of my weekend was spent with my nose in Dr. Bernstein’s Diabetes Solution, which arrived on my doorstep Friday afternoon. I’d hoped to get more read before my appointment with my endocrinologist’s PA this afternoon, but at least I got through the most important parts, which were sections on diet, exercise, and oral hypoglycemic agents. This book is incredible – I already have a better understanding as to what exactly is going on with my body, but at the same time I’m a bit nervous about the work I have ahead of me if I want to aim for the goal of TRULY normal blood sugars. By truly normal I don’t mean my current goal of 130mg/dl one hour after a meal – I mean normal as in what a non-diabetic would have (under 100mg/dl), which seems to be the only way to completely avoid diabetes complications down the road.
I also finally understand why the low-carb diet is so crucial to all diabetics, no matter what kind of treatment they are on, and that injected insulin can never do as good as a job that the insulin your body makes, so insulin is not going to be my free ticket to eating “normal” again like I once naively thought. I also learned that consuming fat does not make you fat, and that your body can survive quite fine on very few carbohydrates at all – yes, even you non-diabetics! That’s pretty darn cool.
Speaking to my PA and doc today about Starlix putting me at risk of beta cell burnout was already #1 on my list of things to bring up, and Dr. Berstein’s information on beta cell preservation, paired with the fact that he never prescribes Starlix and other drugs that work by pushing or stimulating your pancreas to produce insulin, definitely make this topic seem all the more urgent. Other topics I’ll be bringing up are:
- what are my alternatives to Starlix?
- what are the advantages/disadvantages of insulin?
- what is the effect of caffeine on blood sugar?
- what is the current availability of Constant Glucose Monitoring devices for non-insulin dependent diabetics?
I also hope to get a prescription for a larger allowance of Freestyle strips (150-200/month) since my current 100-count prescription isn’t lasting me through the month – if I check 5 times a day, which sometimes I check more, I need at least 150 a month. More thoughts on my Dr. Bernstein readings later, time to make my way towards Dr. Diabetes’ office!