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.