Archive for April, 2007
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.
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.
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?.
Every time I’ve injected and every time I’ve changed clothes and looked in the mirror over the past 48 hours or so, I’ve found myself on the verge of tears. I’m ashamed of feeling so sorry for myself, but my abdomen is spotted with yellow and blue bruises and every injection I’ve given myself in the past 48 hours has hurt, either during or after, bled. Some (like the one I just did) itch! I went a week without a painful injection – what happened? I feel once again like I have no idea what I’m doing. Am I supposed to be coming in at an angle? Am I even using the right places? What is the consequence of not picking a “fat” enough place to inject? Is there some sort of system or pattern I can use to help me remember where to inject? I’m reserving some time this afternoon to research, but if any experienced insulin users out there have any advice, please please leave a comment – my bruised abdomen will thank you.
At my last visit, the Diabetes Clinician reminded me that, especially now that I am using insulin, it’d be a good idea to get either an ID bracelet or necklace indicating that I am diabetic. I’d looked online a bit last week and was surprised how much more attractive my options are than they were 10 years ago when I first ordered a MedicAlert bracelet (which I reluctantly wore for about a year then lost). The one that most resembles a piece of jewelry I’d actually purchase for non-medical purposes is a charm bracelet made by America Medical ID:
Of course all the jewelry browsing made me wonder how the medical versions compared to the real deal. Long story short, this beauty, this beauty from Tiffany and Co. is now being hand-engraved to read “Diabetic”, and will be waiting for me at the store in about three weeks.
Sure, it cost more than the American Medical ID bracelets, but I justified the expense knowing that a) I’d actually want to put it on every day and b) it should last a lifetime.
Nothing much to report on the insulin front. Some days I feel like a lab rat with all these charts, graphs and needles, but I do like labs and some rats are pretty cute, so that’s OK.
The first few days of high blood sugar readings were tiring, both physically and mentally, but I think I’m starting to get a better feel for dosages and timing. It’s tempting to draw conclusions about carb intake right now based on the fact that the only good numbers I’ve seen this week have been after lower-carb meals, but I will hold my tongue and give it some time.
For my diet and blood sugar tracking, I’ve gone low-tech and started using some photocopied worksheets that the dietitian gave me. The upper third of the page is an area to plot my BG on,the middle third is a chart with a column for each hour of the day and rows for blood glucose, carbohydrates, exercise, insulin doses, stress, ketones, etc. The bottom third is for food and other notes. This format will be the easiest to fax back to my PA at the end of each week, plus I really enjoy connecting the dots on the glucose plot at the end of the day. I’m thinking of enlisting my husband to makes some improvements, notably a place to record where I injected. Right now I just randomly pick an injection site and hope I don’t hit the same place twice.
I’ve returned to FitDay for my diet tracking. Combined with the occasional quick lookup on CalorieKing.com and the handy recipe analyzer on Calorie-count.com, I have a decent system for carb counting and making sure I’m getting enough calories each day. I would still like to get some sort of pocket-sized nutrition handbook to carry with me and to keep in the kitchen so I don’t need a computer when I’m planning meals and doses – any recommendations?
These How-To articles on Dsolve.com have been quite helpful in helping me understand that only time, patience and diligent testing and documentation will lead the way to normal blood sugars with insulin. Even though I have a newfound appreciation for the ease, simplicity and efficiency of Starlix, I haven’t resorted back to it – I’m just too determined to get the insulin to work.
Friday night I injected my very first dose of insulin. Before dinner I decided to check the Lilly and Humalog sites one last time for some updated Luxura information and found a video tutorial on how to use the Luxura. Fabulous – the video was excellent – clear, easy to follow, and almost as good as having someone in the house showing me what to do.
After carefully (or so I thought) calculating the carbs in the meal, I rewound the tutorial, had my husband put the pizza in the oven, then went for it.
Closeup of the dose dial
My instructor for the evening
Spread of equipment
Priming the pen
Injecting and counting to five
Success (and a little red dot)!
Since I knew my food was cooking and the clock was ticking, I had no problems pushing the needle in. Once it was over I did have that kind of post-adrenalin rush shakey/cold-sweat feeling, but otherwise was A-OK. Simple as pie and didn’t hurt one bit.
I only wish that calculating the dose was as easy as administering it. After five pre-meal injections, I have still not been able to replicate the excellent one-hour post-prandial BGs that Starlix gave me. I just have to be patient and remind myself that it takes time to figure out insulin/carb ratios. I don’t like spending the day with post-meals in the 150s-200s and resting BGs in the 110-120s instead of my usual constant 80s and 90s though – it makes me anxious and physically tired. One thing I’m noticing is that whatever my BG is at the 1 hour mark, it will be at the 2 hour mark, which is discouraging – is the Humalog even doing anything? Edit: I’m also seeing my BG hit a good target at one hour, then rise up to 130-150 at the two-hour mark. 😦
I’m not sure if the error is in my a) timing b) carbohydrate counting or c) insulin to carb ratio. Right now I’m using 1 unit per 20 carbohydrates, which so far doesn’t seem to be enough. I’m also unclear on whether I’m supposed to cover proteins – my PA didn’t mention it, but Dr. Bernstein does.
I had one low on Saturday one hour after dinner (65), which I treated with three dex-4 glucose tablets per the dietician’s “rule of 15” instructions. I waited 15 minutes and tested again to find it had doubled my BG – yikes! Next time I try ONE tablet and wait 15 minutes.
So far I really like the pen. It has a nice weight and feels like it is built to last. The only thing I dislike about it for now is having to waste two units of insulin to prime the pen before every dose. Squirting 2 units into the air is also a bit messy – what happens if insulin gets on your furniture? Clothes? Floors?
Wish me luck (and patience) getting this whole dosing thing down straight.