Posts filed under ‘doctor appointment’
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!
Things are continuing to improve on the insulin front. I had a follow-up with both the dietitian and PA last Wednesday, and left with two prizes: an A1C of 5.8 (I was expecting higher) and an I-Port.
For those of you not familiar, the I-Port is a neat-o insulin delivery device that gives you one place to inject into for 72 hours, after which it is disposed of and a new one is installed. You inject into it rather than your skin, so there is no pain involved other than the normal sting associated with the insulin hitting your tissue.
I’m on my fourth day and second I-Port, and the novelty of feeling a bit bionic has not yet begun to wear off. I adore not having to hunt for injection sites, endure bruises, and remember to rotate. It’s too soon to say whether its having any affect on my BG control, but expect a full review and more photos after I’ve spent a bit more time with my new, button-esque friend.
Back from a morning spent at the hospital visiting the dietician and my PA. I’m having a hard time capturing my current state of annoyance, confusion and disappointment into words, but I will try.
My one-on-one carbohydrate counting and meal planning session with the dietician was quite helpful. I don’t think meeting the amount of carbs that she wants me to eat at each meal is going to be as hard as I anticipated, and I’m certainly looking forward to being able to eat things like fruit again on a regular basis. I now have an idea of how many calories, carbohydrates, proteins and fats I should be aiming for every day, and I’ll see her again in a month for a follow-up and to see how the meal plan works with my insulin. I’d say it was a productive visit, and I wish I could say the same about the visit to my endocrinologist’s office that followed.
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.
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.
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!