Posts filed under ‘endocrinologist’
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?.
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.
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!