Friday, April 17, 2015

Insulin Potency

When I filled my prescription for NPH, the pharmacy tech said it was good for 28 days. The patient insert, however, stated 42 days. I have so far used it for 42 days. I think maybe I've seen a loss in potency in the last week but am not sure. Looking for definitive answers, I found  this non-answer of an article:
http://care.diabetesjournals.org/content/26/9/2665.full
In which none of the manufacturers advocates 42 days, one says 7 days (!) and much evidence is offered that the decline in potency of Lantus over time is more noticable than that of NPH.

When I personally  tried using a Lantus vial (out of the fridge) for as long as I could, it was day 53 when I gave up on it due to very high blood sugar for the previous two nights. I have used Novolog past five months and it worked fine; I've used a vial of Novolin R for about two months with no problem.

Now I guess I'll give the NPH a whirl and see how long it lasts... maybe? I keep going back and forth with myself about whether I should bother.

Monday, March 16, 2015

Phoo on Glu

I just did a Glu survey last week and I'm still feeling disgruntled. There was no feedback form and it was written HORRIBLY and unlike most of the surveys I take there wasn't a "write to plony almony with comments or complaints" at the beginning plus as the consent form says, it's a commercial thing for profit.

And this is of and for the diabetes community?! Screw that. I'm not filling out any more glu surveys.

Sunday, March 08, 2015

On Friday I got back on the Dexcom.
On Saturday, after fifteen months of pumping, I took off the pump and started on NPH (with R).

So far, my thoughts:
1. I NEED to get a vial protector to put on one vial because the N and R look way too similar. Feel too similar too.
2. Wow is it ever nice to get undressed without pulling on tubing.
3. Too bad I can't do corrections by just pressing a button.
4. I haven't figured out how NPH works in my body yet. I keep jumping to guesses that are proved wrong within hours.

Wednesday, March 04, 2015

Thinking about active insulin

On the Minimed 530 G, if I go to Basal Review, Standard Basal (11.35 u total), it looks like this:
1)00:00  0.850 U/H
2)05:30  0.200 U/H
3)14:30  0.450 U/H
4)20:00 0.600  U/H

If I pretend that Regular (which is the insulin that I pump) is equally active in the hour that I get it and the subsequent three hours, then the amount of basal insulin lowering my blood sugar in each hour is:

0000-0100) 0.6625
0100-0200) 0.7250
0200-0300) 0.7875
0300-0400) 0.8500
0400-0500) 0.8500
0500-0600) 0.7688
0600-0700) 0.6063
0700-0800) 0.4438
0800-0900) 0.2813
0900-1000) 0.2000
1000-1100) 0.2000
1100-1200) 0.2000
1200-1300) 0.2000
1300-1400) 0.2000
1400-1500) 0.2313
1500-1600) 0.2938
1600-1700) 0.2563
1700-1800) 0.4188
1800-1900) 0.4500
1900-2000) 0.4500
2000-2100) 0.4875
2100-2200) 0.5250
2200-2300) 0.5625
2300-0000) 0.6000

Which looks much more like a smooth rise from 2 in the afternoon until three in the morning, and a drop from five in the morning until about nine in the morning.

Sunday, March 01, 2015

7 Prescriptions And What Became of Them

I went to the endocrinologist recently and got six prescriptions:

  1. Novolin R, as usual. 
  2. 6 Relion Prime test strips per day- as usual.
  3. Syringes, for when I go off the pump, because the jet injector company appears to be out of business.
  4. Novolin N, to give a try.
  5. Glucagon, because the only ones I had were expired.
  6. Multiclix drums, because I ought to change my lancet every now and then.

Then I took the prescriptions to Walmart. Here's what happened:
  1. Insurance covered it but paid nothing. I paid $75 for three vials.
  2. Insurance denied saying I needed prior authorization for such a large number. Also, that step testing was required. Paperwork was faxed to the endo. Does this make sense? No, particularly not given that my plan's formulary specifically states that PAST six per day, prior authorization is needed. I did not fill this 'scrip
  3. Insurance covered but did not pay. So I bought just two boxes.
  4. Insurance covered but did not pay. I bought one vial for $25.
  5. The pharmacy had none in stock. As it turns out, insurance covers this and pays most of the cost, leaving me with $30 to pay should I ever fill the prescription.
  6. Insurance paid 100%. I paid nothing for lancets.
Somehow this whole business seems backwards to me. They'll pay for the glucagon and lancets, which I could arguably do without, but not the insulin, syringes, or test strips?

I also called Dexcom last week to ask about getting insurance coverage to buy a new system. They left me a voice mail message saying that it's covered and I just need to call them back and approve it. Of course, I want to know how much insurance would leave me to pay, given that it has covered but left me with the full cost of most of my prescriptions so far!

In other news, I am now eight and a half years past diagnosis. My eyes still see, my heart still beats, my kidneys are making urine aplenty, and my feet are both still attached. 

Saturday, February 07, 2015

Measurements of Depression and Diabetes

It's often reported that diabetics are more likely to be depressed. However, it's really hard to believe that measures of depression are accurate with regards to diabetes.
I just read a study on depression in type 2 diabetics right before starting insulin, and after 6 months on insulin, that reported that insulin (and especially the drop in A1c) lowered rates of depression.
To measure depression, they used the PHQ-9 scale, which I've taken myself at an awful lot of doctor visits. It was developed by Pfizer to help market antidepressants.
Here's how I would have scored the day before I went on insulin:
Q1: Over the last two weeks, how often have you had little interest or pleasure in doing things?
A: Well- I am still interested but it hurts to move, so not much pleasure. Let's say every day (3 points)
Q2: Over the last two weeks, how often have you felt down, depressed, or hopeless?
A: I felt desperate and determined, so I'll say not at all (0 points)
Q3: Over the last two weeks, how often have you had trouble falling asleep, staying asleep, or slept too much?
A: Well gee whiz, I can't sleep when I'm being eaten alive by thirst, and every time I do fall asleep, the need to pee wakes me up. Every single night! (3 points)
Q4: How often have you had trouble with having little to no energy?
A: Every minute of every day (3 points).
Q5: How often have you had an unusually big or little appetite?
A: I'm starving! (3 points)
Q6: Feeling bad about yourself- that you are a failure and have let yourself or others down?
A: Not all of the time, but I feel unable to meet my obligations. Let's say "several days" (1 point)
Q7: Trouble concentrating on things, such as reading the newspaper.
A: I lost the ability to keep concentrating enough to count to 20 roughly three weeks before my diagnosis. (3 points).
Q8: Moving slowly, or the opposite,  being fidgety.
A: Well, okay, I'm autistic anyways, so this is one I continue to score positively on. But at the time of diagnosis, it had gotten hard to walk, and people were noticing. 3 points.
Q9: Thoughts of hurting and/or killing yourself.
A: Actually, for the first time in many years, I STOPPED having these thoughts shortly before I was diagnosed. 0 points.

Bonus Question: How difficult have these things made it for you to do your work and get along with people?
A: Really difficult.

According to the study I just read on type 2 diabetes, a score of 15-19 qualified as moderately severe (20 was severe depression). 
And yet, I was not depressed, just in DKA. 

The article said every 1 point drop in A1c lowered score by an average of 40%. I say yeah, that's cause the high A1cs mess with memory, energy, sleep, and hunger, not because they cause depression. It's not pathological to feel exhausted and hungry if you're high.

Why I Won't Be Recommending Afrezza

Inhaled insulin is once again on the market, but I have four good reasons not to use it. Here they are:

-Dosing is in increments of 4 units. So for your breakfast insulin, you can take 4 units, 8 units, 12 units, 16 units, 20 units, or 24 units. Or none. And for corrections, you have the same options. I'm sorry, 4 units is way too big of an increment. I like to be able to treat highs of 220 when I go to bed, and 4 units would be overkill (big overkill).

-No clinical trials were done with diabetics whose A1cs were below 7. When enrolling patients for trials, Afrezza was tried only in diabetics with A1cs above 7% (and below 10%). Afrezza was compared to using an inhaler that didn't contain a medication (in T2s) and to injected Novolog (in T1s). 6 months later, 27% of Novolog users got A1cs at or below 7% - twice as many as with Afrezza (13% got down there on Afrezza). Additionally, the average drop in A1c over the six months was 0.40% on Novolog vs 0.19% on Afrezza, which is statistically significant.
I'm not sure how much of this difference is because Novolog can be dosed in smaller increments.

-Afrezza has a significant risk of causing reduction in lung function. I like my lungs. Admittedly, it probably doesn't cause lipodystrophy, and it might be a reasonable choice for people with severe lipodystrophy and fairly high insulin needs.

-Although I have not seen any proof of what Afrezza will cost, estimates put it in the neighborhood of $100-$200/month without insurance. The discount card makes it cost $30/month with non-governmental insurance. I pay $24.88 per vial of Regular.

Wednesday, January 21, 2015

And the HbA1c is...

6.9%

I started pumping with an A1c of 6.3%. It was 6.4% after six months on the pump. Now it's been 13 months pumping.
Of course, if the 530G system is responsible for the rise in A1c (and it might not be) I think the sensors are more to blame than the pump.

I wore a sof-sensor from Sunday to this morning along with my Enlite. Because they disagreed so vehemently most of the time, I checked my blood sugar much more often. They were both very far from the meter. Nonetheless, with the Guardian returned to the study, I once again pretend the 530G is telling me truths.

Wednesday, January 14, 2015

Rough

Last night my sensor failed and I didn't put in a new one.
This morning, I went to see the hand surgeon. I was really nervous about it, and was very jumpy and flappy. I checked my blood sugar prior to the appointment and it was 207; I took half a unit.

The doctor said that it was a ganglion cyst. He was able to transilluminate it. He also says I have a much smaller one on the other wrist. And we're going to just leave those cysts alone unless they either grow a lot or start hurting more (right now the big one hurts somewhat if I move the wrist in various ways).

After the appointment, I walked three quarters of a mile to the bus stop, waited around, took a bus I hadn't taken before. Checked my blood sugar after twenty minutes on the bus. 492. Rechecked. 438. Looked at my site. It looked fine. Checked that I had bolused for breakfast. I had. Bolused 7 units (twice the pump recommendation- I have my ISFs set at 80 to 100 depending on time of day). They went through. When I got home, 50 minutes later, I washed my hands and checked again. 330.

Next week I am participating in a research study that I don't really understand yet. It involves type 1 diabetes, heart disease, and a sleep study. When I asked if they would be telling me some of the heart risk results, they said no because those won't be computed until the end of the study. However, they will be doing an A1c and CBC that they'll be sharing with me. So! I'm having an A1c next week! Hope today's excursion doesn't show up too much.

Numbers like 207 don't tend to surprise me. They just happen. Numbers like 492, OTOH... it's been a long time since I saw a reading so high. And the only cause I can see for it (other than diabetes, of course) is anxiety.

Sunday, January 04, 2015

Just Life

1. My brother Globe is in the hospital. He's been extremely sick since October 20th. He cannot walk or eat without lots of help; he can't talk (or sign or nod his head) at all.
P.S. I started this post yesterday. Today he said "mama" once.

2. So who cares about my diabetes anyways?

3. I haven't really carb counted in forever. I'm really sick of pumping. When I called MM about a really bad sensor that failed rapidly, I got chewed out for not calibrating often enough and also for wearing my sensors in locations other than the belly. I tried a belly sensor. It wasn't accurate either. I'm not gonna reorder sensors or pump supplies. I'm contemplating not using sensors at all but I guess I'll go back to dexcom.

4. I think I've only seen my endo twice this year. Only one A1c reading. But then, with lots of sensor wear, who cares about my A1c?

5. My new insurance has not paid for ANYTHING yet. Not even my insulin. WTF? I'm wondering if I got signed up for something other than the plan I thought I picked.

6. I have a lump on my left wrist that's probably just a ganglion cyst, but I have an appointment with a hand surgeon because I want to be sure that it's a ganglion cyst. It's been there since September and it's growing.