Monday, March 31, 2008

Does TOO Hurt

I just read 30 ways to manage diabetes, a diabetes forecast article that's been circulating, and I'm cool with numbers 2-30, but number one says that insulin injections come in tiny needles and don't hurt. Well, I beg to differ: does TOO hurt.
No, they don't hurt as much as being sick does and it's really not such a big deal but!
My body is sore. My body is bruised. My body is scarred. My body has endured shots into bruises. My body has endured my desperate searching for a spot with a pinch that doesn't already hurt. My body has endured over 2000 injections of insulin in a year and a half's time, and it has bruised hundreds of times.
I got warned, when I was new to this injection business, to rotate my sites, so that there'd be less scarring. I got warned that you could get in the habit of using one spot and then it'd scar fast. I got warned that I'd get happy spots that wouldn't get good absorption and wouldn't hurt. I got warned- but they were wrong.
I rotate sites because they HURT. I don't heal well, I guess.
The people who say that shots don't hurt? They don't speak for me. Mine hurt.

Saturday, March 29, 2008

u/kg or insulin sensitivity

I've read in books that a person without insulin resistance should use .5-1.0 units of insulin per kilogram of body weight per day. The Do You Know More than A Doctor About Insulin test says that a normal adult with type one diabetes uses only .5-.7 units of insulin per day.
I am a very active person. I do a hell of a lot of walking, and twice a week weight lifting (and I have to take insulin before I lift weights 'cause it consistantly raises my blood sugar). My job isn't a desk job though it doesn't involve much heavy lifting or anything. I'm not overweight. My family history includes one person with type 2 diabetes, and he developed it past the age of 60 when obese and having lost the weight he's also euglycemic now.
Nonetheless, when I'm not sick I average about .9 units of insulin per kg of body weight per day, and when I'm sick it's more like 1.2 units of insulin per kg of body weight per day. Do I have insulin resistance?
It doesn't sound right to me: for one thing, if I stop eating for a day I can get by with a mere 8-12 units of Lantus. Otherwise I take about 18 units (at least this week- it has fluctuated from 8 to 40, but in the last 18 months has probably averaged 16-17). My Novolog use for the day tends to be about twice my Lantus dose, although that's obviously not a constant.
My breakfast carb ratio is about 1:7, the first 20 carbs of lunch are covered by Lantus with the rest being about 1:20, same for a midafternoon snack. Supper is about 1:12. As far as I can tell, these are about normal for type 1 diabetics.
Question: I know that adolescents are expected to have a different insulin need- for the type one diabetics out there, what's your tdd compared to your weight? If you're over 25 and don't have significant kidney disease, did you need more insulin when you were 20 than you do now?

Wednesday, March 26, 2008

Six words and a visit to the dentist

Six words: Friends arrive only after great devastation.
'Cause when you've got no self confidence and you'd do anything to make a friend, people get repulsed your cloying desperation and it's only after you say "forget that, I don't need no friends" that you can love yourself and then people see that you're worth loving. You have to hit rock bottom on your own, which really sucks.
I was tagged by Megan, who is taking a nursing course with a really ignorant professor at the moment.

I go to see a dentist for the first time since July 2002. He tells me, very sternly, that my dental hygiene needs to improve. He says he's sure that I can find a toothepaste that I can tolerate and the floride is important. Yeah right. I am too intimidated to say anything; tears are threatening. Twenty minutes later I will bolt upright in his chair, gasping for breath, my teeth chattering, goosebumps on my skin, rocking myself, knowing that he is speaking to me and making out maybe half the words, unable to speak. I will lie back down without recovering the ability to speak.
LISTEN! I am autistic and I have severe sensory processing dysfunction. I put that on your form, which you glanced over in front of me. It took me a great deal of courage to get to your office. I'm scared. I don't need a lecture. I'm spending my entire paycheck to be here. I have very big problems in my life and my teeth don't rank very high on my list of concerns. I appreciate that teeth matter a lot to you, but you need to ask me how much my teeth matter to me and what level of care I'm willing to do for them, and you neeed to respect my answer. I do not neglect my teeth just because I'd like them to rot or because I'm ignorant. As a matter of fact, brushing my teeth is extremely painful for me. I'd rather be punched in the nose. Heck, I'd rather be kicked in the stomache. Are you hearing me? Listen!

Wednesday, March 19, 2008

What? Alcohol Consumption and Diabetes

I was browsing pubmed and came accross this study, which was conduced in California in the mid 90s. 40,000 adult diabetics were asked about their alcohol consumption, and their A1cs were drawn. The A1c results were sorted by self reported drinking habits. Guess who had the highest A1cs? The ones who didn't drink! Maybe the hypoglycemia pulls down A1c? Of course, the averages for all of the groups' A1c scores were over 8% (and below 9%), and the differences between the groups weren't that large.
I though that this was odd enough to deserve a blog post.

P.S. Still reading through pubmed, here's another study claiming that drinking at least weekly has a positive effect on diabetes outcomes. This one makes an even stronger argument, because instead of comparing A1c to drinking rates, it compares complication rates to drinking rates.

Monday, March 17, 2008

I think my blood sugars are getting better. According to my meter, the seven day average (n=40) is 119. The 14 day (n=71) is 134. The 30 day (n=123) is 145. Who da man? I'm going down down baby! (I hate that that stupid song still pops in my head- I haven't heard it in seven years!)
Yeah, my meter average was above 150 for like a month and I'm relieved to see it heading back down to normal. Yump. In case you're thinking, Only 123 checks in 30 days?! I think that I was using another meter for a lot of that time. At least, I hope so. My sense of time is pretty poor. It does seem like I haven't had to open new boxes of test strips as frequently as usual, but on the other hand I just started using boxes that contain two cannisters for a total of a hundred strips, rather than the old Accu-Chek boxes with one cannister for a total of fifty strips. That means fewer code chips.
I have no idea what's going on with my body that my numbers are getting better. My insulin needs seem to be heading down down baby. After a month of doing 25-40 units of Lantus per day, I'm down to about 20 per day for the last week. I was using Novolog at a rate of like 40 units per day, and now- maybe 20. In case you're thinking that that's still a lot of insulin for a small person, maybe I should tell you that I gained ten pounds in the last three months. Which is fine. A lot of it is muscle. I don't think weight lifting does anything good for my blood sugar.

Friday, March 14, 2008


The A1c is 7.0, up from 6.4. I think I can get it back down though; my blood sugar went totally icky for the nights for about six weeks and has been back to normal for the last week, and I think that that's the difference. But 7.0, yuck. My doctor didn't even say anything negative; I guess he knows that I already know it sucks.

Wednesday, March 12, 2008

Low BUN and Creatinine?

Had an endo visit this morning. Got weighed and measured, spent a long time talking.
The endo said a few things. One, he doesn't care where I inject, as long as I can get a pinch- it's enough fat. Two, different areas have different absorption rates and the research on the variance of absorption rates is contradictory. Three, if I need bigger syringes, he'll prescribe them. Four, yes I am probably on too much testosterone. Five, it is within the variety of normality for my temperature to be 99 degrees in the evenings but not in the mornings.
Very interestingly, I asked if I could see December's full results, and he said sure. I expected only two numbers to have been out of range- my A1c and blood sugar. However, an additional two results had been flagged by the lab- my BUN and Creatinine levels were both below the normal range. I asked my endo what those meant and why he hadn't mentioned it. He said that what's really getting measured there is how efficient my kidneys are in getting urea and creatinine out of my blood. So, more efficient kidneys are no problem he knows of. Also, my result was close to the normal range and he knows I don't have malnutrition. A look at the previous blood draws showed that both figures had dropped at each consecutive blood draw.
I thought I'd check online to see what could cause the low numbers. Two of the reasons are obviously not me: pregnancy and malnutrition. Eating too little protein can also lower these numbers- maybe I should eat more protein? As a vegan, if I stick to my parents' food, I don't get a whole lot of protein. Other causes are hyperhydration, which I guess could be a possibility, and severe liver damage. I have been highly symptomatic of liver problems lately, but my liver's gotten tested and tested and tested and seems to be fine. However, somebody close to me tested as having liver damage- though not any of the forms of hepatitis tested for- over the summer.
I think right now I'm going to try adding more protein to my diet.

Sunday, March 09, 2008

Roche, Radio Shack, and 2 New 2032 Batteries

When yet another of my accu-chek aviva meters said that the battery was too low, I headed to radio shack. I didn't bring my meter with me. Walking into radio shack, I was greeted by a friendly guy around 50, who asked me what I was looking for. I told him that I wanted a battery, yea big, for my glucometer. He asked if I knew what type of battery, and I said no. He looked on his computer to find the battery type and couldn't. The radio shack computers don't have adobe on them, so that employees won't spend their time looking at more amusing things than customers, so he couldn't open the accu-chek aviva owners' manuel from online. So he called Roche customer service and handed me the phone.
After I picked the correct menu option (I HATE having to pick phone menu options), I was connected with a woman who told me the number of the battery I needed after about 40 seconds, but who then wanted to know all about me. She asked if I wanted a new battery sent to me, and I said sure. I also picked out a battery from Radio Shack, bought that (for 4.99 plus about 50 cents tax).
Well, a few days later there was a fedex box, about 8"x 4"x5" in front of my door. That's a lot bigger than is needed for one tiny battery- ten glucometers could fit in there. On one side of the box was a sticker that was probably the reason for the size of the box. It was red, white, orange, and black. It said:

Attention Fed Ex
Courier/Service Agent Express


This package MUST be inspected by the origin location Dangerous Goods Specialist

Then there was a picture with a picture of a passenger airplane that said: DANGER DO NOT LOAD IN PASSENGER AIRCRAFT



My roommate says the sticker would be a cool thing to put on a guitar case. I wonder about how, if the battery in a sealed box can't be taken aboard a passenger airplane, how the hell I would be allowed to fly with it in my pocket? I'm glad I don't fly. I also think that the shipping and handling probably cost more than the battery did and it would have been cheaper to, I dunno, give me credit at radio shack or something like that.

EDIT: Blogger seems to be acting funny. The link to the picture that was in the middle of the sticker is: