I called the patient information network this morning to access the lab results from my blood draw and doctor visit Monday.

My A1c is exactly what I guessed, 7.1%. Last time I was spot on accurate too, but last time it was 6.4%. I think my endo was joking when he said in the message that maybe we should stop drawing it since I guess my A1c so precisely.

My TSH came back 1.54, normal normal normal. Also, only .02 different from last time, so maybe I've stabilized. I can hope, hey? My thyroid is still tender.

My endo didn't say exactly how my other labwork came in, just that it was normal. Except for my blood sugar, which was 207. My accu-chek had read 206 just a few minutes earlier. Which reminds me that I've been meaning to make a list of things about the accu-chek aviva:

1. It's accurate.
2. It takes .6 microliters of blood (half the amount of the newer accu-chek).
3. There are four ways to turn the meter on that I've figured out so far. You can hit the forward button a few times, you can hit the back button a few times, you can hit the rather redundant on button, or you can insert a test strip.
4. It comes with the multiclix, which comes with easy to change, not horribly painful lancets.
5. It has skins.
6. And it comes with great customer service from accu-chek.

Yom Kippur Log (written after Yom Kippur)

September 27, 2009

1704 hours -bg 153 Injected 20 units for the before fast feast. Started stuffing my face.

1814 hours- bg 103 20 minutes until the fast. Decided to eat another 30 carbs of fig newtons. Was absolutely full, vomitted a bit. Stayed home from services.

2011 hours- bg 213 Ignored it, read.

2035 hours- took 10 units Lantus. Ketones negative.

2116 hours- bg 246 Two units Novolog. Hoped it wasn't too much.

2249 hours- bg 217 Went to bed.

September 28

0628 hours- bg 252 Took two units of Novolog, went back to sleep.

0909 hours- bg 147 Ketones negative. Walked to the synagogue (about a mile and a half)

1030 hours- bg 121 no action

1205 hours- bg 156 no action

1426 hours- bg 163 morning services ended, I decided to stay in the synagogue rather than risk lowering my blood sugar by walking someplace

1655 hours- bg 149 evening services started

1942 hours- bg 128 evening services ended

2000 hours- took 6 units Novolog, broke my fast with 2 cups chili plus half cup granola, a little (I mean a little) melon, three slices cucumber, one slice tomato, one cup water

2119 hours- bg 331 took another 6 units Novolog, 14 units Lantus.


So, all in all, it went well. I should have been more aggressive with the post fast feast.

A No Good Rotten Cold

I started showing symptoms of a cold at exactly 1:40 PM on Monday. It was unusual mostly in its suddenness. I got a runny nose, sore throat, sore eyes. On Tuesday I woke up feeling horrible in the middle of the night covered in sweat (bg 142). I went back to sleep after an hour, woke up again at 6 AM feeling better by a bit, even more coated in sweat (it is not hot in my place). I made it through the day with nothing worse than a persistant runny nose and a sore feeling in my throat.
On Wednesday, my students heard it. Mr. B, are you coming down with something? Mr. B, I have a question. Are you sick? I know you feel, Mr. B, my baby sister is sick, too.
On Thursday, I started losing my voice, throughout the day, my voice fading in and out. I developed a hot feeling all over my body, and felt very sore when anything touched me.
On Friday, more of the same.
Saturday (today, really), I stayed home and did nothing much all day. I've only had two or three times when my voice didn't come out and I don't feel too bad.

Thing is, the insulin resistance is driving me insane.
I had 0 readings above 300 from August 2- September 14 inclusive. I had an explainable reading of 300 on September 15. But then, what happens with a cold? Two readings in the last week above 300. And insulin resistance unpredictable.

Here's a story. Today, I finish lunch (and its insulin) by half past noon. At 3:20 PM I check my blood sugar: 221. Nothing too unusual about that, I'm sorry to say. I would usually correct that with an injection of 2.5 units Novolog (at an ISF between 40 and 45), but I decide that I'll inject 9 units of Novolog, wait an hour, and then eat for the extra 6.5 units. Brilliant, right?
So an hour comes and goes, I check my blood sugar again. 246! No drop at all, in fact a rise!
So instead of having a lovely 45 carb meal, I go have some tea (peppermint papaya, no carbs or caffeine) with some celery and lettuce (that was my mother's idea). After another two hours, when the Novolog has done it's job, I am down to 132. Not a bad number- but it took 9 units to get there?!
So I had some more to eat at that point, took what should have been enough insulin too. A couple hours later I'm at 123, looks good. Took a bit more Lantus than usual. Shabbes ends, I go on the computer.

Three more hours later (right before writing this post, in fact), I check my blood sugar just because and SURPRISE! 340. Now what? I haven't seen a number that high since August 1. I'm not at all sure what my insulin sensitivity is. What to do? I took 9 units. I'll check again after an hour, I suppose.

And the worst part of this story? Yom Kippur is on Monday! It's hard enough fasting on Yom Kippur with my body's usual shenanigans- now I have to add a cold into the mix?! Oy vey!
What Lantus dose will I take next? Will I be able to fast on that holiest day of the year? Stay tuned to find out...

New Meters

On Friday, I changed the code chip in my meter, and had a hard time putting the new chip in because the plastic was loose where the chip goes in and was blocking the place where the chip goes in. So, although my meter was well out of warrantee, I called Accu-Chek. When the woman on the phone (named Eilene) found out that my back up Accu-Chek Aviva meter, also out of warrantee, also didn't totally work (the forward button is broke), she said she'd send me two new meters.

The new meters came today. I took out my usual meter, and both of the new ones. I drew a large drop of blood from my right big toe. I applied it to my usual meter on a test strip. Then I took the code chip out, put in one of the new meters, put a strip in that meter, and put blood from the same drop there. I repeated that for the third meter.
And a minor miracle occurred, for lo and behold! My meters were not 50 points aparts, not 10 points apart, no! Not even by one mg/dl did they differ. So I decided to capture the moment. Look!

Ketosis

This morning I woke up with a blood sugar of 300. It was the highest reading I'd had in, oh, 44 days :rolleyes: However, I'm no stranger to blood sugar readings that high, and I did the correction and went about with my morning routine. Just as a matter of habit, I checked urine ketones- something I always do with readings over 300. I was SHOCKED to see that my urine ketones were small, because that is the first time I've had ketones since the month of dx that weren't within a few hours of throwing up. I rechecked and they were small again. In the past, I have even forgotten bedtime Lantus, woken up with a blood sugar in the upper 400s- no ketones.

So now I'm wondering if this is a sign of things to come: am I going to be more ketone prone than I have been in the past?


And as a post script to my previous post, I took off the demo pod today, almost exactly 72 hours after putting it on. The site under where the pod had been was red and in some places purple, and there was some lumpiness under the site. This is with no cannula, nothing. The wearing of the demo pump was tolerable, but the fact that my stomache is looking this irritated after nothing but the adhesive and the weight of the solo, suggests that pumping with the solo would probably not be a great option for me.

Dummy Solo

I ordered a dummy pump from Solo a few weeks ago and it came in the mail today. I put it on my stomach, because I've been curious about what it would be like to wear soemthing there, on account of it not being smooth at all. Would the adhesive stick to a surface so hilly? Would the adhesive hurt? Etc. So far, better than expected. Of course, there's no needle or canula with the dummy, so it's not the same as it would be, and it's not entirely comfortable, but better than expected. I'm a little disappointed that the dummy can't be taken apart, because I wonder if that would be painful if I was actually wearing a Solo pump, but that's okay.

Insurance Question

So, I'm going to be all certified and ready to get a job in December, and will be starting to look for jobs in October. The thing I am looking forward to the most is getting an insurance plan that will cover a CGMS.

So here is the question: How do I find out, before choosing an insurance, whether or not it would cover a CGMS for me? My googlesearch so far has not been useful.

If you are in Illinois and have been either approved or denied for a CGMS by your insurance, particularly if you are in my age range, please let me know which insurance and what decision.
I am on BCBS-IL-PPO and they are covering for persons 25 and up who check blood sugar 8x+ per day, and who are willing to wear a blinded CGMS for three days first. I think you also have to have hypos below 50 but that is not a problem here. My problem is, I am 20. I will be 21 by the time I switch insurance plans, but this still means I need an insurance that isn't following the stupid JDRF study as the basis for its decisions.

BCBS-IL-HMO covers CGMS for everybody as far as I've heard.

Any other Illinois experiences? Knowledge of a dependable online resource? Way to look at insurance websites or call them up or anything like that?

YES!

I called the patient information network a few minutes ago, got my message.

"Jonah, your test is back [sic]. Your guesses were surprisingly accurate. Your hemoglobin A1c is 6.4%, like you guessed it would be. Your TSH is 0.88, which is normal- the normal range is .4-4. So, that's very good! Call me if you have any questions."

I love that he says "That's very good!" most of the time when telling me my A1c. When I was in his office on Friday, there was a drug rep in there, and I tested my blood sugar (88). The rep asked me if I was testing my A1c, and I said no, I was testing my blood sugar. He looked confused, so I told him an A1c is a sort of a measure of average blood sugar, where as I was testing my blood sugar of the right now. Then I went and sat next to the rep and showed him the components of my meter and the memory. He was fascinated, and said so (hopefully this was not sarcasm that my autistic brain missed). However, when I scrolled back he said that my blood sugar had quite a lot of variability, so I said I was doing exceptionally well for a person of my age (20 years) with my islet cell function (not enough for a cpeptide to measure anything). I told him I thought my numbers translated to an A1c of 6.4, and he thought for a moment, and said, "That's pretty high, right?" and I said well, it's high for a nondiabetic, but it's very good for a 20 year old type 1 diabetic." Eventually, I said, "You must not be a diabetes drug rep, right? What kind of stuff are you selling?" and he told me that he was there with blood pressure medicines. Which, so far, I don't have any reason to be very interested in.

So anyways, I am quite happy about the drop in HbA1c. I would love to see it drop even lower, but this appears to be my floor; my A1c readings not counting those within a week of diagnosis have been: 6.3, 6.3,6.3,6.4, 6.4, 6.5, 6.6, 6.9, 7.0, 7.2.
So while I've shown myself to be quite capable of getting higher A1cs, it also looks like what I get when I pour myself into it and my body cooperates is 6.3-6.5. And in light of that fact, 6.4 is a very nice number.

Today's Endo Visit

Was not so good, not so bad.

My weight was down a teensy bit from three weeks ago at my other doctor's office. That's not good news, but not horrible news.
I received a seasonal flu vaccine in my left shoulder, and a pneumonia vaccination in the right shoulder, and had blood drawn for an A1c and TSH (expect a post on that topic on Monday or Tuesday).
I had my feet checked for neuropathy and didn't do too great but not horribly. I wanted them checked partly because I check blood sugar on my toes and would stop if there was evidence of neuropathy After he did the check, the endo said, "Well, that's not such strong evidence of neuropathy, but you probably should stop checking the toes." So.... I think that I do have neuropathy in my feet. I felt the filament just fine, and I could tell if he was bending my toes up or down, but when he touched a vibrating thingy to my big toes in turn and asked me to tell him when the vibration stopped- I couldn't tell. I think that means I have neuropathy, but on second thought I'm not sure. Maybe I should have the conductivity test done... but why bother? The doctor wants me to stop with testing on my feet due to risk of infection. I asked him if my immune system is really compromised with my level of blood sugar control. He said no, BUT since my blood sugar control isn't guaranteed to stay stable and can get worse fast (and did get a lot worse this past spring for a couple months), it's just overall best not to risk it. Feet are too vulnerable, he said. However, I am not fully convinced.
We also discussed switching me from Lantus to Levemir. He said that studies show that Levemir is more consistantly bioavailable than Lantus, meaning less daily variation in how the drug works. I told him I would think about it... and I am. Have any of you switched from Levemir to Lantus or vice versa?

Both my most favorite and least favorite part of the visit is the blood draw. It's my least favorite because it hurts, but it's my most favorite because we sort of chit chat. I know autistic people aren't supposed to like small talk, but I do. I love how you can discover odd and unexpected things about people. I asked my endo what prompted him to go into endocrinology and he said it was working at the University of Michigan when Jerome Conn decided from the evidence that hyperaldosteronism existed and set about proving it. This was back in the days when they couldn't image these things, which is what they now do, and nobody was sure that there would really be such a thing. When the very first patient was sent into the OR on Conn's suspicion that he had an aldosterone producing tumor on his adrenals, the hospital caferia was abuzz, waiting to see if the guy really did have a tumor- and he did!

I just looked up Jerome Conn and his syndrome, and it was discovered in 1955! I didn't realize my endo was that old. That means my endo has been practicing medicine for over fifty years. My father was born in 1955.

Endo Visit Coming Up On Friday

On Friday I go to see the endo. Haven't seen him since June, haven't spoken to him since July. I guess that's not so long. I've been trying to think about what to say to him. Some things are obvious:
I need to ask about what he thinks about me getting the flu shots, particularly for the H1N1 thing.
I need to report my awful terrible stomache pains.
I'll have my blood drawn for an A1c and for TSH, both of which I'm very curious about. The A1c I can guess at- somewhere between 6.4 and 6.8, is my guess. The last A1c was 7.2, but my my blood sugar average for the last two months has stayed below 140, so I'm pretty sure that the A1c will be done. The 30 day average when the A1c was 7.2 was something like 155. I suspect that the TSH will be back down below the normal range, but I don't know. Maybe it will be normal. In the last week I've had that sort of shaky feeling that I often get before I'm visibly shaky, and I've had it most of the time. I'm also thinking I'm looking skinnier than I did two weeks ago, so my guess for weight is something like 102 lb (last weigh in was 104, and before that was 99).
I need to ask about what insurances have him as preferred because I'll be job hunting in just another month or two.
Some things I do every now and then:
I'm going to ask for him to run the monofilament on my feet, because I check my blood sugar on my toes and I'm only planning to do that for as long as there's no overt neuropathy in my feet.
I'm thinking about asking for a celiac panel, although I think not this time.
We'll probably check my urine for microalbuminuria.

If anybody can think of anything else I need to bring up, tell me now.

Heat and Diabetes

I had a bunch of really unusually good blood sugar days this week and when I talked to a friend with diabetes- so had she. I've been wondering about the affects of weather on diabetes. I searched on pubmed, and discovered a few things:
That keeping lab animals at room temperature gives them insulin resistance vs if there's temperature variation.
A bunch of articles on vitamin D deficiency and brown fat and developing diabetes.
An article about the 2006 California heat wave noting a 3% increase in hospitalizations due to diabetes during the heat wave.
Two articles about people with pumps going into DKA due to heat related damage of the insulin in the pumps.

In sum, it seems that moderately hot and cold weather decreases the amount of insulin people need, and that beyond that there isn't much research.

If you have multiple D householders, do you notice that their blood sugars tend to go high or low on the same days?
Does anybody know of any articles about daily weather- as opposed to seasonal- affecting blood sugar? Please comment.

Answer

Bernard got it. I forgot that the ice would account for a sizable volume, and that I did not in fact get 16 ounces. My guess is that I got less than half of 16 ounces of pineapple juice; I went hypo within the hour and despite treating the hypo, stayed hypo for over an hour and a half. Oops, hopefully won't make that mistake again. The next day I ordered tomato juice and injected for only half of the volume to better results.

Rookie Restaurant Mistake

I'm taking a course in wetland conservation and we had a field trip today to learn about wetland delineation. The school paid for the class to eat lunch in a classy restaurant.
So we go in, sit down, I go the bathroom and wash my hands, dry them, and check my blood sugar. 61. Okay, good thing it's lunchtime.
So I go sit back down, the waiter asks if we'd like a drink, tells us they've got water and colas. I ask about juice: he says they've got pineapple, cranberry, and lemonade. I ask for pineapple, and soon I get it; a tall glass of ice and pineapple juice with a straw. I ask for nutrition information and drink the whole glass.
The waiter comes back with a can of pineapple juice; the side says 8 oz is a serving and that there are 35 g of carbohydrates per serving. The waiter tells me I got 16 oz.
I wait until my dish, hummus and vegetables, arives, before I inject. I inject for 60 carbs.


Can you find the rookie mistake? Did I go high or low? Answer in next post.

Loser, loser, loser.

I'm always losing stuff.

On Wednesday night and Thursday was a Jewish fast day, the 9th of Av, and I managed to fast the whole day. I just cut the basal from 12.5 to 8.5 Lantus that night. I woke up 228, took a unit of insulin, was down to 130 by lunch, rose to 150 by midafternoon, dropped to 72 by 5 PM, and hovered there - with another reading of 72 and a reading of 68- until I broke the fast at 9 PM. Then I couldn't find my NovoPen Jr. I looked and looked to no avail, so I took out a cartridge and used a syringe to dose for supper. This, I think, makes the fourth one lost in under 3 years.

Still taking my Novolog out of cartridges with a rapidly dwindling syringe supply, Friday night I couldn't locate my Lantus. It's usually in the fridge. I looked and looked and then gave up for the night; decided to take some expired Lantus to hold me through the night. I took 4 units, and woke up around 2 AM. My blood sugar was 441 and my urine ketones were negative. I took 7 units of Novolog and went back to sleep.
In the morning my blood sugar was 252 and my ketones still negative. I decided to open a new vial of Lantus and just not worry about wasting the opened vial. So now I'm back to morning Lantus shots. Hope this works out.

I will be buying a new NovoPen Jr. or two ASAP.

I got sent the glucagon I've been waiting for, finally- but I got sent three glucagon kits instead of the one I was supposed to get. Since I was billed the same as if I was sent one (insurance paid the full price for the other two) and since they say nonreturnable on them, I think I will just let it be. Store them in different places and I'll have plenty!

My blood sugar's been pretty bouncy but still not bad at all. It turned out the Lantus had not gone bad. I wish my body was more consistant. I'm having a problem getting the Lantus dose right. It seems like I wake up either high or low most of the time- I woke up 203 and dehydrated this morning and 48 and psychotic the previous morning and I had not dropped the dose much at all. And no, it isn't Symogii.

2 for 12

Mike Lawson posts 12 pictures on the 12th of each month and I always think that's really cool.I was planning to do the same but am having trouble uploading pictures. So here are a mere two pictuers instead.

All Better Now, And Hoping It Stays That Way

Thyroid level tests all came in normal range, with the TSH, T3, T4 all being just above the bottom of normal. My endo says to call him if I get symptomatic of hypothyroidism, because he thinks that might be where I'm headed to.
The erythrocyte sedimentation rate came in at 3, which is low- not a symptom of inflammation, though it doesn't rule out the possibility. The lowness of it may be a continuing symptom of the polycythemia I had, I don't know.
The c reactive protein was too low to measure, also a sign that there wasn't inflammation.

My diabetes numbers continue to be nice and low, but my Novolog needs are falling dramatically again and I'm had a bad hypo on Wednesday like nobody's business. Ahhh- I'll take that over the highs. If this keeps up for another two months, I bet I'll see an A1c in the lower 6s or even (dare I hope?) upper 5s. My 7 day average is now 120! The 14 day is 138, and the 30 day is 150. I haven't seen a 7 day average of 120 since last fall. Heck, I haven't seen a 138 average since winter. I'm holding my breath, hoping this lasts.

Waiting, Waiting, Waiting

I saw the endo on Friday. He drew blood for thyroid hormone levels and erythrocyte sedimentation rate. He asked me if I'd like my A1c drawn and I said no. I hadn't been decided, but when I looked at the needle and the vial, I just didn't want the blood drawn when I knew it would have been an awful A1c. My 30 day average at that point was close to 170. Starting last week on Sunday, I've been running excellent blood sugars. My 7 day average is 123, my 14 day is 145, and my 30 day is 151. I'm loving it. The doctor said that my results would be in on Monday but hasn't gotten back to me. I don't like this pattern at all.

I'm at a sort of a camp for autistic people right now. My roommate's been curious about blood sugar and I've tested him three times, which I suppose affects my average, except his three tests were 145, 134, and 104, which I think averages to higher than my 7 day average anyhow. He's not diabetic. He says if he was, he wouldn't take shots, just could not do it, but he seems fascinated by the needles. I dunno what to make of that.

My iodine uptake is low. My thyroid antibodies have been retested and are negative still. My TSH is low. My T3 and T4 are normal. My thyroid is painful and tender. So. My endocrinologist has suggested that I may have subacute thyroiditis, although he says that that is not the only possibility. This will cure itself sooner or later, and in the meantime I just have to hold on and wait for the ride to end. My endo would like me to come in once per month for monitoring. That way, if I plunge from hyperthyroid to hypothyroid (a definite possibility) we can treat that as fast as possible, and if I go more severely hyperthyroid, we'll know and respond to that. Also, he mentioned that beta blockers may be an option if my cardiac symptoms become more pronounced.
All in all, I think this is confusing but mostly pretty good news.

Yesterday I had the unusual occurrance that I saw THREE other T1s. One person on the bus I saw with a minimed 722 pump; I went and sat next to her. She's had diabetes for 52 years. I was impressed. Then I met up with Carrie, who I know because of this blog, so that wasn't a random coincidence. And then towards the end of my day I was about to eat supper and I had taken out my Novopen Jr, and somebody said to me, "Hey, is that an insulin pen?" and I said Yeah, how'd you know? And she pulled out her humalog pen. A most unusual day.

The Uptake Scan That Wasn't

Tuesday night I lowered my insulin dose, checked when the early bus was leaving. Wednesday I caught the bus at 6:16 in the morning and headed to the hospital. Checked in around 7:15, filled out paperwork. A nurse took me into her office at around 7:40. We went over my papers and she asked me some questions about my health. Then she told me that I'd be swallowing a capsule. Stop right there.

I can't swallow pills. I can't swallow capsules either. For the medications I've had to take that were in those forms, we've either emptied the capsule and let me take it that way, or I've chewed it, or we've ordered an alternate form. Some of these things have been horrendously bitter and I've attempted to learn to swallow them- to no avail.

I informed the nurse that I can't swallow a capsule. She picked up the phone that was on her desk and called. "Marcy, I've got a young man here with orders for a 123 scan and he has grave doubts about his ability to swallow the capsule." Within minutes a meeting is convened: the nurse who I've been talking to, the head nurse, the pharmacist and me. We run through the options:

1) Could I attempt to chew this thing? No, that would render the test extremely inaccurate.
2) Is there a liquid form? No. The capsule can be melted, but nobody in the building has ever done that before, and they're not confident that they can do it right. There is a guy in the department who can, but he's on leave for the week.
3) Can we do the I131 scan instead? That's a liquid. No, because there's a suspicion of cancer and the 131's not nearly as accurate in that area.

So we rescheduled for a week later when the guy who melts the capsules will be back. They were really apologetic and offered me any time slot I might want and I stupidly picked a 10 AM time; I need to call and move it to earlier because they want me NPO from midnight until 2 hours after taking the thing, and I want to be able to eat lunch. Missing breakfast messes with my blood sugar plenty.

Glucagon Expiration

My mother keeps a glucagon kit in her bedroom, and it expired at the end of April. I have a glucagon kit in my refridgerator which I thought I'd switch with hers, but it turns out that that one expires at the end of May, which is to say, today. I am not sure if we have any other glucagon kit around somewhere.
So I thought, okay, I'll order a glucagon with the next round of supplies and I ought to be about due for a round of supplies, right? But when I checked I realized that I have a 5 month supply of Lantus, and while it's harder to tell with the rest, I think I have about 3-6 months' worth of the rest of my supplies too. So should I reorder? I'm thinking about it.

We haven't used a glucagon in our 2 years and 9 months with diabetes so far. I am not at all convinced that anybody would be on hand to use one if the situation arose. On the other hand, I do go below 45 fairly frequently and it might make my folks feel safer.
But maybe the expired one will be good enough for the next few months? I don't know.

One Lovely Blog Award

was given to me by Vivian. Vivian writes about her family and its many challenges. Her posts are well written and have lots of pictures. If you want to read a caregiver blog and are willing to read about more than just your own medical issue, I recommend it.

I suppose I should offer this award to others, so here are my top three:

My favorite diabetes blog is Life After Dx. Lee is a diabetes educator of the paid but uncertified sort; he works in a clinic that serves mostly poor folk in New Mexico. Lee is also a type 1 diabetic and a family man, and he's really funny. And he's an author. His blog is about 80% diabetes stuff, although not all about his own diabetes, and I just like it.

What Some Would Call Lies is another blog by a diabetic, but this blog is not diabetes focused- it's probably around 10% diabetes stuff, maybe even less. Mike was originally diagnosed t2 but went into DKA when he didn't take his insulin, and I notice his profile now says he has t1. So I guess this is a LADA blogger. He is funny and all of his posts have pictures (I like pictures). He's also gay and he has dogs and he makes culture and work references. Yeah.

Nancy Reyes doesn't write often enough. She's a retired nurse in the Phillipines with an unusual perspective on health care. She's not diabetic and this isn't a diabetes blog.

Absorption

On Saturday evening before I took my Lantus, my blood sugar was 145 and it had been a couple of hours since supper. Two hours later as I was heading for bed, I checked my blood sugar again and it was about 220. So I took 2.5 units of Novolog and went to sleep. In the morning when I woke up, my blood sugar was 236. I corrected with another 2.5 units of Novolog and went back to sleep. Two hours later I was 179. I had breakfast with a correction (total of 8 units Novolog), and then went to help out an elderly couple that I visit most Sunday mornings. I walked to their place and back, a mile each way. When I got home I was 204, so I took 2 more units of Novolog. Went and volunteered at the library, shelving on my feet. When I left I was in the 230s again. Took 2 units of Novolog, walked a mile to the Clark bus, walked a half mile after getting off the bus and went to a friend's house. Two hours later I was 159, and an hour after that, before supper, I was 136. I ate a very small supper and injected for it. When I got home and got ready to take that night's Lantus, I was again in the 230s. I took 2.5 units Novolog and pondered.

I had a problem. That day I'd taken 9.5 units of correction and 10 units to eat with for Novolog. The previous night I had taken 10 units of Lantus. I knew that I hadn't had nearly enough basal insulin in my body that day. I would have thought that I hadn't taken the Lantus at all, except that I remembered taking it- it had been a particularly painful injection. Should I take more basal insulin on the chance that I'd merely grown very insulin resistant? Should I take less, banking on the possibility that that one shot had absorbed poorly? I took 10 units of Lantus.

Two hours later falling asleep I was 124, and when I woke up this morning I was down to 61. While this doesn't prove the hypothesis that Saturday night's Lantus injection wasn't absorbed well (if at all), it strongly supports it. This is the first time that I've really thought I had insulin that wasn't being absorbed (excluding during that I-PORT trial), and I'm wondering what (if anything) I should do to prevent a similar future occurance.

Candy

I have got a sweet tooth. I like candy, and I am very capable of eating a pound of sugar in a sitting.
I have also got really a strong ascetic streak. From October 30, 2001 until about sometime in the summer of 2002, I didn't eat any processed sugar at all; and I repeated the feat for a couple of years a bit later. I also didn't eat honey.
I've been on various diets mostly for fun; a vegetarian since late 1997, a vegan since early 2000; gluten free from August 1 until the end of 2005; no processed sugar at all from October 2001- August 2002.
I am very much an all or nothing kind of a guy.

When I was diagnosed with diabetes, my parents and the diabetes educator and the nutritionist and I sat around and talked about stuff. The nutritionist quizzed me about my diet and said I was getting in all the vitamins I ought to be and that overall I was eating a healthier diet than most; keep up the good work.
Then the CDE said I needed to have some simple carbohydrates on me at all times. Problem: I was concerned that I would eat the food when I wasn't hypo and therefore it wouldn't be there when I was. This has, in fact, remained a problem for me. Here are my solutions so far:

1) Treat hypos with a source of sugar that is not very appealing, such as plain honey. Drawback: Either it turns out that the food is more appealing than I thought, or else when I'm cantakarous and low, I refuse to eat it.

2) Get a ton of candy and allow myself to eat as much as I want of it, leaving some on hand for hypos. Drawback: While this often works, and I find that I had more discipline than I though, often what happens is that I simply eat a lot of candy. It's available for lows, and candy ironically is one of the easiest foods for me to manage blood sugar wise, but I am not convinced that it's a nutritionally sound choice.

3) Treat hypos with normal food. Drawback: not usually a fast acting carb, and I have to restock because normal food goes bad.

So what do I do? Some combination. Often what I do is carry around an extra meal's worht of food, and also some packets of sugar. Sometimes I do go and buy a five pound bag of soft mints or smarties.

Recently, I had a really bad low. It was only a 42, which doesn't sound so bad, but the thing is that it was just past midnight, I hadn't had Novolog in about three hours, and I ate 50 carbs of sugar and soy ice cream, didn't inject at all, and a couple hours later was up to only 120. Also, my vision was blurry and I felt really anxious. In the morning, I was down to 71.
So I went and bought a five pound bag of mints, and now I keep eating the damn things when I'm not hypo. In fact, I want one right now.

:-/ There are worse things than having permission to eat candy, I am sure.

So....

This morning I woke up at 7 AM, blearily hearing my mother going by. I eyed the clock and went back to sleep.
At 8 AM, my father came by to make sure I was awake and doing fine. I got up, feeling fine, went to the bathroom to wash my foot and came back, checked my blood sugar.
"Thirty-eight", I told him.
"Thirty-eight? Without a one in front?" he is incredulous.
So am I, when it comes right down to it, but I let him walk with me up the stairs to my parents' apartment, where I eat a bowl of cereal and don't inject any insulin. An hour later, curious, I check my blood sugar: 86. So I guess the earlier reading was for real. Later in the morning I went a little bit high, but nothing too bad. My blood sugar was fine all afternoon and evening.

I thought I didn't have a thyroid family history, but my uncle is here because my father is having surgery (prostatectomy due to cancer) tommorow. And he says that my father's mother and one of her sisters both developed hyperthyroidism in their 70s, and neither of them had to have anything but blood tests to diagnose it, and both got radioactive iodine to treat it and were fine. He doesn't know what kind of hyperthyroidism, but he does know that they didn't have to have uptake scans.
My guess is that that means Graves', because I figure the antibodies showed up in the bloodwork; either that or it means doctors who didn't really care what kind of hyperthyroidism these very sick women close to 80 had.

Inconclusive Results

The bloodwork from Friday (six days ago) is back. The TSH halved, now at 0.10 with a normal range of 0.40-4.50 . The antibodies came back in the normal range, which makes it unlikely (but not impossible) that I have Graves'. Either the doctor didn't test for Hashi's antibodies, or they aren't back; however, since I've been tested for those before as a routine "we do this to all T1s" thing and they have been negative, I assume that Hashi's is a pretty low risk too.

So now what? Well, now I get an iodine uptake scan done. On the message the endo left me, he said to do a 131 Iodine Uptake Scan, but on the paperwork he gave me last week to give to the lab, it says 123 Iodine Uptake Panel. So I will give him a call in the morning to see what's what.

In the meantime, my imagination is running away with me, imagining thyroid cancer.

In nondmedical news, I interviewed for a student teaching position today and I think I got it, although of course I don't know yet.
In nonthyroid but sort of medical news, I spent a bit over ten hours in the last two days at my best friend's house. His mother is extremely sick due to cancer and due to the treatments she's been on. She is taking steroids and her husband was told to monitor her blood sugar but given nothing but a prescription with only the word "glucometer" on it as instructions for how to check that glucose. So I brought over one of my accu-chek aviva meters, one of the multiclix lancing devices that Lee so generously sent me, and a canister of strips, and I did a little tutorial in how to check blood sugar. They'll be checking once per day until she either develops a fasting blood sugar over 200, or gets too sick for checking blood sugar to be meaningful. The doctor told them only to be concerned if her blood sugar was "over two or three hundred". Way to be precise, doc. That was sarcasm.
When I was hospitalized with new onset diabetes, my friend and his mother came to visit me and I was really really glad to have them visit. This is not exactly returning the favor; but I keep thinking about it anyhow.

In three weeks between endo visits, my weight dropped two and a quarter pounds, which doesn't sound like much except that I've been losing weight at approximately that speed for twenty two and a quarter pounds now.

My endo thinks it is extremely unlikely that my thyroid disease will go away on its own, particularly as I was very symptomatic in his office on Friday. I had a rapid pulse (88 resting), a tremor in multiple body parts, and I don't remember what else. He is rechecking the TSH and says that unless it's normal now, he wants me to have an iodine uptake scan. I'm having the 123 kind of scan.

I had kind of thought that he was going to say that it was such mild hyperthyroidism that we didn't really need to do anything and that treating or not was up to me; it was something of a shock when he said we needed to treat it. He even mentioned surgery as a possibility.
Please, no surgery. That is what I think.
He said my options are Graves', Hashitoxicosis, or Plummer's. I know I don't get to pick, but I have been wondering which I'd pick if I could. The good thing about Graves' is that it might go into remission; the good thing about Plummer's is that you can remove just a part of the thyroid; the good thing about Hashi's is that you don't have to damage or remove the thyroid because Hashi's will do that on it's own, eventually.

By the Way

The prelim path report on my gallbladder says that I had numerous stones, the largest of which had a largest diameter of 7mm. I only know how long 7mm is because my needles come in 5mm, 6mm, and 8mm lengths. The stones appear to be normal bile stones- that is, they're green. The gallbladder disease appears to have been chronic but mild- there was an overall decrease in gallbladder size (that is, it was smaller than what is considered the normal range, and chronic gallbladder disease makes gallbladders shrink), and a slight thickening of the gallbladder walls. There was a lot of scar tissue on the outside of the gallbladder, but also "prominant vasculature".

My blood sugar was great for the first few days after surgery, then horrible, then practically back to normal, and then I got a cold. I woke up at 3 AM with a blood sugar of 414, which was 380 upon recheck, making it my second foray above 400 since diagnosis. 6 units of Novolog and I went back to sleep. Didn't even feel thirsty, but I made myself drink a quart of water just 'cause I figured dehydration is a bad thing. Didn't check ketones because I've lost my ketone strips. I know they're around here somewhere. Anyhow, since the 414 I've been under 200. I don't know why. I hate colds. I hate bouncy appetites. I hate sore throats, and I hate waking up in the middle of the night. And I especially hate waking up high in the middle of the night.

Every evening for the last week I've been having dizzy shaky blurry awful spells, and every time I think I'm hypo, and every time I'm not. I have an appointment with the endo for this afternoon to discuss the thyroid. I assume that we are going to draw blood for antibodies and/or send me to the radiology lab for visualization of the thyroid, to decide if this is Graves or Hashitoxicosis or what. Also we'll find out what my weight is doing. 3 weeks ago when I was last weighed, I was three and a half pound away from being underweight by BMI standards. I would not be the tiniest bit surprised if I'm underweight now.

I am having a really hard time finding fat for injections. My forearms, upper arms, and boobs have all stopped having enough fat for me to get a needle into fat anywhere on them. I have given up on them for now. My stomache retains perhaps 3 square surface inches of injectable tissue, although more may open up once I heal a bit more. My thighs are both bruised on more than half of the available area (it is really dramatic looking on my right thigh). My calves are still good for a couple injections per day, but frankly, this is no good! I averaged 6.1 shots per day in April. I can't put them all in my calves! My butt I use for Lantus injections and occasionally testosterone but I consider it good practice not to inject the Lantus and Novolog into the same regions of the body, so the butt is off limits to Novolog.

Well on the Road to Recovery

Surgery was brutal but apparently routine. I managed my own blood sugar before and after surgery; it wasn't even checked during surgery. Cholocysectomy was performed laparascopically and took two hours due to adhesions. First, second, and third days were agonizing; the fourth has gone pretty well. Blood sugar going into surgery was 218 and coming out was 221. Blood sugar has mostly been as good or better than usual; appetite is absent. Insulin are very low but on the rise (no insulin resistance seen).

One thing I'm wondering about is this: I was having really dramatic rises in blood sugar at the same time as excruciating pain before. Now I'm having lots of pain without any rise in blood sugar. Were the previous elevations in blood sugar due to the same thing causing the pain, rather than the pain itself?

Good News

And about time, huh?
It turns out that I had two messages on the patient info network and I thought both were my pre-op results but one of them was actually from a couple of weeks ago. My lvier enzymes were elevated; they are down to normal now. I was polycythemic; I'm not now.
I really did have an A1c of 7.2%, although my two week average is currently 130, with a 7 day of 126, and a 30 day of 144. I don't know where the 7.2% comes from.
I really do have a TSH of 0.2, but my doctor says that the T3 and T4 are not quite over the top of normal, so I am cleared for surgery. He says he wants to meet with me a week or two after surgery to discuss my treatment options, which I assume means we'll be treating it.
My TSH, he says, hadn't been tested since January 2007, more than two years ago, when it was 0.56, which is in the normal range but already kind of low.

TSH, by the way, stands for thyroid stimulating hormone. When the thyroid is already making too much hormone, the TSH tends to go down, and in hypothyroidism, when the thyroid is spluttering and inefficient, the TSH tends to get high. The normal range at the lab is 0.4-4.5.

10 Things About Jonah

1. Jonah sees life as alternately a puzzle and an adventure. Sometimes both.

2. Jonah likes everybody. Yes, really.

3. Jonah cries every day. Usually for less than a minute.

4. Jonah prefers to sleep sitting up.

5. Jonah will be having his very first surgery on April 22- a colocystectomy. He is trying to see this as an adventure.

6. Jonah is the firstborn son of a firstborn son, so he always attends a siyum with his father on the day before passover. Which is today.

7. Jonah likes to sort things.

8. Jonah is ticklish. Don't tickle him though, because he will hit you if you try it.

9. Jonah likes to read, and keeps lots of lists of books. Sometimes he reads books because one of his lists is missing a book by an author whose name starts with X, or that is catalouged under SK in the library of congress, or some other silly reason.

10. Jonah's least favorite key on the keyboard is the one that says "Ins" because he keeps pressing it by accident.

My baby brother was down here this morning, playing with the magnets on my fridge.

Cholesystitis

I can't even remember the name of what I have for very long. Anyways, my gallbladder has a bunch of stones in it (probably it had a bigger one that was hurting and I'm in less pain because the big one is now in pieces). Also my gallbladder is inflamed and at risk for infection. My endo wants me to have it removed. He isn't sure about how urgent it is. I have a Monday morning appointment to talk to the surgeon that the endo recommended. I hope the surgeon will let me direct my diabetes care, is comfortable with queer people, is familiar with adrenal hyperplasia, and is great with gallbladder removal. Any comments from diabetics whose gallbladders have been removed on what that does to diabetes would be appreciated.
My blood sugar currently is vaccillating wildly. I don't think it's been this bad in over two years. I hit the 30s and the 290s today, and it wasn't even a rebound or correction- the 34 was in the mid afternoon, when I maybe had a little bit of lunch novolog on board, and the 290 was in the evening out of nowhere.

Lee sent me three multiclix and some drums. After using the softclix for a month, I am very grateful for the multiclix. I keep expecting the sharp stab of the softclix and in comparison the multiclix does not hurt at all. I keep not even feeling the prick. I love the multiclix! Thank you, Lee.

Some crazy stuff is happening with insurance re:CGMS coverage. The rep still thinks that I'll be able to get coverage within a month, but I may need to wear an iPRO to prove that my blood sugar does indeed fluctuate. If I do, Medtronic will pay for the one time use of the iPRO, since my doctor doesn't use an iPRO. My rep is hoping that as a pre-existing Guardian user, I won't have to wear an iPRO. After speaking to my rep, I read a rumor that only people 25 and over will be covered. Aaeee! I'm 20. I think the rep knows that, but maybe he doesn't.

I Guessed Wrong

You know how I said that my doctor wouldn't have the ultrasound results for at least a few days? He left a message on my answering machine that I should call to talk to him about the ultrasound. It was around 7:30 PM when I got in, and I figured I'd let it wait until morning. Da da dum...
Since he has the results so much quicker than usual, and since he called, and since he sounded pretty concerned, my guess is that something or other showed up abnormal, but I'm hopeful that it won't be anything particularly horrible.
Or maybe he doesn't have the results at all and they got lost and he's calling to tell me that I have to do it again. I don't know- but tommorow I will.

Update on Abdominal Agonies

The stomache pain has faded but isn't gone.
I saw the endo last week, and he did some bloodwork (electrolytes, white blood cells, etc), although I don't know the results. He gave me two bottles of Nexium40 samples, which should help if acid is the problem, but they don't seem to have made any difference thus far.
I had a gallbladder ultrasound this morning, where a student of some kind (with supervision) took pictures of my gallbladder, liver, and pancreas. I asked if the pacreas looks normal in diabetics, and the supervisor said yes. I wonder if I can get a copy of the picture of my pancreas. That would be cool. The doctor won't have my results from the ultrasound all that soon, and I won't have the results any sooner than he will, so I'm guessing that I'll have no more news on that topic for a few more days.

Abdominal Agonies

I've been in abdominal pain of various levels of severity since Thursday evening, and it is now Wednesday morning. The pain has woken me up every night, I've spent over an hour each day (and more than six hours on some days) in the kind of agony that shuts out everything else, the rest of the time being in pain but not so bad that I can't walk or shelve or dress a loom or go to a museum.
I have not thrown up (though some weird gobs came up to my throat). The pain itself has sent my blood sugar up, as much as 300 points in under an hour. The abdominal pain doesn't seem to be caused by food, although eating sometimes makes it a little bit worse- but not eating doesn't help, I haven't thrown up, and it's been six days so I don't think it's the food.

This morning, after waking up in pain and spending an hour rolling, pacing, thrashing, rocking, etc, I asked my mother whether she thought I should see one of my usual doctors or a regular internist or a gastroenterologist, and she suggested my endocrinologist, so in four minutes, when his office opens, I intend to make an appointment for this morning, tommorow evening, or Friday. I've packed in case the visit results in a hospitalization (my mother the MD thinks it may be a gallbladder stone, and I keep wondering about appendicitis). I decided not to take the Lantus with me, but I labeled it in the fridge so that my parents will be able to locate it if I need them to.

Lantus formats

11 days ago, I mailed in a prescription for Lantus penfils. Yesterday I got an automated phone call that there'd been a problem with my order but that it would ship in a couple of days. Today my mother conveyed a message from my endocrinologist; the pharmacy called him to ask if I wanted the Solostar or Opticlix. I'm supposed to call him and tell him. Of course, I want the Opticlix because that's just plain insulin cartriges; the Solostar is an actual disposable insulin pen. I mean, I could draw the insulin from that too; but it doses in full units only, requires more force than I want, and isn't known to be accurate.
I am sooooo impatient for my supplies to come!

Waiting for the Shipment

I am waiting for the new supplies. Anxiously. It was time to use a new thing of Lantus last week but I was hoping to start on the new penfills (I'm not switching to a pen, it's just that I hate wasting the stuff), so I waited. But I changed Lantus vials today. It was really time for that.
I'm no longer upset about the 6.9 A1c because I've figured out that the higher hemoglobin level probably caused the rise. It's okay. If it was just a tad higher, insurance might care because I'd be "uncontrolled" but for insurance purposes, the difference between the 6.4 I expected and the 6.9 I got doesn't exist. And I know perfectly well what my blood sugar average is without an A1c to tell me. I am somewhat concerned about the high hemoglobin level now that I've read more about it, but I'll be sure to talk about it at my next appointment in another two and a half weeks. Maybe I'll have a fructosamine drawn while I'm at it.

When my supplies come (from Prime Mail Pharmaceuticals, btw), I'm sure I'll take pictures and post them. In the meantime, here are some of my thoughts.

Tip: Always get your endo to write prescriptions for more than you need. Your needs may increase between now and when you next get scrips, it might take the pharmacy too long to fill your order- whatever. More is better. This is particularly true for the insured.

Tip: For drugs other than narcotics and anabolic steroids and stuff like that, prescriptions are generally good for twelve months. The doctor can check a little box that says you get to refill and he can either write in a number of refills or check unlimitted refills (I get unlimitted refills on glucagon and limitted on the rest of my stuff).

It's possible that it's your insurance's fault if you have to resend prescriptions every 6 months.

Tip: Prescriptions will be kept on record by most mail in pharmacies and walgreens, so you'll only need them once, but you can get your doctor to write two versions if you think you'll switch pharmacies.

Tip: Get the NDC or a very exact description on the prescription itself if you use a mail in pharmacy; otherwise you may get something that wasn't exactly what you want. For example, a couple of years ago I got a prescription for pen needles. I wanted BD 5mm pen needles, which are preferred by my insurance; the mail in company sent me 6mm novofine needles, which are not preferred by my insurance and are longer besides.
Also, have the doctor check that no substitutions are allowed!

Tip: If you use a mail in pharmacy, avoid ordering in December. The mail is way too slow.

Tip: Complain to the pharmacies if you need to. They replace stuff.

Tip: If you use a mail in pharmacy and they send you insulin, you'll never need to buy an ice pack again. Save the ice thingies.

Tip: The labels that are on your boxes of prescription items have details that the pharmacy will want next time, and they also count as prescriptions for police and airline security purposes. Don't lose those labels! If the pharmacy prints your name wrong on them, get them to give you new labels. Walgreens gives me labels than say "John" instead of "Jonah" most of the time, then put on a new label with my actual name after I complain.