Sunday, May 31, 2009

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.

Wednesday, May 27, 2009

One Lovely Blog Award

Picture of lacey cup with roses and more roses outside the cup with the caption One Lovely Blog Award written in pink

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.

Monday, May 25, 2009


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.

Thursday, May 21, 2009


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.

Monday, May 18, 2009


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.

Thursday, May 14, 2009

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.

Saturday, May 09, 2009

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.

Friday, May 08, 2009

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.