Saturday, August 29, 2009


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.

Friday, August 28, 2009

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.

Tuesday, August 25, 2009

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.

Tuesday, August 18, 2009

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.

Wednesday, August 05, 2009


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.

Monday, August 03, 2009

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.

Sunday, August 02, 2009

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.