Monday, March 26, 2012

Impatient! and a mathematical thought

I still don't have a message from the endo re: A1c and calcium. Probably it's the calcium that's causing the holdup. I was kind of patient for about 48 hours and since then I've been calling calling calling the patient information network. Fortunately I can check for messages from my doctor without dealing with anything other than the robot system so I don't drive anybody nuts. I guess I could overwhelm the robot with call volume.

I called activa to order a jet injector, and got put on a waitlist. They'll call me when they've filled the orders that are already waiting. The person on the phone said that would probably be in August or September. That's a long time!

This morning I put the needle up against my skin for the breakfast injection and it hurt right away so I moved the needle over half an inch and pressed. That spot gave me some real resistance before the needle went in, but didn't really hurt. They both bled. It feels like it bled like crazy and I did check blood sugar off of it. But it was probably only a total of like 5 microliters of blood. Microliters! That's millionths of a liter, that's how we measure the blood for blood sugar testing.
I'm a pretty small adult; my body contains roughly 3 liters of blood. The test strips I use need 0.6 microliters of blood. That means a blood test requires roughly one five-millionth of my total blood.
That also means that even if I were to check my blood sugar 10 times per day for 100 years, the amount of blood used (does not count all the blood wasted in blood sugar checking attempts) would be 10 per day * 365 days per year * 100 * 0.6 microliters = 219 milliliters or roughly one fifth of a liter. That's at most a twelfth of the blood in my body right now. One blood donation that wouldn't kill me would amount to all of the blood needed for all of the blood sugar checks for my entire life.

Wednesday, March 21, 2012

Immediately Post Endo-Visit

Endo visit was quick. I weighed 101 lb, bp 110/70, pulse 64, and thyroid exam normal. I got a prescription for a jet injector. My endo said his impression of jet injectors was that although they work well, they're cumbersome and most people would rather use insulin pens, especially since insurance often won't pay.
He did a blood draw for the A1c, for calcium, ionized calcium, and PTH (follow up because my calcium levels have been running high for the last few years and the last calcium level was high enough to be problematic). He says the PTH is a sensitive test and might take a few days but it might be back tomorrow even. He says back in the day, when he became an endocrinologist, there wasn't a good way to do PTHs and only one guy in the country who did even an OK job with them and things sure have changed.

Tuesday, March 20, 2012

Let's Guess My A1c!

In a few hours I'll have an A1c draw. I'll probably get the results Thursday night or Friday day, unless there's some other weird labs. Let's see if we can guess my HbA1c, hey?

My Dexcom average for the last week is 133. For the month, the average is 146, and for the past three months, the average is 143. I took five sensor sessions and compared all calibrations made while the Dexcom was giving a reading (so no start ups) and compared the meter readings with the sensor reading prior to the meter reading. For the five sensor sessions (with 100 calibrations), the average error was that the dexcom read 3.7% higher than the accu chek. This may or may not mean anything. And for those who haven't been reading this blog forever, it may be worth noting that almost everytime we've compared an accu chek reading done in my doctor's office to the lab draw reading, the accu chek has read something higher- by 10%-30%. So my suspicion is that my average blood sugar is actually a bit lower than Dexcom says.
The last A1c I had done was in October and it was 6.1%.
My total hemoglobin and hematocrit tend to be about 16 g/dl and 48%, respectively.

There are a bunch of online A1c calculators that use different formulas. If you like one best, go ahead and predict with it.

Me, here's my guess: 6.7% Can you beat my guess?
Prize is... uh... I'll profile you or your blog, if you want me to.

Thursday, March 15, 2012

Injections of my future

On Wednesday morning, I'll be seeing my endocrinologist. There's bloodwork I need. I may go over some of the blood sugar patterns that are driving me batty- unfortunately I suspect his recommendation will be switching from Lantus to Levemir and I don't really want to. I'll probably get a battery of bloodwork since I haven't been in since November- a CBC, A1c, TSH, a lipid panel. My A1c is probably going to be up a bit, so I'm not looking forward to seeing it. I'm thinking it'll be in the upper 6s. I'm probably due for a microalbumin test too. I was planning on having my nurse practitioner test my testosterone levels next month, but maybe I'll ask the endo to run those tests.

I'm planning to talk to my endo about getting a jet injector. I just got off the phone with a technician at Activa, a Canadian company that makes jet injectors. I forgot to ask if she thought insurance would help with the cost. In any case, there's a start up price of $695, to paid after they build the injector, and an ongoing price for vial adaptors. For each vial used with the jet injector, you use a new vial adaptor (meaning one disposable item per vial instead of per injection) and a pack of four of those is $38. Since I'm figuring on using this just for Regular, that would mean I'd need to buy two packs per year, since I'd use about eight vials of Regular per year. That would make the ongoing cost $78 per year for me if insurance paid nothing, vs $200 per year in copays for syringes. At a savings of $122 per year, it would take five years for the injector to pay for itself, and that's assuming that I stayed insured and my copays didn't increase (it's also assuming I won't need to buy syringes during that time, which may be a false assumption given that I inject testosterone as well). The jet injector comes with a two year warranty but existing customers can buy replacement jet injectors for under $200.

At this point, the only thing making me hesitate is the question in my mind about how long I'll be doing shots for. I see no advantage to me in the current insulin pumps available in the United States, because their pump+CGM combo doesn't change insulin administration based on CGM readings on its own. If and when the US gets a pump+CGM combo that features an automatic basal turn off based on low blood sugars, then I would be interested, although I'd first want to see how well I tolerated the sensors and infusion sets. The sof-sensors are not good enough for my skin. I was very disappointed to see that in Europe, where the Animas Vibe has been released, the Animas does nothing based on Dexcom readings. It just lets you use one receiver/monitor for the Dexcom CGM and Animas pump.
I think the soonest something I'd be willing to use would be available in two years. Realistically, I think it may be even longer, since Dexcom doesn't seem to going in that direction and minimed hasn't gotten FDA approval for the low glucose suspend or for the enlite sensors. And I'd need to try out the enlite sensors before switching to the pump because I'd want to be reasonably certain that the sensors were wearable for me as well as reasonably accurate; otherwise there'd be no point to having a pump that relied on them.
Anyways, if I figure I'd need to be needing injections for five more years before the jet injector paid for itself, then it might or might not end up paying for itself but I'm interested in trying something new anyways. Maybe it will really give me a better injection experience, anyways. That would be nice! And hopefully it will be nicer for the environment. And maybe with there being no needles, it would be sort of more discrete.

Saturday, March 10, 2012


The week before last was the sort of exhausting week where my exhaustion makes me make mistakes that make me even more exhausted. About ten days ago, I left my Dexcom receiver on the bus. Realized my mistake immediately, crossed the street to wait for the bus to come back. Waited half an hour only to find that my bus had been the first of the evening to go to the garage instead of turning and continuing the route in the other direction. Oy! It was just barely too late to go to the garage.
The next morning after prayers I went over to the garage, where they have a lost and found, and asked (through a window) if they'd found my Dexcom. The guy sorted through a file cabinet, picked out something that looked exactly like my Dexcom, at least through the window, and said sorry, no. So I filled out a form describing the bus, the Dexcom, my name and number and they said they'd call me if it came in. I was really hoping for a message on my machine Tuesday evening (I don't have a cell, just a home phone). No message. I hoped on Wednesday. No message. On Thursday morning I called the garage. They had my Dexcom!
On Thursday afternoon I went in and picked it up. They made me fill out paperwork and photocopied my ID before giving me the Dexcom. The lady at the window wanted to know what it was. It's a medical device, I said. It gives me an approximation of my blood sugar every five minutes.
Oh, you're diabetic too? Says the woman. I've never heard of that. I'm gonna have to look it up. Does it replace the finger (mimes jabbing a finger)?
So maybe that was hashgacha pratis (divine intervention) for that woman? I dunno.
My Dexcom battery had gone to zero and needed a while to recharge, which was the first time I'd run down the battery like that, but it was okay. It's working great at the moment.

Last week, Wednesday night-Thursday, was the Jewish holiday of Purim. Wednesday day was the fast of Esther. I tried fasting. I got up in the morning with a reasonable blood sugar (around 150) but it hit 200 just after prayers and I took 2 units of Regular. Around 3 hours later, my blood sugar went below 70, and stayed there for about an hour, while I ate a candy (admittedly not my best choice of candy- it was 15 grams of carbs but also had about 5 grams of fat and another 3 of protein). Very slowly through the afternoon my blood sugar went up up up until I injected for it around 4 PM.
The nondenominational prayer group I often pray with had teamed up with a Reform congregation for the holiday, and the Reform group didn't include people fasting, so they had food before the the megillah reading (when I couldn't eat) so started the reading late. Then it turned out they weren't planning a kosher megillah reading, but they had a scroll. So I got the scroll and started reading, out loud. By the time I finished, I was shaking from exhaustion. Breaking fasts is kind of hard, bg wise; my body seems to utilize all of the sugar immediately instead of storing some in the liver, so I need a lot more insulin per carb and have much more of a tendency to shoot high. So I took a lot of insulin and didn't eat all that much. Then I went to a friend's house and spent a couple of hours practicing reading the book of Esther for the following morning. He took me home around midnight, and just then my blood sugar plumetted. I ate a bit more and went to bed.

On Purim day, I got up at 4:30 AM (after about four hours of sleep) to practice my megillah reading. I was a little high then but by the time I went to prayers I was in range and dropping. Unfortunately, I was so nervous during the reading that the tune didn't come out of my mouth- my voice was flat from anxiety. But at least I said all the words loudly and pronounced them correctly. I put together some great food stuffs, but then spent three hours really hypo and couldn't deliver them, and then I had to go to teach. I gave my students the food, which made them happy.

Anyways, Purim is over. Now to plan for passover!