Friday, August 31, 2012

Am Dancing on the Inside

The A1c is 6.2%!
The microalbumin is 0.4!!
The serum creatinine and TSH and just about everything are NORMAL.
The total cholesterol is 104 with LDL and HDL both being about 40.
And did I mention? I gained weight!

Wednesday, August 29, 2012

Post Endo Visit

What we did:
- I got weighed in and my weight is up to 102 lb. Woot!
- Discussed my blood sugar trends. He thinks it's looking pretty good- suggested taking an extra shot of Regular around 5 PM to forstall the rise in blood sugar that I often see.
- Discussed my hands- he says it probably isn't diabetic neuropathy.
- Discussed injection methods. He told me a few stories about patients and people with diabetes he's known. I wonder if I'm a story he tells or will tell anybody. I love hearing his stories.
- Got prescriptions for Regular, test strips, and glucagon.
- Mentioned the cardiac issues. He mentioned a holter monitor. Didn't think it was necessary, but an option to keep in mind.
- Had blood drawn for blood chemistry, A1c and TSH. Gave a urine sample for microalbumin.

If anybody wants to guess my A1c, you have until he tells me the results. My one month average is 131, the previous month was 139, and the three month average is 134.

Saturday, August 25, 2012

The endo appointment is Wednesday and I've been looking at my numbers really critically the last few days. My average as far back as this Dexcom goes (which is between two and three months) is 134. My biggest blood sugar weaknesses are: night time, especially when I'm asleep, and suppertime. In order to get a good distribution chart of when my BG is in what range, I reset the range to each 10 pt interval and looked at % in range. For 10 pt ranges after the 260s, the percent in range always came out 0, but there really is 1 last percentage point if you look at all points 270+, which is why the numbers on this graph add up to 99%.

Online Graphing
Make a graph

Edit: None of the diabetes software I've used has ever offered "mode" as a stat, but you the term for the most common data point in a group is mode. In the chart above, 110s is my mode

Friday, August 17, 2012

Made an Endo Appt

It's been 5 months since I saw the endo, although it doesn't feel that long. I scheduled an appointment for the 29th, three days before my six year anniversary of being on insulin. I want to get my endo's take on what's going on with my hands.

I am going to put up lots of data between now and then about what my blood sugar's been doing and you all are once again invited to guess at my A1c.
For July, my Dexcom average was 139 with a standard deviation of 52. But it was really not being all that accurate, I don't know why. For August so far I'm averaging 132. But it's still being really inaccurate. For instance, of my last ten calibrations:

Dexcom v Accu Chek
224 v 150
98 v 60
209 v 168
189 v 153
243 v 181
64 v 98
148 v 191 (for this one, it should be admitted that my blood sugar was rising rapidly)
162 v 240
85 v 120
108 v 54

Pretty poor, yeah? None closer than 34 mg/dl apart. Compare this to a time when my sensors were doing much better, say, one month ago. Looking at my chart for July 17 and going back 10 readings, the accuracy is like this:

Dexcom v Accu Chekt
261 v 256
204 v 186
128 v 116
160 v 120
254 v 264
157 v 138
207 v 177
171 v 171
244 v 231
218 v 156

Which is worse blood sugars (really, yuck) but features one pair that was exactly the same, a lot of pairs really close, and only two pairs with a difference big enough to change whether or not I'd give insulin or eat (the fourth and last).

I really noticed the inaccuracy starting a couple of days after I injured my hand and suspect that the medication I took for the hand (Voltarin) was part of that, although I'm now off the Voltarin and the numbers don't seem better.
On Wednesday I met with an occupational therapist that the orthopedic surgeon had suggested. She did some testing, and didn't really find anything wrong, other than what I said was wrong. My grip strength and pinch strengths are normal. My range of motion is normal, and my flexibility is normal.
The OT doesn't particularly think I have carpal tunnel or diabetic neuropathy. She thinks I am generally overworked and carry too much stuff and don't get enough rest and it just happens to be manifesting in my hands.

Although most of what she said is somewhat disturbing, one of the things she said keeps niggling at me. I asked if she said I had diabetic neuropathy. And she said I could, I could not, and that it didn't matter- I shouldn't be thinking that that's the problem because, according to her, that would be too easy. That would let me say, it's not an issue of how much I'm overworking my body, or what I'm doing lifestyle wise.

Diabetic neuropathy, easy? It's a thought.

There is, of course, the larger issue that she does not believe occupational therapy would help me with my hands and that what I really need to do is figure out how to work less, and less intensively. Which is the sort of thing I feel like a person can better get away with she has been working for thirty plus years, and not so much when he is applying for jobs. Also, I don't really feel comfortable taking things easy.

Monday, August 06, 2012

I first flunked a neuropathy screening on my feet in 2009, which prompted me to reduce blood sugar testing on my toes, and I stopped testing on my toes altogether in 2010 when I started using Dexcom and reduced the total number of blood sugar tests that I was doing.

As it was three years from diabetes diagnosis to the first suggestion that I had neuropathy, it was three years from the suggestion of neuropathy to the suggestion that I had neuropathy not just in a foot, but in all four limbs. 

And now I wonder- my hands are being medicated. I have an NSAID goop on them. Should I go back to checking blood sugar on my toes? I mean... if I have neuropathy in my hands as well as feet, why favor the feet?

Saturday, August 04, 2012

You'd think being in pain and stressed out would raise my insulin needs but it hasn't. Instead I'm taking 7 units of Lantus per night and about 15 units of Regular per day.  My insulin needs really haven't picked up since I got back from vacation and I don't know why.

My orthopedic surgeon changed the diagnosis from diabetic neuropathy with carpal (tarsal) tunnel, to neuritis with carpal (tarsal) tunnel. I think that's because it's getting better, whatever the heck it is.

I'm having second thoughts about buying the jet injector because I'm not getting a person when I call (I did on my first couple of calls- why not now?) and because I keep thinking that it's a long term investment and what if something better comes along?