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.