I went to see the endo yesterday. And. I. Hate. Waiting! Not in his office, but for lab results.
I have a pretty great endo in that he takes the time to talk to me. Yesterday what happened was this: I arrived, I waited a little in the waiting room, I went in and got weighed (104 lb), asked the nurse if I could look through my file, she said she'd photocopy it for me. Then took a good look around the room. The endo came in, we crafted a letter of medical necessity together to try to convince insurance to pay for a CGMS, having a conversation in the process.
Then we talked about labwork: the TSH I really wanted and that was the primary point of the visit. The low creatinine that has been in most of my bloodwork, and which indicates hyperfiltration (more on that in a minute). How stomach aches really mess with my willingness to prebolus. Decided to measure vitamin D levels just because we haven't done it before and I'm curious and the endo thinks it's a good idea. Decided to run a lipid panel just because. Put in an A1c, and my guess of a 6.8. Talked about what lab values mean, reviewed the past. The blood draw itself was remarkably painless- I thought it especially special because I was pretty darned dehydrated, having woken up with a blood sugar of 358 (2010's high) and not really having gotten rehydrated since. Then I did a urine sample for microalbuminuria,traded it with the nurse for an envelope with my labworks for the last two years, and that was that. Afterwards I went to the downtown library, since I just so happened to be downtown, and picked out eleven lovely books.

From my conversation with the endo, a few things stick out.

Foremost is the creatinine. Two or three years ago I had a below normal creatinine and BUN, and pointed them out to the endo, and he said he hadn't seen that much and didn't know what it meant and don't worry. The next time, they came in normal and he told me that on the phone, relieved. But for the last year and half, about six readings, the serum creatinine has been low. With a normal range of 80-130, mine has been from 45-65. Sometimes the BUN is also low; sometimes not. I had looked this up myself and not found much, and I pointed it out again to my endo yesterday. Guess I have some great kidneys, huh? I said, knowing that that wasn't really great, not anymore than a hypoglycemic reading would be great on a diabetes screening.
And my endo then told me what I had already guessed: That the kidneys become overactive in a small percentage of type 1 diabetics, in a condition called hyperfiltration, and that this usually turns into the more classic form of chronic kidney disease. And I knew that, and at the immediate level that was a sort of a relief to hear him say what I had been suspecting. I left the meeting feeling really good and happy, actually. But at another level... I have kidney disease that shows up in bloodwork. I have blood pressure that is too low to make an ACE inhibitor seem like a good option, and I have had elevated microalbuminuria readings. I am afraid of what my future holds, and I am afraid of when my future might reveal itself.
My endo said he had to take a microalbuminuria reading because otherwise my insurance would send him a letter of admonition, and I said okay, but don't tell me the results unless there's something I can do about it. I don't want to know.

When I mentioned the hyperfiltration to my mother later, she said I should have asked if this could be the reason why I get stomach aches when I drink water. ???

I mentioned to the endo that I wanted my vitamin D levels checked and he said, "We haven't checked that before?" And then he gave me a mini-lecture (like a professor's lecture, not like a parental lecture) on new research regarding vitamin D. He told me about how, when vitamin D levels are low, parathyroid hormone levels go up, and looking at how much vitamin D it takes to keep the parathyroid less active is how the "normal" range for vitamin D got set at something that only 60% of the population fits into. I pointed out that my serum calcium levels have been a bit high the last year and a half, and said that I'd thought that was because of my thyroiditis (which led us onto a tangential look at ideopathic thyroiditis), and he said that while that is possible, it's also possible that was caused by a vitamin D deficiency. I asked him if the vitamin supplements were vegetarian and he said he didn't know, but that he thought they were synthetic. (My boss tells me that she and her husband get vitamin D supplements from a vegetarian vitamin company).

I've been reading a lot of books lately, happily, and it is driving me bonkers how in so many of them, people who ought to know better will say that they or their loved ones had "low blood sugar" or even "dangerously low blood sugar" when what they mean is that they were hungry. They did not check their blood sugar, they cannot say that they had low blood sugar, they definitely do not know that they had dangerously low blood sugar! This is one of my pet peeves.

January Stats

Four Highest Highs: 344, 331, 314, 306
Four Lowest Lows: 31, 39, 42, 43
30-day average (n=50) on the last day of January: 142
Median daily Lantus dose: 10 units
Mean daily Lantus dose: 10.3 units
Range of Lantus doses: 8-16 units
Mean Novolog dose: 27 units
Range of Novolog doses: 11.5- 40 units
and just 'cause I was looking through what was on my calendar
Total number of bus rides: 47
Total number of train rides: 2
Total number of car rides: 7

Scariest story of the month: So, it was noon and my blood sugar was 220. I decided to take 3 units of correction, add that to 6 units for lunch (I use a 1:7 carb ratio), and to wait an hour or so to eat, in order to come down a bit before eating.
At 12: 45 I develop an excruciating stomach ache. At one, rocking and grimacing and biting myself, I check my blood sugar, and it is 120. I cannot eat; I am in too much pain.
I rock on the floor and breath in every calming way I know and hold poses and rock and rock and try to stand and fall. At some point, I feel prickles down my back and know that I have gone hypo, but I can't even stand and I really don't want to try eating. I spit and my stomach clenches as though I were going to vomit but I don't.
At 2:15, the pain suddenly goes away, leaving me exhausted. I check my blood sugar.
It is 31.
I've been a lot more cautious about prebolusing since then.

More triumphant story of the month: I got a second job, teaching after school chess, and so far my blood sugars have not been an issue and I am doing a good job of it. Yay!

2010

I started the new year with a disappointing blood sugar of 234. How 'bout you?

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?