I called Minimed and a replacement receiver is 550, a replacement transmitter is 649. If you are a previous Guardian user, getting a new receiver and transmitter is 1199 dollars. If you then bought a box of four sensors, you'd be at the 1344 cited as the price of start up. But you could buy only 10 pack boxes.
I think I'm going with Dexcom anyways. I want less pain.
I talked it over with my mother. She thinks I should have my thyroid function retested, as I have a history of thyroiditis and thyroid dysfunction can mess up blood sugar. She agreed that, at least if this continues, she's willing to help pay for a CGMS for me.
So I'm thinking about whether I should go in soon to see the endo for a TSH. Maybe. I'm overdue to see my other doctor anyways, so maybe I'll ask her to run a TSH even though it's always been my endo who's done that.
Wednesday, July 14, 2010
Tuesday, July 13, 2010
Guardian v Dexcom
I have had nutsy blood sugar in the past month, details below. I'm therefore thinking about buying a CGMS out of pocket again. My last experience, in 2008, was with the Guardian. I found it accurate for at least a week per sensor, all sensors I wore in the arm, but continuously painful and itchy. I lost the transmitter and decided not to get another. I still have some sensors, now expired. Anyways.
I'm looking at the Dexcom Seven Plus. I spent a couple hours reading about it today, plus I called customer service. Sales there says I can buy a starter pack and a box of four sensors now for the price of 999 dollars if I pay out of pocket. A box of 4 sensors is 319 dollars unless I agree to buy six or more boxes in a 12 month period, in which case it's 289 dollars per box. The transmitter and receiver each have 12 month warrantees.
So for one year, if I used 28 Dexcom sensors, the total cost would be 2733 dollars.
But if I had to use 36 Dexcom sensors, the cost would be 3311 dollars.
If I went with the Guardian again, then as I remember it startup cost is 1344 dollars and that includes 4 sensors (despite what the internet says). A box of 10 sensors is 350 dollars. The receiver is warranteed for twelve months, but the transmitter only for six months. I forget the replacement cost for the transmitter; either it's 450 or 650 dollars. So if it's 450 and I had to replace it, and I used 34 Minimed sensors, the total cost over one year would be 2844 dollars.
If I needed 44 sensors, the total cost would only grow to 3194 dollars.
Now, I've used the Guardian before so I'm pretty sure I really could stretch 34 sensors over a whole year. I've never used the Dexcom so I don't know how long I could get out of one of their sensors, which is one of the things making me hesitate. Some other thoughts:
The Dexcom only needs to be recharged, and doesn't need batteries. This would probably be a savings of over 100 dollars over the course of a year of full time use.
The Dexcom people charge shipping and handling, which I hear can add up to 15 dollars per shipment. That could add up quick.
I hated dealing with Minimed customer service. Although they replaced the receiver twice, they were horrible with my financial transactions and with talking to insurance.
I hated the feeling of wearing the Minimed sensors and I hope the Dexcom ones would feel less painful.
I loved the data analysis, graphing, and predictive alarm features on the Guardian. I also loved that the screen stayed on. The Dexcom has none of these features. Even worse, the Dexcom has a low alarm that can't be turned off. This would make continuing to use the sensor as it fails probably worse because it reads a little low as it goes bad, and I could accommodate for that if I could turn off the alarms.
Dexcom users can't use tylenol. Probably not a big deal as I don't use tylenol.
The dexcom transmitter doesn't store data and you're not supposed to go swimming with it for more than 30 minutes. I don't go swimming often... but sometimes.
The shape of the dexcom makes buying additional tape to keep it down less likely to be necessary.
I went on a road trip in early June for a week and my Lantus needs went down.
I came home and my Lantus needs rose back to 8 units per day or so.
I left again after two weeks, and on the road I achieved steadyish overnight blood sugar with Lantus doses of 4-6 units.
I got home and my wake up numbers climbed. I took 8 units, 9 units, 10 units.
I woke up in the 200s, 300s, 300s, and more 300s.
I opened a new vial of Lantus.
I still woke up in the 300s. Not only that, but my daytime numbers kept rising out of nowhere, no food on board, 300s and 300s and I took 20 units of Novolog last night when my suppertime number was 316. I ate about 30 cabs (my usual ratio is 1:8, so that means I ate for about four units). I kept checking to see if I'd come down, but all I got down to was 180.
Well, finally I just rage basaled and took 15 units of Lantus last night. I woke up with a blood sugar of 75. But after breakfast I was up at 302. Hoping it would come down, I didn't correct; at 11 AM it was 324. I took 6 units of Novolog. At 12:30 it was down to 296. I left it alone. At 2:30 it was 90. At 2:50 it was 54. I ate 24 carbs of granola bar. At 3:25 it was 52. I ate a muffin and put lots of honey on top, then walked home, a distance of about a mile and a half. At 3:50 I was 132. At 4:50 I was 192 and I took 2 units. At 7:00, I was 232.
I'm looking at the Dexcom Seven Plus. I spent a couple hours reading about it today, plus I called customer service. Sales there says I can buy a starter pack and a box of four sensors now for the price of 999 dollars if I pay out of pocket. A box of 4 sensors is 319 dollars unless I agree to buy six or more boxes in a 12 month period, in which case it's 289 dollars per box. The transmitter and receiver each have 12 month warrantees.
So for one year, if I used 28 Dexcom sensors, the total cost would be 2733 dollars.
But if I had to use 36 Dexcom sensors, the cost would be 3311 dollars.
If I went with the Guardian again, then as I remember it startup cost is 1344 dollars and that includes 4 sensors (despite what the internet says). A box of 10 sensors is 350 dollars. The receiver is warranteed for twelve months, but the transmitter only for six months. I forget the replacement cost for the transmitter; either it's 450 or 650 dollars. So if it's 450 and I had to replace it, and I used 34 Minimed sensors, the total cost over one year would be 2844 dollars.
If I needed 44 sensors, the total cost would only grow to 3194 dollars.
Now, I've used the Guardian before so I'm pretty sure I really could stretch 34 sensors over a whole year. I've never used the Dexcom so I don't know how long I could get out of one of their sensors, which is one of the things making me hesitate. Some other thoughts:
The Dexcom only needs to be recharged, and doesn't need batteries. This would probably be a savings of over 100 dollars over the course of a year of full time use.
The Dexcom people charge shipping and handling, which I hear can add up to 15 dollars per shipment. That could add up quick.
I hated dealing with Minimed customer service. Although they replaced the receiver twice, they were horrible with my financial transactions and with talking to insurance.
I hated the feeling of wearing the Minimed sensors and I hope the Dexcom ones would feel less painful.
I loved the data analysis, graphing, and predictive alarm features on the Guardian. I also loved that the screen stayed on. The Dexcom has none of these features. Even worse, the Dexcom has a low alarm that can't be turned off. This would make continuing to use the sensor as it fails probably worse because it reads a little low as it goes bad, and I could accommodate for that if I could turn off the alarms.
Dexcom users can't use tylenol. Probably not a big deal as I don't use tylenol.
The dexcom transmitter doesn't store data and you're not supposed to go swimming with it for more than 30 minutes. I don't go swimming often... but sometimes.
The shape of the dexcom makes buying additional tape to keep it down less likely to be necessary.
I went on a road trip in early June for a week and my Lantus needs went down.
I came home and my Lantus needs rose back to 8 units per day or so.
I left again after two weeks, and on the road I achieved steadyish overnight blood sugar with Lantus doses of 4-6 units.
I got home and my wake up numbers climbed. I took 8 units, 9 units, 10 units.
I woke up in the 200s, 300s, 300s, and more 300s.
I opened a new vial of Lantus.
I still woke up in the 300s. Not only that, but my daytime numbers kept rising out of nowhere, no food on board, 300s and 300s and I took 20 units of Novolog last night when my suppertime number was 316. I ate about 30 cabs (my usual ratio is 1:8, so that means I ate for about four units). I kept checking to see if I'd come down, but all I got down to was 180.
Well, finally I just rage basaled and took 15 units of Lantus last night. I woke up with a blood sugar of 75. But after breakfast I was up at 302. Hoping it would come down, I didn't correct; at 11 AM it was 324. I took 6 units of Novolog. At 12:30 it was down to 296. I left it alone. At 2:30 it was 90. At 2:50 it was 54. I ate 24 carbs of granola bar. At 3:25 it was 52. I ate a muffin and put lots of honey on top, then walked home, a distance of about a mile and a half. At 3:50 I was 132. At 4:50 I was 192 and I took 2 units. At 7:00, I was 232.
Tuesday, May 25, 2010
Update
In my February visit with the endo, I gave a urine sample for microalbuminuria testing, and asked not to be told the results. I'm really glad I asked that. Because at yesterday's visit, I learned that February's test had been macroalbuminuric. Fortunately, yesterday's urine sample was totally normal, and I didn't have that much time to freak out.
My blood sugar's been an unholy mess lately and my 7 day average at one point was something like 179, which is the highest it had been in three and a half years. But my A1c didn't budge from February, at 7.0%.
My meter had read 145 right before the blood draw; the lab said 138. Good enough.
My vitamin D level skyrocketed above the normal range and I'm supposed to stop taking the vitamin D supplements and come back in another month.
I haven't gained any weight over the last few months, but I haven't lost any either, so that's okay. My appetite is not very good, but I guess there are worse things. My pain levels are way down; I haven't been woken by pain in forever (though I have been woken by hypos and am wondering if nocturnal hypoglycemia could've caused the lower A1c), I haven't had to stop working because of pain... I have no cause for complaint. I do have soreness and tenderness in my abdomen, particularly over my pancreas, and I have a persistent pain in my lower back on the left side. I'm also having squeezing headaches. But I haven't fallen. I took my pulse for a full minute each time about twenty five times over the course of a week and found that my pulse was anywhere from 48 to 81, but usually 55-65. At bedtime it was in the 50s but in the daytime it tended to be in the 60s, and when I was waiting in my therapist's office, it was 81.
So, I think I was even sicker than I realized before the gallstones were removed, and I am on the mend.
Oh, and I did send in paperwork for a CGMS but Dexcom lost it and then I couldn't find the forms I'd filled out (and had my endo fill out) so I decided to just not worry about it for now.
My blood sugar's been an unholy mess lately and my 7 day average at one point was something like 179, which is the highest it had been in three and a half years. But my A1c didn't budge from February, at 7.0%.
My meter had read 145 right before the blood draw; the lab said 138. Good enough.
My vitamin D level skyrocketed above the normal range and I'm supposed to stop taking the vitamin D supplements and come back in another month.
I haven't gained any weight over the last few months, but I haven't lost any either, so that's okay. My appetite is not very good, but I guess there are worse things. My pain levels are way down; I haven't been woken by pain in forever (though I have been woken by hypos and am wondering if nocturnal hypoglycemia could've caused the lower A1c), I haven't had to stop working because of pain... I have no cause for complaint. I do have soreness and tenderness in my abdomen, particularly over my pancreas, and I have a persistent pain in my lower back on the left side. I'm also having squeezing headaches. But I haven't fallen. I took my pulse for a full minute each time about twenty five times over the course of a week and found that my pulse was anywhere from 48 to 81, but usually 55-65. At bedtime it was in the 50s but in the daytime it tended to be in the 60s, and when I was waiting in my therapist's office, it was 81.
So, I think I was even sicker than I realized before the gallstones were removed, and I am on the mend.
Oh, and I did send in paperwork for a CGMS but Dexcom lost it and then I couldn't find the forms I'd filled out (and had my endo fill out) so I decided to just not worry about it for now.
Saturday, April 17, 2010
Sabotaging Urges
After a really rotten blood sugar week filled with 30s and 300s and an average of 169, I had a day like this:
0010 hours 80
0820 hours 104
1020 hours 100
1220 hours 95
1550 hours 72
1720 hours 102
2040 hours 86
2205 hours 125
Can you believe that goodness? Nothing at all high, nothing low enough to be symptomatic. AND I had a huge breakfast with life cereal and potatos, and a lunch with potatoes and pie and supper with sandwiches... not a low carb day- I took 39 units of Novolog and 8 units of Lantus. And I ran around and played catch and stuff. And it was frickin' perfect.
By comparison, here was the 15th:
0005 hours 377
0205 hours 151
0745 hours 45
1125 hours 304
1325 hours 173
1609 hours 86
1730 hours 101
1805 hours 119
2115 hours 221
2330 hours 221
Now, it totally makes sense that on the 15th, I felt like it was partly my fault, and partly a very frustrating body, and that I really wanted to change what was going on. I mean, out of 10 readings, 4 were in my target range of 65-155. But what doesn't make sense to me is that I felt almost as out of control today because... where were those numbers coming from? 8 out of 8 numbers in range?!
When I have one, two, three target range numbers in a row, I feel pretty good. When I have five, six, seven, I start to feel surreal. I start getting an urge to prove that I really do have diabetes, to test the bounds of my body. ARGH! Take your blessings and run, Jonah!
Fortunately, I haven't done anything stupid yet today. I'm plenty wiped out from the week I've just had and I could really use a run of days like today... not that that's at all likely to happen.
One thing I've been figuring out is that my ISF seems to have gone up. It was 35 for a while, then 40. A couple months ago I changed it to 50, but the way I'm crashing after corrections, I'm going to try 60, assuming I go high anytime soon :-) More surprisingly, I think my BCR has also gone up, and that that's part of why I'm seeing so many highs- that it doesn't take as many carbs to do the job. My BCR has been around 4.5 for a long while, maybe as high as five, but it's seemed to me lately that it has gone up- maybe to around 7? I am perplexed. My ICR I changed from 7 to 8 a few months ago and seems to be holding steady.
EDIT: It is now 2330 hours and my blood sugar is 201 (I haven't eaten in at least five hours). I think I'll go with 1.5 units of Novolog.
0010 hours 80
0820 hours 104
1020 hours 100
1220 hours 95
1550 hours 72
1720 hours 102
2040 hours 86
2205 hours 125
Can you believe that goodness? Nothing at all high, nothing low enough to be symptomatic. AND I had a huge breakfast with life cereal and potatos, and a lunch with potatoes and pie and supper with sandwiches... not a low carb day- I took 39 units of Novolog and 8 units of Lantus. And I ran around and played catch and stuff. And it was frickin' perfect.
By comparison, here was the 15th:
0005 hours 377
0205 hours 151
0745 hours 45
1125 hours 304
1325 hours 173
1609 hours 86
1730 hours 101
1805 hours 119
2115 hours 221
2330 hours 221
Now, it totally makes sense that on the 15th, I felt like it was partly my fault, and partly a very frustrating body, and that I really wanted to change what was going on. I mean, out of 10 readings, 4 were in my target range of 65-155. But what doesn't make sense to me is that I felt almost as out of control today because... where were those numbers coming from? 8 out of 8 numbers in range?!
When I have one, two, three target range numbers in a row, I feel pretty good. When I have five, six, seven, I start to feel surreal. I start getting an urge to prove that I really do have diabetes, to test the bounds of my body. ARGH! Take your blessings and run, Jonah!
Fortunately, I haven't done anything stupid yet today. I'm plenty wiped out from the week I've just had and I could really use a run of days like today... not that that's at all likely to happen.
One thing I've been figuring out is that my ISF seems to have gone up. It was 35 for a while, then 40. A couple months ago I changed it to 50, but the way I'm crashing after corrections, I'm going to try 60, assuming I go high anytime soon :-) More surprisingly, I think my BCR has also gone up, and that that's part of why I'm seeing so many highs- that it doesn't take as many carbs to do the job. My BCR has been around 4.5 for a long while, maybe as high as five, but it's seemed to me lately that it has gone up- maybe to around 7? I am perplexed. My ICR I changed from 7 to 8 a few months ago and seems to be holding steady.
EDIT: It is now 2330 hours and my blood sugar is 201 (I haven't eaten in at least five hours). I think I'll go with 1.5 units of Novolog.
Friday, March 19, 2010
Pancreatitis and Type 1 Diabetes
This post was edited significantly after I discussed the facts with my doctor.
On Wednesday I was discharged from the hospital. The diagnoses I accrued while there were: choledocholithiases, cholangitis, and the biggee, gallstone pancreatitis. The spell checker thinks all of those are misspellings. Sorry, spell checker.
I had asked to be tested for pancreatitis three times in the past year, and had been. In fact, only ten days before my hospital admission, my lipase was 11; at admission it was 4040.
An ultrasound showed three stones in my pancreas, and an endoscopic retrograde cholangiopancreatography was performed, removing, according to my discharge papers "2 large stones and several stone fragments".
In type 1 diabetes, the production of amylase and lipase is often mildly to moderately abnormal and may not be an accurate marker of pancreatitis. BEWARE.
Anyways, I am on the mend. I am dealing with much lower insulin needs, probably 'cause I'm not in so much pain and am eating less. Last night I took only 7 units of Lantus, but woke up with a blood sugar of 39 this morning. I think tonight I will take 5.5 units of Lantus instead.
On Wednesday I was discharged from the hospital. The diagnoses I accrued while there were: choledocholithiases, cholangitis, and the biggee, gallstone pancreatitis. The spell checker thinks all of those are misspellings. Sorry, spell checker.
I had asked to be tested for pancreatitis three times in the past year, and had been. In fact, only ten days before my hospital admission, my lipase was 11; at admission it was 4040.
An ultrasound showed three stones in my pancreas, and an endoscopic retrograde cholangiopancreatography was performed, removing, according to my discharge papers "2 large stones and several stone fragments".
In type 1 diabetes, the production of amylase and lipase is often mildly to moderately abnormal and may not be an accurate marker of pancreatitis. BEWARE.
Anyways, I am on the mend. I am dealing with much lower insulin needs, probably 'cause I'm not in so much pain and am eating less. Last night I took only 7 units of Lantus, but woke up with a blood sugar of 39 this morning. I think tonight I will take 5.5 units of Lantus instead.
Sunday, March 07, 2010
Tough News
I got my bloodwork results back on Tuesday, and I've been in shock since then.
My A1c was 7.0%, which was higher than I was hoping for but not a huge big deal.
My vitamin D levels were very low, and I have started on a repletion dose of 8000 IU per day, dissolved in olive oil.
My hemoglobin and hematocrit were moderately and mildly elevated, and I'm hoping that that was caused by dehydration.
But the kick in the stomach was that my liver enzymes, the ALT and the AST, came back dramatically elevated. I went in for more bloodwork on Friday and should have results on Monday. I will also be going in for an abdominal ultrasound this week. If the liver enzymes are high again, and the extra bloodwork and the ultrasound do not reveal an obvious cause, then I'll be seeing a gastroenterologist or hepatologist.
I am taking a low dose of testosterone, and my endo had hoped that this could be the cause, but he doesn't think it's likely; neither does the doctor who prescribes my T. Friday's bloodwork included a check of testosterone levels.
I believe that at this point the most likely diagnosis is autoimmune hepatitis, and I am scared.
I intend to post February diabetes stats soon, but right now they seem sort of moot point.
My A1c was 7.0%, which was higher than I was hoping for but not a huge big deal.
My vitamin D levels were very low, and I have started on a repletion dose of 8000 IU per day, dissolved in olive oil.
My hemoglobin and hematocrit were moderately and mildly elevated, and I'm hoping that that was caused by dehydration.
But the kick in the stomach was that my liver enzymes, the ALT and the AST, came back dramatically elevated. I went in for more bloodwork on Friday and should have results on Monday. I will also be going in for an abdominal ultrasound this week. If the liver enzymes are high again, and the extra bloodwork and the ultrasound do not reveal an obvious cause, then I'll be seeing a gastroenterologist or hepatologist.
I am taking a low dose of testosterone, and my endo had hoped that this could be the cause, but he doesn't think it's likely; neither does the doctor who prescribes my T. Friday's bloodwork included a check of testosterone levels.
I believe that at this point the most likely diagnosis is autoimmune hepatitis, and I am scared.
I intend to post February diabetes stats soon, but right now they seem sort of moot point.
Wednesday, February 24, 2010
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.
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.
Thursday, February 04, 2010
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!
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!
Friday, January 01, 2010
Wednesday, November 25, 2009
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.
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.
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