Entries in Kicking Ass and Tracking Glucose (4)

Wednesday
Jun272012

Winning the game

So big things happening this week on the diabetes front. Got the results of back of my first post-diagnosis A1C and I have to say I'm pretty proud. Here's the run down:

Normal Hemoglobin A1C: 4.8% - 5.6% (Therapeutic goal for a diabetic is >7%)
Normal Average Glucose: Range is 70 - 110 mg/DL

May 1st(Diagnosis)
A1C: 13.3%
Average Glucose: 336 mg/DL

June 25th
A1C: 7.5% (a 6.5% drop)
Average Glucose: 169 mg/DL (166 point drop)

So I'm pretty stoked about these numbers. Particularly because this these results are skewed from my highs pre-diagnosis which hopefully means that when I retake my A1C in late August, I will be squarely in the normal range. That's the plan anyway.

My endocrinogolist was very pleased with my numbers and was very congratulatory about such a big drop in just shy of two months. It was really nice to get the encouragement particularly when I've been having some tough days this month.

We have been crazy busy with visitors and parties and volunteering and just general to-do lists that it seems like I've hardly got time to catch my breath. This has been all well and good but it has proved challenging when it comes to eating as we have gone out quite a bit or to potlucks where it's a crap-shoot as to what will be available to eat and how it will be served. This last weekend for example, we were at a potluck and I decided I wanted a beer - okay 1 unit of insulin there. But wait, what about dinner? Well at this point, dinner is not yet served so I can't account for what I'm going to eat yet. So I take the shot of insulin for the beer. Thirty minutes later, it's dinner time. I load my plate and then take another shot to cover those carbs. But wait, there's more. That's right, you guessed it - dessert! And German chocolate cake to boot! When was the last time you had German chocolate cake?! Exactly! That's what I was thinking, so I took a small slice and yet again another shot of insulin to cover the cake.

Three shots over the course of about a hour/hour and a half. Three needles. Three injection sites. Three times to attempt being a diabetes ninja (when you can test your blood or taking your insulin shot in the blink of an eye without drawing attention to yourself).

And although I had been toying with this thought over the last few weeks, it dawned on me then in a post-German chocolate stupor, this would have been a lot easier with an insulin pump.

This past Monday, I met again with Chandra (RD/CDE) and amongst other topics, we chatted once again about a pump. The reasons have been adding up for me and as much as the tubing idea freaks me out, the benefits have swayed in favor of a pump. I think a lot of the hold up for me was my misconceptions about pumps. I had it in my head that a permanent catheter would be implanted in my tummy, that the tubing was the size of a water hose, and that I would forever have to wear a fanny pack to transport the thing (this being the scariest factor of all). Not the case it turns out.

Chandra was very reassuring about the pump and made it very clear that if I don't like it, I don't have to use it. That if I was to disconnect from it for an hour, a day, a week just because I feel like it, that that's fine too. I will always have to have some insulin pens on hand in case of a pump malfunction, so if I decide to go back to pens for a period of time or a specific circumstance, then that's okay too. She reminded me that the pump is to let me have better control and to make my life easier and that ultimately I need to determine a strategy that works for me and it's okay if that's a combination of pump therapy and MDI (multiple daily injections) if that is what I want.

So after thinking on this and talking to Nathan, I pulled the trigger today at my appointment with my endocrinologist and she is going to get started on the paperwork for the pump I'm interested in using. I think she is rather please with my decision to give it a go, although I think she wanted me to go with a different version that has a linked CGM (Continuous Glucose Monitor). Can't please them all, right?

Oh and the salad I mentioned last week - here's the recipe - it's delicious - you're welcome.

Tuesday
Jun192012

ugh. what a week. 

I have been nursing a yucky feeling for a few days now. My blood sugars are just this side of normal and I am less than pleased about that.  Did you know that illness, along with that time of the month, can raise your blood sugar? If yes, a gold star for you. Just another bonus of T1D.  

Life has been been hectic and crazy and depressing and wonderful and stressful and all kinds of busy in just the last week alone. With that in mind, this is just going to be a quick update and later I'll write in more detail on some fronts.  I'm in the midst of deciding how much I want this blog to drift into realms of my life not directly related to T1D. Although I guess the argument could be made that no such part of my life is non-affected by this condition...

Yesterday I had not one but two doctors appointments sandwiching my workday.  I started off bright and early with an appointment with an actual podiatrist rather than a off-kilter LCSW with projection issues.  She was delightful and quite funny which made the visit much better than expected. Now it's my turn for a gold star. After all my freaking out over my cold foot, I got a complete and thorough look-see and according to my DPM, my feet are not diabetic aka low risk for issue. Which is really the best I can get diagnosis wise as everyone is essentially low-risk.  You (that's right, you) could step on a nail tomorrow or break your toe or get some awesome gnarly gash that get's nasty infected. That's right, I said it.  Low-risk is the best anyone can expect. 

She did say that I should make a habit of always wearing shoes (not socks. something with a sole) even when just walking around the house as a precautionary measure. I can't say I'm thrilled about this but as with everything - if I have to wear 'em - they are going to look good.  And thanks to a simple question on Facebook, I have quite a few brands to explore. I tell you - you ask ladies about footwear and you get ANSWERS ;) And thank you Zappos VIP - my new shoes come tomorrow!

The doc also made a crack about how she'd be out of a job if they went around cutting people's feet off whenever someone had an infection.  After reciprocating with a joke about job security, she went on to reassure me that even if I notice something out of the ordinary that doesn't mean the worse. I just need to be diligent and proactive. Once again - this is really something everyone should do when it comes to their health - foot care or otherwise. 

I ended my day with a visit to my amazing PCP. We were essentially just checking in to see how I've been dealing with everything since the diagnosis. I brought my numbers to show her (and let's face - brag a bit. I might as well take some pride in my control, right?).  She was kind and said she had been keeping an eye on my charts and she too is excited to see my A1C next week.  Despite my crew over at the endocrinology building, I think it's going to help to stay in contact with my PCP as I have known her much longer and am very comfortable with her, plus it will no doubt help my care for her to be more intimately in the loop.

Remind me to write later about a great recipe I got to try out this past week at a couple of potlucks - Fresh Mediterranean Salad - only 6 carbs for a cup's worth.  Until then... 

Monday
Jun042012

Camping Luedtke-style

Camping! The new (old) frontier! Nathan and I went on a 2-day adventure for his 30th birthday to the far reaches of Santa Clara County to the largest state park in California - Henry Coe State Park. Aside from the jerks in the camping spot next to us (note - if you are a douche, don't hold your bachelor party at a state park - kids and generally decent people, really don't want to hear about your sexual conquests, that, let's face it, are probably lies), we had a great time. The views were really spectacular and it was pretty amazing to explore such a variety of environments all within the scope of one day hike. We explored live oak forests, canyon streams, chaparral ridges and there were even some pine trees and a few redwoods for good measure. Not to mention a lot of wildlife. On the drive up we saw a young buck, at the campsite there was a very curious raccoon, and quite a few hawks and quail along the way.

The challenge of managing my diabetes during the course of a day-long hike in a variety of terrain and high temperatures was a large one. Especially considering that I am still getting the swing of things and figuring out the particulars of how my body responds to exercise, and this was going to be a special circumstance as it was not a 30 minutes jog but a 6.5 hour hike. The map below shows our route (the yellow was our day walk - around 13 miles, and the pink was our evening hike - about 2.5 miles).

The plan was that I would not take any fast-acting insulin but rather combine the exercise with a steady, reasonable intake of carbs, protein and fats throughout the hike to keep my blood glucose in a healthy range. We started out around 9:30am with a hearty protein laden breakfast of a salmon burger with scrambled eggs, gluten-free bun, and avocado. About every hour to hour and a half, I took my BG and adjusted as needed.

Well enough suspense already, here are my numbers from our half marathon of a birthday hike: 

  • 7:43AM (Wake-up) - 96 mg/dl

  • 9:38AM (Start of the hike) - 131 mg/dl

  • 11:04AM - 107 mg/dl

  • 11:49AM - 108 mg/dl

  • 1:27PM - 96 mg/dl

  • 2:48PM - 89 mg/dl

  • 3:40PM - 130 mg/dl (so there's bit of an increase here, as our water stores had run out so I slowly drank a juice box over the course of a half hour to avoid dehydration)

  • 4:24PM - 144 mg/dl

If anything, I got sick of eating constantly to keep my sugars up. I just wanted to walk and not munch away on some almond butter or a lara bar. Lucky for me, my husband enjoys a snack or two, and was very good about not only getting me to test but also making sure we didn't go longer than 30 minutes without at least a bite of dried meat or some trail mix. To some extent, it became a bit of game, and it was really rewarding to see how well we were able to manage my numbers with consistent monitoring both of the actual numbers and how I felt as we climbed. 

Wednesday
May232012

Gold Star (or better put: Score 1 for Michelle!)

Ok. So been a big long busy week of activity on all fronts.  As such, let's roll back to last Thursday and start there, shall we?  Side note - did  you know that last week was the 3rd Annual Diabetes Blog week!? Who knew?  Guess I'll have to do some sort of fancy themed piece next year. One thing about finding this out after the fact is that I do have time to plan ahead.  

So last Thursday was a big day on the medical front as I had appointments with both my endocrinologist as well as my first appointment with the diabetes counselor.  We'll go chronologically for ease - so we start with the endo doc.  I think it is important to give you a visual of how adorable my endocrinologist is. She is a teeny Iranian woman who is petite in both stature and size and compensates with impressive heals. I feel like a giant around her however and thus I'm certain that I have terrible posture during my visits.

We started with the what is now normal rigamarole of downloading my BG numbers from my meter. Luckily I do work for a research firm, so the data end of this disease I do find quite interesting. As did she in this case as she was quite impressed with what she saw and kept saying, "This is so great Michelle - these numbers are really good." For all you medical types out there, I have been averaging around 130 on the whole and only had maybe two readings over 200 in the last 10 days or so.  Considering my last A1C showed my average glucose around 335, this is a HUGE improvement.  So much so that my doctor wants to me to get my AC1 run again in 6 weeks rather than waiting another 12, which was the original plan. She was very excited and exclaimed how she thinks we'll see a big change and let's run it early as she doesn't want to wait.  

So I took this to mean I must be doing something right.  Right? I mean is it weird to feel some pride in getting a gold star on your diabetes care?  I suppose it's a bit like: "Hey you are doing what you should so you don't die. Right on!"But I'll take what I can get I suppose.  I have always been good at following instructions, so in a way, this whole management approach of TEST, COUNT CARBS, TAKE INSULIN, REPEAT, is really right up my alley. 

Following the good news of my doctor's visit, I went on to have my initial appointment with my new counselor (at least for the time being, as I'm rather skeptical about the whole thing).  So the counselor is a licensed clinical social worker in the process of also getting her certificate in diabetes education. For ease I shall refer to her by her title of LCSW.  

So I think the problem (problem is the wrong word, let's say issue?) I find with counseling is that I'm not unawares of their methods. I've gone to more than a few 'feelings' exercises over the years (RA training, anyone?) that I know why they are asking the questions. What they are getting at and thus I start a bit stand-offish about the whole thing. But after all the stressors of the past 5 months, I did think it would be good to vent to someone other than family and the co-pay was reasonable.  

Just as I thought - weird. Helpful I suppose. But so is my Xanax prescription and I don't have to spill my guts for it to help me out. She suggested that Nathan come with me to a visit as this whole mess is playing out with him too and it might be good to all hold hands and chant together or something of that nature.  We'll see. She seemed like a nice enough lady so I figure I'll give it an honest effort and see how it helps. There is an obscene amount of items inscribed with the word 'Peace' in her office however. 

Aside from the doctor's appointments, this past weekend we hosted a "Come Eat Our Carbs" party and had about 20/25 folks come over to the house and help in the consumption of carbohydrate packed items.  I made an enormous bowl of pasta salad along with some chocolate cupcakes and gave out party favors of Annie's fruit snacks, Israeli cous cous, sugar and flour. A grand time was had by all.  A big thanks to everyone that came out. 

Monday saw another visit to Chandra, my dietitian, which also resulted in a lot of positive feedback about my numbers.  Enough consistency and improvement to defer my next appointment by 6 weeks or so when initially I had been told I'd be seeing someone weekly until I got the swing of things.  

As has been the case with Chandra, we had a nice time and a few laughs. She gave me some good recommendations on how to approach my insulin, particularly in reference to exercise. I'm currently having some low dips when I exercise. Which can happen, however since my pancreas is still doing a little something, I tend to dip a bit more significantly. As such, I either have to up my carbs prior to exercise or back off my insulin a bit.  All good things to figure out as Nathan and I are starting to get back in our running routine and are in training for the Wharf to Wharf in Capitola in July.  

We also talked more about pumps as this is definitely a concept I'm becoming more open to dicussing.  In my last post I talked a bit about the Omnipod which is the patch pump, which I have now seen in person. I also saw the other two major insulin pumps on the market. All are about the size of a pager and aside from the Omnipod which sticks onto your skin, the other's are usually worn on a belt or in a pocket.  Chandra was telling me that you can also get straps for when you wear dresses where they affix to your upper thigh, like you're a spy or something.  A lot to think about but it was nice to get a better feel of what they are and how they function so I can be more educated if/when the time comes to use one.  

It's pretty amazing on the whole when you start seeing all the technology that is out there for diabetes care and management.  I was just reading today about the prospect of using nanotechnology among other things in new ways to track blood glucose levels. Cool stuff. Something to look forward to I guess.