2 for 12

Mike Lawson posts 12 pictures on the 12th of each month and I always think that's really cool.I was planning to do the same but am having trouble uploading pictures. So here are a mere two pictuers instead.

All Better Now, And Hoping It Stays That Way

Thyroid level tests all came in normal range, with the TSH, T3, T4 all being just above the bottom of normal. My endo says to call him if I get symptomatic of hypothyroidism, because he thinks that might be where I'm headed to.
The erythrocyte sedimentation rate came in at 3, which is low- not a symptom of inflammation, though it doesn't rule out the possibility. The lowness of it may be a continuing symptom of the polycythemia I had, I don't know.
The c reactive protein was too low to measure, also a sign that there wasn't inflammation.

My diabetes numbers continue to be nice and low, but my Novolog needs are falling dramatically again and I'm had a bad hypo on Wednesday like nobody's business. Ahhh- I'll take that over the highs. If this keeps up for another two months, I bet I'll see an A1c in the lower 6s or even (dare I hope?) upper 5s. My 7 day average is now 120! The 14 day is 138, and the 30 day is 150. I haven't seen a 7 day average of 120 since last fall. Heck, I haven't seen a 138 average since winter. I'm holding my breath, hoping this lasts.

Waiting, Waiting, Waiting

I saw the endo on Friday. He drew blood for thyroid hormone levels and erythrocyte sedimentation rate. He asked me if I'd like my A1c drawn and I said no. I hadn't been decided, but when I looked at the needle and the vial, I just didn't want the blood drawn when I knew it would have been an awful A1c. My 30 day average at that point was close to 170. Starting last week on Sunday, I've been running excellent blood sugars. My 7 day average is 123, my 14 day is 145, and my 30 day is 151. I'm loving it. The doctor said that my results would be in on Monday but hasn't gotten back to me. I don't like this pattern at all.

I'm at a sort of a camp for autistic people right now. My roommate's been curious about blood sugar and I've tested him three times, which I suppose affects my average, except his three tests were 145, 134, and 104, which I think averages to higher than my 7 day average anyhow. He's not diabetic. He says if he was, he wouldn't take shots, just could not do it, but he seems fascinated by the needles. I dunno what to make of that.

My iodine uptake is low. My thyroid antibodies have been retested and are negative still. My TSH is low. My T3 and T4 are normal. My thyroid is painful and tender. So. My endocrinologist has suggested that I may have subacute thyroiditis, although he says that that is not the only possibility. This will cure itself sooner or later, and in the meantime I just have to hold on and wait for the ride to end. My endo would like me to come in once per month for monitoring. That way, if I plunge from hyperthyroid to hypothyroid (a definite possibility) we can treat that as fast as possible, and if I go more severely hyperthyroid, we'll know and respond to that. Also, he mentioned that beta blockers may be an option if my cardiac symptoms become more pronounced.
All in all, I think this is confusing but mostly pretty good news.

Yesterday I had the unusual occurrance that I saw THREE other T1s. One person on the bus I saw with a minimed 722 pump; I went and sat next to her. She's had diabetes for 52 years. I was impressed. Then I met up with Carrie, who I know because of this blog, so that wasn't a random coincidence. And then towards the end of my day I was about to eat supper and I had taken out my Novopen Jr, and somebody said to me, "Hey, is that an insulin pen?" and I said Yeah, how'd you know? And she pulled out her humalog pen. A most unusual day.

The Uptake Scan That Wasn't

Tuesday night I lowered my insulin dose, checked when the early bus was leaving. Wednesday I caught the bus at 6:16 in the morning and headed to the hospital. Checked in around 7:15, filled out paperwork. A nurse took me into her office at around 7:40. We went over my papers and she asked me some questions about my health. Then she told me that I'd be swallowing a capsule. Stop right there.

I can't swallow pills. I can't swallow capsules either. For the medications I've had to take that were in those forms, we've either emptied the capsule and let me take it that way, or I've chewed it, or we've ordered an alternate form. Some of these things have been horrendously bitter and I've attempted to learn to swallow them- to no avail.

I informed the nurse that I can't swallow a capsule. She picked up the phone that was on her desk and called. "Marcy, I've got a young man here with orders for a 123 scan and he has grave doubts about his ability to swallow the capsule." Within minutes a meeting is convened: the nurse who I've been talking to, the head nurse, the pharmacist and me. We run through the options:

1) Could I attempt to chew this thing? No, that would render the test extremely inaccurate.
2) Is there a liquid form? No. The capsule can be melted, but nobody in the building has ever done that before, and they're not confident that they can do it right. There is a guy in the department who can, but he's on leave for the week.
3) Can we do the I131 scan instead? That's a liquid. No, because there's a suspicion of cancer and the 131's not nearly as accurate in that area.

So we rescheduled for a week later when the guy who melts the capsules will be back. They were really apologetic and offered me any time slot I might want and I stupidly picked a 10 AM time; I need to call and move it to earlier because they want me NPO from midnight until 2 hours after taking the thing, and I want to be able to eat lunch. Missing breakfast messes with my blood sugar plenty.

Glucagon Expiration

My mother keeps a glucagon kit in her bedroom, and it expired at the end of April. I have a glucagon kit in my refridgerator which I thought I'd switch with hers, but it turns out that that one expires at the end of May, which is to say, today. I am not sure if we have any other glucagon kit around somewhere.
So I thought, okay, I'll order a glucagon with the next round of supplies and I ought to be about due for a round of supplies, right? But when I checked I realized that I have a 5 month supply of Lantus, and while it's harder to tell with the rest, I think I have about 3-6 months' worth of the rest of my supplies too. So should I reorder? I'm thinking about it.

We haven't used a glucagon in our 2 years and 9 months with diabetes so far. I am not at all convinced that anybody would be on hand to use one if the situation arose. On the other hand, I do go below 45 fairly frequently and it might make my folks feel safer.
But maybe the expired one will be good enough for the next few months? I don't know.

One Lovely Blog Award

was given to me by Vivian. Vivian writes about her family and its many challenges. Her posts are well written and have lots of pictures. If you want to read a caregiver blog and are willing to read about more than just your own medical issue, I recommend it.

I suppose I should offer this award to others, so here are my top three:

My favorite diabetes blog is Life After Dx. Lee is a diabetes educator of the paid but uncertified sort; he works in a clinic that serves mostly poor folk in New Mexico. Lee is also a type 1 diabetic and a family man, and he's really funny. And he's an author. His blog is about 80% diabetes stuff, although not all about his own diabetes, and I just like it.

What Some Would Call Lies is another blog by a diabetic, but this blog is not diabetes focused- it's probably around 10% diabetes stuff, maybe even less. Mike was originally diagnosed t2 but went into DKA when he didn't take his insulin, and I notice his profile now says he has t1. So I guess this is a LADA blogger. He is funny and all of his posts have pictures (I like pictures). He's also gay and he has dogs and he makes culture and work references. Yeah.

Nancy Reyes doesn't write often enough. She's a retired nurse in the Phillipines with an unusual perspective on health care. She's not diabetic and this isn't a diabetes blog.

Absorption

On Saturday evening before I took my Lantus, my blood sugar was 145 and it had been a couple of hours since supper. Two hours later as I was heading for bed, I checked my blood sugar again and it was about 220. So I took 2.5 units of Novolog and went to sleep. In the morning when I woke up, my blood sugar was 236. I corrected with another 2.5 units of Novolog and went back to sleep. Two hours later I was 179. I had breakfast with a correction (total of 8 units Novolog), and then went to help out an elderly couple that I visit most Sunday mornings. I walked to their place and back, a mile each way. When I got home I was 204, so I took 2 more units of Novolog. Went and volunteered at the library, shelving on my feet. When I left I was in the 230s again. Took 2 units of Novolog, walked a mile to the Clark bus, walked a half mile after getting off the bus and went to a friend's house. Two hours later I was 159, and an hour after that, before supper, I was 136. I ate a very small supper and injected for it. When I got home and got ready to take that night's Lantus, I was again in the 230s. I took 2.5 units Novolog and pondered.

I had a problem. That day I'd taken 9.5 units of correction and 10 units to eat with for Novolog. The previous night I had taken 10 units of Lantus. I knew that I hadn't had nearly enough basal insulin in my body that day. I would have thought that I hadn't taken the Lantus at all, except that I remembered taking it- it had been a particularly painful injection. Should I take more basal insulin on the chance that I'd merely grown very insulin resistant? Should I take less, banking on the possibility that that one shot had absorbed poorly? I took 10 units of Lantus.

Two hours later falling asleep I was 124, and when I woke up this morning I was down to 61. While this doesn't prove the hypothesis that Saturday night's Lantus injection wasn't absorbed well (if at all), it strongly supports it. This is the first time that I've really thought I had insulin that wasn't being absorbed (excluding during that I-PORT trial), and I'm wondering what (if anything) I should do to prevent a similar future occurance.

Candy

I have got a sweet tooth. I like candy, and I am very capable of eating a pound of sugar in a sitting.
I have also got really a strong ascetic streak. From October 30, 2001 until about sometime in the summer of 2002, I didn't eat any processed sugar at all; and I repeated the feat for a couple of years a bit later. I also didn't eat honey.
I've been on various diets mostly for fun; a vegetarian since late 1997, a vegan since early 2000; gluten free from August 1 until the end of 2005; no processed sugar at all from October 2001- August 2002.
I am very much an all or nothing kind of a guy.

When I was diagnosed with diabetes, my parents and the diabetes educator and the nutritionist and I sat around and talked about stuff. The nutritionist quizzed me about my diet and said I was getting in all the vitamins I ought to be and that overall I was eating a healthier diet than most; keep up the good work.
Then the CDE said I needed to have some simple carbohydrates on me at all times. Problem: I was concerned that I would eat the food when I wasn't hypo and therefore it wouldn't be there when I was. This has, in fact, remained a problem for me. Here are my solutions so far:

1) Treat hypos with a source of sugar that is not very appealing, such as plain honey. Drawback: Either it turns out that the food is more appealing than I thought, or else when I'm cantakarous and low, I refuse to eat it.

2) Get a ton of candy and allow myself to eat as much as I want of it, leaving some on hand for hypos. Drawback: While this often works, and I find that I had more discipline than I though, often what happens is that I simply eat a lot of candy. It's available for lows, and candy ironically is one of the easiest foods for me to manage blood sugar wise, but I am not convinced that it's a nutritionally sound choice.

3) Treat hypos with normal food. Drawback: not usually a fast acting carb, and I have to restock because normal food goes bad.

So what do I do? Some combination. Often what I do is carry around an extra meal's worht of food, and also some packets of sugar. Sometimes I do go and buy a five pound bag of soft mints or smarties.

Recently, I had a really bad low. It was only a 42, which doesn't sound so bad, but the thing is that it was just past midnight, I hadn't had Novolog in about three hours, and I ate 50 carbs of sugar and soy ice cream, didn't inject at all, and a couple hours later was up to only 120. Also, my vision was blurry and I felt really anxious. In the morning, I was down to 71.
So I went and bought a five pound bag of mints, and now I keep eating the damn things when I'm not hypo. In fact, I want one right now.

:-/ There are worse things than having permission to eat candy, I am sure.

So....

This morning I woke up at 7 AM, blearily hearing my mother going by. I eyed the clock and went back to sleep.
At 8 AM, my father came by to make sure I was awake and doing fine. I got up, feeling fine, went to the bathroom to wash my foot and came back, checked my blood sugar.
"Thirty-eight", I told him.
"Thirty-eight? Without a one in front?" he is incredulous.
So am I, when it comes right down to it, but I let him walk with me up the stairs to my parents' apartment, where I eat a bowl of cereal and don't inject any insulin. An hour later, curious, I check my blood sugar: 86. So I guess the earlier reading was for real. Later in the morning I went a little bit high, but nothing too bad. My blood sugar was fine all afternoon and evening.

I thought I didn't have a thyroid family history, but my uncle is here because my father is having surgery (prostatectomy due to cancer) tommorow. And he says that my father's mother and one of her sisters both developed hyperthyroidism in their 70s, and neither of them had to have anything but blood tests to diagnose it, and both got radioactive iodine to treat it and were fine. He doesn't know what kind of hyperthyroidism, but he does know that they didn't have to have uptake scans.
My guess is that that means Graves', because I figure the antibodies showed up in the bloodwork; either that or it means doctors who didn't really care what kind of hyperthyroidism these very sick women close to 80 had.