Metformin Helps Dawn Phenomenon

I stopped taking metformin several weeks ago as an experiment. Was it causing my lower GI problems? Yes!

However, I'm certain now that it has a significant positive impact and have titrated back up to 1,000 MG per day.

I clearly have Dawn Phenomenon. During the time time I was off the metformin here are the salient numbers:

• Bedtime average = 150
• 3:00 a.m. average = 173
• Waking a.m. average = 180

Here are the numbers now that I'm back up to a relevant dose of metformin:

• Bedtime average = 146
• 3:00 a.m. average = 166
• Waking a.m. average = 103

One interesting postscript to this experiment is that I also appear to have delayed Dawn Phenomenon, meaning that my BG goes up and up and up after waking until about 11:00 a.m., at which time I crash and go low, low, low. Starting today, I'm adjusting my carb ratio for breakfast and my morning basal dose in order to compensate.

Addicted to Tu Diabetes

It's official. I am addicted to a social networking site!

Don't get me wrong...I love reading everyone's d-blogs (I subscribe to over 150 in my Google Reader).



But this site is just great. I feel like I'm connected to others through the forums, and have a place to ask all the questions my CDE doesn't have time for (or that I feel too silly to ask otherwise).

I joined Facebook a couple of years ago...in my capacity as a geek at a university whose job it is to understand this phenomenon and explain it to others. But being 43 years old, I have never really used it for my own networking. I just lurked.

But Tu Diabetes is fabulous.

C-Peptide Results

I recently was a participant in a clinical drug trial.

At the end of my participation, they conducted one last round of labs (9 vials of blood - eek!). Today I received my check for participating ($300 - woo hoo! enough to keep me in glucose tabs for a while) and the final lab results.

My C-Peptide was .9 and the "reference range" was 1.1 - 5.0.

So I guess that means I'm still producing some insulin but I'm below the low end of the range. I'm really curious how these numbers translate. Do I have 50% production? More? Less?

Also, I've read elsewhere that the "reference range" can vary from one person to the next and must take into account age, gender and so on. I assume that the reference range in my results do so.

All in all, it's just one more number in the big picture, but I am curious about it.

Insulin-o-phobia

That is my really special personal term for being afraid of taking big doses of insulin.

I am not afraid of needles or injecting myself.

I am afraid of taking so much insulin that I have a hypoglycemic episode. So maybe I should really be calling it "Hypoglycemia-o-phobia" instead.

I am sensitive to insulin, and still produce some of my own. My TDD is about 50 units. My meal bolus is typically around 4-6 units. But there have been instances where I'm going to eat a really big meal, and/or I am really high (like, say 347!) and so I need more insulin. So when I do the math and the calculator on my Palm Treo suggest that I inject 12 units, it freaks me out! The thought of injecting that much insulin scares me to death! Going low! Overcorrecting! Overcorrecting again! Going low again! Argh!

Yet I know 12 units ain't nothin' to many people. And that is likely going to be the case for me eventually as well. I need to just suck it up.

Getting a Pump: Part 2

I am now immersed in the process of reading all about the various pumps. I have very slick promotional brochures from each of the major manufacturers. Some of these are very well put together - well organized, easy to read and so on. Others are not. I'm trying to remember that the marketing arm of a large corporation might not be the best yardstick by which to judge the technical arm. But I do tend to believe that those with very good marketing materials just might have a better product in the end.

I'm also doing some online review. Here is a great site that succinctly lists the pros/cons of each major device. It is put out by Integrated Diabetes Services, a practice headed up by the guy who wrote "Think Like a Pancreas" -
http://www.integrateddiabetes.com/pumpcomp/pump_comparison.htm

Here is another site that provides some good information:
http://www.diabetesnet.com/diabetes_technology/insulinpumps.php

And, of course, reviewing the websites of the manufacturers, which are noted on the links above. I will write more later as my thoughts on all of this gel a bit more.

Getting a Pump: Part 1

I met with the CDE at the my clinic. She was great.

Bottom line, she thinks I can get a pump, and may even be able to bypass the insurance company's "on insulin for 6 months" rule. The clinic supports all six major pumps currently on the market. She said that the insurance company recently told two of her patients that they were no longer going to pay for the Omnipod because it is not "durable medical equipment" in their opinion. But the CDE thinks that they have straightened it all out.

Next steps are for me to:

1. Go pump shopping. I left her office with product brochures for each of the six pumps, and am reviewing those and surfing the 'net for other reviews. Other bloggers' stories have already been incredibly helpful in navigating what each of the features mean in real life
2. Meet with my Endo in a couple weeks. He will start documenting my medical record with all the tidbits that will help get me through the insurance process. Things like: being sensitive to insulin (I'm still at only about 40-50 units for my TDD); Dawn Phenomenon; going hypo and hyper; my preferred method of excercise (biking).
3. From there, he sends of the prescription for the pump of my choice to the pump company, who then sends it to the insurance company. From there, lots of wrangling I suspect.
   

In the end, I might have to wait the 6 months (late October), and even then I'm not sure if the insurance company requires all this extra rationale or not.

In the meantime, she interviewed me at length about all D-related activities, meds, insulin and eating, and carefully reviewed my meter history. Based on that, she calculated my carb ratio (2 units per 15 carbs) and my correction ratio (40), and had me adjust my basal (take night time dose later, and reduce amount of morning dose). I'm carefully logging everything, and will fax her my info in a week and adjust more from there.

Internet Based Study for People with Diabetes

This research project has been advertised quite a bit on other blogs. I went to the site and checked it out. Seemed to be worthwhile, so I signed up.

The project itself, overall, seems to be well conceptualized. However, I am not very impressed with the survey instruments. The instructions are not always clear, and answer options in many cases do not fit the question.

Nonetheless, I am continuing to participate. They are looking for more volunteers, so feel free to take a look.

http://www.clas.wayne.edu/~radcliff/index.php

Tu Diabetes

A new social networking website for affected by diabetes. I've created my account and joined the Southeast US group. I'd really like to connect with some others in this area.

http://www.tudiabetes.com/

Dr. John Buse in the News

This guy is a heavy hitter in the field of diabetes research. He is technically my doctor, since he supervises all cases handled by the Physician's Assistant that I see at the UNC Diabetes Clinic. Dr. Buse has been at the center of the all the Avandia uproar recently, and will be the new President of the American Diabetes Association soon. Our local newspaper, the Raleigh News & Observer, did a fairly big write-up of him for the June 22, 2007 issue.

Frio Math

How many Frio bags does it take to store enough insulin for 9 days of vacation?

Let's see. For my carb boluses, I use about 4-6 units per meal, 3 times a day. That's like 25 units a day, right? No, wait. That's only like 18 units a day max. So let's round it up to 20 because I can only do math that ends in zeros. Or is that zeroes?

Then there's the correction bolus. Hmmm. Still don't know my correction factor. I haven't been able to lease enough time on NASA's Cray Computers to make that computation yet. So let's say 2 units a day. So that's 22 units a day so far. Wait. That doesn't end in zero. Let's take it back down to 20 since I had rounded up from 18 to begin with. OK - 20 units of Novolog per day.

Basal...well, about 12-14 in the evening and about 12 in the mornings. That's 24-26...average of 25? It's not a zero, but it will do. So 25 units of Levemir per day.

So now each pen holds 300 units. No, wait again. That says 100. So I can only get about 4-5 days out of each pen. That means I'll need two pens of each, plus an additional pen for backup, so that's six pens. Is that right? Let's see...there's four quarts in a gallon...ok, that sounds right.

WAIT! I look again! It says 100 units per mg, and 3 mg per pen...so it IS 300 units. OK. Is that true for both Novolog and Levemir? Yes. Good.

So 20 a day ...5 days to use up 100 units. So 10 days for 300 units. OK, now we are getting somewhere. If I start with a fresh pen, I should be able to get enough for the entire 9 day vacation. Same deal with the basal.

Considering I need one pen each for backup, that is a total of two pens each of Novolog and Levemir.

Now the tricky part! How many Frios do I take? Actually, since I have two Frio Duo pouches, it works out well. One each in the Duo pouch that I will carry with me at all times, and one each in the Duo pouch that will stay with my luggage in the hotel.

Or should I take two each for backup? That means the small Frio bag that holds up to 5 pens...but I really want to use my new green Frio...so now I'm considering Frio Fashion while doing the Frio Math.

Omnipod Looks Impressive

I have read that sometimes a patient is limited to the pumps supported by their clinic or endo practice. I wondered if the UNC Diabetes Clinic had any such limitations...or at least any products they seem to endorse.

A bit of research reveals that the pump trainer I will see in 2 weeks has done some work with the Omnipod, which has a very slick website. The 'pod is reviewed very highly by DiabetesMine blogger Amy Tenderich, and others out in the d-blogger world.

Gotta Wait 5 Months to Pump

Well, a little research and I answered some of my own questions. According to my health plan, I must be on insulin for at least 6 months to be considered for a pump. I've got 6 weeks under my belt, so about 5 more months to go. There are other requirements, which I don't think I'll have any problem meeting.

The only requirement that could get dicey is having an A1C of than 7.0. I'm currently at 7.8. I guess I could possibly get down to 7.0 but I doubt it, since I don't yet to seem to have a very good insulin regimen. An A1C of 7.0 or lower could still be considered if there are enough documented hypos to account for the lower number. It all boils down to lacking tight control to a high enough degree to qualify. Crazy.

There is an option whereby the patient has been on insulin "less than 6 months but more than 3 months and the patient has documented extenuating circumstances. These cases may be reviewed on an individual consideration basis." But I'm guessing there ain't nothing special about me or my life or my health right now that be construed as an extenuating circumstance.

My Story

More details on my Dx are now posted in the "Your Story" section of the fabulous Six Until Me blog.

Maybe a Pump

When I first started taking insulin, and then surfing d-blogs, all I seemed to read about were pumps. I don't know what percentage of insulin users actually use a pump, but it seemed like everyone at first! And I certainly had no interest at that point. Trying to figure everything out these last six weeks has been crazy. The thought of adding a pump to the equation was just out of the question.

But I have since changed my mind, for a number of reasons. Just in the last week I've gone from "Pump? No way" to "I think there's a pump in my future...maybe" to "How soon can I get one?" Here is what has swayed me.

1. I have a very close friend whose husband just started on a pump, and hearing all the details has taken some of the mystery out of it.

2. Inserting an infusion set once every couple of days seems less annoying than 5-7 separate injections per day.

3. I'm fairly sensitive to insulin, and I think that measuring by half-units or less would really be helpful (currently, I use a Novo flex pen for both basal and bolus, and it only dispenses in whole units).

4. The learning curve on "me on insulin" is huge...why not just roll it in with learning to pump?

5. These Groovy Patches look like fun.

I have an appointment with the pump trainer at my clinic near the end of the month, and I suppose she'll decide if a pump is for me, and we'll go from there.

Licking the Spoon

Guilty Pleasure Moment: When I make chocolate milk for my daughter (Hershey's syrup and whole milk), I automatically lick the spoon!

How many carbs in that, I wonder?

Can I Slap You?

This is what both my sister and my sister-in-law each independently asked me mid-way through my careful description of what to do should I seem to have a reaction to high or low blood sugar.

Not wanting to disappoint them, I indicated that a good slap was always welcome and that I wouldn't take it personally. They each seemed pleased. :-)

My sister-in-law also is looking forward to re-enacting a scene from Steel Magnolias where M'Lynn gives Shelby some orange juice (and later, her kidney, as I reminded my sis-in-law...in for a penny and all that).

So far they all seem to be taking full advantage of my condition.

In that spirit, here is a link to movies that have characters with diabetes.

Six Until Me

When I first started lurking d-blogs, it didn't take long to notice that many listed "Six Until Me" as a favorite d-blogger. I went to the site, and enjoyed what I read.

But I never got the "Six Until Me" title. I looked around for some explanation on the blog website - About Me, My Profile, and so on. No clue. So I gave up, and just enjoyed the blog.

Finally, I found (through yet another person's blog) a link to the post which explains the title. It is incredibly moving and well written.

"Six Until Me" Title Post (on old blog)

Current "Six Until Me" Blog

Both are worth the read.

Metformin

I have been taking metformin since my original Dx early in 2006. Actually, I started on Glucophage then switched to the generic when I began participation in a drug trial.

I started at 500 MG per day and finally saw a drop in my BG numbers when I reached 1,000 MG. This was the only medication I was taking at the time.

That dosage was upped for the drug trial, and I've been at 2,000 MG per day for almost 10 months. The additional 1,000 MG per day made no difference.

The problem?

The lower gastro-intestinal distress problem (code for "diarrhea"). Ugh. I've always had this problem (mild, but annoying) since hitting the 2,000 MG level.

So I finally decided to take a break, and I stopped the Metformin for about a week. The mild but annoying problem cleared right up. But my BG has been high. I need to resume the meds, but I have read that metformin for T1 is not a good idea. But it is what my Endo has kept me on even after my new T1 DX. Maybe I should request to back off the dosage since the extra 1,000 MG doesn't seem to make much difference.

To Bike or Not To Bike

I can't decide if/when to get back on my bike.

I took up road biking a few years ago. My brother-in-law became the head guy for the MS Society in our neck of the woods, and their biggest fund raiser is the MS150. Year 1, I didn't do anything but buy a cheap hybrid bike. Year 2, I trained for the event, but had a couple of bike accidents that prevented me from biking the event. Year 3, I was able to ride the entire first day of 75 miles. Year 4, I was able to complete all 150 miles (and got my Dx earlier that year).

But now I'm worried about going low while riding. Scares me to death.

Sharps

I finally have generated enough used needles to force the issue on how to best dispose of them. A little research revealed that the State of North Carolina doesn't not require any special processing. Aside from the recommendation of putting them into a hard-walled container, household sharps can be discarded with household waste. There don't appear to be any county restrictions either.

So off I went to dump them from the special red container into something bigger (since I want to keep using the red container in my kitchen). I decided on a detergent bottle that was just about done. After starting one more load of laundry with the remaining liquid, I started the dump process.

The opening has one of those built-in spouts...not very big. So now I'm having to craft a funnel type contraption. A mailer-postcard-thingy in the recycling bin finally did the trick. A quick notation with the permanent marker that it is sharps (and no longer detergent...I hope that the rattle is a clue to the family and they aren't relying on the label!) and mission accomplished. I think.

Who Switched the Insulin??

Oops. I did!

I'm traveling this weekend, and this is the first I've done so with insulin out-of-town. During the ride in the car, I was talking about d-stuff to my hubby (which is, of course, all I talk about these days), and I mentioned that I read how others had accidently taken one type of insulin instead of another.

And then what do I do this morning? Exactly that.

I took more than twice the mount of bolus insulin as usual, thinking I was injecting my basal.

As so I enjoyed a huge carbo-licious breakfast to counteract the dose. So far so good.

My sister offered to smack me if I had a low, hoping that was an accepted treatment!

Watch Your Frio While It Soaks!

I recently purchased Frio insulin wallets in several sizes (Individual, Duo and Small). The very first time I used one, I let the case sit in water for just a minute or two longer than recommended, and it puffed up so much I couldn't use it for several days.

I'm leaving on a trip later today, so I had to get out the next size wallet and activate it. I stood and watched it carefully this time while it sat in the water. Perfect results.

My experience so far with the Individual wallet is that it has stayed cool for 6 days now. We'll see how the Duo does on my long weekend trip. So far, I think this is a great accessory.

(For the record, I wish I could find it in red, as advertised on their website. I suppose I could have bought it online straight from Frio, but it was somewhat less expensive through other online stores.)

Family Affair

This is not about the incidence rates of Type 2 in families, or how likely a child of a Type 1 parent is to develop Type 1 herself.

No, this is not about that particular aspect of families and diabetes.

This is about how families (or at least my own family) respond to those who have the disease.

My husband has said several times: "This didn't happen to you. This happened to us. We will all get through this together." And true to his word, the dear man continues to be my partner in life in everyway, including diabetes. He asks every morning what my number is, and wants a full report when we come home from work every day. (Granted, this is the early stages, so who knows how interested we will both be in a year, or 5 years or 10 or 20 years...) He helps me think about each meal and insulin dosages. He's constantly on the lookout for lows (since they've been a constant companion while I get things figured out), always ready to grab me the orange juice. He's offered to read the Using Insulin book himself (that I've been devouring for a couple weeks), so he can give me his take on how the various formulas might be used in my particular case. He's ready to completely adjust his (and our daughter's) meal plans on a whim based on my need. He fetches my glucose meter in the evening while we are watching TV and it's time for my 2-hour-post-meal test. (That's just me being lazy, and him being sweet.) And he constantly reminds me that all I have to do is ask, and he will do just about anything else I need for him to do.

And, of course, "this happened to us" has further meaning. My diagnosis has meant change for my family that isn't always positive. Eating earlier or later because of my needs isn't a real big deal, but I'm sure it is already a pain to alway accommodate me. (Hopefully as I get things figured out, I will be able to add flexibility to the menu!) We also modified our vacation plans to something less demanding since we leave in 2 weeks and I'm still dealing with lows, etc. But no complaints despite all this.

So I guess tonight I'm feeling grateful that I'm not facing this by myself. Between hubby and daughter, I feel surrounded by people who will love me and care for me no matter what. That is indeed a nice thing.

Belly Lancing?

Belly Lancing? No, that's not a typo.

I sat down to go through the whole d-routine before dinner. I mindlessly got out all the various d-paraphernalia, while chatting with the hubby. Next thing I know, I'm squeezing some of the belly fat with one hand, and getting ready to attack it with my meter lancet in the other!

Oops! Wrong sharp object!

Just in time I realized what I was about to do. After a couple laughs, I got back on track. Poked the finger, stabbed the belly with insulin, and all was well.

The post title was just too good to pass up.

Diabetes Shorthand

As I type these posts, I realize I've picked up some of the shorthand I've seen in others' blogs. I'm getting ready to point my parents and some other non-d folks to my blog, and I'm thinking now that they might need some help in interpreting some of this lingo. I'm sure this isn't complete, but it should help.

• A1C - (also HbA1c) Hemoglobin A1C
  
• ADA - American Diabetes Association
• BG - Blood Glucose (also BS for Blood Sugar; also FBG for Fasting Blood Glucose)
  
• CDE - Certified Diabetes Educator
  
• CHO - Carbohydrate
  
• CGMS - Continuous Glucose Monitoring System
• D-books (also D-software, D-blogger, D-supplies, etc.) - D = Diabetes
• DM - Diabetes Mellitus
• DoD - Date of Diagnosis
  
• Dx - Diagnosis
• End0 - Endocrinologist
• GI - Glycemic Index
• Hypo - Hypoglycemic; low blood sugar (also "going low")
• Hyper - Hyperglycemic; high blood sugart
  
• LADA - Latent Autoimmune Diabetes Adult (also Type 1.5)
• MDI - Multiple Daily Injections (of insulin)
  
• PCP - Primary Care Physician (also GP for General Practitioner)
  
• T1 - Type 1
• T2 - Type 2
• TTD - Total Daily Dose (of insulin - basal and bolus combined)
  
• PWD - Person with Diabetes
• U - Units (standard unit of measure for insulin)
• WOE - Way of Eating - euphemism for "diet" (also WOL for Way of Living)
  

One-Armed Diabetic

Anyone who's ever broken a finger, sprained a wrist, hurt a hand....you know what it's like trying to button a shirt or zip up your pants. Hard, ain't it? Ever tried to test your blood sugar with only one hand? How about giving yourself an insulin shot? Now THERE'S a challenge!

I fell down a flight of steps on Monday. For those of you who know me, this is actually just another in a series of life-long klutz moves on my part. My husband now refers to me as CJ....for Calamity Jane. [Actually, not a bad nickname, since Jane apparently liked to dress, drink and cuss like a man.]

Anyway, it was a nice-sized flight of stairs...about 12-15 steps. And I hit them all on the way to the bottom. Nothing broken, though I did have to get xrays to confirm...it hurt that bad! Some very impressive contusions and bruises. I feel like I was in a car accident.

My left shoulder got slammed into the ground and I broke my fall (at the bottom, finally) with my left hand. So that particular appendage has been of little use this week! I have amused myself with my efforts to do all the 'betes stuff with just one hand. Get pills out of a bottle. Screw a needle on the insulin injection pen. Lance my finger and squeeze the blood onto the meter test strip. Even just unzipping my little meter case was practically impossible!

Luckily, my two-armed husband and our two-armed daughter have both been up to the task, so it's mostly just been (slightly) painful, (slightly) embarassing, and (mostly) amusing.

Absent from Life

I am getting ready to send this blog link to a number of friends. It will be the first time I've really had any contact with many of them in a very long time. Everyone has their own life issues, events and activities going on, and I've not really checked in to lend an ear, be a friend. So I'm feeling a little guilty throwing all this at them. But, as good friends do, they will be supportive and forgiving of my absence from our friendships.

I have just been completely consumed with the 'betes for months now. I started a drug trial just days after having gall bladder surgery. Between recovering from that surgery, dealing with the effects of the new drugs, and then being re-diagnosed and then starting on an insulin regimen, my life has just been totally upside down. I've missed weeks and weeks of work since the first of January (and was out for 5 weeks prior to that with the whole gall bladder thing). I have unable to really do much of anything on the home front - as a wife, as a parent, as a homeowner. I've spent scads and scads of money on drugs, books, dr. office visits, software and gadgets (OK, so I love shopping for gadgets...but I still feel guilty). I've been blogging like crazy.

On top of all that, anyone around me has been inundated (whether they like it or not) with my constant updates on my medical status. I'm sick of it!

So, with that finally all written/said/typed, I now declare at least a brief moratorium on all this. I'm going to concentrate on giving back to my family and my friends. Looking forward to reconnecting to you all!

What I Miss

I haven't given most of these items up permanently, but am not enjoying them as frequently, or in the same quantities as previously. So in no particular order...

1. Popcorn. Anyone who knows me knows that I love my 'corn. Absolutely love it. But, too many carbs to eat it the way I used to.
2. Wine. I haven't figured out yet the impact of wine now that I'm using insulin. So for now I generally play it safe and only have one glass. So my strategy is to have one really really yummy glass. I guess I've become a bit of a wine snob over the years. I can't stand the house wine they serve at places like Olive Garden anymore! Guess this is a good excuse to only buy the best!
   
3. Pasta. Oh man. I'm drooling just thinking about it. Two favorites are the tortellini alfredo served at Casa Carbone (Raleigh, NC) and the raviolini served at Pastaria 811 (Pawleys Island, SC).
   
4. Sugar in my tea. I'm doing that fake-sugar thing instead. But I really miss having the real thing. And I would use a LOT! I tried stevia (recommended by my ultra-crunchy sister....but too much aftertaste); and splenda (pretty good). But my BG seems to rise after using Splenda...have since discovered it's probably the bulking agent used in Splenda and other powdered sweeteners. So now I'm using Equal tablets. It's OK....but it ain't no shugah, dahlin'.
5. Skipping meals. Just can't do it. Or at least I can't figure out yet how to do it with my current insulin regimen. I used to skip breakfast. And lunch.
   
6. Gran Marnier. I love Gran Marnier. Love it. Love it. Love it. It has lots of carbs (about 35 for 5 ounces, which is a full meal worth of carbs on my current WOE). It's alcohol, so it lowers the ol' BG. Haven't yet figured out how to work it in with the insulin regiment. I usually like it late at night before bed.
   

MedicAlert Watch

I gave up wearing a watch several years ago. I hated having something on my wrist, and I could find the time on my phone or computer. But with the 'betes, you gotta know what time it is constantly!

So, I recently ordered a MedicAlert Watch, and it arrived a couple days ago. It was pricey ($139 plus S&H), but I really needed a watch/M-A bracelet solution. I had to have the band adjusted, but that was an easy $7 to spend.


Here's what I like:

• Two birds, one stone. I know what time it is, and I don't have to wear a separate MedicAlert bracelet.
• If your medical info changes, you can get a new case back for only $20.
• High quality watch. Citizen seems to be a good brand that gets good reviews.
• Fairly comfortable.
• Water resistant. No scuba diving, but showering and washing dishes OK.
  
• This watch is Solar powered...no battery replacement ever needed. (branded as "Eco-Drive")
• It has a second hand.
• It doesn't have an audible "tick" sound.

Here's what I don't like:

• No luminous hands
• No backlight
• While it is fairly comfortable and fits well, it is difficult to take on and off. The band doesn't stretch very much.
• It was impossible to order on-line. The "purchase" function on the website doesn't work. I ended up just calling MedicAlert on the phone, and it was easy from there.
  

Overall, I like this watch.

A Great (Insulin) Math Book!

This book was recommended on a number of d-websites and d-blogs, so I made the purchase at my local bookstore:

Using Insulin: Everything You Need for Success with Insulin
by Walsh, John
Paperback - $23.95

It is great. It has a tremendous amount of detailed information about how various insulin (and insulin regimens) work. Most importantly, it has the math!

When I was first (incorrectly) diagnosed as Type 2, I skipped (or at best, skimmed) all the "insulin" chapters in all the books I purchased. But even just in skimming and seeing insulin mentioned on the web, it was clear that insulin treatment is a tricky thing. Lots of calculations including your weight, your A1C, your BG reading at the moment, your anticipated carb intake, your target BG level, and so on.

When I was re-diagnosed as Type 1, along with that came basal insulin and the instruction to "start at 10 units, and titrate every couple of days with a goal of getting your FBS between 90-100."

Easy enough. That accomplished, I was still having big spikes with meals, and reported that via email to my d-Doc. Here was his reply:

"You probably should stop the Amaryl, and start meal insulin. You can begin with 4 units each meal and titrate to a 2 hour post meal target of 140 mg/dl. As your bedtime readings should come down, you may need to reduce the Levemir, as it will most likely over correct you and cause you to go low. I can e script the prescription for Novolog pen for meals. Take it 0-15 minutes prior to the meal. Let me know how it goes in a few days."

Easy enough again. But what about all that math??? I go back to all my books. No specifics about how to fine tune a dosage.

Hence, the "Using Insulin" purchase.

It is great. Very detailed information about how all of the various factors fit into calculating a correct dosage of the various types of insulin. It will take several readings to really digest it all, but I'm looking forward to doing math for the first time in my life.

Luckily, my husband is a math wizard. He's offered to learn the formulas and be my human calculator!

D-Geek

Yes, having diabetes totally sucks.

But.....

Oh, the accessories! The gadgets! The books! The blogs! I'm in geek heaven!

I have two meters....and I want a third!

I'm on my second MedicAlert bracelet...and just ordered the watch!

I have experimented with about 5 brands of d-software...and just purchased yet another package!

I already own 12 d-books...and just ordered two more!

I have to admit that I get my geek-fix totally on with diabetes. I've been spending money like crazy since my Dx, and it doesn't look like it will stop anytime soon. I am into the tech stuff, so I've enjoyed researching all the various meters that will upload to a computer, and the software that goes with them. I've been playing with a couple of programs for my PDA (Palm Treo) as well.

Macs and D-Software

I am a multi-platform user on the job, but prefer/use Mac at home. I usually scoff when colleagues or friends say that they "hear that you can't get the same stuff for a Mac that you can for a PC"......because that just mostly isn't true any more. But....that is very true regarding diabetes related software. The LifeScan website addresses that issue as follows:

"Is OneTouch Diabetes Management Software compatible with a Macintosh® Computer?

No. The software is designed to work with an IBM-compatible computer with a Pentium II processor (or greater). There are no plans to launch a Macintosh version of the software."

For some reason, this kinda ticks me off...it's almost obnoxious in its tone. However, you can get the LifeScan UltraSmart to work with a Mac using other software. To be more accurate, I was able to use The Body Journal v1 and it uploaded from my UltraSmart meter just fine...for a while. I upgraded to v1.5 and the driver no longer worked. For the record, multiple email requests to the support address went unanswered.

I have since purchased Health Engage Diabetes v3.9.2, and have spent considerable time trying to get my meter to upload, but with no success. I like the software well enough otherwise to just manually enter my BG readings, but I'd really love to upload. I think it is a driver issue. I hope to get some assistance soon in getting this resolved.

My Current Numbers

I am posting here (and with updates in the future) my current d-numbers, for a variety of reasons.

• I have found the specific "numbers" information posted on others' diabetes-related blogs to be very helpful. Maybe my numbers will be of help to someone else.
• I am using this blog as place to journal for myself. Although I use d-tracking software for the details, this kind of summary will be a good quick reference for myself.
• This blog might be reviewed by others in my life who are keeping track because they care about me. This bit of detail may be of interest to those individuals.
  

So, here is the current information...drumroll, please.....

• Diagnosis
• Initial - Type 2 on February 2, 2006
• Rediagnosis - Type 1 on May 7, 2007
• A1C
  
• Februay 2, 2006 = 9.2
• May 7, 2007 = 7.8
• Oral Medications
• Aspirin 81 MG
• Metformin 2,000 MG
  
• Insulin
• Levemir 12 U daily via flexpen
  
• Novolog 4 U each meal via flexpen
• Blood Glucose Meters
• LifeScan OneTouch UltraSmart
• Precision Xtra (provided through clinical trial)
  

Travel

Today I am at an all-day retreat for work. Clearly my insulin regimen is not adequate (or at least not yet fine tuned), because things are already out of whack.

Due to our early departure time, I had to eat breakfast much earlier than usual, and so there is a domino effect from that. Another complication is that during the retreat, I had to present, which uses lots of energy...plus it threw me off my food schedule yet again. I'm not sure how to deal with that. {"Sorry folks...just talk amongst yourselves for a moment while I shoot up and grab a bite."}

Packing even for just a day trip requires lots of planning. Extra of everything, including plenty of snack food even though our meals are provided.

On the plus side, I'm getting to use my Frio case for the first time. It is much bulkier than I had imagined, but it's not a problem.

How Low Can I Go?

I've been on basal insulin for about 2 weeks, and bolus insulin for about 1 week. As of this evening, I've had about 48 continuous hours of BG that were not "high." {Lots of interesting debates out there about what is considered in range.} I think my high during this time period has been 114.

So there's gotta be a catch, right? Of course! It's those hypos! I've experienced my first official "low" readings, and all the fun symptoms that come with it. And not just once! No, I had three such lows yesterday, and a couple today. I hit 54 a couple of hours ago...didn't feel too awful bad, but it was still a bit troubling since I was in the grocery store with my 10 year old daughter. Really makes me think twice about testing before driving.

I also woke up in the middle of the night with a low...now THAT was freaky. The shakes, sweating, clammy, etc. I was just glad that I woke up.

So, I'm actually thrilled that my numbers overall are down. I just need to get my carbs and insulin adjusted. I'm trying the low-carb approach and am pleased that I obviously need less insulin with fewer carbs.

In the meantime, those glucose tablets are now everywhere!

Liraglutide - Clinical Trial

I recently participated in a Phase III Clinical Trial for Liraglutide, which is a product of Novo Nordisk. This is a "sister" drug to Byetta, the difference being that Liraglutide is long-acting and only requires one daily injection.

My participation began last October, and the trial was scheduled to conclude in August. However, I dropped out a few weeks ago (more on that in a moment). I am assuming that I received the trial drug (and not the placebo) because I experienced the reported side effects of Liraglutide. [But who knows...the mind is a powerful thing!] I then experienced additional side effects which ultimately led me to discontinue my participation. I just couldn't take it anymore!

I should clarify that the trial was for Type 2 patients, and I recently was re-diagnosed as Type 1.5. So no wonder the trial drug wasn't doing anything for me! So please don't take this post as any particular endorsement or criticism of Liraglutide. Hopefully it will indeed be very effective and on the market in the next year or so.

Being part of a clinical trial was very interesting. I got quite the full health screening. They drew nine vials of blood at the beginning and end of my participation, and a few times in between, so I had just about every lab recommended for diabetes patients. I had a monthly A1C, which was nice information as well. At every visit (which varied between bi-weekly and monthly), my blood pressure was taken not once, but three times. And during blood pressure readings, I had to sit with my legs un-crossed and rest. I found this interesting because this kind of care has not always been taken in other settings when I've had my blood pressure taken. They also measured my waist and hips at each visit (and again, not once...but three times).

Big positive- everything was free. All my appointments with the doctors and trial coordinator, all my lab work, all the medication...all of it was free. I also got to keep the meter and supplies that were provided, and a few little gifts as well (a gym bag and a portable clock).

Big bonus - I got paid! I quit the study early, so I only made the $275 of the $300 I was suppose to get, but that's still a nice check!

Liraglutide is an injectible drug. I thought that I might someday need insulin, so this clinical trial was also an opportunity to learn all about injections. Turns out the finger stick is much worse! And, since my re-diagnosis, I've started on insulin...so at least that was one skill I had mastered.

One negative to report. The oral meds which were part of this study (metformin and Avandia) came in cardboard blister packs. I got sores on my fingers from punching out each and every pill!

Overal, this was an enlightening experience.

Why a Blog?

I've spent a lot of time reading other d-related blogs, and have found it very helpful...both from a logistics point of view, and emotionally as well. One blogger posts at length about the toll the disease takes on her as the spouse of someone with diabetes. It has made me think about my own husband, and how great he has responded to all of this.

Being only 43, I have decades of diabetes treatment and complications in my future. That means decades of obsessing and whining! And I don't want to wear out my marriage. My parents, in-laws, friends and colleagues at work also hear all the gory details all of the time. I mean...ALL ....OF....THE...TIME. So far everyone has been very supportive, seeming very interested in hearing the latest. But I know over time that it gets old hearing all about it over and over.

Blogging gives me one more outlet to share what's going on. By "spreading the joy" to others through my blog, I can dial down my need to vent with everyone else in person.

I have no idea if anyone will actually read any of this or not. I'm not even sure who in my circle of family and friends that I will point to this blog. But the effort of recording my thoughts is already helpful.

It's Official

Today I received my diagnosis of having Type 1 diabetes. I was diagnosed about a year ago as having Type 2, but a number of things led my current endo to test for antibodies. Bingo. Finally, lots of questions answered as to why I was not responding to oral medications. My internet research suggests that I should really be calling this Type 1.5 or LADA.

So pick a name....in the end, what really matters is that I'm hoping to finally get better control of my BG levels. I've been on long-acting insulin for about a week, and will start short-term insulin today or tomorrow. We'll see how it goes.

So, yippee!