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.