Comments (5)

By shannon, March 10, 2010 9:41 am

As I expected, my A1c went up.  I just didn’t expect it to go up *that* much.  For almost two years, my A1c has been below 7%.  It’s a lot of work, but totally worth it.

I admit that I rebelled a bit.  I also got lazy.  I was just so tired of the tight control and limitations.  I went a little nuts.  I have the weight gain and lousy A1c to show for it. 

All other tests were good.  BP was “excellent” according to Dr. S.  He also said that I’d *lost* two pounds since my last appointment.  This just doesn’t seem right, but I wasn’t about to argue.  He gave me a list of group meetings and events (read: support groups) for Type 1s and encourage me to attend.  I don’t know if I will – I admit that it would be nice to meet some other Type 1s in person, though. 

As I mentioned yesterday, I wanted to talk to Dr. S. about Symlin.  After looking at my A1c, Dex graphs, and logbook, his initial feeling was to further increase my basals.  Since I had decided that I was not going to let that happen, I needed to find an alternative.  See, *I* think my basals are too high as it is.  The highs I’m experiencing aren’t the result of too-low basal settings; it’s because I’ve been eating like shit for months and, more often than not, SWAG bolusing.  So, I’m high because I didn’t count carbs correctly.  Sure, I correct, but once I’m high, it’s so hard to get back down. 

Which, once again, led me to the Symlin talk.  I’d tried it once before and gave up after a few days.  I was told that it is not indicated for pregnant women, and since we were actively trying at that point (and blissfully unaware of our fertility issues), I decided that it was best to stop.  To be honest, I was not heartbroken to lose the awful nausea that accompanied it.  But, the thing is, I never really gave it a chance. 

In preparation for my appointment, I did a bunch of research.  I learned that the nausea goes away pretty quickly and that the key is to stick with it.  I learned that some people have lost huge amounts of weight thanks to it.  I learned that most decrease their boluses by at least half.  All of these facts solidified my resolve to give it another shot.

So, just before dinner last night, I dialed up the minimum 15mcg and gave myself the shot.  I ate my meal slowly (I did notice that I got fuller faster) and waited.  I carefully calculated the carbs in what I ate (49 grams total), and programmed a 60-minute extended bolus.  And I waited. 

Sure, I felt a little nauseated, but nothing too extreme (I definitely didn’t feel like I was going to puke or anything).  I wasn’t hungry either, which was nice.  I often feel hungry even after eating a decent meal.  Dex showed almost no movement in my BG for over an hour.  Since I was super exhausted yesterday, I went to bed early. 

At 11:53pm, Dex beeped.  The dreaded low alarm.  I looked at the screen: 68 mg/dl.  Not too bad, but I did a finger stick to confirm:  66 mg/dl.  Since Dex indicated a downward trend, I decided to drink a juice box.  Then, I did something really stupid.  I programmed a temp basal of 50%.  I was spooked; I admit it.  I didn’t want to have a horrible low that would be difficult to treat because of the Symlin (I’d read that this happens).  I wanted to play it safe. 

Just as any sane person would expect, a few hours later, my BG started to climb.  Nothing drastic – I was sitting at 150ish.  Then my usual Dawn Phenomenon kicked in (I have a basal rate that is more than two times greater during the hours of 5am-8am).  A temp basal of 50% was not going to make a dent in that train wreck.  After my shower, I was sitting at 180 mg/dl and climbing. 

Since the pod was due for a change, I swapped it out and canceled that stupid temp basal.  Now, as I write this at 9:16am, I am at 189 mg/dl.  This is despite two decent correction boluses.  I know the crash is coming, and I’m ready for it.  I’m just pissed off at myself for giving in to the fear.  It’s the fear of lows that gives me a 7.5% A1c.  It’s unacceptable.

Ugh, diabetes, I hate you.

**UPDATE**

As I wrote this post, I got a call from the fertility doc’s office.  They wanted to tell me that they’d received a copy of my A1c (which the nurse described as “elevated”), and that for conception, they want it to be under 6%.  As if I didn’t already feel shitty enough.

Comments (4)

By shannon, March 9, 2010 10:28 am

There are a few things I want to write about today, but they’re not really interconnected.  So, I’m going to just jump from topic to topic.  Try to keep up

Today, I see Dr. S.  I’m not looking forward to getting my A1c because I know it’s going to be higher than last time.  I just hope it’s under 7% so that the baby progress can continue.  I’m strongly considering going back on Symlin.  I took it once before and had awful nausea, but I didn’t really give it a chance.  I stopped after a few days – mostly because we decided to start “actively trying to conceive,” which meant no Symlin.  Frankly, I wasn’t sorry to see it go. 

But now, I’m really trying to lose weight.  It’s my primary goal and I feel like I’m fighting a losing battle.  I’ve got HUGE genetic factors working against me.  On my father’s side, which is the side I take after, there is not a single person under 200lbs.  I’ve always had to fight my body’s natural inclination to be heavy, but now I need a little extra help. 

The other benefit of Symlin is that it will help to reduce those spikes I get after meals AND reduce my TDD.  So, if I can handle a couple of weeks of nausea, I think it would probably help me.  I’m not looking forward to a form of MDI again, but I’ll deal.

************************************************************************************

Next, I want to talk about Roddy Pippin.  We had some good news in our fight last week.  The Warden of the Jester III prison granted Roddy a few considerations:

1. He would be allowed to attend Sunday worship services – something he’s been denied since December.
2. He would have access to a telephone.
3. He would be allowed to change channels on the television in the infirmary (this one isn’t all that big of a deal since Roddy isn’t a TV watcher).

Unfortunately, these considerations were short-lived.  The prison P.A. said No more – “No more worship service for Pippin!  And no recreation, no law library, etc.”  The P.A. also said “Pippin is NOT allowed to leave the prison solitary confinement for the next 3 years and 8 months!”  This is not a disciplinary case issue.  So, we know that the prison P.A. is in cahoots with the D.A., but the question I have is this:  Does the P.A. have more power than the Warden?  Evidently, she does. 

There was a recent AP article done on Roddy.  While I initially liked the tone of the article, I don’t like what various publications did with it.  One, in particular, was the Dallas Morning News.  They created a headline that was not at all relevant to the article.  They did this to incite anger in their readers, and they succeeded.  I spent some time trying to respond to the nasty comments that followed the article, but most people were content believing a bunch of lies and exaggerations.  I’ve learned that it’s a losing battle with the press.  Unless/until the story breaks out of Texas journalism, it will never be told truthfully.

************************************************************************************

Last, I want to talk about the unbelievable liar my body is making me out to be.  I sat in Dr. T.’s office last week (ironically the day my period was due) and told her how “regular” I am.  Hell, I am more reliable than a calendar.  Until this month.  I am now officially one week late.  I’m not-so-patiently waiting to have all of these tests done, which are dependent on my period.  But my period is MIA.  It’s so frustrating.

Comments (9)

By shannon, March 4, 2010 11:50 am

The scene:  A lab

The players:  Me, Phlebotomist (herein referred to as “Moron”), and a Supervisor

The Time:  9:14am

As part of my recent fertility consultation, I was instructed to have a blood test to determine if I carried the gene for Cystic Fibrosis.  Since I am due for my regular A1c draw, I figured I’d kill two birds with one stone (I hate that expression – who actually kills a bird with a stone?).

I walked into the lab, signed in, and sat down.  I always dread having blood drawn because I know that the inevitable battle will begin. 

<digression> Since my very first blood draw (that I can remember), I’d pass out.  Faint.  Hit-the-deck.  A few years ago, I had a very nice phlebotomist tell me that I have extremely small veins and that when having my blood drawn, I should always request a butterfly.  From that moment on, I never passed out again (as long as a butterfly is used).  I know some of you will think that this is a psychological problem, but I can prove that it’s not. 

Once, I requested a butterfly, and the phlebotomist agreed to use it.  Since I never watch the actual blood draw, I assumed that the prick I felt was the agreed-upon butterfly.  After a few seconds, I started to get that feeling.  The one where you see little black dots, begin sweating, and feeling very, very tired.  The next thing I knew, I was waking up on the floor.  She helped me back into the chair.  I apologized for fainting and said how strange it was because I NEVER faint when a butterfly is used.  She shrugged and turned away.

That’s when I saw it.  She didn’t use a butterfly.  When I asked her about it, she claimed to have “forgotten” that I requested one.  Bitch. </digression>

Anyway, back to today.

After 15 minutes, my name was finally called.  I handed moron the lab slips and my insurance card.  She instructed me to have a seat in Room 2 across the hall.  I did.  She came into the room and began entering all of the required information into her computer.  I waited.  Finally, she spoke:

Moron:  Oh, I see it was your birthday.  Happy belated birthday.

Me:  Thanks! (thinking this draw is going to be cake!  She’s actually nice)

Me:  As you can see, I’ve got two different lab slips from two different doctors.  Is it possible to send the results of my A1c to both doctors?

Moron:  (grabbing a clipboard with a release form) Sure.  You just have to sign this release, and we can send it to anyone.

Me:  Great, thanks.  I also have one more request.  When you draw my blood, can you please use a butterfly?  Otherwise, I’ll pass out.

Moron:  (looking at me like *I’m* a moron) I’ll need to look at your arm first because we don’t use butterflies on everyone.  What’s the big deal, anyway?  A needle is a needle.

Me:  Look, I’m not afraid of needles.  I’m a type 1 diabetic, so I’m pretty used to needles.  My issue is that my veins are really small, and with the bigger needle, the blood comes out too fast and causes my blood pressure to drop until I pass out.  Every time I’ve had my blood drawn here, they’ve used a butterfly.

Moron:  Well, I’ll have to look at your arms first. (indicating that she wasn’t going to use a butterfly unless hell froze over first)

Me: (really pissed off) Fine, but don’t be surprised when I pass out.

Moron spent the next 35 minutes trying to get the paperwork straightened out.  I repeated my original instructions that Dr. T. also gets a copy of my A1c.  Moron set up the paperwork to give Dr. S. the results of the CF screen.  Hence, the moniker, moron.

Finally, she wraps the rubber band around my arm and tells me to make a fist.  She pokes my veins to find her target.  Knowing what’s coming, I look away.  I felt the needle prick, and, at first, I felt ok.  I thought that maybe she’d listened to me and used a butterfly.  But, I started to feel that all-too-familiar sensation.  The last thing I heard was her clicking off the first vial and grabbing another. 

I came to on the floor.  Moron had called for backup.  They helped me back into the chair, gave me some juice, and waited.  After 10 minutes, Moron came back into the room with Supervisor. 

Supervisor: (taking one look at my arm) Her veins are tiny.  You should have used a butterfly on her.

Me:  I asked for a butterfly, but she refused.

Supervisor:  I’ll take it from here.  Unfortunately, she wasn’t able to get both vials before you passed out, so I’m going to have to prick you again.

Me:  You can prick me all day as long as you use a butterfly.  I wasn’t being a baby – this is just how it is. 

Supervisor: (after the blood draw was done) You’re all set.  You can wait here for a few minutes if you need to. 

Me:  (having already spent over an hour in the lab) I’m fine.  I really need to get to work.  I would appreciate it if you’d have a talk with moron about listening to patients.  This entire scenario could have been avoided if she’d just listened to me.

Supervisor:  I intend to.  We don’t like it when you faint any more than you do.

Me:  Thanks.

Comments (8)

By shannon, February 23, 2010 8:14 am

So, in a couple of weeks, I have my quarterly appointment with Dr. S.  For the first time in a while, I’m dreading this appointment.  I should be focusing on things like getting my blood drawn, having an excuse to get a pedicure, and figuring out what to wear.  Instead, I’m bombarded by images of what our appointment is going to look like.

I figure it will start with the not-so-good news that my A1c has gone up since last time.  I know this is going to happen.  Then, we’ll take a look at my Dexcom reports, which will clearly show how horribly I’m slacking.  Dr. S. will ask me what’s going on.  He won’t be critical, he’ll just want to know if there’s some reason for my shitty numbers and weight gain.  He’ll talk about basals and boluses, but that’s not the problem.  The problem is that I’ve been in such a funk that I really haven’t cared as much about diabetes.  My numbers aren’t crazy; they’re just not as good as they have been.

This is when I’ll probably lose it.  I’ll have to tell him that I really don’t feel the need or desire to work so hard since there’s zero chance of me getting pregnant accidentally.  I’ll say sure, put me on whatever meds you want (Symlin, Lisinopril, etc.) because it really doesn’t matter which pregnancy category they are.  And, I’ll cry.  I know I will.  I’ll probably make him very uncomfortable – he’s an endocrinologist not a psychiatrist, after all.  He’s also got two beautiful children.  So, I’ll sit there blubbering about the unfair hand Brian and I have been dealt. 

He’ll probably attempt to get the appointment back on track by moving on to the physical exam.  I’ll sit there like a good patient, breathing in and out on cue.  He’ll declare me “healthy,” and that will be that.  We’ll go back to his office where he’ll write prescriptions, talk about what I can do to improve, and schedule our next appointment. 

So, life goes on.  On the outside, nothing has changed.  I continue to breathe in and out on cue.

Comments (3)

By shannon, February 12, 2010 12:11 pm

When I first went on a carb counting regimen,  after six months of pills that did nothing except make me sick, and another six months of NPH and R, which dropped me like a stone at random, unpredictable times, I used Humalog. 

I liked Humalog.  I was able to keep my TDD low, and I seemed to respond well to its peaks and duration.  At some point, I don’t even know when, I was switched over to Novolog.  It might have been for insurance purposes or maybe it was when I moved to insulin pump therapy.  I honestly can’t remember.

I have a point (I’m just getting there slowly, like everything else I’m doing today).  Since using Novolog, my TDD has slowly been creeping up.  Is it insulin resistance because I’m a lazy putz who doesn’t want to exercise?  Possibly.  But, it could also be that Novolog’s peak time and duration have so totally screwed up my dosing that I’m taking more and more correction boluses for foods that shouldn’t require a correction.  I’ve had to tweak my basals more, too.

So, not liking the fact that I’m taking so much more insulin than I used to, I did some research.  I know, I know, you’re all shocked and amazed.  What I learned is that Novolog has a reputation for being the slowest acting of the three rapid insulins (Novolog, Humalog, and Apidra).  What most people say is that Apidra is the fastest.  Some people have even cut down their TDD with Apidra. 

While I’m not expecting miracles, I do think it’s time to make a change.  So, first thing this morning, I dialed up Dr. S’s office to see about making the switch.  I know he must think I’m a complete pain in the ass at this point (first the switch from MM CGM to Dexcom, then from MM 722 to Omnipod, and now from Novolog to Apidra), but my goal is to achieve better numbers, so that should be commended, right.  I’m still a pain in the ass, though.  I know it, and I’m ok with it.

So, I’ve tried Humalog (and liked it), I’m using Novolog (not happily), and I now I’m switching to Apidra. 

I’m also starting an exercise schedule and eating more healthier (yes, I know that’s not grammatically correct, but I like it, so deal).

Comments (6)

By shannon, October 31, 2009 7:49 pm

Last Tuesday, I made the oh-so-fun trip to downtown Baltimore for my appointment with Dr. S.  This was the first time I’d seen him in his native environment; I’d always had my appointments at a satellite office.

When I finally found his office (in a large Baltimore hospital), I signed in and waited.  And waited.  It seemed like I was waiting forever, but it was probably just twenty minutes or so.  I am very impatient.  At last, his office door opened, he peeked his head out, found me, and gestured me inside.

At this point, “normal Shannon” disappears.  The thing is, Dr. S. intimidates me.  Not in a “you’re scary/mean/ultra smart” kind of way.  No, my problem is that he’s just so cute.  CUTE!  So, like any immature girl, I get all tongue-tied around him and say really stupid things.  Or nothing at all.  I forget simple words like “ointment;” thank God for the “low blood sugar” excuse – I pull that one out of the deck frequently.  Then, there’s the blushing.  I’m Irish, and I have very fair, freckled skin.  I blush often, but not in a pretty way.  I turn tomato red.

So, here’s what happened on Tuesday.  Dr. S. went over my labs (good!) and took me back into an exam room for the usual once over.  He did the thyroid feel, heartbeat check, lung-deep-breathing thing (why do they make you hyperventilate?).  With each touch, I’m turning redder.  He even wonders if I’m having some sort of allergic reaction (hives).  Ummm, no, I’m just a silly girl.  But, then comes the foot exam.

I like shoes.  I like pretty shoes, with high heels, and don’t even get me started on boots.  I spend a lot of money on shoes (my recent acquisition of the most amazing pair of Manolo boots is epic!).  I forgot the point of this because I’m thinking about shoes.  Damn!

Anyway, I’m lying back on the exam table when Dr. S. lifts up my foot (clad in the aforementioned Manolo boots).  He attempts to pull my boot off himself (OMG!).  I tell him that they zip up so I’ll have to do it.  He made some innocuous comment about my propensity for “nice shoes,” and the blushing starts anew.  So, I finally get the boot off, as well as my trouser sock (sort of fish-netty), and we both look at my other foot.

“Do you need me to take both off?”  I ask.

“Um, yeah.  Don’t I always?”  He responds.

“You’re so high maintenance!”  I respond.  I have no idea where that came from, but (thankfully) he laughed.

So, with my boots off, he checks the pulse on my feet (very good), and does the sensation test (also very good).  He declares my feet to be in excellent condition, but comments on the indentation that the seam of my trouser sock is causing in my toes (obviously caused by my pointy-toed boots).  He’s a little concerned, and tells me that it could be a problem.

“If you tell me that I have to wear ugly shoes, *we’re* gonna have a problem.”

Laughing, he tells me that if I had any sort of neuropathy, he’d have to pull the plug on my shoe obsession.  However, since my feet are fine, I’m spared a sentence of “ugly shoes.”

As if I needed more incentive to stay healthy.  Dr. S. is one smart endo.  Did I mention how cute he is?!?

Comments (0)

By shannon, October 27, 2009 11:30 am

Yep, it’s that time again.  I’m off to see Dr. S. for my three-month appointment.  This one could be a little awkward because of the recent issues (i.e., DexCom), but I’m hoping we can move past it pretty quickly.  I always liked Dr. S., and I appreciate his medical style.

Since I had my A1c done last month (along with the antibody tests), I’m not sure what we’ll talk about today.  I’m sure he’ll order more bloodwork and probably review my DexCom reports.

Tomorrow will probably be an interesting post . . .

Comments (0)

By shannon, September 24, 2009 10:41 am

For almost 10 years, I’ve been told different things about my diabetes. I was diagnosed as a type 2, despite my young age, “normal” BMI, very high A1c, and no family history of type 2.

I was put on oral meds (metformin), which did nothing except make me incredibly sick. I vomited almost everyday while taking it, and my blood sugar remained high. This pattern continued for six months, with a few ER trips for DKA-type episodes in between. I changed doctors twice, but neither thought to test me for type 1. In fact, one even said that such testing would be stupid because if I was a type 1 and not taking insulin, I would be dead within a few days.

Like a good little patient, I believed them. I went to the required CDE classes, learning all about how my poor eating habits and lack of exercise caused my diabetes. I was the youngest and smallest person in the group.

After one year of taking metformin and losing 40 pounds (yes, 40!), I made an appointment with a new endo practice. I was immediately placed on insulin, which was an entirely new experience for a reformed needle-phobe. My doctor told me that I probably had type 1.5, but she did no testing to confirm. Since my treatment would be insulin, it didn’t really matter what type I had (or so I thought).

After many years of MDIs, I decided to make the transition to insulin pump therapy. My endo at that time was a proponent of Minimed, so I went with their Paradigm 722pump. Eventually, I decided to ditch my doctor (she treated me like a child – threatening to withhold pump supply prescriptions if I changed any pump settings myself), and I found a new endo.

I began seeing Dr. S. about a year and a half ago. Our relationship started off well. He was more interested in my opinions and feedback than any doctor I’d ever met. He encouraged me to adjust my basals and worked with me to get a Minimed CGM.

When the subject of my “type” came up, I told him that I had never received a definitive answer. He ordered a c-peptide test, which came back low. Despite this, he decided to classify me as a type 2. I know why he did this. In the years since I began taking insulin, my weight has crept up to its now “obese” BMI. There are some underlying reasons for the most recent weight gain, but they’re not really relevant to this issue.

Flash forward to last month. After using the Minimed CGM for 18 months, I decided that I’d had enough of painful insertions, bleeding, and sensor errors. I called DexCom, requested and completed the materials to get approval, and waited for my new system. I couldn’t have imagined what happened next.

When Dr. S. sent the Letter of Medical Necessity, he classified me as a type 2 diabetic. He did this in spite of the evidence to suggest otherwise (lack of insulin resistance, low c-peptide, etc.). He also told the DexCom folks that I expressed concern over the cost of supplies as a type 2. While we did have a hypothetical discussion about the need to know what type I am so that insurance would cover my supplies, it wasn’t with the understanding that I was a type 2. His statement insinuated that I was trying to pass myself off as a type 1 so that I could get “stuff.”

Naturally, as a type 2, insurance is reluctant to pay for high-ticket items like pumps and CGMs for me. I immediately sent an email to Dr. S. to find out why he’d told DexCom such a thing. His response was that he “really doesn’t think I’m a type 2.” He ordered antibody testing to be sure, but he felt confident that his diagnosis (type 2) was correct.

I received the following email from Dr. S. last week:

” . . . labs showed a positive GAD antibody. In addition, with a fasting glucose of 146, the c-peptide was low . . . This is consistent with Latent Autoimmune Diabetes of the Adult, a form of Type 1 DM. I was not sure before, but it is clear now that you are a Type 1 diabetic.”

To say I feel vindicated is such an understatement. I feel like I had to fight for this diagnosis for one reason: my weight. Doctors really need to step out of the box when diagnosing patients.

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By shannon, June 13, 2009 12:06 pm

As an update to my last post, I had new bloodwork done last week. The next morning (at a really early hour), Dr. S. called.

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By shannon, April 25, 2009 10:11 am

Every three months I see my endocrinologist.  Usually it’s just a recap of what’s been going on, a review of my labs, discussion of medication needs, and quick exam (feet, glands, etc.).  Sometimes it feels more like a trip to the principal’s office – I know I’ve done something wrong, but I don’t know what the punishment will be.