Starving for Enlightenment

These basal tests are really starting to get to me. On first glance, it feels like a carefully planned eating disorder. You skip meals, poke yourself repeatedly for blood, and then binge because you’d skipped a meal, thus throwing the rest of your day off because you are correcting your indulgence. Because diabetes management relies on discovering patterns and adjusting accordingly, each test requires at least 3 attempts per time of day. (Unless the basal rates are perfect the first go-around.)

There are four tests you can and should take: overnight, breakfast, lunch, and dinner. If the test fails by having the blood sugar go too high (over 250) or too low (under 70), you repeat the test the next day or whenever convenient to see if a pattern arises. Adjustments will be made and tests are to be repeated to try the new basal rate or to get more conclusive results.

Yesterday was my second dinner time test since before Christmas. On my first attempts, I decided to try gluten free meals for both tests I took. Bad idea. Apparently gluten free meals don’t hold the same carb breakdown as non-GF meals, so my insulin dosage at lunch sent my sugars plummeting around 3:00 pm. I was advised to eat “real” food at lunch and try the test again. (Or just food I would typically eat, rather than stuff I was experimenting with.)

On these last two tests, I tried two variations: first day was quinoa and some Indian spinach curry and cheese, second day was a plain ol’ PB sandwich on wheat. I survived my 2:00 pm and 4:00 pm checks, which means my lunch dosage is as it should be. On both days, however, precisely at 6:15 pm, my blood sugar dropped to 63 and 65 mg/dl, respectively.

A pattern! (And the test is over… I can have dinner after all.)

Not only did this tell me something was wrong with the basal rate at this time, but it also explained all of the strange issues I was having in November and December. During those months, I’d get off work at 5:00ish, go grab a Subway sandwich, and eat dinner before my 6:30 pm dance lesson. Shortly after eating my sandwich or during the lesson itself, I would plummet down to hypoglycemiaville. (Which made spinning and learning choreography that much more complicated.)

My CDE and I were trying to adjust my dinner bolus rates to account for my activity levels in the evening. Hmm. Maybe we fixed the wrong thing.

Now that we have a pattern, we’ll probably adjust. Which will then lead to another round of testing to see if the adjustments succeed.

Sigh.

These tests aren’t for people with active calendars. During these tests, you are supposed to keep activity, stress, high fat foods, (life), to a minimum because, as all PWDs know, anything can have an effect on blood glucose control. Never mind that you aren’t eating anything for about 8 hours straight. (Or trying to.) Since I have a lot of evening plans, explaining that I need to skip dinner three nights in a row is impossible (which is why I didn’t test during the holidays). Not doing any exercise for three nights in a row is also impossible. If you are female, you can pretty much forget testing one week out of the month.

I am still struggling with my morning rates, so there are a couple of skipped breakfasts in my future. Possibly even an overnight test because I’m not quite sure if that’s effecting my mornings. (Which equates to getting up at midnight, 2 am, and 4 am.) All in the name of science, I suppose.

As much as I hate starving myself repeatedly and the wrenches that get thrown into plans when I can’t pass, the results are quite enlightening. I just wish there was an easier way to see if you were administering the correct doses.

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Back to your Regularly Scheduled Program

I’m slowly getting my sleep patterns back on track after this weekend. It was a fun weekend, and I’m glad I experienced this convention. But holy hell… I’m pretty sure I got a collective 10 hours of sleep during the entire weekend. And upon my return on Sunday, I promptly fell asleep on the couch at 8:15 pm, only to be prodded by the hubs to head to bed around 9. Wow. All in good fun and thankfully, my blood sugars behaved for the most part.

I also don’t recommend competing with hypoglycemia. Especially if you are unaware. Just saying. Yeah, it happened.

So after all my sleep deprivation, the only natural thing I should do come Monday morning is run a basal test, right? Sure!!! Who needs coffee or food when the high from the weekend can keep you awake and sustained?

Right…

Good news: I passed the afternoon basal test, which disproves my doc’s hypothesis that my extremely high bolus rates are compensating for my extremely low basal rates. In fact, I managed to stay between 77 mg/dl and 88 mg/dl for about 6 hours. This still leaves the question as to why my blood sugars sky rocket to oblivion an hour after I eat and just stay there. Do I really need a 1:3 carb ratio? Seriously?

Bad news: This test is shit! Seriously. Could NOT do anything productive because I ate at 7 am and could not stuff my face until 5 pm. (And I did… still paying for it now…) I was starving. I was waiting for the inevitable crash that never happened and seriously wanted to just fail the test so I could eat my left overs. I had 3 major headaches throughout the day and pretty much stared at my computer screen for 2 hours pretending to be productive. By 4:30, I wanted to eat my laptop with a side of the contract for our company Christmas party. (You know, because paper has fiber and stuff.)

I’m assuming that since I passed with flying colors that I only need to do this time period test once. (Because why would anyone want to do this three times, as instructed???)

Lesson learned kids: starving is bad.

Judgement Day

If you’ve never seen this in person (the painting… not judgement day), it’s pretty out of this world.

I know, I know… the end of the world isn’t supposed to happen until NEXT month. But this morning was kind of my own mini-judgement day.

My lab results came in. (For the most part; I’m still waiting on the orange vat of despair.)

Good news: My A1C is down to 6.3%. Probably the lowest I’ve seen it since I was in elementary school. But yeah… most of those are hypos. So I still have some work to do. Yay basal testing next week! Ugh!

Bad news: My cholesterol sucks. My overall is about 169, which is still “normal” but elevated from my last test. And my LDL is 108, which is also semi normal, but really, should be under 100. So, maybe that statin was doing something. Or I’ve chosen really bad snacks to consume. (Many almonds… cheese… full fat yogurt… my boxed Indian food… yeah…)

My endo recommended that I maybe start my statin again. However, the whole trying to conceive thing may hinder that. But, I should at least go back on it for good when I turn 35.

In the meantime, it’s time to start looking at diet changes… again.

A New Appreciation for Breakfast Sandwiches

Today was lab work day… so in a few days, I should be able to see if all of this extra insulin and random hypoglycemia is actually making my A1Cs better. (It certainly isn’t making my waistline any better because I feel like I’m eating every 20 minutes.) Anyway, this morning, my awkward orange vat and I travelled back to my clinic to be tested. And since I was killing two orders with one stone, I was also cautiously teetering near hypo-ville while fasting.

I always get nervous when I go to a new hospital for lab work. I have a very specific arm and very specific vein that bleeds out… well, specifically. My right arm never wants to work and don’t even come near the veins in my hand without a fight. I went to the same clinic for years before I switched insurance plans because they just knew how to make everything as painless as possible.

So, of course, my tech is chatty. Like to the point of tedium. Or… “I’m just going to talk too much with the hope that you’ll forget I’m jabbing your arm with a needle.” And she also missed the vein the first time and started digging. DIGGING! Then said “oh you need to relax because the vein is hiding from me.” WTF? Of COURSE it’s hiding from you.

More chatting. <band head here>

Then she is waiting for the last vial to fill and starts PUSHING the needle in FURTHER.

What I should have said:

Instead I say: “Oh… no, you aren’t hurting me. Oh, I need to do a micro-albumin test after this? Because the awkward orange vat isn’t enough for y’all. Okay.”

Finally free of my new not-so-favorite new place, I treat myself to a much needed Skinny Vanilla Latte and a Turkey Bacon and Egg breakfast sandwich. I don’t think I’ve ever had something so delicious.

November is Diabetes Awareness Month

Duh – of course my situation needs it’s own month. So, if you are following the blog and see me regularly, be sure to give me an extra hug or something this month. 😛

Anyway, I survived Halloween with very little excitement other than the complete error in carb counting judgement of my lunch. (Bounced up to over 300… ouch.) Apparently that uber delish eggplant, spinach and sundried tomato sandwich had a lot more in it than slices of heaven. (Yes, kids, it was THAT good. Or maybe I was just reallllly hungry.)

My day started, however, with a trip to my new endocrinologist. At 8:00 am. About 35 minutes from my house. After I had been out dancing the night before. Yeah – I dragged.

The doc is new to the facility and kind of has a “take-no-bullshit” attitude. Which is maybe what I need. My last endo was nice enough, and the educators were nice, but I always kind of felt that they just settled for my 7.0 A1C and said “well that’s what you are… the end.”

He immediately commented on the fact that I don’t wear a med ID (I have a pump on!), don’t have a Glucagon kit at home (horror stories from my childhood plague me still from that stuff), and why I refuse to have a flu shot (not that I’m anti vaccines… just I feel this one just doesn’t work.) And then told me to stop taking the Statin I’ve been on for the last 8 years or so because it’s pointless to take drugs “for prevention” at my age and there are no indicators that I am at risk for high cholesterol (THANK YOU!)

I also got hypo while at the doctor’s office. And got to awkwardly search for glucose tablets at the bottom of my purse. Doc finally gave up and got me juice from his office. (By the way – warm OJ is gross.)

But no babies until the blood sugars are down. (sigh.) And I’ve developed a tiny bit of Neuropathy in the tips of my toes. Kind of normal… but sad because this is the first it’s been noticed. But really, I’ve been a diabetic for 30+ years now. It was bound to happen at some point.

So he gave me the number to the diabetic educators’ office, sent a referral, and scheduled a follow up in 3 months. And since NO ONE can figure out my 445 pages of medical records from my previous med facility, I’m quite literally starting clean and establishing brand new base lines.

In my near future shall be lots of record keeping, adjustments, blood work, and basal testing (bleh!).

I’m gonna be stressed. Remember that hug thing earlier? Yeah.

An Anamoly

Well kids, I’ve stumped another diabetes professional. That increases my count to about 5 people that really have no idea what to suggest to help me counteract the extreme postprandial readings I experience, mostly after breakfast and lunch.

Backstory: I’m not a textbook diabetic. I’m sure many people can argue this, but really. I’m so not! It’s not that I’m insulin resistant – it’s just that the meds that are supposed to peak at 15-30 minutes usually peak at an hour instead. Thus resulting in an epic spike an hour to two hours post meal, and then an epic drop to normalcy around the three hour mark. This of course hurts my chances of ever maintaining a controlled rise. My doctors have tried cocktails of insulins to try and counter the spikes, which typically only left me crawling on the floor asking for juice to pick me up from hypoglycemia. But – perinatal docs all want me to have my postprandials at 120-140 during pregnancy… which is my struggle.

So today I saw a dietitian that specializes in mostly GD, but also works with T1s and T2s during pregnancy. I figured she’d have a better idea or different suggestions on how to get her patients to stop spiking.

Our conversation went like this:

Me: So I have been micromanaging my eating habits and blood sugars lately and I’m not seeing a difference. I’ve got dinner down, but breakfast is hell. I’ve tried just about everything humanly possible with the exception of starving myself.”

D: Well, maybe you shouldn’t have any milk or dairy at breakfast.

Me: I don’t.

D: Well, have you tried complex carbs and under 30 grams.

Me: I have. Sometimes I just have 15 grams.

D: Are you consuming about 8-10 grams of protein as well?

Me: Sometimes more. I was given a rule of thumb to try a 1:2 ratio between protein:carbs.

D: And you still spike?

Me: Every time.

D: …

Me: …

D: I have no idea. Maybe you should talk to your endocrinologist.

Me: <ragequit>

I’ll give it to her though. At least she’s being honest and was extremely happy that I’m trying to figure out what the hell is going on BEFORE we start trying to throw pregnancy into the loop. But as a dietitian  she couldn’t really advise me to increase my already, crazy high, insulin ratios. (1:4 most times of the day.) And bonus – apparently this clinic appointment was 100% covered by my insurance so I didn’t need a co-pay to get more non-answers.

However, I apparently gave my perinatal the impression that I had no idea what I was doing, carb wise. Though I’m pretty sure I told her that I’ve tried everything and that my docs at the previous hospital pretty much threw up their hands and said “no idea!”

Next week, I meet with the endocrinologist  who can probably hook me up with a dietitian that, you know, works with diabetics. (Concept!? Amazing!)