June 11, 2006

My Diabetes: Day 245

Steph and I are at the ADA meeting in DC, where I had the opportunity to get my A1c done as a freebie from one of the vendors at the exhibit hall. As some of you might recall, I was diagnosed with diabetes last year, at which time my A1c was 11.1 (normal range up to 7). I've had subsequent A1c's with progressive improvement, but getting a 5-minute result (with Metrika's A1CNow+ device) for free just couldn't be passed up.

And the result was awesome: 5.9 -- which left me floating on cloud nine for a while... all those shots (2 shots of Lantus daily, 3-5 shots of Novolog/day, and zillions of fingersticks for blood sugars) have indeed done something.

Just like I've always told my patients.


Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at http://www.diabetesmonitor.com/




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May 09, 2006

My Diabetes: Day 200andsomething

Well, it's day 200+ and I haven't written anything recently about my diabetes. After mulling over for quite a while what to discuss, my insurance company gave me a good excuse to post a new blog entry.

Today, I got in the mail a semipersonalized letter from the Senior Medical Director of my insurance company's "Healthy Outlook Program", inviting me to participate in their "Caring for Diabetes" program. Since they are available 24/7, I decided to give them a jingle. Especially as I wasn't sure how they had found out I have diabetes!

Well, the very patient people on the phone call explained that the insurance company apparently extracts diagnoses from claims forms from doctors' visits, lab forms, and meds. Not hard therefore to figure out that since I'm taking insulin, getting A1c's, and checking my BG, that I might be a candidate for their program. Interestingly, however, the people on the phone at the Healthy Outlook Program had no idea whether I am checking sugars (they asked if I wanted a free meter -- but no free strips), nor whether I'm on insulin or pills or both or neither, so they apparently were willing to believe whatever I might tell them, no matter how outrageous.

Turns out that the RN's answering calls are specialists in (get this!) diabetes, low back pain, and two other disorders... No CDEs, no RDs, no expertise except at reading scripts. And unclear about the "American Diabetic Association", and unwilling or unable to give advice when I specifically offered an example: I had a BG of 146 before driving home from work (I'm usually averaging about 100-105), and he didn't have anything except platitudes to offer. I pointed out he could ask about missed meds, extra stress or calories, malfunctioning meter, etc., but I think this wasn't available in his script.

I did let the cat out of the bag, and told the RN that I was an endocrinologist myself, and invited him to read this blog entry. He was good enough to remain unshaken at this, and I hope he does, and if so, please add any comment you want.

Why am I frustrated and a bit p/o'ed? Because the company nowhere indicated that some of their clients are under the care of endocrinologists with ready access to CDEs, and are offering this competitive service to what endocrinologists do on a daily basis. Maybe their program might help some patients who are under the care of stupid or stubborn physicians (and my profession certainly has its fair share), but for the admittedly small minority of patients who are seeing a diabetes team already, this "service" is self-serving, redundant to what the diabetes teams offer, and smacks of a PR stunt, not a serious effort to help the highly-motivated person with diabetes who routinely reads and participates at this blog.

BTW, I figured out why my BG was high this afternoon: I had a meeting right after eating lunch, and forgot my noontime bolus injection of insulin.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at http://www.diabetesmonitor.com/




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February 18, 2006

My Diabetes: Day 135

It's now over four months since I was diagnosed as having the Big D. My BGs continue mostly in the 80's to low 100's (lowest to date 48, highest 293 -- and that was the very first time I ever checked. Averaging about 105 mg/dl recently). Checking my BGL about 4 times/day, and giving myself shots about 5-6 times/day (doses of rapid-acting insulin after every meal, sometimes as corrective boluses if after-meal sugar too high, plus 2 shots a day of a long-lasting insulin).

Today, I'd like to mention something that Amy (from DiabetesMine.com) and I discussed yesterday: a new observation I have about treating hypoglycemia -- treating with insulin as well as food! That's against the rules:

The Humalog USPI states:
Humalog is contraindicated during episodes of hypoglycemia...
Novolog USPI ditto
NovoLog is contraindicated during episodes of hypoglycemia...

It had never crossed my mind until it after it happened to me: treating a hypo with a big bagel (which usually needs about 6 units of insulin to cover) was too much carb and kicked my BG to the 200's. But I love bagels, and at my workplace, for some reason or other, they seem to be everywhere every time food is around.

Anyway, when hypoglycemic, I'm frequently ravenously hungry, and one bagel resolves the hunger. But the subsequent hyperglycemia was annoying. So, why not cover the hypo with a lesser dose of insulin? Well, it works. If I'm somewhere in the 50's or 60's and feeling hypo, one bagel plus 3 units of insulin fixes everything and the BGL ends up in the expected near-normal range.

Well, almost everything. If I do it too often, I'll inevitably gain weight...

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com.




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January 08, 2006

My Diabetes (day 94)

It's now over 3 months since I was diagnosed as having the Big D. My BGs continue mostly in the 80's to low 100's (lowest to date 48, highest 293 -- and that was the very first time I ever checked). Checking my BGL about 4 times/day (less than before), but still checking before driving every time, and giving myself shots about 5-6 times/day (doses of rapid-acting insulin after every meal, sometimes as corrective boluses if after-meal sugar too high, plus 2 shots a day of a long-lasting insulin).

Most shots through clothing -- I'm amazed that I never recommended it to my patients in the past, but maybe that's because my diabetes nurse educator with diabetes used a pump so it wasn't an issue for her. I'll have to set up a poll at the Diabetes Monitor to see how many readers inject through their clothing...

Made it through the holidays, although with some screwy numbers (due to guessing wrong on how much rapid-acting insulin to cover for holiday treats). Still no severe insulin reactions. I'm carrying a tube of liquid gooey glucose with me in my shirt pocket (along with my insulin pen) anytime I leave the house.

Almost every time -- there was one time Steph & I decided to eat out, and I totally blanked on remembering to bring the insulin pen with me. So, afterwards, I rechecked sugar, and gave a VERY late shot. Things settled down a few hours later.

Presently, my biggest unknown is how much BG screwiness to expect whenever I have the bad luck to have a bad virus. I've suffered through the standard winter cough-and-crud without losing either BG control nor appetite, but someday when I get the inevitable chills/fever/loss of appetite, I will have to see how it goes.

Still having very mixed emotions about whether to seriously entertain using a pump (although it's a consideration now and then). A pump would resolve some issues (like forgetting to bring the pen), but the flexibility of a pump in allowing an extra bolus of rapid-acting insulin is just as do-able with a pen injecting though clothing. Maybe someday...

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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November 27, 2005

My Diabetes (day 52)

It's now approaching 2 months since I was diagnosed as having the Big D. My BGs continue mostly in the 80's to low100's (lowest to date 55, highest 293 -- and that was the very first time I ever checked). Checking my BGL about 6 or more times/day, including checking before driving every time, and giving myself shots about 5 -6 times/day. Got my updated MedicAlert dogtags with the words "diabetes, taking insulin" on it.

Had my recheck with my endo (and found out what the lab tests showed). The lab was supposed to send them directly to me, but I got the results from my endo before I got them from the lab -- by 1/2 day (the results were awaiting me at home the same evening I got them from my endo!). A1c down to 8.3 (had been 11.1 a month earlier). Antibodies negative, and C-peptide at lower limit of normal (0.8). Lab did only the "routine" antibody test, but I guess I'll just leave my diagnosis as "either Type 2 or maybe LADA".

Most astonishing (!) recent discovery: 1 bagel with cream cheese is more than sufficient (!) to treat a low...

To date, I have not used alcohol to swab the skin for either shots or fingersticks. Also, have reused the same needle on the insulin pen for every shot each day (3-4 shots per day), then replaced for the next day. And reused lancet for entire's day fingerpoking then replace for next day. And I'm still alive and uninfected...

Oh, and about 80% of shots are given through the clothing (shirt/undershirt). All shots to date in belly. And yes, I do have a few bruises (I'm on aspirin for its heart/stroke protection).

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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November 09, 2005

My Diabetes (day 31)

It's now been over a month since I was diagnosed as having the Big D. My BGs now stay mostly in the low100's (highest in the 160's). I'm checking my BGL about 6 or more times/day and giving myself shots about 5 times/day.

It's about time for my recheck with my endo (and find out what the lab tests showed). The lab was supposed to send them directly to me, but I haven't gotten them yet (I had to fill out a form and sign it when the blood was collected, and they said it would have to be done every time!). Anyhow, while writing this, I called the lab, and learned that 2 weeks isn't enough time to expect the results. The stupid form (required by our friendly Federal gov'mint) has to be faxed to their headquarters, and an approval received from their lawyers (!) before the results can be released. (Full employment for attorneys -- at least this way they're not out there suing physicians...) So I expect I'll get the results from my endo before I get them from the lab!

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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October 25, 2005

My Diabetes (day 18)

It's now two-and-a-half weeks since I was diagnosed as having the Big D. My BGs now stay mostly in the low-to-mid 100's and frequently down into the 80's; still (amazingly) only one insulin reaction (see Day 7). Rarely bounce into the low 200's. I continue to check about 8 or more BGs/day and giving myself shots about 5-7 times/day.

One of the more common questions I get from my friends who are doctors and nurses is, "why didn't you start with diabetes pills, instead of jumping right in with insulin?".

Well, there are several reasons:

  • First, the side effect profile of insulin is very simple: hypoglycemia if you overdose, and weight gain if you overeat.
  • Second, why futz around with pills, where changing doses takes days (or weeks) to clarify what change in effect may (or may not) have occurred, compared to insulin, where I can adjust doses hourly if I want to (e.g., popping 2 more units if I misjudged the mealtime bolus).
  • Third, no matter whether the pills work or don't when initially tried, sooner or later, the big D will progress and as the pancreas gradually poops out, insulin will be needed sooner-or-later.

So my decision was to start insulin sooner.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




Posted by Bill the diabetesdoc at 19:24:17 | Permanent Link | Comments (2) |

October 22, 2005

My Diabetes (day 15)

It's been over 2 weeks since my wife Steph (who's a CDE) and I diagnosed me as having the Big D. My BGs are now mostly in the low 100's and frequently down to the 80's; still (amazingly) only one insulin reaction (see Day 7). Occasionally bounce into the low 200's. I continue to check about 8 or more BGs/day and giving myself shots about 5-7 times/day.

A reader recently commented that I should consider using an insulin pump. That's something that Steph and I have been discussing back and forth, and I am seriously considering. I've got no objection to being tethered to a mechanical monster 24/7 (heck, I've got a cell phone, a PDA, and go nuts if I can't check my e-mails every few hours, so I live with electronic miracles all the time). But on the other hand, I've no objection to carrying an insulin pen and using it at any time (such as at meals in restaurants, in meetings, etc.): it's small enough to be almost totally unnoticeable by others nearby.

What's your opinion about whether I should be on a pump, and why or why not?

As always, many thanks to everyone for the words of sympathy and support.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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October 20, 2005

My Diabetes (day 13)

It's been almost 2 weeks since Steph and I diagnosed me as having the Big D. My BGs are now mostly in the low 100's; it's irritating (emotionally) when I don't guess right on insulin dose, and end up in the 200's. I continue to check about 8 BGs/day and giving myself shots about 5-7 times/day.

I'm giving more shots, as I've become more comfortable with small touch-up doses if I'm high after guessing wrong on a mealtime bolus. Warning: Don't try this unless you're checking before & after meals, and before driving, and carrying sugar, and wearing MedicAlert ID.

I've learned to jab my belly for injections right through my shirt -- it's a snap, and that way I don't have to worry about tucking my shirttails back in...

By the way, I don't bother with the alcohol swabbing stuff. I always thought that all the alcohol did was irritate the skin germs, and stir them up (sort of like batting on a hornet's nest?). Anyway, as anticipated, it's a lot easier, and no skin irritation or infection.

And as always, many thanks to everyone for the words of sympathy and support.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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October 16, 2005

My Diabetes (day 9)

So, now it's been over a week since Steph and I diagnosed me as having the Big D. BGs staying mostly in the 100's; slowly increasing insulin doses to slowly bring the numbers down better & better. Continue to check about 8 BGs/day and shooting up about 5 times/day. Gotta get my fasting lab sometime soon (my endo said, and I agree, that there's no rush).

Taking insulin (by insulin pen) at mealtimes, usually afterwards so I can count up how many units to balance the carbs, occasional "touch-up" doses (sometimes called correction doses) when it stays a bit too high 2 hr after eating, and a single dose of long-lasting
insulin every evening.

Actually it's becoming quite routine. Bit scary to say that, as one of these days (sooner or later) I expect I'll have one of those rip-roaring insulin reactions where you not only "crash" but "crater".

Again, many thanks to everyone for the words of sympathy and support.

Bill the diabetesdoc
wwq@diabetesmonitor.com

Diabetes.Blog.Com is a blogcompanion to our main website, the Diabetes Monitor, which you can find at www.DiabetesMonitor.com

 




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