Endo Appointment Review – Another Great Discussion

Last Monday was my endo appointment. Unfortunately, I didn’t realize it was my endo appointment, so I didn’t get any blood work done before hand. This would usually be a waste of an appointment, but I’m thankful for the 630G and a lot of great data that we could discuss anyway.

First, we started with an in-office A1C, for whatever that’s worth. 8.1. Not very good. I knew it was going to be high because I spent 45 days without going to the gym and visiting my family in PA, which I tend to eat pretty bad while up there. My weight was down, but only about a pound, not too happy about that.

We couldn’t go over any labs, which I was curious to know where my triglyceride numbers had gone to. Previously, they were amazing, 6 months after being at “heart attack” levels. I’m going to get my blood work done this week, so I am lucky to have an endo that is willing to review my reports after an appointment and send me an email with any recommendations or updates after viewing that.

I had two main concerns going into the appointment, which is how we start out, her asking me, what’s been going on? Morning and after meal spikes. In the morning, as soon as I wake up, my blood sugar just starts to shoot up. Without eating, without drinking anything, just as soon as I wake up, it just shoots up. I do drink coffee pretty soon after I wake up, but I’ve purposely held off on the coffee for a little while and the same thing happened.

What I’ve done in the past is just take a 5-7 unit bolus as soon as I wake up. No real rhyme or reason behind it, just give a little extra insulin to combat that spike that I know is coming. Then, I need to cut out all carbs during breakfast, well as many as I can. I typically eat a 3 egg omelette with cheese or ham in it. When I do this, it definitely helps stabilize my blood sugars until lunch.

But, then that’s when the next issue happens (depending on what’s for lunch). If I eat what I’m supposed to which is a salad with no croutons and a vineagar based dressing, then it doesn’t spike that bad. I can usually control this lunch spike. 

On a good, normal day, I will then hit the gym. This brings down any high that I had and usually drops me pretty low. This is where I see a fun amusement park looking slide on my CGM. This is followed up with a nice, cold Gatorade that also puts back into my body 120 calories that I just burned off.

Dinner is my biggest problem and my biggest spike. Dinner is where I tend to slip up. When I am on my healthy eating habits, none of this happens. So, that is the root cause of the problem. Eating healthier. Unfortunately, I eat unhealthy way too often. When I do, I eat a lot of carbs. Those carbs then cause a spike. I have tried all of the different times to take insulin before eating my meal. I’ve taken insulin 15 minutes before and pre-bolused… same thing. I’ve taken it 30 minutes before, same thing. I’ve taken it the same time I eat, 10 minutes after…. it doesn’t matter.

We discussed that it seems like an insulin sensitivity issue. Where I place my infusion sites is the same areas I’ve been doing it for 11 years. I also use a lot of insulin, so within 2 days there’s nearly 250 units of insulin that has been delivered through that cannula. This is where the problem exists… too much insulin.

We felt that all of these spikes can be resolved with less insulin. So, like I try and do with any problem, we reverse engineered it. I’m using a lot of insulin because of lack of exercise and poor eating habits. So, if we change these two items, I will need less insulin, which will have an effect on my insulin sensitivity. Less insulin being delivered in a short period of time, will allow my body to absorb this insulin and allow the insulin to do what it needs to do.

We also discussed several other things. The use of Metformin as an additional treatment to people with type 1. Invokana being used as an additional med used also.

She knows that I do not like adding additional medications to my list of ones that I’m already using. This is why she will make a recommendation, tell me to do my own homework, talk with people in the DOC and then come back with a decision. So, for now, the goal is to accomplish this all naturally with better eating habits.

There is also the idea of quitting pumping all together and just doing MDI again, but I don’t know if I’m ready for that.

Endo Appointment Leads to New Diet and New Changes

I haven’t been to the endo in 7 months. I had 3 different appointments all get cancelled and rescheduled for multiple different reasons. I was flying back to south Florida from the north on Sunday and was hoping that the winter up there wasn’t going to delay me and make me cancel my appointment again on Monday. My endo office made it clear that I needed to be at this appointment or there would be no more prescriptions written, which is completely understandable in my eyes.

I got my blood work done up in PA while I was up there, but I wasn’t sure it was going to be completed in time for the appointment, but luckily it was.

But, just like I thought, the blood work was not good.

I was previously on a statin and something for my triglycerides because they were extremely high. I had ran out of refills and my primary doctor would not call in any refills, I had to set an appointment. Well, I should say, my FORMER primary doctor, because he no longer is because of that. Since I could not get refills (they were prescribed by PCP, not my endo), I stopped taking the pills. For this reason, I knew my cholesterol and triglycerides were going to be off the charts. And they were.

I also hit my highest weight I have ever reached. I’m actually quite embarrassed by it, and I don’t get embarrassed easily.

We had a very nice heart to heart conversation about your 30’s being different than your 20’s. I’m now married, with a kid, own a home, own a business and have a shit load of other stressful items, so life is a bit different.

We also talked about how my body is already at a disadvantage by having diabetes, so we have to try and level the playing field. Also, in order to get my labs back at a normal level, I really needed to make changes. I am now back on a generic Lipitor, triglyceride meds, blood pressure and Vitamin D. My pill collection is growing.

I used to be anti-medication because once you start, it’s tough to stop. But I am at a point in my life that I just want to be healthy, and if taking a pill is necessary to reach that goal, then so be it.

I also needed to lose weight. My insulin usage is out of control, my basals are so damn high, and I get it, as long as my levels are under control, it doesn’t matter how much insulin I use. However, I need to cut that back by cutting out my diet a bit.

new-dietSo, she put me on a diet that I have been doing for 2 days now and I feel confident in sticking to this diet. Basically, this is the diet:

Breakfast – 3 egg omelette. One day with cheese, the next day with ham. Alternating back and forth.

Lunch – As big of a salad as I want. Vinegar based dressing. No croutons

Dinner – 6 oz of meat ( 8 oz of fish). Non-starchy veggies.

Snacks – Mixed nuts. I have set aside a certain amount for the day and I have been eating it throughout the day.

So far, it has been great. My blood sugar levels have been nearly perfect (perfect to me).

I am excited to continue on with these changes and losing the weight and becoming a better person.

Follow me on Snapchat to follow my journey on this new diet and new changes. Just screenshot the image below and follow the steps:

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Holding Myself Accountable

When things go wrong, excuses usually begin to fly. This is not only true with diabetes, but also with anything in life.  So, this morning when it was time to review my latest blood work, I was going to hold myself accountable for whatever the numbers told us.  I was not going to blame it on the diabetes, but my choices.

I knew going into reviewing the labs that my A1C was going to be higher and that there may be some issues with the lipid panel because of the horrible diet and forgetting what the inside of my gym looks like.

A1C was a little higher than last time, but lower than what I thought.  I honestly felt that my A1C was going to be between 8.0 – 8.5 because I’ve seen the numbers on my meter and they have been bad, probably my worst 3 months in the past 5-6 years.  Which is also why I knew it was time to go back onto the pump and get off of MDI.  The A1C was 7.5.  Not good, but better than I expected.  It was 7.1 six months ago, so I obviously wanted to improve on that, but didn’t.

Everything else in the lab results was good, except for one big issue.  Triglycerides.

I’ve never had an issue with my triglycerides being high because I always had some form of exercise, not intense, but would get at least an average of 15 minutes per day.  My triglycerides were 455.  If you know about triglycerides, then you know that’s pretty damn high.  The doc was concerned about this number obviously, but as I’ve written before, we have a great relationship and she does not scold me, but provides me with the information I need to make better decisions and make improvements.

There was a side of her that wanted to put me on medication, but she knows that by giving me a warning and doing labs again in 90 days, that it will motivate me to improve that number that she feels I won’t need medication.

So, here is to holding myself accountable. No more bolusing 40-50 units for one meal. Yes, you read that right, 40-50 units for just one meal!  No more just sitting on the couch watching horrible reality tv shows (my wife loves that shit!) and more of getting back to the gym, walking around the neighborhood, ANYTHING.

Here’s to lowering triglycerides

Humulin N Mistaken for Humalog

Yesterday I posted about the excitement that I had about ordering and receiving my first 90 day supply order since having insurance for the first time in 15 months. However, I also had to add an update because after coming home and opening the box, there was 3 vials of Humulin in this box.

Ut-oh!

20130919-171350.jpgI started thinking about why their would be Humulin N in this box and not Humalog, so right away I called the insurance company. They told me that the RX they had on file that the doctor faxed over was for Humulin N, 10 units a day, which meant 3 vials for a 90 day supply. What is this? I’ve never used Humulin N in my life. In fact, I didn’t even know what Humulin N is!

So I asked OptumRX what the process was to return this insulin and to get my $25 back for this 90 day supply because I will never use this insulin and it’s just going to go to waste. Well, since they shipped the insulin that the doctor faxed over, they cannot refund the money and they cannot accept the insulin back as a return. I mentioned that it was a doctor mistake and I’m not even using Humulin so it’s not an actual doctor’s order because I don’t use this stuff, never have.

Their answer, “Sorry, sir, we apologize for the inconvenience, but we cannot refund the $25 or accept the insulin back as a return”

One day back with an insurance company and already the hoops, loops, obstacles, and BS has started. I also mentioned yesterday that I will never complain about insurance or pharmacies again because I have lived without having them, so I am completely grateful for this and the $25 loss is well worth it, as long as the correct insulin is ordered and shipped.

I called the doctors office this morning and explained the situation. The doctor’s assistant is the one who faxed over the RX and there was a bit of confusion….so, let me explain.

During my last visit, we discussed ways to try and cut out these highs in the morning. Here’s an example of one, I woke up this morning at 124 @6:30 a.m. I fell back asleep until 9:30 and my blood sugar was 325. That’s it, no food, no coffee, nothing, just simply waking up increases my blood sugars crazy high. So, my doctor recommended taking 10 units of Humulin N at night before bed to try and stop those lows.

There was the confusion, I guess.

Doctor’s assistant saw the visit notes and saw Humulin and did not see anything about Humalog, because I was on Apidra, but it’s too expensive right now and went with Humalog. Even though I told the receptionist Humalog, and I know she didn’t get it wrong because she’s probably the best doctor’s receptionist I’ve ever had before.

Bottom line is that the issue is fixed….I hope. My credit card was charged another $25, so I’m assuming I should be getting an email later tonight about the order shipping and hopefully will get it tomorrow. If not, it’s back to the doctor for a sample vial of insulin to get me through the weekend.

Day One of Diabetes Blog Week – Share and Don’t Share

If you haven’t heard of Diabetes Blog Week, then click the link and read all about it.  Today’s prompt is:

Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see?  (Thanks to Melissa Lee of Sweetly Voiced for this topic suggestion.)

I have blogged before that I am very lucky to have the medical team that I have. My previous endo was type 1 herself and wore a pump and knew the daily struggles that I was going through, so I never had to feel like I was making excuses for things.  She totally understood, but would push me to be better. (more…)

Driving with Diabetes Study

Last week when I was at my endo for a pump training for a trial of an insulin pump that I am starting this week, my doctor gave me a print out for a Driving with Diabetes test / study.  The information is below.

Do you have Type 1 Diabetes?

Are you 18-70 Years Old?

Do you Drive Regularly?

If YES, you may find www.DiabetesDriving.com useful.

What is Driving With Diabetes?

  • An internet program developed to potentially help ALL drivers with Type 1 Diabetes.
  • Interactive, very engaging, convenient and confidential.

Participation in this NIH study involves:

  • Random assignment to:
    • the Internet program group, or
    • the routine care group
  • Sharing your driving experiences
  • Completing online questionnaires
  • No clinic visits – done entirely in your home
  • Earning up to $270 in Internet gift cards and helping others with Diabetes
Principal Investigator for the Study: Dr. Daniel Cox.
For more information, please visit www.DiabetesDriving.com

Results from My Endo Appointment

Today was the big endo appointment. I haven’t had one since July because my previous one was cancelled and I couldn’t get in until now. This was a big appointment because there have been a lot of changes in my life. The main ones were my diet and being on Apidra full time which means that I am using less insulin. Over the past week, I have talked about the multiple lows that I am getting every single night and during the day, so I have been making a few adjustments to basal rates and carb ratios trying to find the perfect match.

(more…)

Endo Appointment Tomorrow

This is a late night post, but I’ve been pretty busy all day trying to catch up on some work.  I’ve also been preparing for my endo appointment tomorrow.  I have not “prepared” for an appointment in probably 7 years.  I usually just grab my meter and go to the doctors office and that’s it.  Not this time.  I’ve been writing some things down because my diabetes has been extra wacky lately. (more…)

Endo Appointment, Bad A1C, and Apidra Costs Too Much

I just got home from my endo appointment about 20 minutes ago, and I wanted to write this blog post while everything was still fresh in my mind.  First, let me mention what some of my thoughts were going into this appointment.  I knew my A1C was going to be high, actually, probably the highest it’s been since being diagnosed.  Why did I think this?  Because my meter results over the last three months say so.  I also knew that I did not wear my Dexcom at all during the last 60 days, so I knew that was going to be a point of discussion.  Finally, I did not reach my goal for my weight loss.  Now, onto what happened. (more…)

New Year New Diet

2012 brings the opportunity to start fresh and start new things.  Every year I set a few goals, and last years goals I did not do a good job in accomplishing them.  As I stated yesterday, I plan on setting smaller goals throughout the year that lead up to the big 2012 total goal.  Today, I am going to talk about the dieting goals that I have.

During my last visit to the endo, I spoke with the nurse practitioner and the dietician about me losing weight.  They mentioned that I should go on a 2 week vegan diet and that I would lose a healthy amount of weight during that 2 week time frame.  I shot down the idea of a vegan diet right away.  So, since I can’t just jump right not that, I’ve decided to cut MOST meats out of my diet.  The only meat that I am going to eat is chicken.  That means no more burgers, no more hot dogs, no more turkey, no more pork, sausage, bacon…. chicken only.  I am also going to cut out cheese and high fat foods.  No more mayo, no more cheese, no more ranch dressing, etc.

Within this 2 weeks, I am also cutting out fast food.  Once I reach this 2 week goal, I will be going camping, so I know for a fact that I will be eating poorly, so that is going to be my reward for reaching a short term goal.

One goal that Amanda and I made together was to not eat out anymore, well at least not as much.  So I will be cooking more often.  I have a lot of recipes that I have tweaked that are healthy that I can’t wait to make.  I am looking for a good recipe for tuna fish and chicken salad.  I am cutting out mayo, and that was what I used to make it awesome.  Mayo and relish and onions.  Anybody know of a good alternative and a healthier solution?

Let me know.

Thanks.