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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.