Day 2 - Better...

After last night's little fiasco - read about that below - my bloodsugar first rebounded to 249 mg/dl (at 10:30 pm) - not high enough to call the doc per instructions, but high enough to correct. So I gave 2.95 units - and waited. At 11:30, feeling kind of cruddy, I retested - 312 mg/dl. Now, that was high enough to call the doc, but I figured, it's 11:30 and I don't want to call this late. So I corrected with a dose of 3 additional units (the pump minused out for insulin on board.)

At 3 am, my sugar rang in at a smooth 98.

At 8 am, I was 147 mg/dl - higher than my usual morning sugar, but I must say, I felt A LOT more comfortable giving the Symlin with my sugar slightly higher than normal considering what had happened last night.

I ate 42 grams of carbs at breakfast - a bowl of total and 1/2 a whole wheat english muffin with an egg white scramble. I gave 1.05 units.

After all this, I headed to work. I'm not feeling any nausea -- maybe a slight queasiness, but nothing really notable. I called the docs office, because I was feeling guilty about not having called about the 11:30 pm 312. As I suspected, he chalked the high up to a rebound from the severe low and confirmed that my correcting was right on the money... Well, alright. I also confirmed that ALL of my meal boluses are reduced - not just the ones at meals that I take with Symlin. He also explained that it may take a couple of days for my body to adjust and that I shouldn't be put off by the wonky sugars... OK...

At 9 am, 139 mg/dl - Well, that's alright.
At 10 am, 116 mg/dl - Still alright...
At 11 am, 201 mg/dl - Gave a correction bolus of 2 units...
At 12 pm, 248 mg/dl - Hmmmmmm...

I ate 15 grams of carb at lunch - only need .4 units of insulin for that - with the suggested correction bolus from the pump, my total lunch dose was 3.20 units.

At 1:30 pm, I was 218 mg/dl - going in the right direction... 2.15 correction suggested and given.

And, right now at 2:30 pm, I'm at 155. Since I'm only correcting over 200 - I get to leave this one be. Excellent.

Day two seems like it's progressing a little better. I'm concerned about the number of high bloodsugars I've had, but I imagine as I start adjusting to the drug and when they up my dose, these ought to come down some...

Now - if I only I can stop wanting to check my sugar every 3 seconds...

Some notes about being on a shot again.

It's not the needle itself that bothers me at all, in fact, I sat with my dad and stepmother this morning in a crowded breakfast room and gave my shot right there at the table. I've never struggled with hiding out in bathrooms or under tables to give my shots. It's the responsiblity of another medication - and one that's not a pill that I can put in a pill box. I have to carry the bottle and at least one - usually two or three - syringes and some alcohol swabs. It's a whole other set of "things" to add to the already too stuffed medication bag.

And - I'm deathly afraid of forgetting it. I guess I'll have to ease myself out of that; which will likely cause me to forget more readily - but I think it's got to be done.

I still can't believe I'm going to need to buy more syringes in a short while. I'm still going to reuse though - is it really THAT bad? Old habits die hard, especially when you're CHEAP, like me.

I don't think I'll get to post much this weekend - a wedding on Saturday (this ought to be fun) and a memorial service on Sunday... But I'll let you know how my first off-schedule kind of days go with the new pal-o-mine...

Oi.

Tonight has been, in a word, scary.

I got home, determined to get the Symlin going.

A normal day for me has me giving about 20 units of basal insulin and another 10-15 of bolus insulin, depending upon my eating, stress levels, etc. The doc's recommendation was to cut my bolus doses back by 50%...

Sooo....

I got home from work, read for awhile, fed the cat, and pretty much did a million other things to put off the start.

Finally, around 7:30, I cooked a turkey burger with cheese, a whole wheat bun and some broccoli and peppers on the side, plus 4 ounces of grape juice for a total of 44 grams of carb - more than I normally eat for dinner. I wanted to have enough padding, in case -- you know?

My normal dose for 44 grams would be 2.80, tonight I gave 1.4 - and then I gave 5 units of Symlin.

You know when you sit just waiting for medication sometimes? That's what I did. Sitting on the bed, a copy of the Calorie King and the Bitch Posse beside me, The Office on television. Weird, though, I was waiting for the nausea - which, by the way, didn't come. What did arrive was a creeping, crawling, speeding freight train of a low bloodsugar. Before I knew it, I was fumbling my way through a test - and discovering a level of 24 mg/dl... YIKES...

Here's what happened next....

Stumble to the phone...

104503541326812 - first try...

1401894131464 - second try...

14018612233 - finally....

And the message "You've reached Dr. X's office, if this is a medical emergency press 6"

After a couple of false starts leaving a message, I press "6" and say "This is Nicole Purcell and my bloodsugar is 24..." And then I accidentally hang up, again...

I redial...

I press "6" and say "I'm sorry I forgot to leave my number here it is..."

I must tell you, I have an excellent doctor. By the time he called back, I had consumed 20 ounces of juice and my sugar had climbed to 58. I was more coherent, of course.

"Nicole?"

"Hi. Dr. H, I guess we might have miscalculated."

"Well, we cut you by 50% just to get you started. Tell me about tonight."

I recite "I was 101 at dinner. I ate 44 grams and gave 1.4 units."

"OK, so we cut you to 1 to 30 -- looks like we'll have to go to 1 to 40."

"And in the morning, I'm going to start at 1 to 50, OK?"

"Sounds good."

"Alright. Hey, the good news is, I didn't have any nausea tonight."

"That is good news."

"So, I hope I don't have to talk to you again soon."

"Well -- don't worry if you do. Don't hesitate even for a minute."

And that's what gives me piece of mind. Having a team that cares about me - with team members that answer the phone with their kids in the background and with a patience unmatched...

Give Me an "S"

Today, I met with a very nice nurse at the Endo's office. My adventure with the mystery-substance pictured to the left shall commence either tonight or tomorrow morning.

Here's what the nurse and I discussed today. Things I knew that were reinforced/things I learned/things I'll need to do once I get started...

* Symlin is a synthetic version of the human hormone Amylin. Amylin works with insulin to control how quickly sugar enters the bloodstream from the stomach and intestines.

Generally, people who don't produce insulin (like some of us), don't produce enough amlyin at mealtimes. Taking SYMLIN replaces the absent or deficient amylin. (These things I knew, but it was nice that the nurse took the time to ensure that I understood them.)

*Symlin, because it helps the body to process food more slowly, can lower post-prandial peaks in bloodsugar.

* Symlin can promote weight loss both because it slows the digestion of food, which means you'll feel full faster and won't eat as much at mealtimes and because it changes the way the body processes food, which means you'll feel full for longer and should snack less. (To be honest, I'm still skeptical that this is going to work in terms of losing weight, and I said as much to the nurse. She replied saying that 95% of patients she's worked with have lost weight with Symlin.)

* At each meal that I take Symlin (breakfast and dinner), I'm required to eat a minimum of 30 grams of carbohydrate.... Hmmmm... This is more than I eat now. Hmmm... How, again is this going to help me lose weight? Also - what if, because of the way Symlin works (see bullet #2) I'm not hungry enough to eat 30 grams of carbs? Looks like I'm really going to need to be looking at some good whole grain options.

* I can no longer ignore feeling low because I'm busy. This was explained to me in very lecturesome detail by the very nice nurse. If you feel low, you MUST stop and test IMMEDIATELY. If you cannot do this, we cannot start you on this medication. OK - so I will stop to test if I feel even the slightest inkling of a low bloodsugar.

* I must continue to test bloodsugar at least 8 times a day. Not a problem, obviously, since I'm already doing it. I could tell, at this point in the conversation, that the nice nurse doesn't deal with a lot of people who don't have a problem with this little nugget of information. She looked a little shocked and checked my doctor-created bloodsugar spreadsheets three times before I think she really believed that I test that much.

* They're starting me on 5 units at breakfast and dinner. If I tolerate the one iffy side-effect - (now well-known in the OC - nausea) - they'll up the dose. I'll take no more than 10 units at breakfast and dinner.

* My basal rates have been adjusted slightly around mealtimes and my boluses at all meals and snacks have been cut by 50%. I am only to correct bloodsugar if it is over 200, though my correction bolus stays the same.

* I am to call the doctor's office on the emergency line if any of the following occur: a bloodsugar of below 75 or above 260, vomiting, or nausea that I cannot tolerate. If my bloodsugar is at 75 or lower, I am to treat as I am calling the doctor's office (don't wait for the call back to get the sugar in.)

* I am to email my bloodsugars to the nurse after two weeks - and I have an appointment with her two days later - we'll review what's happening with weight, bloodsugar, side-effects, and dose...

So there we go. Give me an "S" folks... As I get to playing ball...

The "BUT-T" of it

I had an appointment with my Endo today. I wasn't surprised by and was thankful for an incredibly good A1C of 5.7.

BUT. There's always a but, isn't there?

I've only lost 6 lbs on the incredibly rigid diet I've been on for the past three months. I'm frustrated. I'm eating three small meals (read: 15-25 grams of carb in each and LOTS of fruits and vegetables) with two snacks and I'm not eating after 7pm. I've also been exercising, faithfully, at least three times a week. But I'm still not losing much weight - and, on top of that, my LDL is still high (120, which is nowhere near the 70 that my doc says I need to be at to avoid dropping dead of a heart attack at a younger age than I should.) Unfortunately for me, statins caused muscle deterioration and Zettia (drug of choice #2) causes pretty severe stomach cramping and other gastrointestinal issues.

There was much discussion. I could tolerate severe stomach cramping and other gastrointestinal issues if it meant I could potentially avoid a heart attack, right? So maybe I go back on the Zettia, along with the Welchol (another cholesterol med from a different family) I'm already on.

Well, the bottom line is, to avoid these kinds of alternatives, I need to drop the 30 or 40 extra pounds that are probably contributing to the high levels of LDL in my blood.

More discussion with the doc.

Maybe I just starve myself... Or maybe I sacrifice my good control to lose some weight.

As you might imagine, he rolled his eyes at some of these suggestions.

Finally, I asked, what about Symlin? And he said, actually that might be a very good option.

But I have zero problems with insulin sensitivity and my post-prandial sugars are well-controlled, I said.

But we both know that the drug is being abused as a weight loss drug in the diabetes-world, he countered.

I don't want to ABUSE a drug, I said, especially given my history.

If we use it properly, it will simply reduce your insulin needs and have the desired effect of weight loss, he said.

Hmmmm... I think I'd like to give it a go. I said. And I meant it.

I see his nurse on Thursday for my Symlin start. I'll certainly post here about it.

I'm very nervous for a number of reasons. With a history of eating disorder - what if this drug becomes a problem? What if I can't tolerate the nausea? What if it simply doesn't work - what if I'm just destined to be too fat for my own good? What if I just buckled down and tried to lose the weight through continued diet/exercise efforts? Is this just plain lazy?

Given that nothing else has helped - medicine for my thyroid, making BIG adjustments to my diet and exercise routines, getting in tight control while avoiding too many low bloodsugars... I'm feeling like this is my only option short of falling back into destructive patterns of behavior, you know? But it's a scary option.

My doc and I marvelled today that he and I rarely discuss my diabetes - outside of downloading and reviewing my bloodsugars and making tiny, tiny adjustments. We always talk about the other genetic/lifestyle issues that diabetes makes SO dangerous - and that I struggle with as much, if not more, than the disease itself.

More later.

Signing off from fat-land - Yours Truly, Chubby

PS (My sign off is just me being snarky, nothing more. Please don't read any mental health issues into it. I'm just frustrated - and my best reaction is to make jokes about it.)

Today

Too many days thinking
Worrying
Taking my time and giving my all
And hoping

Too many times
Forgetting
Minutes and hours lost in a woozy wave
And resurfacing

Too much of my life
Working
Against and with a partner? I can't see
And managing

Too often
Cursing
The uncertainty, the unpredictability, the nonsense
And hating

Too long
Knowing
That I can only do so much
And living

Today is my Anniversary. Although I feel proud of the way I live with this disease, I still long to know what my life might have yielded without my having diabetes. That debate has certainly been had around the OC -- you know, "the would you choose not to have been diagnosed" one -- I just can't help feeling that, even with the lessons I've learned, this is an Anniversary that I certainly would rather not be marking.

Quick Update

Thank you for all of your warm wishes and prayers!

Daniel's two surgeries are completed. Next week, he'll be fitted for contact lenses designed for infant's eyes. Can you imagine? Contacts for an infant? The whole idea scares me quite a bit. As usual though, my brother is taking it in stride. The docs have warned that the baby may still have some serious vision trouble in the next few years -- they've described that his vision will most likely be akin to the way that someone without his condition would see underwater. But he'll be able to see and that's what counts.

I'd ask for your continued thoughts/prayers as we navigate the next few weeks.