Tuesday, June 27, 2006

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.)


Scott K. Johnson said...

Hey Nicole,

Congrats on the A1C. That's great!

As far as the weight goes, I'm not one to talk, being bigger than I'd like too, but there are a couple things I thought about reading your post.

1) When I met with the dietician way back when, she mentioned some of the oral meds that they use for T2's who are resistant to insulin. These meds would have the same effect on a T1, which is less insulin. Less insulin typically works out to lost weight. Something else to consider if you have trouble with Symlin.

2) Do you think that even with the lower carb meals you were still eating too many calories? Maybe something else to watch?

I don't know - it's terribly frustrating to work so hard at it and not see the results you were expecting.

Keep us posted!

Shannon said...

Beautiful A1C!!

As for the weight loss, be patient. I've been losing weight since September and each week I've lost anywhere from .2 lbs to 1.5 lbs. per week. That's with exercise and eating less calories (no restrictions on food groups).

It's better to lose slowly than all at once. Can't give advice on the meds, but I can certainly give support anytime you want it :)

George said...

Wow! Your A1C is awesome!

I am very interested to see how the Symlin works out for you. I will be keeping my fingers crossed for your success.

Lyrehca said...

Indeed, nice A1c. Looking forward to hearing how Symilin works for you.

KSC said...

A really interesting post, it sounds like such a puzzle. I found that when my A1c's in the 5's, it was because i was letting myself get into too many reactions while eating a low-carb diet. That meant that when I treated lows, I was over treating them, but my Average was good... Eventually, it meant that I needed to go completely whole grain but increase the carb #'s. I actually kept my weight and lows in control better, because whole grains digest more slowly...don't know if this is useful to you but I hope it is.

Nicole P said...

Thanks, all, for your comments. I know that you all know just how much it means to have a group of folks in my life that understand what I'm going through - and to whom all this diabetes talk isn't Greek...I thank you so much for that.

As nervous as I am, I'm anxious to give the Symlin a go... For those curious... Here's a sample day of eating for me:

AM - 1/2 whole wheat english muffin, 1 egg white with peppers.

AM snack - yogurt or berries with nuts

Lunch - One Lean Cuisine Entree -- Low Fat/Low Carb versions only (ie; Beef Peppercorn with Green Beans or Grilled Chicken with Brocolli and Yellow Peppers) 1 apple or orange

PM snack - 6 Whole Wheat Saltine crackers with Smart Balance PB or Reduced Fat Cheese or Celery Sticks with same.

Dinner - 1-2 cups vegetables (brocolli, carrots, beans, asparagus, brussel sprouts), 6 oz chicken, fish, or turkey with fresh salsa (not always, usually depending on how much veggies I have), piece of fruit or sugar free jello. Twice or three times a week I sometimes have whole wheat pasta or brown rice with dinner.

Nighttime Snack - Sugar free jello/popsicle.

80 ounces water - EVERYDAY.

I've been very strict with myself. I don't eat off of the diet. Even if I switch things up, the calorie count remains the same (ie; I might eat 3 cups popcorn in the PM instead of crackers or celery or I might not eat fruit at lunch -- I'm always under or at the calorie count they recommended for weight loss.)

I track my levels and look at the results very carefully - so I'm not having a lot of fluctuations. The 5.7 is pretty true -- minus a couple of days each month that I simply can't explain when the sugars hit the fans...

That said, KSC, I'm very intrigued with the whole grains idea. I do eat mostly whole grains -- but I wonder if I couldn't be stricter about it. How do you manage it? Could you give me some examples of menu plans?

I'll post more later in the week, once the adventure begins. Wish me luck!

Andrea said...

Oh, Nicole, my friend!

I SO understand your frustration... I definitely share that struggle with trying to manage my diabetes and my weight. But before I go on even more about that, I want to just remark on your A1c- can I just say how awesome you are doing?! :) :) :) You should be EXTREMELY proud of yourself! I would kill for that A1c..and wait a sec, 6lbs is 6 lbs... that's also a great acoomplishment- do not downplay that! Celebrate your success, girlie! You done good! :)

Ok, back to eating issues, as someone who's also had past eating issues, I know how difficult it can be to deal with unwanted weight. Honestly, there have been times when I've had thoughts that could be considered self-destructive. That being said, I've resisted the urge to act on those thoughts. Believe me, there were times where I thought I am just going to start skipping meals or workout for hours... but then I snap out of it and realize how that's ultimately going to hurt and NOT help me. I hope you see that for yourself and resist those thoughts as well.

I did read your current diet. My goodness, you are SO disciplined. I don't know how you do it- you must have a lot of determination! That's wonderful.

Sharing a bit of my personal hx, after being dxed with diabetes, I decided I needed to start eating more healthfully. Unfortunatley with that (and insulin), I put on weight and more than I would have liked to. In fact, each visit to my doctor's, I'd hop up on the scale to find out that I had gained weight. At that point, after dealing with years and years of being extremely restrictive, I think all my self-discipline and control went out the window. So I probably ate more than I needed to and of course put on weight... And I wasn't happy.

My weight reached a high point... and I decided things had to change. So I started working out harder than before... Increasing the length and intensity of my workouts. Now, I know it's easy to slip from one disorder to another and I was and am still aware of crossing that line, but Ithink I found a healthy balance.

I eat relatively well... basically what I want, but I put in an hour at the gym each day. I have lost weight and I'm hoping to drop another 10 lbs with some time.

I think you need to continue what you are doing. You are eating well... (sounds very healthy :) ) and you are exercising, now I think you just need to be patient. Someone pointed out to me, that the weight I gained didn't just come on overnight- it took time. Well, it's going to take time to take it off. However, I'm not the most patient person, so I get frustrated too. I guess we all want an immediate fix.

My advice along with being patient and hanging in there is to keep at it... and don't give up. I know how easy it is to want to throw in the towel when we've lost patience, but I think if you keep doing what you are doing, you will see good results.

Also, Symlin may also be a help. I actually had to put that on hold for the moment while I figure out my basal rates, but it is something I am looking forward to trying.

So, I will end this comment-sorry for going on and on (and on)... but I wish you the best with everything and hope you cointiue to see good things...

Take care :)

justme said...

Congrats on the A1C!

I am battling to loose a few kilo's myself. Ever since I started insulin treatment I have been going to gym religiously, and eating pretty healthy, but these fat cells seem to be quite happy where they are with no intention of going away...

Looking forward to reading about your experience with Symlin!

J said...

Good to see you posting Nikki.. I hear you I joke to help myself though the shakes too.. is symilin really being used for weight loss? and does it work? the short time I tryed it I only got to 10 units and was feeling sweating and nusea..but other people I have talked to tolorated it fine.. but I did not notice the difference in appitiete maybe I did not give it a good enough go.. give it a shot and love to hear how you make out with it .. I often have "Fat Days" myself and so understand the trying and doing everything right and yet the scale does not show it.. I hope you keep it up and don't give up because your stronger than you know...