Wednesday, May 22, 2013

I Have No Answer

How many total insulin units do you take in a day?

I hate. this. question.

Because honestly, I don't know the answer.  And to say "it varies" does not go into a nice little check box.

"Just guess."

Is it my birthday?  My kid's birthday?  Have I been sick?  Is it my period?  Have I been exercising?  Have I been depressed?  Did I run out of eggs?  Did somebody take me to the cheesecake factory?  Have I been going low carb?

"Just, you know, a typical day."

I have no answer.  A typical day doesn't exist anymore.

I can tell you how many units of Levemir I take.  Novolog, I can't really tell you.  Did I have the dawn phenom? (Probably, but not always)  Did I go high at night (Probably, but not always).  Did I overcorrect a low and have to bring it down with insulin?  Did I switch cholesterol medications and suddenly become insulin resistant for no reason?

" 12? Maybe 4 per meal?"


"Sure.  Put that."

I get why some people have to ask it.  Clinical trials like to say "we took this person from x units a day to y units per day."  Only numbers are useful.  But honestly I can take anywhere from 0 - 8 units per meal depending on where I started (oh look at that high!) and what I'm eating (hello, spinach salad).

 Plus snacks, if I'm feeling like I need one. And frankly, I rarely snack, and I miss it.  I'm thinking the pump will help with that, but then it will increase the number of units I need per day and that is bad know.  It just is.

I always wonder how the trials do it, unless the patient is eating the same thing over and over and seeing if it changes...which of course it will just with regular diabetes, so, there's that.  I did try to keep my meals consistent when I was on my trial so they would know if there was a difference. But are all patients doing that?  I don't know.

My doctor always asks this.  I'm so tired of it.  I always say "it depends on what I'm eating" and he says "your chart says 3 per meal.  Is that about right?" and I say "that's what the idiot hospitalist told me to do at the hospital when I was diagnosed and didn't even say anything about varying it per carbs.  Thank goodness the CDE brought it up." "OK, good, so you're carb counting.  Well, we'll just leave it."  And then we have the same conversation every six months.  "Are you still at 3 per meal?'

I bring this up because I thought I would sign up for some more clinical trials if they'll have me.  I am all for experimental drugs.  But then I am paralyzed every time by this question.  EVERY TIME. Can I please just say VARIES?  Because it does.  And I bet it does with every Type 1, all the time.  No trial has heard of temporary basal rates for exercise or illness?

Nope.  Just put in a number.  Guesstimate.  Give an average.

The BEST is when you are at a non-diabetic doctor's office (like the ob or the dentist) and they ask you to list your medications and the dosage.  "So, the Novolog, how much?" "Changes daily."  Blink. Stare. Silence. And then I give them an accurate answer:  "One unit per 10g of carbohydrates if it's breakfast or dinner, and and 1:15 if it's lunch, plus one unit for every 50 points of correction needed, and if I exercised really hard, I change all of that by 5 points."  " much is that?"  "I don't know."  And then as they stare at me blankly, I say "You can put 12 if that makes you feel better, although sometimes it's double or half that."  And they nod and put 12 and scurry away, grateful to deal with people who can say "10 mg."

I have an endo appointment next month.  I am going to ask for a pump.  And a billion people are going to ask me how much I take every day so they can help me figure out how to work the pump. And I might just cry.

How do you answer this?

Saturday, May 18, 2013

Dream Diabetes Device

I am going to use the "wildcard" option for this D-BLog week post.


Back by popular demand, let's revisit this prompt from last year! Tell us what your fantasy diabetes device would be? Think of your dream blood glucose checker, delivery system for insulin or other meds, magic carb counter, etc etc etc. The sky is the limit – what would you love to see?

I would LOVE to see a device that measures the efficacy of insulin.  I want to know if the Arizona sun has ruined the insulin, if this bottle is too old, if a batch is bad, etc.  Much like the "control solution" can tell you if your meter is working, I would love to be able to add a few drops of insulin into a device that would say "Efficacy: 100%.  or Potency: 80% or whatever."

THEN, you could add that into your pump (if you had one, which I don't, but I will someday soon) and have it calculate for you.  Insulin needed: 4 units, efficacy is currently at 75% so I will deliver 5 units so you get 4 fully effective ones.  (If that math is wrong, I'm sorry.) (The pump would do it right, though.) (Probably). And that, my friends, would effectively prevent, or at least explain, some highs.  Also it would cut down on the wasted insulin, because you could use the entire bottle, even it has been open a long time.  Also it would be awesome.

Please pay me money for my idea.

Thank you. :)

Other posts here.

Thursday, May 16, 2013

D-Blog Week - Biggest Accomplishment

Ok, so it's Diabetes Blog Week.  I'm supposed to have been blogging about various topics all week.  I haven't been, and I'm OK with that.  The DOC will forgive me - they're cool like that.

This is the prompt for today -
We don’t always realize it, but each one of us had come a long way since diabetes first came into our life. It doesn’t matter if it’s been 5 weeks, 5 years or 50 years, you’ve done something outstanding diabetes-wise. So today let’s share the greatest accomplishment you've made in terms of dealing with your (or your loved one’s) diabetes. No accomplishment is too big or too small - think about self-acceptance, something you’ve mastered (pump / exercise / diet / etc.), making a tough care decision (finding a new endo or support group / choosing to use or not use a technology / etc.

Not to get all mushy or anything, but my biggest accomplishment happened last night.

I found this on YouTube.  Weird Al made my night.  My week.  My diagnosis. You're welcome.  

More blogs on this topic here.

Monday, May 13, 2013

Is it due to a medication change?

So...I really like these ICE drinks.  Today I grabbed a grapefruit one at the store.

Then I remembered I wasn't supposed to drink grapefruit juice while on this stupid statin drug, even though there was probably very little actual juice in it, I decided to forego it, because well, I am little, and don't need extra drugs circulating in my system.

Except.  I went and read about Lipitor and grapefruit juice, and came across the "juicy" little tidbit (ha!  see what I did there?) that Lipitor can raise blood sugar, so please tell your doctor if you have diabetes.


I should have known this.  I should have read more about this when they switched my statins, whining about how Zocor wasn't doing the trick.  (They were whining about the Zocor, I was just whining about how much I hate statins.)

Personally, I do hate statins.  I think high cholesterol is a fake problem. I argue with my doctors every time.  My triglycerides are always super awesome and that's where I keep reading the real problem is, not with the total number, or even the evil "LDL."

I did not go to medical school.  They know this. I know it too, and so I yield.  I am still bitter, though.

Anyway, he switched me to Lipitor a while back but for some reason the pharmacy didn't get it and so they kept filling the Zocor.  I did not see the need to fuss about this, but when the year mark was up for the Zocor, they said the doc would not refill that scrip and so here's your Lipitor, lady.

Okee-dokee.  I'll be "compliant".  I'll take my pills.

After reading that about the blood sugar thing, and how it can cause Type 2 diabetes, especially in women, especially if your BMI is under 25, I got very curious.  I went back through this blog.  I went back through my prescription history.  Coincidentally, I started whining about I was battling highs constantly and the insulin wasn't working, and maybe some residual beta cells died at EXACTLY the same time I switched to Lipitor. (March)

I pretty much guarantee this'll be brought up at my next doctor's appt, which is next month.

You can also bet that I will not be taking the Lipitor for the next month to see if my sugars go back to behaving, at least as far as they usually "behave." Because seriously, lately it seems like I can't get below 200 to save my life. I am up night after night trying to bring this down. A shot at 10, another at 2, and finally at 4 my sugars are down, only to rise again at 7.  My fastings are terrible.  I have increased my Levemir, I've changed the ratio, I've started exercising 4 times a week instead of 2.  And apart from eating pizza, nothing has helped.

I've really wondered about insulin resistance, and why I would develop such a thing now.  This might be the answer.

Today.  Sadly, very typical lately.

Hopefully I've found an answer to the high sugars.  Hopefully we can deal with the cholesterol in a separate way.  This is my hope.  Because truly, I do not want any complications, and NOTHING is more frustrating than doing everything "right" and still having the results suck.  I might as well be eating cupcakes and jolly ranchers.