Doctor's Visits Again

Went to the doctor.  Because, you know, I do that.  Kind of a lot.

I went to the dentist too, but I was so ticked off after I left and I didn't blog it, and the bottom line is I really need a new dentist.

He said he got a lovely little note from the CDE about me.  I took that to mean that I harass her way too much.  (He didn't say that, I just feel guilty about it). But hey.  I am a new pumper.  I am entitled to harass people until I get things set right.  RIGHT?

He was very confused looking at my numbers.  Which made me feel better, because I get very confused looking at my numbers.

"Why are some nights really high and others really low?  And here's some that are perfect.  I am not seeing a pattern here.  Your days are good, though."

Yeah, me neither.  And if we could figure out the night time thing, that would make me happy.  REALLY happy.

"You seem to go high at midnight."

Yep.

"But not always."

Yep.

"Have you noticed a trend if you eat specific things?"

Nope.

"Huh.  Here's a 261.  But the day before at the same time you were at 63."

Yep.

And round and round we go......it's very hard to set insulin levels when there's no pattern.

We've had various theories about the nighttime highs.  We used to think the Levemir was wearing off, and that's why I went high.  Now that's not a thing, because I'm not on Levemir anymore.  We used to think maybe it was the fat and protein from dinner, and an extended bolus would fix it.  It hasn't seemed to, plus midnight is about 5-6 hours after I eat.  So who knows?  Not me. Not him.

I blame goblins.

The bloodwork came back.  He called today (Saturday) while I was in the grocery store to give me my results.  Nice man.

A1C was 6.4.  Nice, and surprising, because I have had so many more highs since I started pumping, and serious ones too - up in the 300s. Kinked cannulas, poor absorption, and just basic "I don't know what I'm doing" highs.  But things have calmed down since the beginning, which really just feeds the theory that the a1c is far more heavily weighted by the more recent numbers.  Also, lots of lows.  Diabetes is always a party.

And then, the cholesterol.  The %&*! cholesterol.  Actually, he just ordered an apoB test.

"We really need to put you back on a statin."

"But the Lipitor made me insulin resistant.  I couldn't get below 200 to save my life.  And the simvastatin (Zocor) didn't work well enough for you."

He scrolled through my history.  Looking at what the simvastatin did, etc, etc.

"You know, if it weren't for the diabetes, I wouldn't treat this. You were at 110, and we want it below 100."

I am so tired of hearing that.  If it weren't for the diabetes, we could treat your test results like ANY OTHER NORMAL PERSON.

I told him that.

"I know. I know, I'm sorry.  But I really would feel better if you were on a statin."

So he prescribed 5 mg of Crestor.  I am unhappy about this.  I know someone who went on Crestor and it seriously messed with his memory.

I was so happy to be off the statins.  The thought of going back on them is depressing.  My HDL is awesome.  My triglycerides are awesome.  My VAP test comes back good every time.  All my cholesterol is "fluffy"  (pattern A).  So I have a lot of LDL. I really don't think it's going to kill me.  However, I didn't go to med school, and so I have Crestor staring me in the face.

My PCP and I have been fighting about this forever.  And my endo is normally on my side, saying without a family history of heart disease, and all the other goodness, we don't need to be overly aggressive, and yet he always seems to come back to "but we do need to treat."

I'm grumpy.

So I bought doughnuts at the store and ate them on the way home.  I had to celebrate the A1C anyway. I'm sure that's good for my cholesterol.

Could it be the infusion set?

So I texted my CDE to discuss why she thought I was suddenly having so many lows.

"How many?"

"Today?  Like 7."

"OK, I'm calling you."

We had discussed making changes to the basal rates, but not turning them down, but adding a profile for PMS which gave me approx. 20% more insulin across the board.

"Did you make the changes? It's early in the cycle for that."

"No."

"Did anything change?  Are you eating less fat?  Are you exercising more?"

I haven't exercised at all this week - my bad, and if anything, I'm eating more crappy foods, because that's what the pump lets you do!  Add a snack here and there that's totally bad for you!  I love it.

The only thing that changed is the site.  I did a site change and used a different infusion set.  I wasn't loving the Cleo, and I was going through them far too quickly, wasting them as they fell off during insertion or whatnot.  I think 90% was user error and "Pump Novicery" but it was getting old.

She decided I had probably hit a blood vessel and that was making the insulin deliver far more rapidly than a standard subcutaneous delivery.  The things I learn, I swear this disease has a never ending learning curve.  The next infusion set should probably see things even out.

Except it hasn't.  A few less lows, that's true, but they are still daily.  And annoying.  And we hates them, yes we do.  We also hates highs too, which basically boils down to: "we hates diabetes."
 (A beta cell is "my precious.")

So, my question is this, does the type of infusion set matter in the delivery of insulin?  I wouldn't think it did, but is it possible?  Or has my pancreas just turned on for a little while (I swear it does that sometimes)?  Or is it just the unknowns of diabetes?

I hate unknowns.  Maybe that's the great life lesson I was supposed to learn from this disease- that not everything can be controlled.  If so, I reject it. :)

Anyone seen changes when you changed the type of infusion set?

That Was New

So I was wandering the mall yesterday.  It was my birthday, and I needed to buy myself something.  It's mandatory.

As a side note, I'm just going to say that wandering the mall is a total assault on your olfactory senses and I do not recommend it if you have a strong sense of smell.  I don't know when every store and kiosk decided to blast scent everywhere but it is extremely annoying and headache inducing, smelling one "pleasant" scent after another.

What happened to just smelling Cinnabon everywhere you went?

Anyway, I digress.

After buying some pants for $7, which I was pretty thrilled about, I was walking around and I began to feel low. Not surprising given the lunch I had (with fabulous friends) plus all the walking immediately afterward, so I found a chair, sat down and checked.

My CGM said 82, and the meter said 75.  Not super bad, but still it merited treatment, especially since I felt the low, and I still had some insulin on board.

So I munch on some candy and start people watching.  I was in the fortunate situation that I had time to wait for my sugars to come up, and I wasn't feeling too bad.  Plus I had new pants.

Immediately this man walks up to me.

"How are you feeling?  Can I get you some orange juice?"

Blink. Blink.

"Um.  I AM having a bit of a low blood sugar, but I will be OK.Thank you."

"Yes, I can tell.  Are you sure you're ok?  You have what you need?"

This was new. I have never had a total stranger come up to me and know that:

a) I am having a low blood sugar  and
b) what to do about it.

Turns out he was a former EMT or firefighter or something. I wasn't quite clear on his job title, he was talking fast and I was having a low, but he was clearly used to dealing with PWD.  He mentioned cruise ships, so maybe he was on the emergency crew there.

I am not positive how he could "tell" I was low, but I think he just recognized the meter or the pump.  I like to think I didn't look like death warmed over. I'm optimistic that way.

"Can you drive in that condition?  Do you want me to call you a cab or a friend or something?"

"No, thank you.  I will be fine.  I just need to sit here for a few minutes and let the candy work."

"Yes, you just sit. Relax.  Feel better."

"Thank you."

And I did.

And when I  left, not only I was thrilled to smell the fresh air again, I was also reminded that there are good people in this world who look out for each other.

Not a bad birthday present, really.  Plus, cheap pants.

Tempting the Diabetes Gods

Ok, so I put up a Facebook status proclaiming that it has taken me a while, but I FINALLY feel like the pump is better than the shots.

Things had been going well, and I could see that it was helping, even to the point where I could finally say, "Yes, this is more convenient."  (I still hate the constant site changes and the wardrobe challenges, but the good now does outweigh the bad).

I should not have done that.

I spent most of the next day battling super high blood sugars.  And for why?  I have no idea.  I'm blaming PMS and the Diabetes Gods laughing at me.

I started rising after my morning workout (not that unusual) but I never really fully came down.  It was kind of bizarre.  I am going to call my CDE and get a PMS setting on my basals.

That night, I also had a conversation with someone.  I'm sure it's a conversation many of you have had.

"So, I used to work for a guy with diabetes.  They had cut off his legs and he had all kinds of problems.  It wasn't pretty."

"Yep, that can happen."

(Beat.  I wait for it.  Oh yes, here it is.)

"Of course, HE didn't take care of it.  Not like you."

I thought of my 270 at lunch that I had desperately tried to bring down, and the fact that I basically ate lettuce, but it still  took hours to get down to 200. (Oh, and 200 is nowhere near the goal).  I thought of what that was probably doing to me.  I thought of how I worked my butt off to still see crappy numbers. I didn't say much.

I get tired of defending diabetics I don't know.  After all, maybe this guy did eat Snickers bars for breakfast, lunch, and dinner, and never took insulin.  I have no idea. However, I do know that even if he did eat like that, it doesn't mean he deserved to lose his leg.  I get tired of trying to convince people to blame the disease, because there is an element of self care that has to take place.  Still, it's exhausting.

"So, what are the long term complications of diabetes?"

"Well, there are heart issues, stroke, kidney failure, blindness, circulation problems that lead to the amputations you speak of, nerve damage, things like that."

"Wow, that list sucks."

"Yes, yes it does."

"But how is YOUR treatment going?"

Again, I thought of the day I was having.

"You know, pretty good, I guess.  I don't have any complications.  I take it a day at a time."

And some days suck.  Lots of them do.

Others, aren't so bad.  If he had asked me the week before, I'd be more optimistic, and think of the string of "no hitters" I'd been having. Still, if my life is cut shorter because of my diabetes, and people start talking at my funeral about how I should have eaten fewer carbs, the Diabetes Gods and I will team up and start haunting you.  Just remember that.