Week 3: Good for Me, Bad for Mom

Well, I am going to use this post to do my update as well as let you all know just how horrible the hospitals treat diabetics and how little they understand this disease!  Here goes nothing…

Today I sat at my kitchen breakfast bar thinking about how much I have NOT missed my insulin pump.  I’m 3 weeks into my MDI experiment and I have to say that I am still LOVING it.   This week has had a few hang ups, the major one being my cell phone alarm deciding not to work for my 2am wake up call to check my blood sugar and take correction insulin if necessary.  So, I ended up replacing the cell phone.  I know that I could easily buy an alarm clock, but I hate the blaring radio or blaring BEEP, BEEP, BEEP, that scares you awake.  I don’t need to initiate a stress response upon waking up!

Last week I mentioned that I was going to add the supplement Insulow, which is R-ALA and Biotin, to my daily plan.  I asked other diabetics if they’d tried it and had noticeable differences in their blood sugars, some said no, some said yes.  From the past 7 days, I’d have to say, thanks be to God because I seriously am crediting better blood sugars to this supplement.  I am taking this supplement each morning previous to breakfast and each evening previous to dinner.  

                                                     (available on amazon)

What will my plan be going into week 4:

Going into this next week I’m challenging myself to do a better job of food journaling.  I definitely want to track my macros and see exactly what I’m ingesting.   I know that my carbs have been very low (under 50g per day) but other than that I haven’t been keeping track.  I eat within 45 minutes of getting up, then 5 hours later, then 5 hours after that usually to ensure that my previous dose of fast acting insulin is completely gone before re-dosing for my next meal.   If you read last week’s post you’ll be familiar with my peanut butter and almond butter addiction and going forward I’ll be trying to curb this as well.  That is challenge number 2!

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Ok, now it’s time for me to get onto my soapbox, we’re moving onto our healthcare professionals and my recent experiences.  If you are my Facebook friend, you know that earlier this week I asked for prayers for my mom.  She has type 2 diabetes and I have been desperately trying to help her get on track with her diabetes treatment.  

Tuesday night she experienced an episode that at first we weren’t sure if it was hypoglycemia (low blood sugar) or a heart attack.  Luckily my dad was able to check her sugar and it was 121.  They took her by ambulance to our local hospital and the emt’s checked her sugar which read 120.  At the hospital 1 doctor argued that she did have a heart attack while the anther said she didn’t.  They put her in the cardiac wing and she waited more than 12 hours to have a stress test with radioactive dye.  She told both the nurse and the doctor on Wednesday morning she hadn’t eaten in over 12 hours and she hadn’t had her diabetes medication in more than 12 hours.  They wouldn’t feed her and they never gave her insulin or metformin.  Therefore her blood sugar began to rise.  However they did offer Tylenol…what???  Oh and don’t forget the ice water and ice chips.  Finally they told her she could eat and said “here, you can have a muffin.”  My mom said, “no, I can’t eat that, it has too many carbs, not to mention there’s no way for me to count the carbs to take my insulin for it.” (it had no food wrapper with nutrition info and no one could find it for her)  They looked at her like she was nuts and told her she could eat it.  When she refused the offered her nabs and yet again she went through the same thing telling them no and that she needed a carb count which they didn’t have.  They finally allowed her to order something from the cafeteria from the “diabetic friendly” menu, which we all know is crap food. Luckily the person on the other end of the phone actually would read the labels to her, but they were completely surprised that anyone would want them to do that.

Here’s a recap, the nurses had no idea what was acceptable for diabetics to eat, they force chemical filled crap down their throats, have no clue about carb counting, and never gave a diabetic taking insulin her insulin during her hospital stay to account for the food she was finally able to eat.  My mother was completely helpless in this situation!

Next we move on to the doctor.  He tried to say my mother was suffering from hypoglycemia.  Again, her blood sugar was 121 at home and 120 in the ambulance.  She tried to talk to the doctor about her diabetes care, what she was doing to control it and about her medication, the doctor waved his hand at her, dismissing anything she was saying.  She also told him that she needed her medication for her diabetes and his response was, “oh, ok, we’ll get right on that,” then nothing.  

It seemed like no one cared, no one treated her and no one paid attention to what she was saying and they definitely were missing the mark on treating someone with diabetes.  How can we change this?  If this was how my mother was treated, that means that there have been plenty of other diabetic patients that have been treated the same way.  How can we get nurses and doctors to understand what diabetics should and shouldn’t be eating and about their medication needs?  I feel as if I need to educate these individuals somehow, but I’m unsure of the path to take.

I have a feeling that while this blog originated just to document my experiment of going from insulin pumping to MDI’s, it is going to morph into diabetes advocacy and education.  My hope is that whatever this turns into, it helps someone else along the way.

Thanks for reading,

~D

2 Weeks In

Week 2 has brought challenges for sure!  I’ve had to readjust my dosages again and I’m hoping that this will work a little better.  My doctor and I decided on upping my night time dosage of long acting insulin, so no more 2am shots, but I’m still waking up at 2am to check my blood sugar.  

I’m still having problems with the dawn phenomenon.  For those of you that don’t know what the dawn phenomenon is, here’s a brief overview;  in the early morning hours the liver deactivates insulin that’s circulating in the blood stream.  Without the proper amount of active insulin in the blood stream, blood sugar rises.  This means that I can go to bed with a normal blood sugar and wake up with a high reading and then have to correct it with more insulin.  Also, this means that my body isn’t as receptive to my insulin in the morning so I typically need more!  Trying to find the right balance has been EXTREMLEY HARD and I have been so frustrated by it, but I know I have to figure some kind of strategy out.

Being sans insulin pump, I’ve discovered that some of my habits MUST DIE!  When I was wearing my insulin pump, I was able to slide with some of my bad habits.  What would those be you ask?  Um, peanut butter binges or almond butter binges, straight from the jar.  Yes, my name is Dorothy and I’m a peanut butter/almond butter addict.  Is there a support group for that, because seriously I’m not the only one that craves multiple spoonfuls of the stuff?  For years, I’ve been able to get away with BLT’s, no not bacon, lettuce and tomato sandwiches, but the “bites, licks and tastes,” that we all forget to count in our daily food consumption.  With my handy dandy insulin pump always delivering a steady stream of insulin and the convenience of hitting one button to deliver my bolus, I could get away with the “BLT’s” of life and like most of us, pretend that they never existed; on MDI’s, there is no way to cheat the system.  If I don’t count these little things, they add up to great BIG numbers on the glucometer screen.   Trying to curb my desire to stick a spoon in the PB jar, or to not have a couple of the tortilla chips my hubby is munching on is much harder than I ever anticipated.  I’ve decided that I need to take up a hobby for the evening hours to keep my brain and hands busy so that I don’t dwell on the fact that there is food in the kitchen that I could eat.  Crocheting anyone?  

My new addition going into week three will be Insulow.  This is a supplement recommended by Dr. Richard Bernstein in his book Diabetes Solution.  It is a mixture of Biotin and R-Alpha Lipoic Acid and it is supposed to help insulin sensitivity.  In case it isn’t apparent yet, I like to go against the grain and I am very interested in the natural approach to medicine.  Granted I will always have to use insulin, if there are other things that nature provides us that I can use, I’m going to use it.  I will keep you all posted on the outcome of the R-ALA.  

Here’s the newest addition to my supply kit.  I finally treated myself to a new, cute, pink glucometer this week.  The lancing device is freaking awesome!  If any fellow diabetics out there are tired of what they’re using, the OneTouch Delica has really impressed me so far.  The lancets are much smaller than any I’ve ever used before and it actually made checking my sugar a bit more pleasant.  I would suggest giving it a spin!

Well, thanks for checking in again this week!  I’ll be writing again soon!

~D

Learning Curve

When attempting anything new or remotely new there is a learning curve.  That is what my first week back to MDI’s has provided.  I made it through the week with minor bumps and lumps, (literally lumps from the injections) and am still trying to smooth out the wrinkles.  I counted on having a few weeks of fine tuning and I am reminding myself daily to not be so hard on myself, that this will not be a perfect journey, but as long as I’m giving it my best effort hopefully all will work out in the end. 

I’ve conducted a few experiments on myself this week; the first experiment being timing and splitting dosages of my long acting insulin, Levemir.  I was told my by MD to split the dose into 2, 1 AM and 1 PM.  I did try that but long acting insulin doesn’t last as long during sleeping states and your body also encounters the dawn phenomenon which drastically eats your insulin like a ravenous bear.  The 12 hour split resulted in higher morning readings.  Therefore I tried splitting my long acting into 3 dosages, 1 in the morning, 1 at about 9PM and 1 at 2AM.  This seems to work a little better, however I still think that the actual amount I’m injecting may need to be adjusted.

The second experiment was with the times that I am eating.   I’ve found that any type of snack after dinner, not that I’ve really needed it but it seems to be the hardest time NOT to snack, is disturbing my sugar levels all night even if I am bolusing for it.  I suppose having food sitting in my stomach at bed time is going to be a no go from here on out.  The funny thing is, growing up T1D, the doctors shove the bed time snack down your throat, like you might die if you don’t eat it.  Well, as we see here that’s not the case.  In fact, I’d be better off 95% of the time without it.

The third experiment was pre-meal boluses.  I decided on the days that time permitted to try using the Regular insulin.  This does match the break-down of protein into glucose much better than Humalog insulin.  In fact the difference is quite amazing.

When I was using my insulin pump I would have numerous low blood sugar incidences each week.  This week, I had ONE!  It was pre-dinner and the reading was 56. 

Besides all of my little experiments, it has become even more evident just how much stress, whether good or bad, impacts blood sugar.  This week, on top of starting a new insulin regime, I started a new job.  I do feel that this could have very well impacted my sugars running slightly higher than I anticipated.

I have adjusted some of my rates.  Last week I started with using 20 units of Levemir per day and now I’m using 23 units per day.  My Humalog and Regular insulin bolus ratios have stayed the same, 1unit:6carbs.  

The only thing that I am unsure about at this moment are the "lumps" I referred to in the 1st paragraph.  My long acting insulin is causing some injection site swelling and a lump feeling under my skin, in some cases for more than 24 hours.  I am hoping that this will dissipate with time as my body adjusts to the medication??  But I just don't know honestly what will happen with the Levemir issue.  I find that injecting it in my legs causes greater reactions than if injected in my buttocks or arm.  Strange!!   

Besides that one issue, I'd consider week 1 a success.

Thanks for reading!

~D

MDI Day 1 Run Down

Wow, day one of MDI’s is complete!  It was strange to not have my pump.  I was continuously finding myself reaching for it, or looking to check the time and then realizing it wasn’t in my pocket.  I figure it will take a little time to remember I’m not wearing it. 

I never elaborated yesterday on exactly what my plan of action was, and for any other diabetics out there, you may be curious.  I have been reading a book that I highly recommend, “Dr. Bernstein’s Diabetes Solution,” which solidified my personal theory that after 12 years of insulin pumping, my tissue had lost quite a bit of its ability to absorb the insulin how it needs to be absorbed.  This has resulted in a steady climb in my A1c (average blood sugar over 3 months) to the highest that it has ever been, 7.3%.  It seemed that it didn’t matter what approach I was taking to try to correct this situation, because the number would only change by .1-.2% over the past few years. 

My plan now includes 3 different insulin’s; Regular, Humalog and Levimir.  Every morning I inject myself with the long acting Levimir before 7:30am.  Depending on when breakfast will be will determine if my next injection will be with Humalog or Regular.  If I plan on eating within 20 minutes of eating, Humalog it will be, longer than that I’ll take the Regular which needs to be injected 40-45 minutes before eating.  My night time long acting injection was taken at 11pm to ensure that I wouldn’t have more than 9 hours until my morning injection. 

Yesterday, I took 10 injections and did 9 finger sticks for my blood sugar.  I’m sure some people are thinking, “HOLY COW, 10 INJECTIONS,” but 4 injections are for my long acting insulin, which has been recommended via my reading to not inject more than 7 units in 1 shot, therefore my 10 units in the morning and 10 units at night, turns into a few more jabs.  I did have a 2 high readings, 1 after heavy lifting at the gym (this even happened wearing my pump) and one when I was getting close to my night time inject of my long acting insulin.  I kind of expected those 2, so I’m not that worked up over them.  I’m hoping though, over the next few weeks, I’ll work out all of the kinks.  On the nutrition end of the spectrum, I tried not to snack during the day.  I did give in however to a few nibbles on some cheese pre-dinner.  Otherwise, I stuck closely to the 6-7 carb breakfast, 12 carb lunch, and I had about 15 carbs for dinner. 

So that was the first day run down, a new experience, but an exciting experience. 

Thanks for reading and have a blessed week!

~D