Where I am now... (or you could ask, "Where the heck have you been?!!")

Okay, a lot has happened since I last found time to write here. Things got crazy at work, I went to MACE, Thanksgiving happened, and it's just been hard to focus much on anything that wasn't absoutely necessary in my life. But it's also been a very good time, even for my diabetes...

The Good News

I had blood drawn at the end of October here at work, and my results were pretty incredible...

My Hemoglobin A1c is 5.1%.

Just to remind everybody, at my diagnosis it was 11.8%. And the reference range for "normal" A1c's is 4.8-6.0%. So from a consistent blood sugar standpoint, my diabetes is totally under control. I was hoping for something at or anywhere less than 6%, and my doctor told me that he would have been happy with anything less than 7%, but we were both blown away by 5.1%.

Personally, I totally attribute this dramatic improvement to using Lantus insulin. I know that a lot of people with diabetes are very scared by the idea of having to take insulin, but I just don't know how you can argue with my results. Lantus is a once-daily injection, and most of the time I barely even feel it. If my doctor had decided to try oral meds only and lifestyle improvement, I bet that we'd still be ironing out the right dosages, I'd still be struggling with losing enough weight to make a difference, and my A1c would still suck. But with the way that Lantus has helped to take some of the strain off of my pancreas, there are actually days when I forget my insulin (which happens more than I'd care to admit) and my blood suger still doesn't get above my average numbers. It's incredible, and I would recommend it to any diabetic that has trouble using other treatments. But that's enough with the Lantus commercial...

Second good lab news; my cholesterol dropped from about 175 down to 150, and my triglycerides fell from being over 200 down to 120. It is such a crime that the media and conventional medical thought blame cholesterol on fat intake, when some significant research (and obvously my personal experience) points to how important carb intake is to the whole picture.

More Good News

Just after my last post, I started having some dizzy spells, especially when exerting myself and standing up. My blood pressure was dropping into the low 90's/50's, and I ended up coming off of one of my medicines (Norvasc). More recently, I've had some more periods of hypotension, and at my physician appointment this week, we cut my other BP med in half. If I continue to lost weight and do well, maybe I can get off of my BP meds altogether!

Speaking of weight, for the first time since being newly married, I'm at or slightly below 300 lbs. That makes my current weight loss about 25 lbs since diagnosis, and I'm about 60 lbs below my all-time high.

But I've Still Got More to Work On

There are still two areas that I need to really refocus some attention on. First, I'm afraid that getting my blood sugars under control so quickly and easily may have been a bit of a detriment to my eating. Because it's so solidly under control, I can eat a lot of stuff that isn't really good for me and still not have my sugar bump up very much at all. I can see how this has undermined the sense of importance and vigilance that I was starting to cultivate about my diet, and I know that I need to do a lot better to build long-term habits that will support me staying in control of my diabetes and losing the weight that I still need to shed (since my goal is still to lose another 75 lbs).

The other thing that has been a thorn in my side is finding time to exercise. Since I bring Samantha with me to the hospital daycare center, I'm very constrained in options for staying late or coming in early. And even within the time limits set by daycare opening and closing times, I just don't want to leave Samantha there any longer than I have to (which is uaually between 9 and 10 hours a day already).

Before she was born, I went through spells where I was pretty active in the local Gold's Gym. But I'd usually spend an hour or two there each time I went. Now, I'm trying to figure out some way to come in early, take short lunches, and then maybe fit in a 20-30 minutes workout after work at the fitness center here in the hospital. We'll see how that works out, and I'll try to keep y'all updated.

Well, I think that's pretty much it for now. Stay tuned, and I'll try my best to give this site and my diabetes the attention they deserve!

Seeing the Signs

Gwen and I went to the third Diabetes class last night, and it was... well, again adequate. They continue to focus a lot on the basics; especially the most important things such as managing hyper- and hypoglycemia. And while I completely appreciate how most people in the class need the repetition, we continued to be a little bored by hearing stuff for the third time.

One interesting thing that we also discussed last night was the impact of stress on blood sugars, and a psychotherapist was there to give us some information about assessing and dealing with our stress. For the most part, though, I handle stress very well. But of course, I've struggled from time to time with the shock and disbelief of the diagnosis, the fear of possible complications, feeling overwhelmed by the changes that I need to make in my life, and the guilt and frustration when I fall off the wagon. But in general, I'm very self-aware, and I don't tend to hold on to or dwell on negative feelings. Plus, I have this blog, GamerChris, and my gaming hobby in general to help me out.

I was also pleased that my weight loss continues to be slow but steady. I lost 2 lbs since last week, which totals to 7 lbs from the start of the program and about 12 lbs since my diagnosis. But as I talk about weight loss, that reminds me of the main purpose that I had for this post, the symptoms that should have led me to seek medical attention earlier.

Seeing the Big Picture of Diabetes Symptoms -

As I've mentioned before, at a previous physical, my blood sugars were in the "prediabetic" range (126 mg/dl if I remember correctly). My doctor and I were mainly working on my blood pressure at the time, however, and neither of us gave the value much attention. Shortly after that appointment, Samantha was born, and I ended up having to cancel the next follow-up because of something or other related to her. It was about 18 months or so before I got back to the Doctor.

On any list of symptoms for type 2 diabetes, excessive thirst and urination are usually at the top. And in retrospect (especially after seeing the drastic reduction in both of these after getting my sugars under control), I certainly had both. But I've always been a thirsty dude, drinking at least 2-3 glasses of beverage with meals and usually sipping on a cup of water all day long, and there was no one point when I noticed a sharp increase. Plus, one of the medications I take for my hypertension is Hydrochlorothiazide, a diuretic. So even when I would get up in the middle of the night sometimes to go to the bathroom, it didn't seem so strange to me (of course, my well-trained bladder from years of critical care nursing probably helped mask the frequency thing as well). Now, however, after having my thirst driven by crazy-high sugars for who knows exactly how long, I'm actually finding it very hard to stay well hydrated.

But the next symptom I should have figured out was unexplained weight loss. With a decrease in effective insulin, your body can't transfer sugar into your cells, and therefore can't use or store energy from your food as well. I definitely noticed this, but frankly, I wasn't too upset by it. And while I'm pretty embarrassed to admit it, I wasn't really aware that weight loss was a common symptom of type 2 diabetes (I thought it was mainly a type 1 thing). So, between not wanting to look a gift horse in the mouth and attributing the loss to another cause (the resolution of an irregular heartbeat that I'd had for about 3 years), I missed this one as well.

The other thing that I can remember as well was an episode of blurry vision that lasted about a week. I was pretty freaked out about it, but couldn't get in to see my Optometrist for several days (by which time it was pretty much cleared up). At the time, he mentioned to me the possibility of a blood sugar spike, so I checked my sugar a time or two at work in the following days, and got readings at or slightly above 100, and therefore attributed the issue to eye strain or something similar. In retrospect, it was probably some freaky sign that my sugars were, in fact, getting more unstable.

And the last symptom that I noticed but ignored is one that you rarely see on lists, a change in bowel pattern. Probably due to the excessive liquids that I was drinking, my poop was looser and more frequent that it had ever been before, and in some ways made me wonder if my weight loss was due to an intestinal issue. It wasn't like diarrhea or anything, however, so I mainly just procrastinated and ignored it.

But as far as the other main symptoms, such as hunger, fatigue, or irritability, I never noticed them at all (but maybe I should ask Gwen about those ;-). At least not that couldn't be attributed to more situational causes (like staying up late to write an entry for my blog or something). And in general, I felt fine right through the day when I found out, even with sugars in the 300's and 400's.

And this is why many people don't seek help for their diabetes until it's often too late. Way too many diabetics get their diagnosis when in the hospital for their first heart attack, or for an out-of-control infection in their foot, or when their kidneys start to go haywire. I mean, I'm a freaking nurse, for goodness sake, and I was able to ignore and rationalize away my symptoms for a year or more because there was no one thing so obvious that I couldn't turn a blind eye to it. The symptoms are subtle, but the complications aren't. Everyone should take their health seriously, see their doctor regularly, and keep an eye on their blood sugars.


Oops, sorry about getting a little preachy there. I looked down and noticed that I was standing on my soap box, but I'll step down now and get on with other things. Have a great day, and take care of yourself!

Treatments and Results

Well, over the last month, my blood sugars have undergone a dramatic transformation. From the 300-400's when I was first diagnosed, down now to the consistently normal range. Just because it's something I wanted to do, here's a couple of charts of what my am (fasting) and pm (after dinner) sugars have looked like:


As you can see, I responded very well to my treatment. Specifically, I started taking 500mg of Metformin at lunch and 15 Units of Lantus insulin at bedtime on 8/18. I increased my Lantus to 19 Units on 8/26, 23 Units on 9/3, and then tweaked it up to 24 Units on 9/11. My Metformin was similar, increasing it to 500mg twice a day on 8/29, 1500mg total on 9/5, and then my final dose of 2000mg a day on 9/12.

For now, it looks like I've got good control. Now if I can just get a handle on my weight loss as well...

Diabetes Class is Underway!

Gwen and I went to our first diabetes class last night... We didn't learn much.

But in the defense of the Lifestyle Center, we weren't exactly the target audience for an "intro to diabetes." As I observed the other people in class, there was a huge range represented. Some were obviously still in the midst of denial and anger about their diagnosis, talking to each other at a break about how they weren't going to hang around for the whole class. Thankfully, they did.

And then there were a few that clearly had no previous understanding of what diabetes really was. Other than the name itself, they didn't have any idea about what a carbohydrate was, or how other nutrients were converted into glucose by the body.

While I didn't learn much new about the pathophysiology of diabetes or the building blocks of a good diet, I did gain a more practical understanding of how this disease ties together so many of us from so many backgrounds. And I feel for those that that have less education, fewer resources, and are generally less empowered to take charge of their treatment and regain control of their lives. As much as I've been rattled and scared by my diagnosis, I at least have the benefit of good information and the advantages to understand it and put it to use.

On a slightly different note, however, I was a little disappointed about my weight last night. While I have by no means gotten my diet under control, I have been eating wayyyyy better than I used to. And I even feel like I've lost some weight in the tightness of my clothes and all. But on the scale, I had lost only about a pound or so over the last two and a half weeks. I'm trying not to be discouraged about it, and I'l chalking it up to the fact that insulin can often cause weight gain. But I certainly don't want that to happen, so I'm going to be trying to continue and intensify my efforts at eating better and incorporating exercise into my routine, and I'll see if that helps by next week.

I've been away at the beach (and away from any internet access) for a little over a week, but I wrote the following on Monday (August 24):

Well, both Gwen and Samantha are asleep, and I’m kinda stuck in our hotel room with nothing else to do, so I thought I’d write a blog entry.

Unfortunately, since we don’t have any internet access for as long as we’re on vacation, I won’t be able to actually post it until I get back. But whenever you’re reading this, let me get to the main issue I want to talk about…

Over the last couple of days, my blood sugar has been running pretty much at normal levels, which is really good overall. But one relatively common issue with that (as I’ve read elsewhere on these internets) is the effect that lowered sugars can have on vision. Because right now, I can’t see anything much very clearly (thus making the writing of this entry less than easy), and it’s even worse when I wear my glasses.

I’ve got a couple of books I’d like to read while on vacation, and I want to work on two or three game reviews as well. But as long as I can’t see well enough to read, both of those activities (and several others as well) will have to wait. I just hope that my eyes adjust soon, or it’s going
to drive me crazy!!!

Well, my vision has started to clear up quite since then, but it's still a little fuzzy up close. I hope that I continue to adjust.

Three Bits of Good News!

Today was another important day, mainly because I had my first appointment at the Lifestyle Center. Specifically, I met with Julie, who is an incredibly patient, knowledgeable, and kind diabetic nurse educator. I started off by filling out 6 or 7 pages of health, diet, and exercise history, then she checked my weight and blood pressure, and finally, we had the actual consultation. Of course, she looked at my blood sugar readings from the last week, and we talked some about exactly how my body is falling apart to cause type 2 diabetes.

Again, it's a little weird to be on the other side of the table. I mean, I don't know how many times I have done teaching for new diabetics while I was in Critical Care. But now that it's happening to me, I'm finding that there are some major holes in my knowledge base. While I am pretty much on top of the pathophysiology and pharmacological treatment of diabetes, along with being exceedingly skilled at stuff like checking blood sugars and giving subcutaneous injections, what I lack is the real, practical knowledge of how to manage this disease.

While I generally knew the type of diet that I'm supposed to eat, actually building a menu and making consistently good food choices just wasn't connecting in my brain. And that's where Julie just excelled in our time together. She gave me general guidelines for meals and snacks, as far as servings and serving sizes of different food types. But more than that, she also gave real, concrete examples of what meals might look like (quite literally, since she even used some fake, plastic food as visual aids). Before I left, she even had me put together a couple of meals, just to make sure that the information had taken root in my brain.

We also got me signed up for the series of diabetes classes that Gwen and I will be coming to in September and October. I'm really glad that she'll be able to come with me to those, because most of these changes are going to be for the both of us (and Samantha as she's growing up).

But there's a little more good news about today! As I mentioned in my last post, my fasting sugars have been down about 100 points from where they were pre-medication. Tonight, when I checked it a couple of hours after supper, my sugar was down to 116! I was pretty blown away, because I had no idea that my glucose might get back into the normal range so quickly (especially after a meal). I ate a bedtime snack (of peanut butter and vanilla wafers), and I'm interested to see what my sugar will do overnight.

And finally, the last cool thing is that we are leaving for vacation tomorrow! Gwen and I have been packing all evening, and we take off for North Myrtle Beach just after we all wake up and get ready in the morning. Since we stay in one of the oldest freaking hotels in town, however, I doubt that they will have internet access (we're probably lucky that they have in-room telephones). If that's so, I obviously won't be able to post anything before next weekend.

So, armed with my new-found knowledge about meal plans, I'm throwing myself neck-deep into the fire as I will be faced with all kinds of culinary temptations while on vacation. Wish me luck!

A Busy Day

I finally saw my doctor today. I was nervous, more about what his thoughts on treatment would be rather than about my condition itself, but I shouldn't have been. Dr. Lamb is completely fantastic, and after listening to my thoughts on how we should approach this, he agreed. In fact, he said that this treatment was what he would have suggested anyway. So, what did he prescribe?

I'm going to start with Lantus insulin 15U before bedtime, which I'll titrate weekly based on my average fasting blood sugars. I'll also be taking metformin, starting at 500mg per day and increasing every week until I'm taking 1000mg twice a day. While the idea of taking insulin isn't exactly thrilling me right now, I'm really pleased that I have a plan for treatment and that I have confidence in the efficacy of that plan.

He also gave me a referral for the Lifestyle Center that is associated with our hospital. I went by there at lunch and made an appointment for Friday to sign paperwork, do an assessment, talk about some basic tips, and set our initial goals. The staff over there seem really nice, and I'm looking forward to that as well.

Of course, I'm also looking forward to my family's beach trip next week. Samantha (my 16-month old) loves both the water and sand, so I'm sure that we'll all have a great time watching and playing with her. But I am a little concerned about how I'll eat while on vacation. Meals are usually like the focus of the day for us at the beach, and I've got to concentrate on making better choices.

But that's enough for now. I've already taken my first dose of metformin with lunch, and I'll be making my first injection before bed. Here's to the start of a new era!