Friday, May 25, 2007

Uppin' ze droogs

So I recently changed my basal rates AND my carb ratios. I always feel kinda weird when I have to increase my insulin intake, and there's been no discernable difference in diet or exercise habits. I think the scariest/most frustrating type of diabetes to be saddled with would be "Type 1.5" where you not only make no insulin, but are also extremely resistant to any insulin you take. I know I'm not Type 1.5, but I guess it's a part of life that at different times and places I am going to need to make some changes to my insulin regime.

Back when I first got on the pump I was on a .55/hr overnight rate, with .65/hr during the day. What's funny is, that was about half the number of units of Lantus that I had been on for my first two years as a diabetic. I self-adjusted my basals over the years, eventually adding in a jump to .75/hr in the wee am hours to combat the dreaded dawn phenomenon.

Recently I've gone to .70/hr for my late morning to mid-afternoon. Then I jump to .75/hr. Then from 12am to 4am I'm at .70/hr again. Then from 4 to 6 I'm at .95/hr. Then from 7 to 10, back to .75/hr. I've never done a basal rate test, but for the most part this seems to be working. I could probably stand to extend the .95 out another hour or two in either direction in fact . . . Overall it's only 17.8 units a day, still about half of the typical Lantus shot I used to take.

Yesterday I changed my i:c ratios from 1:9 to 1:8. When I was first diagnosed I was getting away with 1:15. Then it went to 1:12. Then 1:10...I'll have to start multiplying instead of dividing soon, it feels like!

Maybe this is the reason for the highs I was bitching about before. It just seemed kinda sudden is all...

I wish diabetes was as scientific and predictable as doctors and pharmaceutical companies would like us to believe. Yeah, I should do a basal rate test and really pin things down to a tee. I can't shake the feeling that half of diabetes management is intuition, though. An art, if you will!

Current blood sugar: 184. ACT-bolus-manual bolus-normal bolus-1.5-ACT!

Thursday, May 17, 2007

Crisis over.

Just as I start to complain, things return to normal. What was with those crazy couple of days? My rage boluses are now, quite rightly, sending me packing into hypoglycemia purgatory. I'm no longer on an elevated basal rate (mostly because I forgot to extend the temp rate last night), but I woke up at a pleasant 85.

I think diabetes was just having a laugh at my expense. Ha. Ha. Haaaa.

Wednesday, May 16, 2007

Grumbledy grumbledy groo!

This is a first . . . persistantly high blood sugars for the past two days for no discernable reason, despite frequent testing and way more insulin than usual. Doesn't matter what I eat, I'm 200-something. Doesn't matter how much I rage bolus, I'll be 200-something in a few hours.

The following variables have been eliminated:
  • bad site (I changed my site this morning and am still experiencing The Wonky BS)
  • stress (work is pretty slow, husband and I are fine, marriage party planning is okay)
  • bad insulin (it works...eventually! I actually got down to 65 yesterday after a few rage boluses. AND despite The Wonk, I have woken up both days with 100 and 109 fastings. I attribute this to a temporary basal rate set for 24 hours at 126%!)
  • pregnancy (tested today; "Not Pregnant." Phew!)
The following variables could be the causes of The Wonk:
  • sickness (maybe I'm still getting over last week)
  • period (I'm a couple of days late at this point, but my cycle has been kind of stupid for the past few months anyway. And I've NEVER had persistant highs like this from premenstrual hormones. Sure, I've had *some* resistance, but this is ridiculous.)
So I guess I'll just soldier on with my basal rate at a temporary 126% and keep rage bolusing until the status quo this point whatever my Bolus Wizard says, I automatically add 1 or 1.5 units and I'm STILL not in range all of the time. I don't know whether I am more mystified or pissed off. Insulin usually works for me. Maybe I need magic fairy dust?

Monday, May 14, 2007

Medical Mania

Actually this is a happy post! Last week was awesome timing...the planets must've aligned, because I didn't work at allllll. My job is great for killing you one week and leaving you with crap-all to do the next week. (I hate that by the way, but I think I've beaten that horse good and dead so we'll move on.) I felt like low-level shite all week, so it was good to have a paid vacation. I sat on the couch, monitored work emails, and did whatever I could without arousing the headache demons.

I've decided that doctors really are a little...sigh. I don't know. Sadist? Funny? Utterly perplexing and infuriating? They're like computers...can't live with 'em, can't live without 'em. When they work they're great, when they don't you want to throw them out of a window. Pick your cliche, I've got 'em all! I have two examples from the past 7 days or so.

I went to my gynecologist on Tuesday of last week, after I met with my endo. She wanted to confirm that my lymphy lump (lumpy lymph?) was truly of lymphatic origin and wasn't something like a hernia or the C-word. Sure 'nuff, WebMD and myself were correct - Dr. Vag* took one quick feel and said "Yep, that's definitely your lymph node!" He then asked if I had any infections in my nether regions that would cause such ire to form in my groin. I couldn't think of a darn thing, except for my pilonidal cyst.

"But it hasn't flared up in almost a year! I do my best to take care of it and it's not that's never messed with my lymph nodes before."
"Well, can I see it? I used to be a general surgeon when I started practicing medicine 500 years ago."

So I mistrustfully turned over, even though I think my pilonidal was probably not at fault in my lymphatic catastrophe. Things have been relatively quiet down there. Dr. Vag immediately stuck a finger right on the tender spot that I do my best to keep off of at all times and PRESSED and RUBBED, just to assuage his curiosity.

Extreme pain! I should've flipped over and treated him with a swift kick to the jaw, but he's elderly and I'm too nice to people.

"Ha, this is nothing. This is a baby pilonidal. Out of all the pilonidals I've ever seen, yours is nothing."

THANKS, THANKS A LOT, I DON'T CARE ABOUT MY PILONIDAL, I KNOW IT IS PRETTY UNREMARKABLE AS FAR AS ASS ABSCESSES GO. Now that I've got my daily dose of pain and you've poked at all of my tenderest spots and confirmed what I had already figured out myself, am I excused?

He then proceeded to tell me that the only way to cure pilonidals was to "cut them out all the way to the bone" (not true) and that diabetics are prone to infection and that I would probably have a lot of problems with infections in my life.

Sigh. Yeah that's me, the leper. I'm just fallin' to pieces here.

My second example of exasperating doctors concerns the aforementioned cholesterol worries I've had over the past months; ever since I've started going to my new endo, in fact. Today I got the results of last Monday's blood work:

A1C: 6.5. Woohoo!
LDL cholesterol: 68. WHAT THE?! Down from 109 four months ago?! I haven't changed my diet or exercise habits.
Total cholesterol: 120, down from 136. WHAT THE?!

So my endo said my HDL was a "little low" in relation to the LDL, but that it looked "fantastic" and if I exercised the HDL should go up.

Ummmmmmm. Okay. How does my cholesterol from "slightly elevated; you should go on statins" to "fantastic"? The only difference I made was that my bloodwork this time was fasting, whereas usually I eat cereal/milk before I go in for my appointment. Could that really have that big of an impact on cholesterol readings? And if so, how many people are inaccurately placed on statins? Can cholesterol really fluctuate that much? Don't get me wrong, I'm ecstatic - but I think I'll be darned before I let myself get pressured into going on pills for my "elevated cholesterol." Seems like blood work is highly variable...?? Is my A1C even reliable? What the heck?

*Name changed to product the innocent and also for minor humor value. If you're into toilet humor like myself. Hur hur.

Monday, May 7, 2007

Sick f'real

I admit that I am a total wuss when it comes to being acutely ill. There's something about a cold or a stomach bug that registers extremely high on my Misery Scale that diabetes just can't touch. On a day to day basis I consider diabetes more of a "condition" than a "disease." Hit me if that doesn't make any sense, but diabetes is like a constant, physical state of being to me. Yeah, it causes discomfort, but on a typical day it doesn't totally incapcitate me or make me feel super uncomfortable. I can deal with diabetes, but a cold or any other seemingly minor ailment? Pisses. Me. Off. I also think this is cos I've got a huge chip on my shoulder - I already have diabetes, I don't deserve anything else, right?! (Pft, tough titty, sister.)

Anyway, I've been feeling a little funky since allergy season is now in full force. This isn't unexpected, but most years I can soldier on by popping a couple of antihistamines and going about my business. Last week I felt nauseous a few times in the am (yeah, making me nervous) but I attributed it to general funkiness. On Thursday I started feeling a mild tenderness on the left side of my groin (where exactly IS the groin, anyway) . By Saturday evening it had swelled to a Genuine Lump. I did a quick internet search and it sounds like I've got myself an angry lymph node friend down there. Well, the general funkiness intensified over Saturday night and by Sunday morning I couldn't stand upright without giving myself a pounding headache. I've had a sinus infection before, about 3 or 4 years ago, and this was similar but not quite the same...I'm still blaming it on sinus though as my nose was a faucet and my face felt puffy around the nasal region. Spent the whole day in bed. It was actually kind of nice, but also frustrating...

This morning I had an appointment with the endo...last time I saw her was in January. I was attempting to fast since I knew I'd have bloodwork drawn. I've never done this before and my stomach was rumbling like crazy about 15 minutes before I left the house. I decided to have a cup of green tea to try and assuage the grumblies. Awful, awful idea. I ended up puking up whatever was in my stomach - mostly tea. I haven't puked since 2002, so this was decidedly unfun. I'm not sure quite what's up with me, but I'd like to have it stop, pronto!

In better news, my PA and endo have given me the green light to go get knocked up (assuming that the blood work they draw today shows that my A1C is under 7). I won't be trying to conceive until late July or early August, but it was nice to get the "good job, way to go" pat on the back. My A1Cs have been under 7 for a couple of years now and my docs seem to have a lot of confidence in my control and ability to self-diagnose and dose. The goals and monitoring we discussed weren't off the wall either - under 90 fasting, 90 pre-prandial, and under 120 2 hours post prandial. Yeah, I am definitely not there yet but as my PA explained, blood sugars tend to drop during pregnancy anyway . . . and like I've said before, babies are great motivators. I've achieved "good" control without busting my butt too much, so if I start busting a little more things should elevate to "great!" I'll get a lot more doc help than I currently do also - fax in the sugar logs a couple of times a week, and a monthly appointment.

From now until August I think I'll be focusing on keeping my nose wiped and my lymph nodes normal sized...ugh!