Tuesday, July 11, 2006

BetterCell (see updated Links) posted a question on how my blood sugars reacted after my surgery... So seeing that it's actually been a while since I have focused my blog on my Diabetes, I think his question gives me a good reason to not only address his question, but also discuss some other things going on in my current Diabetes management.

Honestly, my Diabetes control wasn't all that great after my surgery... At first, I really didn't notice too much of a change in how my blood sugar is usually. But then, as time went on, I started seeing more and more elevated numbers :o(, to my dismay.

I guess it's sort of understandable- I was off my usual routine, spending most of the day lounging, and got no kind of exercise or activity of any type. I contemplated increasing my basal rates... but, ultimately, opted not to. Instead, I thought I would ride it out. I knew that my week off would end & I would get back in the groove... and, with any luck, my readings would respond accordingly. And I have found this to pretty much be the case- so that is good :)

However, saying that my blood sugar is back to normal isn't saying that my blood sugar is great. Because, honestly, it is NOT. Unfortunately, I am still having some of my old issues. And there's one main issue that I am beginning to think will never go away... that being, my nighttime readings.

Sometimes I wonder if I have some kind of insulin resistance going on in the evening hours. I don't know if that's even possible... All I know is that I eat dinner and my post dinner readings are almost always in the 200 range, no matter what I eat :(. Not only does this leave me frustrated and upset too many times to count, but it's hurting my control.

To give you an example, yesterday, I ate a slice of turkey meatloaf with salad and my post-dinner reading was 243~ wtf! Yes, the dressing had carbs, some of the veggies in the salad may have had a low amount of carbs, and even the meatloaf may have had some carbs (due to the tomato sauce and bread that was listed as ingredients). But, I took about 5 units of Novolog, which I would think would be enough. Evidently not. :(.

So despite my Endo's opinions of perfecting my basal rates before introducing another variable into the mix, I started Symlin (actually started two Sundays ago). I came to a point where I felt like I wasn't getting anywhere with basal test after basal test, that I felt like I had to make an executive decision and take charge of my own disease.

However, saying that, I can't really say that I have seen much of a difference. In fact, I've seen very little difference at all. The first days I took it, I had the same familiar readings after dinner. .. In other words, highs, which, yes, are a little disappointing. So then I thought that maybe I should up the dose a little.

Instead of taking the initial 2.5 units they recommend starting on, I opted to take 5 units instead. Well, the first time I did this, I did see a difference... I think I had a reading of 113 (perfect!) but this also has not been consistent, nor have I been consistent taking it (last nite I forgot!) But, still, it seems like some days it works and sometimes not.

Then tonight I again used it at dinner... I had the meal of turkey meatloaf and salad again, took my 5 units of Symlin, bolused 2 units to correct a pre-dinner high (of 200), and bolused 2.4 units to cover my meal. Two hours later, I was sitting at 154... which is really good for me. But like I said, to take that much insulin for a meal so low in carbs kind of surprises me and makes me think there is another issue going on.

I know 2.4 units doesn't sound like a lot of insulin to cover a meal, but don't forget that when you are on Symlin, you take half of what you would regularly take for the meal w/o it. So that would mean that my meal would typically require about 5 units of insulin,in addition to the 2 I gave to correct... It seems like an awfully large amount of insulin to take when I don't believe that my meal was chock full of carbs to begin with.

The only other thing that might explain things is whether or not my Symlin is even working. I actually opened the bottle a couple of months ago... but my Endo wanted me to hold off on it (in effort to work on my basals), so I closed it up and left it in the fridge. I think it's possible that it's lost some of it's potency and may not be working to it's full potential.

That would sort of make sense to me, b/c that would mean, for instance, tonight my meal wouldn't really require 5 units of insulin, but instead that the 2.4 units was sufficient. It would also explain why I haven't had excellent post meal readings. Plus, it would also explain why I haven't had any negative side effects, such as the hypoglycemic reactions, nausea, or vomiting that some have described.

The only thing it doesn't explain is the weight loss I have seen recently. But now that I am thinking further about it, I think there could be other reasons for that. In the last few months, I have been able to cut down on the insulin I take w/o Symlin, as I have been eating lower carb. Also, I haven't been grazing as much. And, I haven't been having to treat a lot of lows. All of which the weight loss could be attributed to.

Well, whatever it is, I'm not complaining :)... But it would be awesome to see a little bit more and, if Symlin can help in that respect, I'd like to further pursue it (full potency this time!). So I am thinking of trying this vial a few times more and seeing how my blood sugar reacts and if I see more bouncing blood sugar, I will go ahead and get a new vial.

That basically sums up the state of things right now regarding my Diabetes... I did have one other piece of news to share, but I think I will save that for now (as this one has gone on forever already). However, I will try to post about that next time and I will, also, keep you posted with how my adventures with Symlin goes... With any luck, I'll be able to report good things next go around!


Blogger Johnboy said...

Good luck! I look forward to hear more about your adventures. Glad to hear that you haven't had any bad lows with Symlin. Stay on your game!!

5:44 AM  
Blogger BetterCell said...

Hello Andrea......Keep in mind, that you will have elevated glucose levels because of the trauma associated with surgery. the healing that your skin(it is an Organ) is undergoing during the post-surgical phase, emotional upsets in your Life and the possibility that you are using a vial of Symlin that has actually expired. Does Symlin have the same loss of potency as insulin, which is 28 days after first opening? Consider as well that there might be Gastroparesis associated with your Diabetes, which is very common in T1DM and in which case, the Symlin would be contraindicated for you.

6:46 AM  
Blogger Nicole P said...

Andrea -

Symlin is only good for 28 days after you open it - refridgerated or not. You have to get a new bottle, or you'll continue to see total inconsistency.

Also, I've found that going on Symlin has unmasked all sorts of issues with my basal rates. It takes a few days of consistently using it - and you should be using it at at least two meals, according to my doc, but your insulin sensitivity should increase with it. I wouldn't recommend going it alone. I also would recommend keeping an open mind to big swings in the amount and times you're taking insulin. Be ready to encounter more highs and lows than usual and to ride out the bounces and follow instructions. If you're needing to make an "executive decision" and by yourself you're starting a drug that requires strict monitoring and the counsel of an outside eye to really see any improvement, perhaps it's time to seek out a new endo?

I, with a brand new bottle of the Symlin and with a dose of 5 units at both breakfast and dinner, have had no nausea or vomitting or any other GI issues. I have seen a significant decrease in appetite and a fairly sizable weight loss in just a week or so.

1:28 PM  
Anonymous Lisa said...

I need to adjust my basal (two hours pre) and pre meal insulin ratios for all three meals. Have your Dr. or a nurse work with you daily to figure this out. You will need to call in daily with blood sugar numbers and insulin doses for two to four weeks till it is sorted out. Remember you are paying you Dr. to figure this out for you-it is not an uncommon problem. Just make sure every one has agreed on the amount of carbs you will consume at dinner time during the test period and that you are within about five grams of that amount.Good luck. Lisa.

10:14 PM  
Blogger NYMOM said...

Hi Andrea:

I'm a lurker on your blog who was following the ups and downs of your surgery story; but I decided to post so I could ask a question.

Do you think it's possible that whatever foods made you diabetic in the first place could force a stronger reaction in your body if you consume them again?

In other words I believe my large consumption of cold cereal, breads, pasta, potatoes, etc., is what caused my cells to become insulin resistant, not sweets or sodas, etc., So NOW I've noticed as soon as I have those foods again my blood sugar levels fly through the roof.

Like maybe my cells are remembering or something.

I mean last week I went to a party at my office. Of coures everysingle thing was sweet...I had one chocolate covered strawberry and one small italian berry pastry...I thought that night my blood sugar would go through the roof...yet it was 180 something (which isn't that high for me)...YET a few days earlier I had a bowl of cold cereal with lowfat milk and my sugar was almost 300...

So I don't know...it's just a thought I had.

12:28 AM  
Blogger Nicole P said...

Nymom -

I'm going to take a shot at your question here.

Type 1 diabetes (that's the type that Andrea and I have) is NOT caused by food intake or insulin resistance. It's an autoimmune condition. Our bodies were trying to fight off a virus or other stressor and ended up killing off the islet cells in the pancreas that make insulin. People with type 1 diabetes need to replace the insulin that our body no longer makes. Most people with type 1 are not insulin resistant unless they are many years into the disease or have other health factors that cause this secondary condition. In people with type 1 diabetes - the disease is not caused by intake of any kind of food.

I'm assuming that you have type 2, which was "caused" by intake of certain foods. But I question even that statement given the genetic roots of type 2 diabetes.

Hope this helps.

1:54 PM  
Blogger Andrea said...

Sorry it took me SO long to respond to your comments- but I'm going to try to make more of an effort to stay on top of things ;).

JB- thanks for your comment. Well, I still haven't had 1 low on the Symlin- so I guess that's not such a bad thing. However, I still have highs, but at least sometimes there's a good reading thrown in. Wish that things could be easier/more level/more stable, but I guess that's the nature of this disease. Unpredictability seems to be par for the course... I don't know if I'll ever get used to that. Thanks, as always, for your kind response ;)

Bettercell- I realize that surgery definitely could have impacted my readings, but I assumed that would have happened right away & not days after... I survived, but I didn't like seeing high after high after high.

I believe the Symlin does lose it's potency after about a month, but I figured that since I hardly had it opened, that maybe it would still hold up for me. It seems to still be working, but probably not to it's full effectiveness as it would if it were a new vial. Maybe I'm cheap, but I guess I want to try and get all the use out of this one before forking over my hard earned cash for a new one. Probably stupid, I know...

Gastroparesis has crossed my mind in the past, but isn't that when your stomach empties too slowly? I think my problem is that it empties too fast, which is why I thought Symlin would be a good choice for me... Anyway, I've brought it up with my Endo in the past, but he doesn't think that's the case with me. First, I haven't had significant weight loss (well, not until recently- and it hasn't been all that much) and I haven't had the disease long enough for that to be a consideration. But I know anything's possible.

I appreciate your take on everything- you definitely know your stuff. Thanks So much :)

Nicole- thanks for filling me on the expiration of Symlin. I sorta figured it would be the same deal as insulin, but as I mentioned above, I am kinda cheap and want to get the most use out of this vial, rather than achieve (possibly) better results and know it's working. Hmm, I may have to rethink this- lol :)

I haven't heard that it should be used for at least 2 meals, but maybe I should consider this... The main reason I use it after dinner is because 1. I have huge spikes in bg after dinner & 2. I have a huge appetite at night and have a hard time controlling what I eat. I don't have these problems as much at other meals...

You're right, I probably should be working more closely with my Endo and his practice, but I guess I kind of lost patience with his suggestions, etc. I may very well try and find a different practice. In fact, I think I have one in mind, so I'll give it some more thought.

I'm glad that you are seeing some good results with your starting Symlin. With any luck, (and with a new Endo & new vial of Symlin) maybe I'll see more good things myself.

I hope to keep reading more about your experiences on your blog. It's one I definitely enjoy reading. Thank-you for taking the time to read & respond to mine :)

Lisa- thanks for your comments. I agree, I am paying my Endo & that practice for them to help me manage this disease and, unfortunately, lately I do not feel like I am getting my money's worth.

Honestly, I can't blame them alone.. I could do better with communicating with them (among other things). I guess I just feel like they aren't doing enough, even when I have my appointments & that I'm not getting anywhere.

I am contemplating switching practices. I think it could very well be in my own best interest... but I don't want to make any rash decisions, so I plan to give it more serious thought.

NYmom- thanks for posting- glad that you decided to come out of lurking :)

Nicole explained things better than I could ever dream to, so I hope that helps to explain things.

Like she said, Type 2 is more related to lifestyle choices (like poor diet & lack of exercise). Type 1 is the autoimmune disease- our bodies turn on themselves and destroy otherwise normal, healthy insulin-producing cells... We need to make up for that depletion, so we end up on insulin injections or an insulin pump in order to stay alive.

All the foods you have listed are carbohydrates, so they will all make an impact on your blood sugar (as carbs make the greatest impact in comparison to protein and fat). Eating too much of anything probably isn't a good thing, but foods that are high in carbs will be the most likley to cause those sugar spikes..

Again, I want to thank you for writing & hopefully I'll be seeing you posting/responding frequently in the future :)

7:51 PM  
Blogger NYMOM said...

Thank you all for your replies.

I'm just coming to an understanding of how different type 1 and type 2 really are. As I'm talking to more people about this, I'm also coming to an understanding of how many darn people I know have type 2 diabetes and just never said anything.

Also for me anyway, I've been getting a lot of attention since I've been sick. I don't know if anyone else has experienced this, but even my bosses are nicer to me now???? AND people have been emailing me who I haven't heard from in ages to see how I am...they heard from so and so that I was sick.

So that's the silver lining in the cloud, I guess. But everyone's situation is different and there are probably people out there who get treated worse when people know they are sick...

5:10 PM  

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