Four v. One

I went to see my endocrinologist today. The results of the blood work had been in for a day or so giving her time to do some homework before seeing me.

"I have good news for you." She said, the excitement building up inside her like water behind a levee. I decided to say nothing and see what would happen if the levee broke. "I have very good news for you." Okay, forget the levee, I wanted to know the news.

"You have very good news? I mean... there' either news or there's VERY good news." She was definitely getting my hopes up and I was trying like a madman to keep them down. It's the roller coaster that's difficult, the inconsistency, the fluctuations that make it hard.

"You are one lucky guy." She was actually pursing her lips together in an attempt to control the rate at which she indulged whatever crazy information she had. "You have something called Polyglandular Autoimmune Endocrinopathy." She paused a bit, as if to give me time to swallow this information, as if I would be able to swallow this information.

"Doc, now you're just making things up."

"I'm not." She said, still smiling, although I was waiting for the explanation of why polywhatular autoimmune endocryoutforme was a good thing. "You have," she turned the packet of my blood work over and started scribbling on the back, "1. Hashimoto Thyroiditis. 2. Type 1 (or maybe Type 1.5) Diabetes. 3. Pernicious Anemia, and 4. Addison's Disease."

*gulp*

"But..." she turned the blood work over "...and I have only seen this in one other patient ever..." she flipped through the pages looking for the number "...your C-Peptide has gone up."

She was pointing at the number but I was having trouble seeing it. Below I saw in bold that my Throid Peroxidase AB (whatever that is) was way too high, and elsewhere on the page were other lines in bold: parietal cell ab titer was too high, my Hemoglobin A1C was still high, GAD-65 Anitbodies were through the roof... where was the C-Peptide number! Why couldn't I find it? Why wasn't it in bold? Wait... it's NOT in bold... that means...

I could hear her voice in my head as if from a distance, as if in a movie, "I have only seen this in one other patient ever." Her giddiness was starting to make sense, her excitement when I came in the door this morning.

"Look at what it was before." She rummaged through my file, already an impressive stack of papers that has increased more in the past two months than it had in the previous 26 years. "When you first came in it was .55" Normal range is between .8 and 3.1. "And then when I sent you to get more blood work three weeks later it was, let's see, .50" Normal range is between .8 and 3.1. "But now," her smile returned, "look at that number!" Normal range is between .8 and 3.1.

Mine was 1.64.

"Ok doc, what are you telling me?" There was a quiver in my voice. I could feel some emotion surfacing, emotion I thought I had already dealt with, that I had already spilled onto 58th St. like an oil slick that terrible night back in December.

"When your body produces insulin it produces something called pro-insulin which is one part insulin and one part C-Peptide. Your body uses the insulin to open cells up for glucose and then the C-Peptide gets dumped into your blood stream. A type 1 Diabetic has no C-Peptide." I felt like she was teasing me. If 1 + 1 is 2, and 2 + 2 is 4 then 3 + 3 means...

"So I'm not diabetic?" That's what I wanted to ask, but of course I didn't. I'd been pricking my finger for over a month now and despite my best efforts I still hadn't managed a "healthy" person's blood glucose range and that was with four daily injections. Of course I was diabetic.

"I spoke with Linda (my nurse) this morning and she agrees that we're going to try to take you off of your Novolog (fast acting injection taken with meals). I'm going to prescribe a pill which will encourage your own bodies insulin production. Take it three times a day with your biggest meals."

"How many carbs should I eat when I take it?"

"You don't have to count carbs anymore. It will be your own body's insulin."

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As you can see it was an eventful doctor's appointment. The rundown is that starting mid-February I'm going to give the pill a try and forgo my mealtime injections. I'm waiting until mid-February because my doctor is going out of town and she wants me to wait until she's back. I'm also going to stay on my high dose of vitamin D three times a week to "put out the fires" in my body. I'm going to double my daily B12 to 2000ug per day to fight of the Pernicious Anemia. And in the words of Dr. Susan Thys-Jacobs, "if anyone, anywhere should be on a gluten free diet, it's you." Well that hurts (read why here).

As for G.I. Jon v. the Four (diseases, that is), I'm going to keep doing what I do best - eating right, working out, and reading as much as I can on the subject. I find it more than a little amusing that all of these diseases/conditions have as side affects fatigue and weakness. Ha! I scoff at you! You try to make me feel weak? You four, you silly four.

Oh, and I know I cruised by this earlier, but my A1C was 8.9. That seems pretty good to me considering it's a 90 day average, I've only been on insulin for 45 days and my initial A1C was 13. We'll know for sure in another month or two.

Finally my blood pressure was 110 over 80, and my weight (with clothes) was 191.


Daily numbers:

10:42 -> 143 Breakfast: pb&j bagel 45c, apple 15c, milk 6c, 2 eggs, 1/2 Larabar 14c = 81c = 2 units. At 3:30 I had a protein shake 6c
5:18 -> 93 Dinner: rice 40c, salad 20c, braised cabbage 15c, chicken drumstick, beans 75c and 1/2 larabar 15c = 165c = 4 units. At 7:00 I had an apple 19c trying to push myself a tad high for the beginning of Joey.
7:45 -> 123 That's a pretty good pre-Joey number but to be safe I had 1/2 larabar 20c.
1:03 -> 99 Awesome pre-dinner number. Dinner: Chicken, vegetables 40c, salad w/avocado 30c, corn 25c = 95c = 2 units of Novolog and 5 units of Lantus.
3:40 -> 109 Wow, I expected it to be a little higher. Maybe the working out is shifting my number a little. As a side note - I ate too much. I may want to start making smaller late night meals.

Workout was pretty mild: I rowed for 10 minutes when I decided that my screaming back might be trying to tell me something valuable. I also did Joey tonight, which was harder than usual because of my overworked rowing muscles.

Day 45