Blood Work: Part 4

I got my blood results today. This is the fourth time I've had blood work done. The first time was with my initial visit to the doctor. The second time only a few weeks later. The third was six weeks after that, and the fourth (most recent) was last week, three months from my initial diagnosis. There's no point in building suspense, I have to take the numbers and the results as a quarterly check in, to see how I'm doing. As always seems to be the case there was some good news and some bad news. The good news was good, the bad news... well, you'll see. (I'm recording these from memory, when I get a copy of the blood work I'll copy edit to make sure all numbers are accurate.)

GOOD NEWS:
Hemoglobin A1C: 6.1% This is amazing news. If I can maintain this number for life it is unlikely that I'll ever experience diabetic complications. Other than a freak high or low, complications are the biggest fear/concern (or should be) of all diabetics. A 6.1% A1C means that my average blood sugar level is about a 126.

Total Cholesterol: 126 Also amazing news. Cholesterol levels are a great indicator of heart and artery health. Even a level of 150, though well below the acceptable level as stated by the American Heart Association of 210, has been shown to increase your chance of heart disease. When I first got tested I was a 170, which is a good number for an American, but a bad number for a diabetic who is determined to live a long healthy life. A 126 on the other hand is amazing! I have to attribute this to my new dietary choices.

BAD NEWS:
C-Peptide: .53 This number will continue to fluctuate, a symptom of type 1.5 diabetes, and one of the biggest challenges I'll face in the next few months/years. The number indicates how much insulin my own body is producing. As this number increases so does my natural insulin production making my blood sugar more stable. As this number goes down (.5 is low) I'll be prone to higher and higher blood sugar levels. In response to this number my doctor put the responsibility of treatment in my hands. In her own words she reminded me that I knew how the Lantus and Novolog and Prandin worked, and to search for a balance with any combination I felt appropriate.

TH: Low. I forget the actual number, but this represents the hormone produced by the Thyroid. Mine is hardly producing at all. I am now the proud new recipient of hypothyroidism (more on that later). She's going to give me two weeks and then have me repeat this blood test. If the results stay the same or get worse I'll have yet another pill...to take daily...for the rest of my life.

So the good news is after a mere 3 months, the things that are in my power to control have been controlled. I've virtually disease proofed myself against a host of complications, and proved to myself that I'm smart enough, willful enough and strong enough to do that.

The bad news is that for the unforeseen future I'm shooting at a moving target when it comes to blood sugar regulation. I'll have to be flexible and alert. And the next few weeks may be rough. Hypothyroidism can cause sluggishness, fatigue, depression, etc. I fear a weekend trip to the Hamptons is only a temporary fix.

Dailies:

11:30 -> 138 That's the highest fasting level I've had since February 4th, not a great sign. Took 2 Prandin with cereal 110c. Walked several miles.
2:44 -> 123 That's better, I guess I'm still producing some insulin. Took 3 Prandin with black eyed peas 100c, apple 30c, clementine 9c, grapefruit 26c, lentils 20c. At 6:00 had bagel with pb & banana 55c
6:50 -> 117 Woah! Awesome, that right after having a bagel too! Had a piece of bread with hummus 20c. Performing as Joey. At 8:30 I had a cupcake 12c, pumpkin seeds 6c, and bread with jam 16c. At 12:00 I had a shot of tequila and a Larabar 26c.
1:54 -> 105 Great! Took 2 Prandin with salad 30c and brussel sprouts with cabbage 30c. If I'm above 150 before bed I'll take 2 units of Lantus with a little snack.
3:21 -> 104 Wow! Looks like the Prandin is still working today. I'll have an orange 20c and some blueberries 16c and go to bed.

Day 91

Fraud Alert for People with Diabetes

I received this email today from a Diabetes organization. Copied in its entirety is a message to Diabetics warning them of criminal acts of fraud targeting diabetics.  I'm sure I don't have to tell you how upset this makes me. News like this leaves me wishing for a prehistoric justice system.  Here's the warning:

"Criminals who plot to defraud the Government and steal money from the American people have a new target: people with diabetes.
Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you. The caller offers "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets. The caller may also offer other supplies such as heating pads, lift seats, foot orthotics, or joint braces, in exchange for the beneficiaries' Medicare or financial information, or confirmation of this type of personal information. Additionally, you may receive items in the mail that you did not order.

The call is a scam.

If you receive such a call, OIG recommends the following actions:

1. Protect Your Medicare and Other Personal Information

Do not provide your Medicare number or other personal information. Be suspicious of anyone who offers free items or services and then asks for your Medicare or financial information. These calls are not coming from Medicare, diabetes associations, or other similar organizations. While the caller says the items are "free," the items are still billed to Medicare. Once your Medicare information is in the hands of a dishonest person or supplier, you are susceptible to further scams. Alert others about this scheme, and remind them not to provide strangers Medicare numbers or other personal information.

2. Report the Call to Law Enforcement

Report the call to the OIG Hotline at 1-800-HHS-TIPS or online at www.OIG.HHS.gov/fraud/hotline. As part of your report, provide the name of the company that called you, the company's telephone number and address, and a summary of your conversation with the caller.

3. Check Your Medicare Summary Notice and Medicare Bills

Check your Medicare Summary Notice and other medical information to see if you were charged for items you did not order or did not receive. Also, check for items that were billed multiple times, such as glucose meters, diabetes test strips and lancets, and other supplies. Report any irregular activity to your health care provider and the OIG Hotline at 1-800-HHS-TIPS or online at www.OIG.HHS.gov/fraud/hotline.

4. Do Not Accept Items That You Did Not Order

You are under no obligation to accept items that you did not order. Instead, you should refuse the delivery and/or return to the sender. Keep a record of the sender's name and the date you returned the item(s) to help OIG catch any future illegal billing.

The Department of Health and Human Services, Office of Inspector General (OIG) fights fraud in Government programs. As part of this effort, the OIG relies upon alert citizens to help them catch those who steal from American taxpayers."

 

Dailies:

11:11 -> 87 Took 3 Prandin with cereal 110c, then apple 25c, kiwi 10c, 1/2 grapefruit 13c, apple 25c, 2 cookies 25c and a pb&j 30c at 4:00. Boy it feels good to eat after yesterday's workout!
5:05 -> 92 Took 2 Prandin with TJs salad 53c, cabbage stew 15c and then took a third Prandin with lentil soup 140c and a grapefruit 22c.
8:33 -> 175 Still pretty hungry, but not going to eat with a number this high.
11:28 -> 87 Took 2 Prandin with dinner: salad 25c, brussel sprouts with kale and jalepenos 20c, bell pepper 7c, pumpkin seeds 15c.
3:18 -> 104 Cookie 9c, kiwi 10c.

This was the greatest number of Prandin I've taken in a single day: 8 and yet the numbers didn't seem that much better or worse than usual. Perhaps I got the dosage right finally, or perhaps it's something else. I have a hypothesis brewing.

Day 87

China Study Review: Part 2

The China Study is nothing if not a vegan manifesto. The list of evidence is compelling. The science is sound. A whole foods plant based diet is the best way to prevent a whole host of diseases including cancers, coronary heart disease, diabetes, osteoporosis, Alhzeimer's disease, etc.

Don't compare what you read in The China Study to what you hear on the news. The China Study is the primary source. This is the book written by the project manager of the biggest most comprehensive study on nutrition ever conducted. A $5 million dollar study examining the dietary traditions of villages across China over decades and the correlation to disease.

Really and truly, the author repeatedly throws some light on fad diets, science of convenience, and agenda based policy and reveals them all for what they are. I've obviously been influenced. If you can find this book in a library, check it out, it is shocking.






And with that I move onto my next book: A Fighter's Heart

Dailies:

11:33 -> 71 Noticing a trend? This is the fifth day in a row I've woken up under 100. Took 2 Prandin with V cereal 110c. At 12:45 had a banana 27c. At 1:30 had two apples 40c.
2:49 -> 86 Pre Joey number. Not high enough. Had a pb sandwich 25c. Did 1st act then had a Larabar 26c. That's a total carb count of 216c for 2 pills.
7:22 -> 74 Wow, impressive how low that is. Took 2 Prandin with beans 67c, chorizo 13c, quinoa 30c, brussels sprouts 20c, chips 20c, blueberries 20c, yam 60c, squash w/ tahini 4c. 234c for 2 pills.
10:03 -> 244 Dang it, I let my appetite get the best of me. If 216 carbs over 8 hours kept me stable with two pills, what made me think that 234 carbs would balance out 2 pills in one sitting. I'm an idiot.
1:00 -> 208 At least I'm heading down (I hope I didn't peak higher between these two numbers, though I probably did). It will be very curious to see what number I wake up at.

Gratitudes:
1. Medical insurance sent me a check, paltry but helpful.
2. My sis arrived in town.
3. Despite some shoulder irritation I completed a very enjoyable performance of Joey.

Day 75

Long Term Complications of Diabetes

Since I switched from thrice daily injections of Bolus insulin in the form of a Novolog pen to .5 mg doses of Prandin I have lost a degree of blood glucose control. For almost two weeks leading up to the switch I had managed to keep my blood glucose under 200 with few lows. It seemed that my average number would have been somewhere in the high 120s to the low 140s. The rules of the game had been set, and I had been able to take down enough data to conclude with precision how many units of insulin would offset a number of carbohydrates. If my pre-meal check was a little high or a little low I could modify the number of carbohydrates to end up where I wanted to a few hours later. The insulin reacted immediately, and if I injected properly and into a good site on my body the results were predictable. But that was synthetic insulin, bio-engineered in a factory somewhere, it was not mine.

Prandin is a pharmaceutical that activates the production of insulin by your pancreas and comes in different strengths from .5 to 4 mg per meal. I was started at .5 mg because of my active lifestyle and regular hypoglycemic spells. After the first pill it was clear that my body was responding positively to the drug since my blood sugar stayed level despite an intake of over 100 carbohydrates. However as the days progressed it became clear that Prandin did not work as mathematically as synthetic insulin. One day a pill metabolized 110 carbohydrates and left me stable, another time two pills were insufficient to metabolize 180 carbs and left me 100 points higher than I began. Another shortfall is the rate at which it stabilizes your blood glucose. With synthetic insulin I knew it would activate within 15 minutes and lose the majority of its potency in three hours. With Prandin it seems that the affects can be seen several hours later, and often don't effect blood sugar levels until almost an hour after being consumed.

The bottom line is that with Prandin I have lost confidence in my ability to adequately regulate my blood glucose levels and I wonder if the advantages gained by taking a drug that encourages your own insulin productions are favorable to taking synthetic insulin that offers you a stricter degree of control. Common sense may forgo sticking bits of metal into your skin and injecting something foreign if you can avoid it, especially if the thing your injecting can be produced naturally. However, common sense probably knows little of the A1C tests administered quarterly to well-monitored diabetics.

The A1C measures your average blood glucose over the past 90 days in the form of a percentage. This percentage roughly corresponds to the kind of numbers we're used to seeing on a glucometer. Here are some numbers presented by About.com:

A1c (%) to eAG (mg/dl)
6.0% = 126 mg/dl
6.5% = 140 mg/dl
7.0% = 154 mg/dl
7.5% = 169 mg/dl
8.0% = 183 mg/dl
8.5% = 197 mg/dl
9.0% = 212 mg/dl
9.5% = 226 mg/dl
10.0% = 240 mg/dl

Notice the pattern? For every half percent the eAG goes up 14 points (15 for every third). When I was diagnosed I had a A1C of a little over 13% and so following the pattern I extended the chart.

10.5% = 255 mg/dl
11.0% = 269 mg/dl
11.5% = 283 mg/dl
12.0% = 298 mg/dl
12.5% = 312 mg/dl
13.0% = 326 mg/dl

Three hundred and twenty six miligrams per decaliter! Holy hell! I was in some serious trouble. Why? Because A1C is one of the best indicators available to show your predisposition towards diabetes related complications. Wanna live with diabetes for 100 years and die of old age at home in your sleep? Keep your A1C under 6%. Wanna slowly watch your health deteriorate until you're on your deathbed at 40? Let your A1C live in the 9s and above. I'm not being hyperbolic. Look at the following chart taken from the Bayer website:



Let me translate. As your A1C grows incrementally your chance of developing diabetes related complication increases exponentially! And if you're not worried about contracting some disease with a long Greek name let me break it down.

Retinopathy is damage to the retina which can lead to blindness (and you'd better believe it will if you don't get it under control). "Almost everyone who has had diabetes for more than 30 years will show signs of diabetic retinopathy"

Nephropathy is damage to your kidneys which is usually not reversible and instead leads to dialysis, a procedure that is considered a temporary solution until a kidney transplant is available. "Diabetic kidney disease is a major cause of sickness and death in people with diabetes."

Neuropathy is damage to the nerves which can lead to a whole host of bigger problems from amputations to heart attack. "About half of people with diabetes will develop nerve damage."

Can you see now why it's so important to keep your A1C in check? Keep it under 6, live forever. Keep in under 7, live a long healthy life. Over 7? I don't want to find out.

Dailies:

11:10 -> 133 Alright, this number isn't so bad, but after the lowest post dinner number I'd yet had on Prandin last night I was hoping for lower. I took 2 Prandin with cereal 110c, banana 25c, and a piece of toast 25c = 160c.
1:52 -> 196 That seems unjustifiably high. Should I have taken 3 Prandin? Would it have helped? Three hours since taking the pills I should have leveled off a bit more than that.
5:37 -> 80 Wow, finally a good number, but what explains the drop from before. Could my Lantus have caused the drop, or simply a late reacting Prandin? Took 1 pill with Dinner: wild boar burger 35c and fries (7oz) 80c = 115c.
11:58 -> 113 Alright, that's another pretty good number. Took 5 units of Lantus and one Prandin with Supper: Salad w/avocado 32c, snow peas 12c, carrots 14c, celery 12c, peanut butter 6c, tahini 6c = 82c.
2:44 -> 172 Again, I seem to be higher than I should be at night.

Thoughts: All in all the numbers weren't too bad. I stayed below 200 (just) and my lowest was 80 which is a perfect number. Oddly enough an 80:1 ratio didn't seem to work for breakfast or supper but was more than enough for dinner... or was it? Does Prandin just work slower than synthetic insulin? A good indicator will be my number tomorrow because I had a relatively low fat supper so most of the sugars should have already been released. If Prandin works slowly I'd expect my number tomorrow morning to be low.

Tomorrow I think I'll also call the doctor and see if there are any adverse side affects to taking multiple pills of Prandin per meal because, to be perfectly frank, I often am hungrier than is reflected by my meals. I can't always stick to 80 carb dinners and have been known to eat upwards of 250 carbs at dinner. How many mg of Prandin would it take to offset that?

Day 57