No More Veganism

This has been a very eventful week regarding my health.

HYPOTHYROIDISM
The tempest began with a visit to my favorite endocrinologist who told me my thyroid has more or less failed and therefore prescribed a daily dose of thyroid hormone to take orally every morning. We guessed on the dosage, she said she could start me super low (.25) but was pretty sure I'd eventually need more (.5 or .75). I told her she might as well give me the bigger dose already (bigger relatively, some people take up to 3mg I think) and so I've started on .5mg of Levothyroxine every morning. As she suspected taking this pill had pretty visible affects in my energy and mood. I found myself able to survive a whole day of rehearsals and shows without the usual moodiness, at least for the first day or two. By the third day, however, I found myself feeling a bit dodgy again. I'd find myself getting lightheaded whenever I stood up too fast, my muscles felt achy just from climbing stairs, I felt weak and then late at night I started feeling very nauseous, which is a sign of...

ADDISON'S DISEASE
My endocrinologist warned me that taking the thyroid pill, though necessary, may speed up the progression of the Addison's disease which has been present in each of the blood tests I've done over the last several months. Up until now, however, my adrenal function has remained fairly normal considering the insane amount of antibodies present in my blood. But inexplicable nausea (especially considering my blood sugar was fine) was a big red flag for me. She said if I experienced any such symptoms to immediately take an oral hydrocortisone pill. I did, and almost immediately my nausea went away and my energy returned in force (along with an abundantly good mood I left somewhere in last September).

 (did you know that when you have both Hashimoto Thyroiditis and Addison's disease it's called Schmidt syndrome?)

What does this have to do with veganism???

Well, to quote wikipedia:

"To form cortisol, the adrenal gland requires cholesterol."  

Cholesterol comes from animal products. My adrenal gland isn't dead, it's just not working very well, and I'm not helping it by starving it to death.

"You need to start eating meat again."
"Okay."

So my 40 or so days of veganism has come to an end. I've had fish thrice, yogurt twice, and a half a chicken since the appointment (the chicken made me a bit ill). I won't forget what I learned though... although I may save it for another post.

The past few days:

April 10, 2012 - First day of Thyroid pills
9:30 -> 142 Way to f***ing high! Took 2P and 2N w/cereal 140c, chips 10c, banana 27c. Took thyroid pill at 1:00. At 3:00 had Larabar 26c.
4:34 -> 108 Had apple then went on 2 mile run (knee hurt) then took 4P w/ CHIPOTLE burrito bowl 110c.
6:54 -> 112 This is good! It means the Prandin is still doing something despite my C-Peptite being at an all time low of .48 during my most recent blood test. At 8:30 had grapefruit 25c and peanuts 5c.
10:55 -> 66 Took 1P and 2N w/greens 18c, squash 30c, salad 30c, yams 90c and Juice 24c.
3:42 -> 186 Poor planning of my meal, I drank the juice because I felt low because the yams hadn't finished cooking yet. Took 5L.

April 11, 2012
11:06 -> 100 Better. Took 2P and 1N w/cereal 140c, pb toast 19c.
4:52 -> 63 Took 4P w/ Black Eyed Peas and kale 180c, then apple 18c, kiwi 10c, pumpkin seeds and peanuts 8c. At 9:30 had apple 18c.
12:25 -> 63 Took 3N w/salad 30c, squash 40c, yams 60c, carrots 30c, potato 40c and just about exploded from a stupid amount of starchy foods.
4:00 -> 140 Took 5L.

April 12, 2012 - First day of Hydrocortizone
10:37 -> 95 Took 2P and 1N w/cereal 140c, apple 18c. At 2:30 had Larabar 331c and grapefruit 24c.
5:17 -> 70 Took 3P w/brussels sprouts 18c, rice 40c, fish, apple 18c, peanuts and pumpkin seeds 10c, apple 18c and kiwi 20c.
12:15 -> 89 Feel weak and nauseous, took a hydrocortizone and 2N w/dumplings 100c, b sprouts 25c and salad 20c.
5:45 -> 102 (don't judge me) Took 5L w/carrot 8c.

April 13, 2012
12:35 -> 98 Good, consistent. One more # like this and I'll go up to 6L at night. Took 2P w/cereal 130c, then apple 18c then kiwi 10c.
4:55 -> 72 Took 1P w/PUR-BIRD 1/2 chicken 5c and roasted cauliflower 15c, pb and banana 58c and two homemade gluten free bacon bourbon chocolate chip cookies 37c.
12:25 -> 89 Took 1P and 1N w/ indian veg 20c, quinoa 60c and kale 6c.
2:25 -> 114 Pretty dang good, had a carrot 8c and took 5L.

Day 115

Rollercoaster

Today was lame.

My blood glucose level can be so temperamental. My first 2 Prandin took care of 180 carbs and then some. My second 2 Prandin knocked out 260 carbs easily and left me low. But the final 2 Prandin couldn't work their way through 196 carbs without giving me a major spike. Hence, lame.

Dailies:

11:20 -> 108 Took 2 Prandin with cereal 110c then an amazing farmer's market cameo apple 25c, snap peas with peanuts 5c. At intermission a small pb&j 18c and a fuji apple 22c.
4:54 -> 88 Took 2 Prandin with dinner: cabbage and squash 50c, lentils 35c, quinoa 60c, salad 15c and hummus 15c, also second cameo apple 28c. Before the show at 8:00 I had a cookie 10c.
10:13 -> 47 I was feeling low during act 2 so I checked my blood glucose before going on stage for the epic marathon that is the final few scenes of WarHorse as Joey. My blood sugar was 47. I had a Gu packet 25c and barely remember the next 20 minutes. At 11:20 I was beginning to feel low again and so I had a Larabar 26c.
12:02 -> 60 Had an Amy's frozen Gluten Free Vegan pizza 102c (I was tired from a long day of shows and lows, so I realize this isn't the healthiest option) and to avoid any further lows also had some curried chickpeas 54c with what I originally thought was 40c worth of quinoa. Turns out it was 60c. So I overshot by 20c.
3:04 -> 242 Looks like I paid for those extra twenty carbs. Without them I'd probably be in shooting range of 180 which would have been happier. Oh well, I don't mind a bit of hyper after so much hypo.

I really do think that without that mistake of counting the carbs I would have been in a pretty good range so there aren't any real lessons to be learned here. I am going to make a note of the fact that my afternoon Prandin seemed so much more effective than my morning and evening doses. I'll see if that's consistent and adjust accordingly.

Why do I have a feeling despite the ups and downs I'll wake up tomorrow between 80-120?

Gratitudes:
1. Daylight savings means more sun starting tomorrow.
2. I didn't pass out during "Joey's Night."
3. The most delicious apples I've had in a long, long time.

Day 81

No Insulin Experiment

"This is my quest, to follow that star, no matter how hopeless, no matter how far."
~ Don Quixote in Man of La Mancha

The results are in and I am pleased to say that I survived my first synthetic insulin free day since December 19, 2011. Does anybody else find this as insanely awesome as I do? What a freakin' journey. I went to the doctor with all the classic symptoms of diabetes. I had an A1C of 13, a blood sugar level of 569, a C Peptide level of .55. In common English that translates to "YOU HAVE DIABETES DUDE!" This to me was an unbeatable disease, that's what everybody said. But in those early days I forgot a very powerful truth.

Unbeatable is not the same as unfightable.

I am very very lucky right now. My doctor has said it before and I've realized it many times since. I'm lucky. I've reversed every number that I just listed. My A1C continues to drop, and if I continue on my current trajectory I hope to get back an A1C under 7 when I get blood work done next week. My blood glucose was 67 last I checked and my C Peptide is 1.65, back in the healthy range.

Now, just because I've stopped taking insulin doesn't mean my Diabetes is in remission or anything like that. I'm still on 6 pills a day. I suffer lows an highs on a daily basis. But remember this:

A diagnosis is not a death sentence.

There are two ways to deal with being diagnosed with any type of Diabetes. You can bend over and allow Western medicine and western doctors to make a statistic out of you, or you can do everything in your power to maintain as close to normal health as possible. Make changes. Be an outlier. And keep up the good fight!

Dailies:

10:43 -> 89 This is my first fasting sugar level after not taking basal insulin. Took 2 Prandin with cereal 110c. At 1:30 had strawberries 30c. At 2:00 had 2 mandarin oranges 17c. At 3:30 had blueberries and nuts 10c. At 4:30 had an apple 25c in anticipation of a workout. Ran with sprints, about 4 miles.
5:30 -> 75 Took 2 Prandin with dinner: lentil soup with rice 100c and salad 30c and 2 mandarin oranges 17c. At 8 had strawberries 30 and fake coffee 4c. At 9:30 had an apple 15c, a cookie 10c and my last orange 9c.
12:31 -> 67 Took 2 Prandin with supper: red cabbage and squash 100c (that's a LOT of cabbage) and beans 57c and quinoa 30c.
3:26 -> 182 I'm not unhappy with this number. A little high, sure, but not so high, and since it's three hours since my last pills I'd guess this number is heading down. Will be interesting to see my morning number on what will be Day 2 of the experiment!

Gratitudes:
1. I held my blood sugar under 200 on my first day off insulin.
2. I felt compelled to periodically sprint during my run today.
3. The sun was out and the sky was clear. Spring is almost here.

Doc told me last time I saw her that she wanted my body to "cool down" which was the reason for ditching the Gluten and for ramping up the vitamins. Well, I'd say my body's pretty cool right now.

Day 78

Hypoglycemia Alert!

I was there on the streets of New York, walking briskly, everything looked gray. I think I was somewhere near Chinatown, although I do sorta remember passing a church that I thought was further north. My sister was walking with me and trying to explain to me about a revelation of sorts she had had. She was beginning to practice honing in on skills she had, interpersonal skills, or perhaps better explained as psychic skills. She would walk down the street without gloves and try to touch the skin of passerbys and see if she could absorb some element of them, pick up on their state or something like that.

Whatever it was I'm not entirely sure because I couldn't stop thinking about how dang slow she was walking. Here I was trying to get somewhere in a hurry and she was dawdling, always dawdling. I think I grabbed her hand at some point and walked faster, but it was as if we couldn't even get to the corner. No matter how fast I tried to walk we didn't get any closer to our destination. I was panicking and I could feel myself sweating, I looked down at my hands and couldn't even see them. I turned around and my sister had vanished, in fact, New York had vanished and was replaced with darkness. Darkness and warmth and sweat and panic.

I threw my covers off and sat up in bed. My pulse was racing. Just a bad dream? I put two fingers to my neck and tried controlling my breathing. It did nothing. I found my glucometer. Pricked my finger, squeezed out a bead of blood, watched as the strip sucked it into the computer and waited five seconds...

It wasn't the lowest I've ever had, but it was certainly the lowest I've ever had in the middle of the night. In fact, this was the first time I've had to wake up in the middle of the night to check my blood sugar. That in itself is a pretty frightening thought. I ran to the fridge trying to think of something to eat and then reassessed and decided to go with quick sugar and had a whole juice box 24c. Thirty minutes later I had raised 43 points to the safe level of 93. I had a mandarin orange 9c and went back to sleep.

Here's why this is peculiar/frustrating/confusing news. I took my last pills of the night at about 7:30pm. Five and a half hours later when I went to bed, my blood sugar was 208. And yet, three and a half hours later I had dropped to 50? What gives? What was still working? I had eaten a massive 230 carbs with two pills. It's hard to imagine that the Prandin was still persuading my pancreas to work overtime. What then? Was it the 5 units of nightly Lantus I've been taking every single night since mid-December?

More importantly what am I going to do about it? Well, for starters tonight I'm going to compensate for any possible late night lows by eating the equivalent of a juice box and mandarin orange right before bed, 33 carbs, you don't have to ask me twice. Then I'm going to check my morning number. If it's pretty low again I'm going to call my Dr. and ask her recommendation and see if I can't decrease my insulin dose.

Dailies:

4:47 am -> 50 Had a juice box 24c.
5:15 -> 93 Much better. Had a mandarin orange 9c.
(morning)
11:03 -> 86 Took 2 Prandin with V cereal 110c. At 1:24 had an apple 20c. At 2:30 had 3 oranges 27c. At 3:30 had 1/2 a VG donut 24c.
5:08 -> 111 Took 2 Prandin with SOUEN RESTAURANT bowl of white sesame ramen 55c and corn bread 45c (which I was possibly misinformed about its gluten content). At 8:00 I had snap peas 6c and 2 oranges 17c.
11:39 -> 69 Took 2 Prandin with salad 20c, fake coffee 6c, 1 cup wild rice 35c, 2 cups lentil soup 60c = 120c. Took 5 units of Lantus.
2:12 -> 131 Not a bad number, however, to avoid a nighttime low I'm going to have another cup of soup 30c with 1/4 cup rice, 9c = 39c. And Bedtime.

Gratitudes:
1. Katy Pfaffl's voice.
2. The existence of an amazingly delicious Gluten Free Ramen restaurant in New York City.
3. Benedict Cumberbatch and the BBC series Sherlock.

Day 76

Identity Crisis - Part 2

Not Knowing Who I Am...

What kind of Diabetic am I?

I was lost in a book today - as I'm prone to be found these days - about health and nutrition in America and the causes of Western Diseases aka Diseases of Affluence (Coronary Heart Disease, Cancer, Diabetes) and I came across a statistic that I've seen many times in the last few months: between 85-90% of diabetics are type 2, the other 10-15% are type 1. Okay, simple enough, I'm diabetic so I must be type...

What are my choices again?

Type 1: Insulin dependent. Diagnosis depends on symptoms and a one time random blood glucose reading that is high. Well, I had symptoms polyurea (peeing), polydipsia (thirst), weight loss, etc. AND when I went in for blood work my blood glucose was 569. My A1C (average blood sugar level) was in the 13s and my C-Peptite was .5. Simple enough, I'm Type 1.

But wait a second. After switching to a gluten free diet and starting a vitamin supplementation program I've gone from 30 units of insulin per day down to 5. My C Peptide has popped back up to 1.6 and now I only need .5-1 mg of Prandin per meal to maintain glucose control. Prandin doesn't work on Type 1 Diabetics so I must be Type 2...

But wait a second. Type 2s usually are accompanied by weight gain, show gradual increases in blood sugar (not 569) and have abnormally high C Peptide numbers because they're insulin resistant. In other words they produce a lot of insulin but their body doesn't use it well. That's not me either, If I inject one unit of insulin it's going to eat up everything in my body and make me crash - hard.

So what type am I? Type 1.5? Come on, now I feel like you're just making it up. Try telling your friends, or even your doctor for that matter, that your a type 1.5 diabetic. They won't know what you're talking about. And what am I supposed to get on this medical bracelet that supposedly I should wear forever... type 1.5? People who find me passed out will think I'm part of a hidden camera show. I feel like "type 1.5" is a name they gave to diabetic anomalies to keep them from asking difficult questions. As if by giving it a name it's totally under control. "Oh that? That's just type 1.5 diabetes... nothing weird there!" Insert salesman smile as they hand you the bill for the "diagnosis."

And what's worse?

There is basically NO information about Type 1.5. Take this quote for example from Diabetes Forecast magazine: "As of now, there is still a lot of uncertainty over how exactly to define LADA (Type 1.5), how it develops, and how important it is for patients to know if they have it."

How important it is for patients to know if they have it? What the hell is that supposed to mean?

From everything I've read I feel like there's a window of opportunity here. That Type 1.5 is some sort of pre-Type 1. It's the first sign of an inevitable progression to being fully insulin dependent. It's like one of those narrow escape scenes from the movies. There's a door in the distance that is slowly closing. Most doctors say, "nah, forget it, just stay in here, once the doors are closed you'll get used to it quickly, you'll adapt, it's better that way." And there I am I'm sprinting towards the door, but I don't know what to do if I get there. Do I run through? Can I run through? Can I prop the door open? How? IS THERE ANYTHING I CAN DO??


Dailies:

11:11 -> 81 Took 2 Prandin w/ v cereal 110c. At 1:30 had vitamins and apple 20c. Banana 27c at 3:30. Total 157c
4:56 -> 78 Took 3 Prandin w/kidney beans and quinoa 83c, yam 75c, salad 30c, grapefruit 30c and fake coffee 5c. Total 223c.
10:40 -> 56 Felt low. Had a Larabar 26c.
11:55 -> 59 Geez! No bueno! Had quinoa 60c, peas 17c, indian eggplant 26c = 103c with 1 Prandin. Took 5 units of Lantus.
2:50 -> 132 Lower than I expected, and lower than I feel comfortable going to sleep. Had celery with peanut butter 15c and blueberries 20c.

Gratitudes:
1. A beautiful sunset.
2. The energy and desire to workout on the river at sunset.
3. Unsweetened Baker's chocolate.

Day 74

Gluten Free Beers

I'm beat. A two show day and a mid-day workout of 10 quick sprints up a three story flight of stairs. So here's a quick round-up of a few beers I've had. All of them surprised me, in a good way. I'm also pleased to announce that there is some diversity between them so I'll start keeping them all on stock if such an opportunity arises.

GLUTEN FREE BEER!!!

Bard's Beer - Bards was a good place to start. I entered with very low expectations and yet it's cold crisp and pleasantly hoppy taste resurrected my faith in a benevolent God. This is beer, gluten free beer. There was a slight metalic taste and the aftertaste reminded me of my college red cup days, but it will suffice in a pinch and is worth the adolescent memories for the first few sweet sips. My life will not be beerless, just no more beers at bars. That's like going to the dentist expecting root canal and finding out it's just a cavity. It's a beer I'll drink if it's handed to me.

Greens - This is the closest I'll get to the Trappist Ales I've had to cut out of my diet. It is Belgian made which automatically makes it the best gluten free brewery in the world. It is the most expensive (to be expected) but has incredible depth, high alcohol content, and a robust sweetness that only comes from a Dubbel style beer. This is the cadillac of gluten free beers, best enjoyed cold, slowly, in a proper mug with a plate of strong cheese, gluten free bread, and a steaming pot of mussels.

New Grist - This beer was [very] light, crisp with a bit of a syrupy aftertaste. This will be the beer to fill those endless warm summer nights outside listening to the cicadas and crickets, or sailing down the coast of California, waves tickling my bare feet that hang over the deck, sun bleaching my saltwind swept hair. I guess what I'm trying to say is, though it's no wheat beer, it is similar enough in flavor quality to a Blue Moon to be my go to when I'm hankerin' for a fruity beer that is still masculine.

Redbridge - Of the four, Redbridge is the best all purpose beer. I'd be equally comfortable drinking this out of a tall and sexy glass at a Vegas club (although why would I be there?), or straight from the bottle at a monster truck rally. This is the beer for poker night, for drinking with a burger, for camping trips and tailgate parties, or for washing down the body aches of a long day working with your hands building a deck, or mending a fence or painting a house. It's gluten-free America in a bottle. Tastes like freedom.



Dailies:

12:00 -> 116 Took 2 Prandin with cereal 110c. At 1:00 apple 20c. At 2:00 had pb toast 15c and fake coffee 10c.
5:45 -> 68 After a few sprints up some stairs. Took 2 Prandin with 32 oz of chili 100-120c? At 8:00 had an apple 20c and quiche 35c. At 10:45 had half a beer.
12:01 -> 64 Based on this number I'd guess the chili was closer to 100c. Had a huge salad w/avocado 35c and chicken. Took my 5 units of Lantus.
2:45 -> 87 I'm going to sleep on this number. I'll keep sugar nearby, but honestly I imagine this to be slowly creeping up. I'll probably wake at 100.

Thoughts: I think the key to using Prandin successfully for me is understanding that it's affect on me is slow. Two of my pre-meal numbers were in the 60s and yet both times I didn't panic at all, felt no low affects and ate shortly afterwards. Those are not 60s that are dropping fast, but simply a reflection of a pancreas that is slowly ticking away and dealing with my obscene amount of food. One day soon I'll probably do a few 2-hour after my meal checks to make sure I'm not having any huge spikes as I was in the early days of Prandin.

Day 68

The City of Unlimited Choices

Today was rough. Not diabetically, not physically, in fact for no reason related to my condition at all. I had a crappy day at work. It happens, we've all been there, I'll live to see another day.

But a bad work day coupled with more wind and rain than we've had in months gave me a positively negative demeanor. And then I passed this...

Choco Bolo

The sign in the window advertised Chocolate, Cake and Coffee.

Chocolate, Cake and Coffee!

CHOCOLATE, CAKE AND COFFEE!!??

I can't have chocolate because I'm Diabetic. I can't have Cake because I'm Gluten Free. And I can't have coffee, because I gave it up for Lent!! AAAHHhGGGGHHhhH!!!

Sometimes I feel as discriminated against as a black man in rural 1950s Alabama. They're all inside there looking so happy, eating away at their eclairs and viennese tortes, sipping their mocha lattes and macchiatos and mayan sipping chocolate, oblivious to the amount of carbohydrates in each, blind to how hard their pancreases are working, to the caffeine that's running through their bodies artificially spiking their heart rate and adrenal production. Oh I envy you coffee drinking chocolate cake eating affluent kept women of the upper west side with your double decker MacLaren strollers and your dogs with cute sweaters, and your Chanel bags and your precocious little children.

I hope you feel a particularly intense burn of lactic acid when you're at your group pilates class at David Barton's gym. I hope your gyrotonics instructor dropped his shot of wheat grass on his way to work and takes it out on you. So there!

Breath,

breath,

breath...

Phew...

Sometimes, you just need a good shouting session. A time and place to vent and the freedom to do so. It's not always easy, living in the city of a thousand choices with so many restriction on you. It's not easy getting the stink eye from cocktail waiters who, while collecting used beer bottles, realize the Gluten Free bottle didn't come from their bar. But what's not easy is hard (I swear. Look it up in the dictionary if you don't believe me). And doing things that are hard make you stronger.

I'll be strong if you will.

Dailies:

11:23 -> 78 Took 2 Prandin w/cereal 110c and an orange 17c. At 2:15 had toast w/pb 15c. At 3:15 had Larabar 15c.
6:00 -> 89 Took 2 Prandin with Chipotle 110c, apple 20c, peanuts 6c and face coffee 10c.
11:20 -> 102 Took 1 Prandin with dinner: brussels sprouts 18c, salad 20c, apple 20c. Took 5 units of Lantus at about 1:00.
2:15 -> 74 pbgft (peanut butter gluten free toast) 15c. Bed

Day 66

Hour of Power

I swear, sometimes I only workout because I know that at the end of the day I'll have something to write about. I dread a blank screen more than I dread a painful training session and so I give myself a minute to decide what sort of workout is best and then I just do it. I wonder if that's the best thing that comes of writing this blog. But if so, then this blog is successful indeed. They call that something, don't they? Doing something not of your own accord but for somebody or something else. They do - they call it accountability.

Who or what are you accountable to? We all have things we could do better. If you're a Type 1.5 diabetic like me, maybe your A1C lives near the 8% mark and you want to get it lower. Maybe you're a type 2 and your goal is weight loss. Or you've taken on the Gluten Free Challenge and find yourself faltering, standing in the aisles at the grocery store with a hand on a box of mac and cheese, or in line at a sandwich shop. Maybe you're training for a competition, or just working towards your own personal goal. Are you a creative type who keeps resolving to start that novel, or finish that screenplay?

Everywhere I look I see people with wonderful wonderful goals. One friend wants to learn Portuguese so he can go to Brazil for the world cup. Another wants to save enough money to buy a house. One has aspirations to be a great banjo player. But goals are cheap. They are. It's a beautiful word that belongs somewhere near maybe or could in the dictionary.

I wrote a bit about willpower yesterday. But today I want you to think about what role accountability can play in fortifying your willpower. And when you're done thinking about it, choose one of your goals (preferably one that is attainable in the near-term, say a month or two) and find a way to hold yourself accountable. Make a pledge to someone who will check in on you and monitor your progress.

So what's an hour of power anyway?

Well, it's a very unoriginal name for sitting on an ergometer...

...and pulling you're butt off...

...for an hour.

It hurts. It's long. It's boring. BUT...




When you finish you realize you've just rowed 9.5 miles, a solid hour, burned over 1000 calories and you know that you are stronger and healthier than you were before. And what's more, you've built your self-confidence and strengthened your resolve. Next time will be easier and easier still until you'll have to make the workout harder to keep up with your progress.

But for those of you who read this only for the fitness aspect, yes, I realize that I've done two epic cardio workouts in one week. I had to do it to prove to myself that I could. It was mental training. Did I have what it would take to push through a distance. I answered that question. My question for next week is, how much intense pain can I suffer in the short term. In other words, sprints, and things like sprints, and lots of them.

Dailies:

12:17 -> 120 Seems a peculiar number. had 2 Prandin w/cereal 110c. Rowed a POWER HOUR! Had an orange 16c and salad w/quinoa 45c and chicken.
5:37 -> 77 Took a Prandin with chicken, quinoa 40c, indian eggplant 26c, orange 16c. Did Joey. At 9:30 had pb toast 15c, protein shake 5c and fake coffee 8c. At 10:45 had a shot of tequila, beer and Larabar 26c. Took 5 units Lantus at 1:50
2:40 -> 74 Don't feel like taking meds and waiting, so I just had baby zucchini 12c w/ tahini 5c.

Day 65

Gluten Free Support

Hello GFers,

How was your first day? I still remember mine. It was as if suddenly, by being forbidden to eat gluten it was the only thing I wanted. I swear I would have had pizza for breakfast, pasta for lunch and beer for dinner. What was more desirable than the gluten itself, however, was the thought of breaking the rules.

So I'll offer you this quote to help you on your journey:

"It's not that some people have willpower and some don't. It's that some people are ready to change and others are not."
- J. Gordon

Are you ready to change?

Dailies:
11:15 -> 77 Wow, lowest morning number I've had in a long time. I think that's a good sign. It's also the most sleep I've had in awhile... correlation? Took 2 Prandin w/cereal 110, orange 16c, blueberries 20c and 1/2 larabar 14c = 160c spread over three hours.
5:09 -> 97 Good number. Took a Prandin with dinner: Chicken and veg 30c, quinoa 30c. Later a Larabar 31c and peanuts 5c.
7:57 -> 141 Good. I was a bit hungry, but I guess I'll wait.
12:21 -> 59 Okay, low. Not crashing low, but slowly lowering because I have a semi-functional pancreas. I didn't worry and just had a low-carb dinner without Prandin: Salad 30c, chicken.
2:45 -> 99 That's a 40 point raise 2.5 hours later with a meal that had lots of protein and some fat (avocado, olive oil) so that number is probably rising slowly. I'll sleep on this number.

Day 64

The Gluten Free Challenge

It was in Turkey back in September of 2009 that I really understood for the first time the purpose of giving something up for Lent. It does not feel so long ago that I was there, wandering the stalls of the Istanbul spice market, feasting on river fish, fresh figs, walnuts crushed with honey and cheese, sipping their dark and syrupy tea in a glass delicately held between my two fingers. A few days later I was on my own in the small seaside town of Amasrat, where I could sprawl on great sun baked rocks and watch the locals exchange village gossip or sit themselves in the shade of the cliffs. But it wasn't until I went to Bolu, a large but unimportant town in central Turkey that the meaning became clear.

Let me start by explaining that there is nothing in Bolu. It is a very dull place unless you are being hosted, which I suppose I was. He met me at the local park, spotting me easily, a tall blonde man made whiter by the goopy thick sunscreen I bought from the nearest convenient store. I've since forgotten his name but he was a slight man, short, dressed in a short sleeved collard button up one size to big tucked into his khaki shorts which were cinched tightly in an effort to give him the waist his God overlooked. When we met he was tired and irritable, nursing a headache and fatigue, but he put his physical troubles aside and took me to a local favorite spot of his for some food. I ordered two sandwiches and some exotic pastries before it dawned on me that he was a very religious man.

September of 2009 was Ramadan, a time of year when Muslims eat only when the sun is down. If you're thinking, "hey, I could just become nocturnal for the month" then you're just where I was two years ago. But even if you did choose to spend your Ramadan sleeping during the day and dining in the dark, which wouldn't be so fun after a few days, you'd be missing the point. As it was explained to me by my Turkish host, the point is to experience life, if only while the sun is up, as the poor and hungry do. He had been fasting since 5am, no food, no water and it was nearly sun down and still in the mid 80s. To feel, actually feel the hunger and the thirst is to understand better their lives. There is no better foundation for compassion than this shared experience.

That night when the sun finally went down he met with friends around a table sagging under the weight of the food. It was a buffet set for kings and as they filled themselves with all the bounty of the very generous Turkish land I saw them come to life again, enjoying food as you never can when it's always there. They had gained an appreciation for the gift of nourishment.

It's not Ramadan, and I'm not Muslim. But tomorrow is Ash Wednesday which means the beginning of Lent. I don't think I've successfully given something up for Lent in years, or even decades. Partially this was due to laziness (I couldn't think of anything big enough not to feel guilty but small enough not to really change my day to day life), partially this was due to a lack of motivation. I asked myself, "what's the point? Why should I give up chocolate... beer... ice cream? What will that teach me?" But those questions are selfish.

And so I come to my challenge for you.



I challenge you, the readers of this blog to learn what it is to be afflicted by gluten free living, to walk for a month in the footsteps of Celiacs and others with dietary restrictions around the world. Feel the small burden of our daily restrictions and sacrifices and know that no matter how annoying it may get, some day your inconvenience will end, but ours is for life.

I welcome you to share your experiences as comments on this post. What was the hardest thing to give up? What did you crave the most? What new foods did you learn to love? How did you find eating at restaurants? Would you be able to make the switch if you had to? I hope we all grow from the experience.

Dailies:

10:33 -> 116 Higher than I've been in the morning, I blame my late night. Took 2 Prandin w/Breakfast: Cereal 110c, banana 25c. At 1:00 had an orange 20c.
3:10 -> 108 Took 1 Prandin with Lunch: 1/2 rotisserie chicken, plantains 70c, salad 5c. At 5:00 had 1/4 protein bar 6c, peanuts 6c, 1/2 orange 10c and teeccino 7c. At 8:30 had peanuts 7c and 1/2 orange 10c.
10:48 -> 79 Took 2 Prandin with Dinner: Salad w/quinoa 60c, asparagus with onions 30c, bagel 26c, banana 26c, peanut butter 8c = 150c.
1:54 -> 256 Felt high, was high. The bagel was too much which is too bad. It was really really delicious. I'm sure I'll drop into range by tomorrow as the Lantus and Prandin continue to work.

Lessons:
1. Don't overshoot it late at night, it's easier to correct a low at night than a high.
2. If you aren't very active during the day expect your ratio to be smaller than usual. Afer the run I was almost 240c:2 pills. Today 150c:2 pills is too high.
3. If you don't sleep long enough you tend to run a little less efficient which can lead to highs.

As for me, since I'm already gluten free, I'm giving up caffeine.

Day 63

Bareburger: Review

Bareburger, Multiple Locations, http://www.bareburger.com/

With an interior reminiscent of the Splash Mountain ride at DisneyLand and amusement park prices I was a bit skeptical when I first visited Bareburger. Several of my colleagues had recommended it, but they were the types who wore flashy wristwatches and go to driving ranges and own recreational vehicles--affluent adults. Our buxom host greeted us with an accent (serbian) and in classic eastern european style corralled us into one of their booths without ever betraying her desire to be somewhere else. The heavy lacquered mid-section of a tree in front of us matched the paper mache busts of bears and was dressed with condiments befitting a boutique hamburger shop.

The menu has ample selections in all the diner categories: burgers, sandwiches, side dishes, milkshakes, etc. But what sets this place apart is their attention to quality ingredients. All their hamburger beef comes from grass-fed cows, along with their milk and cheeses. Their lamb, bison, elk and wild boar are pasture raised. The chicken, turkey and ostrich are free range. Vegetables are entirely organic. And they offer a gluten free bun option! They care about food and the planet, and it shows.

The first time I went I was steered towards getting the California Burger a clean and hearty sandwich of cheddar, avocado, lettuce, tomato, onion and your choice of meat--my server suggested ostrich. The 6oz patties makes for a manageable sandwich that fills you up without giving you the meat sweats. The burger arrived shortly, cooked rare and stacked high with the bright colors of a California summer bursting from beneath the top bun. It was juicy and fresh tasting, maybe too fresh, I felt robbed a little of the dark savory flavors I associate with a "dirtier" burger. On my next visit I felt similarly about the Canadian Burger with swiss, fried onions, bourbon sauteed mushrooms and two kinds of bacon on an Elk patty. You would think the sandwich would have exploded with the salty smokiness of bacon on the cracklingly sweet onions, with a quick stab of sharpness from the swiss and a lingering muskiness from the bourbon. They were all there, but... underwhelming. I wanted more flavor from the meat, a more careless salting hand perhaps, or a more seasoned grill, but the depth in the meat was lacking. The burger was not bad, but didn't seem worth the $15 price tag. I did better with a lamb patty in the Mediterranean burger, essentially a Bareburger take on a gyro. And the Maui Wowie, a decadent stack of pineapple, bacon, fried onions and smoked mozarella atop a wild boar patty that looked and tasted more like a greasy breakfast sausage was so delicious it made me feel guilty despite being free-range and organic. The Jalepeno Express delivers a welcome punch of spice in a glove of colby jack gooiness. And the Big Blue Bacon is big and stuffed with melting blue cheese and thick cut blackened bacon.

Where their burgers aren't all created equal, their fries are uniformly perfect. Deep fried in peanut oil the fries taste like... "potatoes," remarked a dining companion. Their served with a curried ketchup, chipotle mayo and Bareburger's signature "special sauce." The impressive basket slowly disappearing as I tried and tried again to determine my favorite of the three sauces. In the end i couldn't decide, and to make matters worse ordered a few additional flavors--pesto mayo and chipotle ketchup. I tried a salad once, and it was fine, but I make better salads at home, and besides only a fool would substitute those fries for a salad. One of these days I'll have to try the onion rings as well which are nearly the size of donuts and look individually browned to perfection.

Their milkshakes may be what they do best. I had the pistachio and now I can never have another flavor.

In short, when I saw a Groupon advertised for Bareburger I quickly bought the 3 coupon limit knowing that at 50% off I'm getting at the very least a solid hamburger with delicious sides and drinks made from quality ingredients. At the best, I'm enjoying one of the more unique, balanced and ultimately satisfying versions of this American classic offered anywhere.

$16-25

Dailies:

10:57 -> 104 Took 2 Prandin with cereal 110c. Half hour later had an apple 20c. Half hour later had a tangelo 20c. At 2:00 had toast with peanut butter 14c and 1/2 cup coffee 4c.
4:55 -> 79 Took 1 Prandin with Dinner: Bareburger 35c fries 105c = 140c. Shouldn't have eaten so many fries but they were so dang good!
7:57 -> 250 Well, it's another high pre-show number. I hoped that the fat from the fries would help slow down the sugar rise and keep it in tandem with my insulin production. At least I'm about to do Joey which should help it back down a little.
12:26 -> 56 Wow, so the Prandin must still have been working even so many hours later. Had an apple 20c. Then at 12:45 I had a Prandin with Supper: Salad 25c, broccoli and cauliflower 20c, beans 40c = 105c
3:26 -> 143 A safe number to go to bed.

Day 60

Reading Labels for Dibetic and Gluten Free Living

Well don't I feel like a fool. I made one of the classic schoolboy errors. Here I am, a guy who grew up reading labels, searching for key words like sugar and high fructose corn syrup and monosodium glutamate and other various additives that aren't good for you my whole life. Since my diagnosis I've gotten even more anal, checking for any glutinous ingredients or any of the manifestations of refined sugar. And I've gotten good, really good. I eat more and more macrobiotic foods, whole plants, unprocessed meats, fresh fruits and unrefined grains. But despite my obsessiveness mistakes happen. Here's an example from yesterday which may explain why my post breakfast numbers have been a bit higher than I'd like.

As one of the components of my breakfast "cereal" I include 3/4 cup of yogurt - organic, nonfat, unsweetened yogurt. I go through it pretty quickly and so I'm always back at the store buying more. Trader Joe's has a few good choices, so does Whole Foods. Both of these stores however get crowded, especially at peak hours. And when I only have 15 minutes to grab what I need, sneak through the line and bolt back to work I rush, and get sloppy and make mistakes. When reaching between an asian couple with a child (in stroller) a man restocking shelves, and an indecisive middle-aged tree-hugging type for yogurt I grabbed what looked like the last of the nonfat yogurts.

Over the next few days I made my cereal concoction as usual, guessed it to be about 110 carbohydrates, ignored my taste buds complaints at how uncharacteristically saccharine it was, and then was surprised at post-breakfast highs. When am I ever above 180 after breakfast? Why don't two pills knock out the carbs from a breakfast of cereal and fresh fruit? What the devil is going on?

I had had it with all these inconsistencies and so this morning went back to the drawing board measuring all my portions and checking it against the food labels. Everything was lining up as it usually did and I was at 100carbohydrates with only yogurt left. Unsweetened plain yogurt should have popped me up to about 110, but the stuff I was shoveling into my mouth was 30 carbohydrates! I was 20c higher than i should have been. I had compromised my health for the sake of saving a few seconds. That explains all the wacky numbers. Luckily the fix is quite simple, use less yogurt until it's done and then go back to what you usually buy.

Later in the day (after I had come up with the idea for this post) I invited a friend of mine out to a Mexican restaurant for dinner. The conversation got serious before we managed to order so I quickly browsed the menu, ordered the enchiladas, haphazardly looked up the carbohydrate content, guestimated the total and threw down a few pills. Once again my health had taken a back seat, this time to save a heartfelt conversation from interruptions. As I was about to finish my meal something began nagging me, so I went back to the carb counter book, added them up again and got a higher number, so high in fact that I decided to take a third pill (that still only totals 1.5mg, max dosage per meal is 4mg so don't freak out about the quantity). But now I was left in a strange situation, I had taken two pills a minute before eating, and then a third pill with only a few minutes left of eating. And what's worse is the book's estimate of the carbohydrate value of enchiladas seemed wrong. After all, they're little more than a tortilla wrapped around chicken with a little sauce. How could that be 49c? I added up the components and got closer to 25. Which put me way under, and since I was still hungry anyway I had a piece of peanut butter covered toast. Now I was one big mess, pills dissolving at different rates, food breaking down at different rates, my Pancreas getting the green light, followed by a second green light. And I was doing Joey tonight!

(this is me unhappy about doing Joey when my body's raging a war inside!)

If you're not used to reading labels as a diabetic or celiac it's time you started. Counting carbs is an art not a science but a good degree of practice is required before you get comfortable. Sometimes the book is wrong. It's your body, use your own judgment. The same goes for recognizing gluten and derivatives of gluten in products. If you're not sure, why risk it. Similarly with diabetes and carbs if I'm not sure I round the carbs up. Better (in my opinion) to start to descend a bit earlier than usual and correct with an extra snack then end up in the stratosphere having to decide whether to take a prandin or shot of insulin on top of what you've already had.

Dailies:

11:00 -> 126 Good enough, wish it was a tad lower though. Took 2 Prandin with cereal (actually 110c) a banana 25c, and apple 20c = 155c. At 3:00 I had a piece of bread with peanut butter 17c.
5:21 ->84 Dinner. Took 2 Prandin with enchiladas 40c, beans 40c, rice 70c, chips with salsa 40c = 190c. But, the carb counter book mislabeled enchiladas as 49 each so I took a third Prandin on mis-information, figured out my mistake later and had an additional piece of bread w/pb 19c. Total carbs 209c with 3 Prandin (1.5mg)
8:17 -> 231 High. Damn it. Probably because my meal was so carb heavy and I didn't give myself anytime to digest the Prandin before I started eating. Performed in Joey and drank a lot of water.
11:00 -> 128 Well either the Prandin is still working or Joey really uses a lot of glucose. Took 5 units of Lantus. Went bowling. First game 115, second game 124. End of year goal 180.
2:20 -> 58 What the hell?? Is the Prandin still working? I mean, I took it 6 hours ago! Unless the Lantus just decided to work really quickly. How can I possibly regulate a medication that takes up to 6 hours to fully work but not at a constant speed at all. Ugh! At least I felt able to eat an apple without worrying about a spike 20c.
2:58 -> 89 Well, finally I catch a break with a decent number. Chances are my blood sugar's on the rise, but how high can an apple put it? Just to be safe I'll also have a bunch of snow peas 12c. And some herring 0c.

These numbers do not a happy GI Jon make. Especially because I was hungry most of the day. I was hungry after breakfast despite eating 155c, and hungry after dinner despite eating 209c. And I'm tired of feeling like I ALWAYS have to load up on protein now! I mean, I eat a lot of vegetables, maybe not today, but in general. I need to be eating probably in the range of 150 carbs per meal, and yet the annoyingly slow rate that Prandin metabolizes my sugar means that that many carbs will probably create a sine curve - first high, then low. The only way i can think to avoid that would be to eat medium sized meals followed by snacks similar to what I did this morning. I would hate to see what a continuous glucose monitor would say about me.

Mamma said they'll be days like this!

Tomorrow, despite rehearsal and a show in horse I'm going to workout. With temperatures projected in the mid-high 40s, I gotta take my bike out for a ride!! :)

Day 58

Life is Good

"Today is a good day to die."
~ author of my favorite autobiography

I love this quote. I'm not exactly sure why. There's something so succinct and terminal, specific and honest. I'm not sure if the quote elevates the importance of death or elevates the value of a single day. One might be quick to read this quote as macabre, but let us not jump to that conclusion too quickly.

Think for a moment, what would be a good day to die? None, you may be thinking, but that's counter productive. As an exercise let's take a step back and think first what would be a bad day to die? Would you want to die young? No, that would be bad. Why? Well, because dying young assumes you die before your time, before you've experienced a lifetime worth of experiences. It assumes you have unfinished business, unresolved conflicts, unprofessed loves. What other circumstances would make a bad day to die? Rain, poverty, loneliness, weakness? Yes, because you wouldn't want your final moments to be surrounded by these lessened states.

Ah ha!!

There it is! Don't you see? That, precisely that, is the beauty of the quote! "Today is a good day to die" because today is a good day! My life has been full, the day is sunny, I am healthy and of positive disposition. So there it is, "today is a good day to die." But...

Today is also a great day to live!

I woke up to a sunny day in the 50s, played some music while I ate breakfast and then took my time getting ready for my first appointment, a trip to the acupuncturist. I felt as healthy as an ox and so asked him simply to boost me up more. He did.

Next I met Joe and Lili for some tasty delights at Baby Cakes. The cinnamon roll was good, the donut was waaaay better, and the cookie sandwich... (I'm gonna need a moment) Coconut butter, vanilla and sugar... thank you lord! I will be coming back to this place, and bringing all my friends and out-of-state relatives.

I was on the rest track tonight and despite doing 100+ pushups and about 40 pullups felt inadequately exercised so when I got home I rowed for 30 minutes. Dinner followed and so too shall bed.

#s
11:19 -> 118 Breakfast: Cereal 100c, bp&j bagel 45c, apple 15c = 160c = 4 units of insulin.
4:51 -> 122 Lunch: Chicken, mashed potatoes 43c, cooked broccoli rabe 7c, cinnamon roll 70c, donut 25c, cookie sandwich 10c = 155c = 4 units.
6:56 -> 92 A bit low to start a show, even a rest track. Had an apple 20c, then at 8:30 had a 5c protein shake.
12:23 -> 70 This is low, but I had just finished a 30 minute rowing piece. Dinner: beans 67, rice 63, salad 14c, apple 25c, red pepper & artichoke tapenade 9c, yam 30c = 208c = 5 units of Novolog (new pen) and only 5 units of Lantus (because the cardio workouts seem to be keeping me low enough).
2:47 -> 164 A bit high, but... I took a very long time eating and felt "low" in the middle. I need not to get distracted once I take insulin to avoid both mid-meal lows and post meal highs. (Although 164 really isn't that bad after a meal)

Saw a documentary film called Waste Land. It succeeded in keeping my focus off the pain of rowing and had the same tear jerking power as a good episode of Extreme Home Makeover. It's amazing what art can do.

Rowed 30 minutes and just over 7,500 meters. Didn't hurt too bad, but my back is getting pretty sore. I'm going to take it easy on my back for a few days. Maybe Thursday I'll do some yoga, or else go for a run or something.


Day 43