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

The Honeymoon is Over?

When I was first diagnosed in December of 2011, I was warned that I would, for the next few weeks or months (or even a year) experience what is commonly called the "honeymoon period." This is a time before T cells have destroyed all insulin producing pancreatic tissue and so your sugar highs and lows, spikes and drops have a buffer zone produced by your failing organ. I was warned, I was. And yet when I experienced some early success with some dietary alterations and regular exercise regimens I allowed my budding hope to harvest within me, dreaming of some diabetic fairytale where I use positivity and vegetables to send this life long auto-immune disease into remission. I was even off the insulin for a little over a week!

But the time bomb that was my flailing pancreas kept ticking towards an inevitable downfall. And though there is still some trace of function in my pancreas I've been increasing insulin dosage almost daily for the past week.

So here are a lot of numbers since I went MIA. Pay careful attention to the meds/insulin I take and watch as they increase:

March 30, 2012
12:00 -> 98 Still too high for the morning. Took 2P w/ cereal 120c, orange 15c, 1/2 banana 12c, peanuts 4c.
4:52 -> 111 Took 3P w/ pb and 1/2 banana 43c, pea soup 100c, pepper 8c, grapefruit 24c, apple 25c, pumpkin seeds 7c.
11:56 -> 71 Took 2P w/ salad 40c and took 1 unit of Novolog w/ 2 yams 55c, tortilla chips 20c, brussels sprouts and fennel 45c.
2:42 -> 127 Took 4 units Lantus w/ 2 cookies 19c.

March 31, 2012
11:09 -> 86 Good, 80s! Took 2P w/cereal 120c, apple 35c. At 3:30 had 2 oranges 32c and pumpkin seeds 6c.
5:27 -> 64 Low Took 3P w/ Whole Foods: sprouts 4c, cauliflower 5c, beans 100c, potatoes 30c, mango 30c, rice 25c, seaweed 5c = 200c + cookes 26c, fake coffee 4c, grapefruit 25c, more pumpkin seeds 6c.
12:04 -> 59 Tortilla chips 10c then 2P w/salad 45c and yams 70c.
2:38 -> 157 That's exactly where I want to be. Took 4 units Lantus.


April 1, 2012
10:37 -> 84 Great! Took 2P w/cereal 120c, 4 mile run, apple 35c, pb toast 16c, cake 40c, orange 15c.
6:50 -> 80 Took 2P w/SOU-EN ramen 55c and cornbread 50c and 1/2 SUN IN BLOOM cookie sandwich 40c, chips and hummus 10c, strawberries 27c, fries 5c, 2 shots of Fernet Branca.
2:31 -> 58 Larabar 31c, 1 Prandin w/salad 50c.
4:06 -> 83 Took 4 units Lantus w/ pb banana 50c.

April 2, 2012
10:53 -> 113 High, the alcohol processes slowly, and the 4am sandwich was too much. Took 2 P w/cereal 120c, apple 40c, Larabar 27c.
8:43 -> 70 Took 2P w/16 oysters, 3 oz salmon, potatoes 100c, spinach 14c, salad 7c, tomatoes 8c, asparagus 4c, 1 glass of wine.
1:04 -> 150 Took 4 units of Lantus.

April 3, 2012
10:33 -> 96 Higher than I'd like. Took 2P w/cereal 120c.
2:19 -> 164 No good! Took 2P AND injected 2 units of Novolog w/quinoa 60c, chickpeas 35c, grapefruit 25c, squash and cabbage 50c, sweet potatoes 40c, seaweed 5c, cookie 9c.
4:35 -> 41 Woops, overdid the meds. Had 2 bananas 60c, cookies 20c, pumpkin seeds 5c, bread w/hummus 18c and orange 17c.
10:54 -> 111 Took 2P w/salad 45c, greens 5c, 2 kiwis 20c, apple 20c.
2:37 -> 167 Took 4 units of Lantus.

April 4, 2012
10:39 -> 111 Too high for fasting level. Took 2P and 1N w/cereal 120c, grapefruit 24c, apple 18c, pb bread 22c, kiwi 10c.
4:41 -> 105 Not bad. Took 3P w/salad 40c and soup 40c, apple 20c, pb banana 58c.
7:41 -> 113 A tad low for Pre-Joey. Had grape leaves 47c. At intermission had kiwi 10c and pumpkin seeds 5c.
11:52 -> 132 Overdid it earlier I guess. Took 1P and 2N w/(rice 105c, beans 67c, chorizo 13c, salsa 10c, avocado 15c, fake cheese 2c, kale 5c) x 2/3 =140c + salad 25c, chips 15c, more kale 10c.
2:36 -> 96 Had grapefruit 24c with 4L.

April 5, 2012
11:04 -> 65 A little low. Took 2P and 1N w/cereal 125c, apple 18c, apple 18c, kiwi 10c, grapefruit 24c, pumpkin seeds 4c, Larabar 31c.
5:00 -> 95 Apple 25c, 6.2 mile run (46 minutes) Gu 25c.
6:49 -> 94 Nice! Took 2P w/yams 50c, cabbage and squash 60c, pb and j 38c, 2 kiwis 20c, pumpkin seeds 5c. At intermission had a grapefruit 25c.
1:00 -> 83 Took 1P and 2N w/spring roll 20c, Momma made casserole 200c.
3:26 -> 187 Took 4L

April 6, 2012
11:44 -> 61 One more low day and I'm going to decrease the Lantus. Took 2P w/cereal 110c, apple 25c, Larabar 27c.
5:24 -> 95 Took 3P w/SOUEN rice 45c and pesto veg 30C, dessert 45c, apple 38c, p seeds/hummus/peanuts 12c. At intermission pb and j 38c.
11:58 -> 93 Took 1P and 2N w/salad 52c, casserol 150c.
2:30 -> 85 Had 2 kiwis 20c, soy ice cream 20c and 4L.

April 7, 2012
10:51 -> 88 Good! Took 3P w/cereal 125c, apple 30c, grapefruit 24c, pumpkin seeds 4c.
4:52 -> 91 Took 2P w/rice 70c, beans 25c, fake cheese 2c, salad 40c, apple 18c, potatoes 60c, salad 10c, horoset 45c.
7:46 -> 140 Good Pre-Joey number. At intermission had pb and j 38c.
11:52 -> 136 Had 1P and 1N w/ brussel sprouts 18c, lentil soup 38c, pepper 6c, fennel 14c.
2:44 -> 106 Took 4 units with Lantus w/ mango piece 10c.

April 8, 2012
12:05 -> 108 Too high again. Took 2P and 1N w/cereal 130c, grapefruit 25c, gluten free muffin 35c, apple 35c.
6:51 -> 66 Not bad, took 3P w/ MAOZ falafel salad 225c, chips and macaroon 20c.
12:02 -> 136 Took 2P and 1N w/salad 30c, apple 40c, 2 kiwis 20c, green beans 8c = 98c.
2:38 -> 156 Woah, why so high? That's a big number after 2P and 1N. Took 4L.

April 9, 2012
10:56 -> 101 Too dang high! Tonight I take 5L. Took 2P and 2N w/cereal 140c, 2 apples 36c, Larabar 31c.
5:59 -> 55 Cookie 9c, coconut juice 16c, collard greens 18c. Then took 1P and 3N w/kurobata squash 45c, roast carrots 70c, potatoes 50c, Black Eyed Peas 45c.
8:42 -> 52 Corrected with a cookie 9c, black eyed peas 20c and an apple 18c.
11:29 -> 195 Over-corrected much? Ugh! Took 2P and 2N w/brussel sprouts 18c, BEPs w/kale 80c, 2 pieces of toast 60c.
2:07 -> 117 I'm appreciative of this good number. I'll have a kiwi 10c and then take 5 units Lantus. I should be fine with that since I haven't been active all day.

So over the time I'm showing you I've gone from 5 units of insulin per day to 11 units per day, and my Prandin dosage has stayed about the same. I've had 2 highs and 7 lows. When the diabetes progresses I always jump to errors I might have made first. Is it that I've become lax with the veganism? Is it that I don't workout daily but instead to huge cardio workouts once or twice a week? Am I getting lazy with my carb counting? Or...

...is the Honeymoon coming to an end?

Tomorrow I see Dr. Thys. I have some questions for her.

Day 111

100 Days of Diabetes!

In honor of my 100th day with diabetes I wanted to share the story of another man to whom the number 100 is quite important:

100 Things

Here's a short description of who he is and what he's doing taken from his website:

"Everyone has at least one thing they have to do before they die. Some even have a list. But how many goals and dreams on this list are actually achieved?

In 2009, at the ripe-old age of 27, Sebastian realized that like most people, he has not achieved anything on his long-forgotten list.?? The death of a close friend combined with a naturally abstract view on life sparks a moment of clarity. In the midst of overseas trip, Sebastian decides to put pen to paper and re-create a list of 100 Things. His goal, to tick off everything. It’s the start of a crazy, no holds barred adventure that sees Sebastian travel to the ends of the earth on a quest to prove that anything is possible, including true fulfillment.

Along the way, Sebastian strives to raise $100,000 for Camp Quality (Item # 4), a great organization creating happiness for children and families affected by cancer."

I am truly inspired by this man's commitment to really living fully. And he asks a great question: What's your 100 list consist of?

Dailies:

12:28 -> 107 Took 2 Prandin and 1 unit of Novolog (because my number was over 100) w/cereal 120c, pb and banana 47c, apple 20c, apple 25c. Ran 6.5 miles!!
5:52 -> 58 Low because of the run. Took 3 P w/pea soup 100c, salad 30c, grapefruit 24c, orange 18c, apple 18c, 2 cookies 35c, Larabar 31c.
11:42 -> 70 Had Larabar 31c, potato wedge 9c.
4:19 -> 99 Took 3 units Lantus and had apple 25c.

Day 100

Running and Smiling

Anybody who's read Born to Run may remember an interesting study done which demonstrated a link between the speed and cardiovascular capacity of a runner and his/her emotional state. In other words you can run faster and longer when you're happy. Surprised? I probably was a bit myself the first time I came across this info. But you shouldn't be. In fact, nothing makes better sense. Time flies (and so do you!) when you're having fun. Everything becomes better when you're in a positive state of mind. Happy children learn more in school. Happy people live longer. Happy athletes perform better.

So I woke up today and knew that part of the slump I had been in for a few days was caused in part by lack of physical activity. Here I am at the physical peak of my life and just sitting around for several consecutive days. What a waste. And even though lethargy is addictive, so is exercise. All it takes is that first plunge.

I donned a wool undershirt and some shorts, pulled a beanie over my ears and set out to loop the park. A short and rapid stride seemed to come naturally so I unleashed my legs and started off at a pretty quick pace. As I began to tire about two miles in I realized my mind was going through this endless cycle of dread. Dreading the pain of running, the hill coming up, a potential sugar high or low, the stiffness of cold hands, etc. How lame!!

Then I forced myself to smile. And just that simple act, a forced smile caused my gaze to rise from the ground in front of me to the nature around me. Instead of the cold on my hands I felt the warmth on my face. Instead of feeling the pain in my joints I felt the pleasure in my muscles. And as quickly as it took for those facial muscles to contract, life became good again.

Dailies:

12:01 -> 86 Love it! 80s! Took 2 Prandin w/cereal 120c. Went for a 4.5 mile run.
3:34 -> 93 Kinda sorta hoped to be lower, but the number's actually good. Took 3 Prandin w/black beans 67c, tortillas 33c, quinoa 60c, salsa 14c, kale 3c, seaweed 15c, apple sauce 15c. Later had a cookie 18c (good lord it was good!), apple 30c, another cookie (did I mention how good they were?). At 10:20 i felt LOW so had a Larabar 31c.
11:54 -> 103 Took 2 Prandin w/dinner: Mache salad 20c, chick pea/beet/carrot salad 45c, grapefruit 25c, 1 cup lentil soup 25c.
2:18 -> 199 A bit high, but I only just finished eating the grapefruit. I'll take 3 units of Lantus tonight because I ran today and have a busy day tomorrow and don't want to risk lows.

As a side note: I never felt any depression today. Thanks exercise!

Day 98

Recipe: Red Cabbage

Hey guys,

I was experimenting in the kitchen a bit and ended up totally falling in love with the outcome. I'll probably end up making this at least every other week if not more often, it's just that dang good.

Red Cabbage recipe

20oz of Butternut squash cut into 1-2 inch cubes
1/2 a head of cabbage, sliced thinly, as if making sauerkraut
16 oz of water
heaping tablespoon of miso
heaping tablespoon of tahini
heaping tablespoon of minced garlic
1/4 cup rice wine vinegar
sunflower seeds to taste

So the preparation is super simple. I started with a 3-inch deep saute pan on high medium high heat and filled it with the water. As the water started boiling I threw in the butternut squash on the bottom. I let that cook for a few minutes and then added all of the cabbage and put a lid on the pot. After about 5 minutes on medium high heat the cabbage should have reduced in size to about half. At this point you want to add the miso, tahini, garlic and vinegar, stir them all in thoroughly and reduce the heat to a simmer. This would be a good time to add water if you want the outcome to be thinner and closer to a soup, or thicker to be served as a side dish. Add the sunflower seeds, I sprinkle them pretty liberally, remove from heat and serve.
This should probably serve a bunch of people, but I've eaten an entire pot myself before. There are roughly 100 carbohydrates in this dish.

This dish is so good, I am literally sad right now typing out this blog and knowing that I've already finished all of the leftovers from the last time I made it.

And now to bed with fingers crossed that my body is working as well as possible tomorrow when I get blood work done.

Dailies x 2:

March 12, 2012
12:31 -> 113 Took 2 Prandin with cereal 110c, ran about 3 miles with 5 hill sprints, 3 of which were "Cardiac Hill."Had a grapefruit 25c and 2 kiwis 20c. At about 6:00 had an apple 20c.
7:10 -> 73 Had maybe 170c worth of Whole Foods hot bar food. At midnight had a Larabar 26c.
1:04 -> 95 Took 2 Prandin with rice 46c, beans 35c, cabbage stew 15c, salad 20c.
3:28 -> 162 Hmm... A bit high for my liking. Is this a sign that I'm creeping back up? Should I go back on the insulin?

March 13, 2012
12:20 -> 125 Not good. This is the highest fasting number I've had in awhile. Maybe it's time to go back on basal insulin. Took 2 Prandin with cereal 110c (substituted chia seeds for yogurt), rowed 2x5000m at about 2:00.00 (slow) then had apple 20c.
3:46 -> 93 Took 2 Prandin w/ salad 30c, rice 63c, lentil soup 90c = 189c. At 8:30 (intermission) had a grapefruit 25c, peanuts and snap peas 8c.
11:11 -> 55 Nice to see the Prandin still works. Could be time of day or the affects of the workout that brought me low despite a lot of carbs. Had a kiwi 10c then took 2 Prandin with 2 yams 110c, fennel 15c and carrots 10c = 145c
1:19 -> 265 Woah, what the heck? I even reckon I overestimated the yams, and a 210 point jump? And I'm still a bit hungry. I'm going to need to start taking a larger dose at night I think. I'll chug some vinegar water and see if I can't salvage a decent number for my blood work tomorrow.

Those numbers won't do. The keen reader will see that my calorie intake was a bit on the low side and yet my evening number was super high. No, that won't do. Tomorrow I'll try taking 3 Prandin with my afternoon meal, eating more, and then eating less with 2 Prandin in the evening.

Days 83 & 84

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

Insulin Free

Since this is my second day without insulin I figured I should let my doctor know. I called the office. She was on vacation. So I texted.


(Actual transcription of my text messages with my doctor.)

Me: "Hey Dr. Thys. I started waking up real low and even having midnight lows and so I stopped taking Lantus 2 days ago. Numbers have been pretty good. Is that okay?"

Her: "Yes"

Communication made easier by technology. I am very very excited at how good the numbers have been. And I figured something else out today. I take usually 6 pills per day. A pill takes care of roughly 100 carbohydrates. A carbohydrate provides 4 calories of energy. Therefore any day that I take 6 pills will be a day that I consume 6x100x4 = 2400 calories worth of carbohydrates. Protein probably makes up at least 10% of my diet or around 60 grams or 240 calories, and I imagine I have at least 30 grams of fat or 270 calories. Combined that is a minimum of 2910 calories per day, a pretty good amount for somebody my size. Although with all the workouts maybe I'll start taking 7 pills and eat an extra 400 calories around lunch. And now for further proof of my insulin-free success!

Dailies:

11:20 -> 93 Perfect morning number! Took 2 Prandin with cereal 110c then at 1:00 had 2 apples 30c an orange 11c and peanuts 8c.
5:31 -> 83 Something obviously working! Took 2 Prandin with dinner of lentil soup with quinoa 115c and salad with hummus and avocado 45c. Also had fake coffee 4c, apple 15c and orange 9c.
10:55 -> 52 Low alert! Apple 15c. Waited a few minutes and then had a yam 75c with 1 Prandin, an orange 9c and a Larabar 24c.
2:42 -> 69 Too low for bed. Had a carrot 11c, 4 celery w/pb 4c and brussels sprouts 20c, and a half cup of apple sauce 20c. Going to bed!

Gratitudes:
1. Got my personal days approved in May.
2. The temperature went over 60 degrees today.
3. A productive physical therapy session.

Day 79

No Insulin Today

Okay, I've been keeping a close eye on myself the past week and am finding that I am trending lower and lower. The Prandin usually works pretty slowly on me which isn't such a problem during the day because I snack quite a bit. But at night, I've been taking it with meals two hours before going to bed. My sugar before going to bed is usually high, but then I've been waking up on the low side. My recent mid-sleep hypoglycemic spell pushed me over the edge. I haven't even been very rigorously active recently. I haven't ran or rowed in several days and still my blood sugar seems a bit on the low side all the time.

I no longer feel comfortable going to sleep with both insulin and Prandin working their slow black magic in the night. I also don't feel comfortable performing as the horse in the show for fear that I'll drop mid-show. Today was one such day. I was performing Topthorn, had a few mandarin oranges before beginning, then a piece of toast mid Act 1, then some more goodies at intermission. But then mid Act 2 I felt myself dropping. I quickly had two cookies and when next I checked my sugar nearly an hour later I was at 71.

I refuse to continue this way. I called my doctor today but was told she's on vacation. So, I'm going to use a bit of my own common sense and try a day without insulin. I was going to just lower my dosage from 5 to 3 or something, but that hardly seemed like enough. And to take only 2 or 1 units of basal seems like stabbing myself for nothing.

So to repeat myself: I am not going to take any basal insulin tonight and will see how that affects me tomorrow. If it's a disaster - which I doubt - I'll go right back tomorrow. But with two shows tomorrow, one of which is Joey, and with the promise of 60 degree weather, which my running shoes finds irresistible, I can't imagine my blood sugar being too high. We shall see.

Dailies:

11:42 -> 62 This is a very low morning number, especially considering I had 45 carbs right before going to bed. This is why I'm not taking Lantus tonight. Took 2 Prandin with cereal 110c. Around 1:30 I had a small apple 15c and then a big apple 28c. Walked the Brooklyn Botanical Gardens
3:48 -> 82 Took 2 Prandin with 3 cups lentil soup 90c with kale 6c and rice 35c. At 6:00 had 3 mandarin oranges 26c, nuts 2c and peas w/hummus 10c. At 7:20 had pb toast 14c. At 8:30 finished the snap peas 6c. At 9:15 felt low and had 2 cookies 21c.
11:14 -> 71 Had a salad 30c, then took 2 Prandin with bok choy (szechuan, ginger, lime, coconut oil) 18c, quinoa 24c and adzuki beans cooked in coconut milk with ginger 62c. Fake coffee 8c.
2:45 -> 147 Let the experiment begin!

Gratitudes:
1. Eric's coat.
2. Subway naps - really, they're the best.
3. The Brooklyn Botanical Garden

Day 77

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

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

Diabetic Purchase - Bike

Days like today make me wonder if, even hypothetically, a diabetic (me) can workout so much that they don't need insulin anymore. When I don't workout I seem to live around a 40:1 ratio, but after I workout I often need more than 60 grams of carbs per unit insulin. That was a two hour workout. What if I literally worked out 10 hours a day by say... hiking across Spain, or cycling across America?

Did somebody mention cycling? What a coincidence. Because today i bought my first bike since... since, well I dunno, since a long time ago. This is what I got.

As listed on Craigslist:


"Classic 1992 Trek 1000, original owner, 58cm Alloy frame made in the USA, Mavic Open Pro wheels, Ultegra Hubs,San Marco Rolls saddle, Shimano 105 brakes, Chain is not stretched nor damaged, Shimano 7 speed RSX group set. New back tire. Bike is in a great condition."

Well, whaddya think? Tomorrow I'm going to head over to Ride Brooklyn and see if they can get me set up with either pedals or clip in shoes (probably pedals) and maybe a second bike lock.

Just another cross-training tool on my road to being the fittest diabetic.


Here are my numbers:
11:53 -> 119 Not bad. Had Cereal 110 with 2 units. Then did a BIG workout with Seth including at least 3 miles running and lots of circuit training including stairs. Had a Lara bar 31c during the workout.
3:22 -> 122 Lunch: Salad 30c, 2 blood oranges 30c, apple 22c, peanut butter on toast 18c = 100c = 2 units with vitamins.
5:43 -> 46 Dang it!! I should have known after such a big workout 50:1 wouldn't work. I had 13c of oj and 14c of a brownie.
8:40 -> 94 Dinnertime: Chips 31c, oysters 8c, brussels sprouts 18c, cheese 1c, pumpkin 32c, beans 67c, salsa 12c, sugar 4c = 173 = 3 units.
11:24 -> 97 Good.
12:45 -> Hungry again: chorizo 13c, tortillas 46c, beans 39c, eggs 3c, cheese 1c, apple 22c = 124c = 2 units.
3:15 -> 105 Good, I'm going to sleep on that number.

Tomorrow - yoga!

Day 49