Friday, November 6, 2009

Diagnosed with Diabetes (part 2)

Well, I have tried most of the day to figure out what I am going to write today. I woke up this morning and took my blood sugar reading. Down around a 4. Not a good start to the day.

When you start with a slight low, you need to be able to adjust the amount of insulin you take with your first meal of the day. But it also means that much of the day, at least for me, will be spent in a fog. The brain just does not want to work right. Getting into any project can be a struggle. I feel scattered and unable to settle for more than a minute or two.

And that's from only a slight low.

I try to keep my numbers in the 6 range, but under a 7. I used to feel anything below a 5. These days I don't feel the lows until I hit around 3 or less so I tend to take more readings during the day than most people. If you are a professional driver you are not supposed to even get behind the wheel if you are under a six and insulin dependent. If you're caught by the DOT you can have your drivers license suspended or revoked! They like you to stay between a 6 and an 8.

One thing I have been able to do, right from the start almost, is self adjust my insulin based on what my numbers are, what I am going to be doing, and most importantly, what type of meal I am eating.

Anything high in carbohydrates is going to mean a little more insulin. A full meal versus a sandwich will make a big difference in how much insulin you take. A salad will require very little insulin, a loaded sandwich with all the trimmings will take more than a plain one, and a full meal will require more yet.

You must eat a protein with everything you eat, be it a snack or a meal. Protein helps your body process what you have eaten a little more slowly and enables your insulin to work better by doing so. Sugar or carbohydrates are a "quick" boost and sometimes your body will process these quicker than your insulin works, resulting in a low. This is one reason that when you have a low and take whatever glucose tabs or liquid you take, they tell you that, if your next meal is more than a half hour away, eat. The sugar/glucose boost will only act for a short time and your body needs food to work with the insulin.

It doesn't take much either. 4 oz of meat with a meal, a handful of peanuts with a snack or one egg with your morning toast. I keep a variety of things on hand like peanuts in the shell, a trail mix, pre-boiled eggs in the fridge. I have little packages of glucose tablets all over the place. In my van, my purse, some of my coat pockets and at home. I am likely to find one almost anywhere that I frequent. Being a security guard I even have some in my "kit" that I take to work with me. Most of what it holds are things to make the time pass. Like a portable DVD player, (DVD's chosen just before I head out), police scanner, two way radios, a book, CD's and Walkman, stuff like that. But in there too are things like a tin of nuts, glucose tablets, maybe some candy or a chocolate bar.

It is always advisable to keep these things around where you are. At your desk, in your vehicle, purse and anywhere handy so that when you do have a low you can deal with it right away.

One thing I don't do is use sugar substitutes. I have researched a lot of them and from what I can glean, most of them are capable of causing more problems than they are worth. But that is my choice. I know a number of diabetics who drink a lot of diet pop and use things like Stevia or Splenda as a sugar substitute and they seem to do fine. I don't like the back taste many of them have either, so I just limit my sweets.

Carbohydrates are the big problem for me, and most diabetics and lets face it, carbs are the cheapest food. For those of us on very limited incomes this can pose a problem. Proteins are expensive for the most part. Meats and cheeses (not the processed stuff) are expensive and on a limited budget many of us don't get much of it. But there are other things available. One very high protein is various types of beans. Chili con carne is almost all beans and meat and very high protein for example. A good bean salad is a good protein source. Lima beans, if you can tolerate them, are also good. Even a can of pork and beans can replace meat for a meal.

One of the hardest things, especially at this time of year, is being invited out to a meal. Many times there are treats and specialty items that are really not good for diabetics.

I remember being invited to a Christmas get together at a friends house when I first was starting to learn about controlling my disease. There were platters of treats all around the house and I didn't take any. I was afraid to. I had eaten my dinner, taken my insulin and now, here was all this extra food hanging around. There were chips, cookies, cake bars, candies, dips etc. just waiting to be nibbled on. Anyone who knows me well, knows I am the original cookie monster. I love cookies (as long as they don't have chocolate bits in them). And potato chips!! MMMM.
Another favorite snack food of mine.

After that I didn't take any invitations. I was afraid to. I was just new to this and didn't know what I could eat and get away with. It's not that way now. I eat pretty much whatever I want, but I limit the amount I eat. It may be only a nibble, a bite or two, but I can say that I had some. And that makes me feel that I am not left out of things.

There are many good cook books out for diabetics now and I would suggest you invest in one or two. Especially if you are newly diagnosed. Places like Save-on-Foods also have free "clinics" where they will teach and show you many of the products you can have. Go to one. Go to a few. Everything you learn about your disease will help you to learn to control it, and sometimes it's even fun. Some of my friends even cook diabetic for me when they invite me over. God Bless their hearts.

It's not such a bad idea to invest in a small kitchen scale. I found it handy when I was newly diagnosed. When I went to the diabetic clinic, the teaching on proper amounts of each food per serving was done in measurements. With the scale I was able to measure the amounts and get a good feel for "diabetic" serving sizes. This helped to be able to start judging how much insulin I would need for a meal. Even if I ate more than suggested serving sizes, I was able to start judging how much more insulin I would need for that meal. And keeping track of that also helped me judge the insulin needed for smaller sized meals.

Well, that's all for now. I hope you're enjoying the posts and that they are at least somewhat informative. Back soon with more.

Thursday, November 5, 2009

Diagnosed with Diabetes (part 1)

I have chosen for my first blog a subject that my life seems to revolve around... diabetes.
First off, if you have any two or more of the following symptoms, please, please be insistent with your medical provider that you be tested properly.
  • uncontrollable thirst
  • frequent urination
  • rapid weight loss or gain (it can strike either way)
  • blurring of vision
  • frequent headaches
  • weakness, extreme fatigue
  • extreme hunger
  • irritability
  • cuts or sores that are slow to heal
  • itchy skin/yeast infections
  • dry mouth
  • leg pain
For me the worst symptoms were the thirst, urination, rapid weight gain, hunger, blurring vision, and extreme fatigue.

It is an insidious disease that went undiagnosed in me for around 17 years, until I could not even find the energy to get from my bedroom at one end of my 53ft trailer to the living room at the other end. This was not for lack of trying to get proper testing done.

At 35yrs old I was told that I needed to take a glucose tolerance test every year because I was then a "borderline" diabetic. (I had for several years previously been told I had hypoglycemia.)But my life was somewhat nomadic and, though I asked many times for the test I was told I needed, in Canada glucose tolerance testing was not done anymore as a primary detection.

Instead they did a "fasting" glucose test, which for me was exactly the WRONG test to do. I always tested normal. No one would listen.

I had a rapid weight gain around this time, packing on over 60 pounds in less than 6 months. Something that is not exactly the norm for most. Far more common is weight loss. It took a long time for my normally 100 pound body to adjust to carrying around what amounted to a second me! I guess part of the problem was the extreme hunger I experienced, along with the fact that I had had a very high metabolism and was used to eating a lot just to maintain weight. If I skipped a meal, I lost, so I was used to snacking throughout the day on high calorie foods.

The metabolism changed. I was tired all the time. I was thirsty all the time. (In the end drinking about 5 gallons of water a day! ) I couldn't be away from a bathroom. I was always hungry. I couldn't see properly, everything was blurry, even though I had my eyes tested only a few months previously.

There was a convenience store less than a city block away from me and I could not make it to there without taking a large bottle of water with me and asking for the bathroom as soon as I got there.

I should interject here that the cycle starts with frequent urination as your body tries to rid itself of the excess glucose in your bloodstream. The thirst is caused from being dehydrated due to this, and the extreme tiredness comes from your body not getting any sustenance from the food you eat, which is why most people lose weight.

Though I asked many times over the intervening years for the glucose tolerance testing, I was told I didn't need it because my fasting test was normal. At last, over 50 years old and so sick I could barely stand up for more than a few minutes, I went in and demanded something be done. The doctor gave me attitude, saying with a very heavy sigh that he would do a random test and asking me how long since I last ate. It had only been an hour or so since I had had a teen burger at A&W so my body would just be processing that meal.

He took the blood test stating that, "if it's not over a 7 , I will go no further." in a very snide tone. Normal range is between 5 and 7.

His tone changed the next day when I was called in for an emergency appointment. I was sitting at 28 for the test and it would have gone higher over the next hour or so. He told me I should be in the hospital, but there was no room so I was put on a waiting list to see a diabetic clinic nurse and explore my treatment options and learn about controlling my disease.

Even though it was an expected diagnosis, I was worried and starting asking several people I knew about it. Many told me it was really nothing. Many had type 2 diabetes and only had to follow a diet and take a pill. Don't listen to them! Diabetes is a progressive and life threatening illness and needs to be cared for properly, like it or not.

I was so sick by then that pills weren't touching it, even though, after my diabetic clinic appointment (almost 2 months after diagnosis), I was put on the maximum dosage. A simple diet change was not an option. Every test they do when you are found to have diabetes was 4 - 5 times normal ranges.

So on to insulin I went (two kinds... long acting used for a base, and a shorter acting when I ate).... plus the pills to combat the insulin resistance. Still at maximum dosage.

Along with these came (as is quite common), high blood pressure medication, and high cholesterol medication. And, of course, the changes in diet that are needed to help.

I was told that sometimes people can get off the insulin after their pancreas has had a rest from producing what was needed. This did hold true for me. After about a year on insulin I was able to work myself off it and just kept using the pills and diet to help control the disease.

A year and a half later though, I started feeling some of the old symptoms once again. I had felt them throughout the time I was off insulin, but was told that my 3 month tests showed that I was within range and I was doing well. I know if I ate too much, I would get so tired I couldn't focus. I used it as a sleeping pill. Jack up my sugars in the evening and I would sleep like a baby.

Not a good practice for sure and not recommended.

But I hid most of this from my doctor at that time.... it was my rebellion you see.... I didn't want to be diabetic and have to watch everything I did... so I didn't. The only yardstick I measured anything by was the 3 month test (A1C I think it is called, or HA1C, something like that). And the only reason I kept taking that is because I couldn't keep my professional drivers license without a Dr.'s report every three months.

There are costs to diabetes one doesn't even think about at first. Not only did I have 3 month checks on my long term average, but to hold my drivers license cost me about $200/year! Eye exams, doctors reports (not to mention that every time I went in for the eye exams my prescription had changed again due to the changing sugar buildup and reduction in my ocular areas). I have since let my professional license go and dropped to a regular class 5, so now all the extra tests are every two years.

At first the onus was on me and I would get papers in the mail every six months to a year to take to the doctor and ophthalmologist. I had (and still have to as far as eye exams go) to pay for these exams, over and above normal fees. And an optometrist was not sufficient because extra testing is involved when you are diabetic. Now much of the onus is on the doctor. The government in Canada has made the doctors responsible to send in the reports every three months and the papers are sent to him. I no longer have to keep track of the elapsed time between testing. His office calls me, makes arrangements for testing at the hospital lab, and books me an appointment that includes the diabetic nurse at his office. At least for the basics. The eye exam papers still come to me, but not as often since I reduced my license class.

Without these reports, and being in good control, you can lose your driver's license completely! Your driver's license costs more too when you renew it! For me it was a difference of $35/year (BC has a 5 year renewal but diabetics get dinged, it seems, every year).

Well, I had had a little freedom from thinking about the disease much (I had even stopped taking any blood sugar readings on my testing kit, trying hard to ignore my illness), but now I was sickening again. Too tired to do much, increasing thirst/urination once again, and just feeling generally lousy all the time. So back to the doc I went to tell him I was going to start on insulin once again.

Only this time the insulin wasn't working as well. I had to take 4 to 5 times the dosage I had been on and still couldn't bring my numbers down. I was down to two pills a day for the diabetes, plus the high blood pressure meds and cholesterol meds which I had never stopped taking. These had to increase once again too. Even taking my blood pressure pills regularly and on time I was often sitting in stroke range (very high), so another was added. And a change in insulin for the long acting dose. The dose was tripled!

I implore you, don't play with this disease. I know that it seems to take over your life and everything you do, or eat revolves around it. Even the amount of activity you have that day effects your numbers and your body does it's own thing too. One day you will be in good control and the next day everything is out of whack even though you ate the same things, did the same activities and to all extents and purposes had an identical day. Your body decides it is going to have a low... or a high... and there is nothing you can do about it. It is frustrating to say the least, but diligent care is the only thing that will keep the progression of the disease slowed down.

By playing with it as I did, I now have "diabetic pain" in my legs, extreme itching which I have to take yet another pill for, and neuropathy has started in my feet and other areas of my body causing numbness in those areas that is annoying and does not go away.

I think I will stop here for today, else this post may get too long to absorb :). I will continue this discussion in a day or so.