Checkup

Last week, I strolled into my endo's office feeling good about my numbers and presented him with the news that I have been honey-mooning without insulin since my last checkup. At my last checkup ( sometime in January or February) he had instructed me to quit the morning insulin ( one unit of Novolog ). I was experiencing a lot of lows ( is 65 considered low?). He gave me a stern look and told me that the results of my last A1C were 7.1 and he would prefer my numbers were lower. My average BG reading was 114. I thought I was doing well.

So...I am back on the insulin. I started taking one unit of insulin before each meal. I fully expected lots of lows. Surprisingly I had the opposite experience. My blood glucose appeared to be bouncing around. I would test two hours after a meal and the BG would be 96. Then four hours after the meal it would be 150. WTF? So I started thinking to myself, "Is the insulin raising my BG?". Irrational, I know.

I increased the dosage to two units and started getting the results I expected. The rational part of my brain continued to search for an explanation. Then today it dawned on me. In a few weeks it will be June 14; the anniversary of my diagnosis. Perhaps the honey moon ( what a stupid phrase ) phase is over. Perhaps I am entering the phase where I spiral down toward full insulin dependence.

This sucks. Sorry. That's how I feel. I guess soon I will be shooting up Levemir as well. I just hope I don't get the pens mixed up. One of the sucky things about taking insulin is storing it when I am not at home. I bought a backpack and keep my supplies in the front zippered and somewhat insulated compartment. But now I have to remember to carry it with me out of the car during the summer and winter. Insulin does not like extreme hear or cold. Well...neither do I.

Insulin Honey Moon

Wow! It's been over 3 months since my last post. December was the last time I saw my endocrinologist. I was experiencing a lot of "lows" so he recommended cutting out the morning insulin ( I was on one unit of NovoLog ) and taking blood glucose readings two (2) hours after each meal. I instead chose to cut out all insulin and hold my carbohydrate intake to 50g or less per meal. I have been doing this for about 3 months and except for a few mistakes ( incorrectly reading labels ) things have gone quite well. My before meal numbers have been between 90 mg/dL and 100 mg/dL with after meal averages of 150 mg/dL.

I eat mostly whole grains (oat, bulgur wheat), vegetables and lean meats (chicken, fish). I was doing this before diabetes so this was not a drastic change. I occasionally indulge in junk food (Cheetos are awesome!) and my favourite ice cream is Häagen-Dazs Rum and Raisin. I keep track of my food intake using the excellent Calorie King Nutrition and Exercise Manager.

Honey Moon Period

I finally had my appointment with an endocronologist after waiting for over 8 weeks.  He explained how the pancreas and insulin work to control blood glucose.  In a normal functioning system the pancrease is able to product sufficient insulin on demand to cover the glucose in the blood.  He suggested that my pancrease may have been declining for quite some time.  However, under extreme stress ( e.g a viral infection), the pancreas can no longer keep up with demand and blood glucose rises.  As the blood glucose rises the pancreas works harder and harder but...eventually gives up.  In my case I had an upper respitory infection just a few weeks prior which may have triggered the stress on my pancrease.  Once I began insulin therapy my pancreas was able to recover a bit.

He said that right now I am doing well controlling my "sugars" but that is to be expected during the "honey moon" period. During this "honey moon" my pancreas is producing insulin almost at full capacity and I can reduce my insulin dosages to match. In fact the doctor suggested that I may even be able to eliminate the insulin altogether.

For example before each meal I was originally taking 1 unit of Novolog for every 15g of carbohydrate and my nightime basal (Lantus) dosage was about 3 units. My blood glucose before each meal was about 105. Now I notice that I can take 1 unit for each 20g of carb and I have eliminated the night time basal dosage. My bloog glucose before each meal is now abouy 88. That's quite low and I think I may need to lower the Novolog to 1 unit per 30g of carbohydrate.

What scares me ( yes, I am afraid ) about all this is that I am basically guessing at the dosage amounts for each meal which can lead to taking too much insulin and risking hypoglycemia. For dinner last night I had slightly more than 60g of carb and 3 units of Novolog. My blood glucose before the meal (around 6 PM) was about 76 ( I tested twice to be sure ). By 10PM my blood glucose was 79. So obviously I took too much Novolog. I ended up eating a late night snack (20g carb) which I had eliminated when I droppred the basal (Lantus) dosage to zero. My blood glucose this morning was 95. This is a very scary honey moon.

My doctor suggest that in about 6 months to 2 years ( what a huge friggin range ) this will change I will need more insuling to cover my meals etc. I now understand why this is called "medical practice'.