4 Months Out with Stats and Goals

The last 4 months since my gastric sleeve surgery seem to have gone by in a blink, but also lasted forever. I MEANT to blog more, share more thoughts, daily challenges and such that I have gone through juggling Type 1 diabetes and having a new stomach through VSG, but wow – it’s like, I have 3 full-time jobs now…..1) The one that makes me money, 2) Type 1 diabetes, and 3) Learning how to eat/drink/take insulin/exercise/function normally with a stomach 1/4 of the size it used to be. And I still have a family and social life, and try to volunteer with JDRF and NC Schnauzer Rescue. It’s a LOT, and my brain hurts a little thinking about it.

I don’t have a ton of time to even write this, but wanted to sum up some current stats, accomplishments, results, and goals, in no particular order:

  •  I’ve lost 50 lbs, gone down 2 pant sizes, and at least 1 shirt size, maybe more (I tend to wear stuff a little loose anyways.)

    Cheese

    Happy me, with my ticket to see Duran Duran Unstaged (a concert film, of sorts) at a local movie theater. Sporting my FitBit, new hair-do, and go-get-em attitude.

  • My plantar fasciitis has improved 110% – I actually get out of bed in the mornings & put my feet on the ground *without pain*, and I only notice it if I’ve walked or stood still a lot throughout the day.
  • I need to exercise more, and build muscle – my energy level is still pretty low (only eating about 1,000 calories per day now), so I’m worried some of my weight loss is muscle.
  • My OB/Gyn recently diagnosed me with adenomyosis. We’ve got a treatment plan in place to hopefully correct it and allow me to remain fertile (and potentially have another baby sometime in the near future?)  Of course, the treatment involves progesterone, which tends to cause insulin resistance.
  • Speaking of insulin resistance, I’ve been taking less and less (and sometimes none) of my Metformin. I feel like my insulin resistance is starting to wane, but if the progesterone I start taking ends up raising my blood sugars, I may tweak things and take the Metformin along with the progesterone and see if they can cancel out each other.
  • I’ve gone from taking 100+ units of insulin per day – about 50 in basal and 50 in boluses – to around 50 units total per day (with 29 of that being in basal.) That should tell you how dramatically I’ve changed my eating habits & caloric intake. Low, low carb, baby.
  • Recent endocrinologist appointment yielded these results: BP = 124/72 – Back to normal for me, but right after surgery I had some serious *low* blood pressure.
    • A1C = 6.6 – Grrrr, it was 6.5 right before surgery, so it went up a smidge. BUT, I have ran high more than low recently, since I’m still tweaking basals and have had several days where I got dehydrated, or didn’t eat enough, and those tend to raise my blood sugar. Also, not many lows to bring down that number (which is a good thing!) I’m still working on getting into this new groove with my stomach, so I’m not going to beat myself up about this too much.
    • Cholesterol = 169, Triglycerides = 69, HDL = 56, LDL = 99.  LDL/HDL Ratio = 1.8. !!! ROCKED it, since I’ve been hanging out with a cholesterol of around 200 for years now.

GOALS for the upcoming next 6 months:

  • Exercise, exercise, exercise. I’ve been pretty good about walking a lot, using my exercise bike, going to the gym, and am way more active than before, but still have to get in a groove for strength training. I’ve GOT to build more muscle, but the challenge is still feeling like I have enough energy.
  • Lose 30-40 more pounds. I’m trying to be realistic here. Even though in 4 months I’ve lost 50 pounds, the weight loss is already slowing down. It is the nature of this surgery. It is a “tool”, not a forever fix. I still have work to do.
  • Drink more water, eat more vegetables. I know that sounds simple, but when you get full really fast, and thus, feel like you’re eating all day long just to get in enough protein, it’s hard to work in vegetables and also fluids, since I am not supposed to drink for 30 minutes before or after eating.

Next blog post will hopefully be soon, and will be about recent bloodwork (a comprehensive panel of about 8,000 things)  done by my surgeon. I am suspicious that I have low vitamin D, and possibly low Iron (hence, the fatigue and lack of energy.) I am taking vitamins and supplements out the wazoo, but still, I just feel lacking the majority of the time, and desperately want to feel more energetic. I’m sure it’s partially due to the minimal carbs and calories I consume, but it would be nice to know if there are any other underlying reasons.

Fun for the day = WordCloud

It’s been showing up in my friend’s Facebook feeds all day today, so thought I would share my WordCloud here:

A little about me...

I’m really not sure where/how they are getting these words out of my Facebook feed, because I swear this is a mish-mash between my personal account, and my account as 15wait15. It also does NOT include several of my most-used words, like my daughter’s name, diabetes (hello!?!) etc. Maybe it’s only for the last few days? I dunno. Anyways, you can try out your own (if you’re on Facebook) at: https://apps.facebook.com/my_wordcloud/

(I know, I know….I need to do a proper informative blog post soon and give another post-surgery update, but I am just too distracted with everything else right now. Lots of life going on! But good news, I’ve moved on to eating regular food now! Not without it’s challenges, but I’m surviving and doing well!)

Don’t Jinx It #dblogcheck

NEVER say, “lows have not been an issue,” or by gosh you will immediately have them EVERY. SINGLE. DAY. I’ve been fighting late day-into-the-night crashes every day since Saturday. I know exactly why – ye olde monthly female visitor has whacked out my hormones, and gone overboard with reducing my insulin resistance. Yay, for reducing insulin resistance! Boo, for causing me to have to drink milk and juice boxes at the most inopportune of times. The female reproductive system just adds even more of a juggling act into the work I’m already doing to manage blood sugars and food intake with this new stomach of mine.

Last week, I was just swimming along, started into being able to eat a “soft, mechanically altered” diet (yum!!), and have been so happy to get to eat the most extensive variety of foods that I’ve had in the past 5+ weeks since before prepping for sleeve surgery. (It’s still not a full regular diet, but I’m getting there!) However, the added tastes and nutrition have not come without their challenges.

Last night's dinner

Last night’s dinner – a couple tablespoons of hummus, and some Trader Joe’s Wine Country Chicken Salad with Cranberries and Pecans. (I tried to avoid the pecans, since technically, they are not “soft food.”) DELICIOUS! And I still didn’t finish all of this…..

Because I’m not relying as heavily on protein shakes and mixes in order to get in protein now, I have to work REALLY hard to make sure each meal has a high % of lean protein as my primary source of nutrition. Then, I also need to add in some soft vegetables, and a teensy-weensy bit of fruit here and there.  I track everything in MyFitnessPal, so I can see how many grams of protein I get in a day (needs to be between 60-120g), how many carbs, calories, etc. I also look at vitamins and minerals, and 2 places where I continue to struggle to get in enough is Iron and Vitamin C. With the Iron, I’m sure it’s because I’m still not consuming as much pure meat as I used to. And with the Vitamin C, I limit my fruits SO much because of the sugar spikes I will inevitably get, so I know I’m lacking there. I have been drinking a lot of Vitamin Water Zeros to try to add in more Vitamin C, AND it helps keep me hydrated as well because I’m supposed to be drinking 64 ounces+ of fluids everyday. It’s a LOT to juggle, just making sure I’m getting nutrition, fluids, taking all my vitamins and supplements each day, keeping my blood sugars in check, and oh yeah – shouldn’t I be exercising?

Argh. My energy level is still so low, but in my follow-up visit with my surgeon last week, he said it was necessary for me to start doing some strength training now, so I don’t waste muscle instead of burning fat. And more muscle will help me burn more fat. I want that, for sure! Went last night with a friend, and signed up for a local “anytime” gym, so that I can find the best time of day to go that works for me. Probably mornings, if I can drag myself out of bed. More on the exercise topic (and challenges) in a later post.

So far, I’ve lost a little over 25 pounds since starting the liquid diet before surgery. I don’t want to jinx it! Every day, I see the scale move just a little more, and it is very motivating. But in order to keep up the momentum, I HAVE to exercise, whether I have the energy or not. Most days, I’m only getting in 600-700 calories, but I will need to up that when I exercise, I’m sure.

I will carry juice boxes everywhere.

(Today is #dblogcheck day!  http://tobesugarfree.com/2014/07/21/dblogcheck-is-tomorrow/)

 

 

Medical History? Say What?

I’ve gotten pretty lax over the years at asking my various doctors about seeing my records. Not just for lab work, but with their notes, commentary, etc from various visits. After my follow-up visit with my bariatric surgeon, I think I need to start checking up on them again….

The surgeon’s office just implemented some nifty electronic patient records system called “Epic,” so now I get these pretty detailed print outs at the end of each visit. Here’s an excerpt from the one I got from yesterday:

Say what?

 

Line by line, I have my own commentary for this list of my supposed “Current Health Issues”:

  • Unknown cause of morbidity or mortality = whose morbidity or mortality? Wait, are they saying I’m a mortal, and they don’t know what caused that? Say what?
  • Family history of breast cancer = true.
  • Type 2 diabetes = really? You put this BEFORE my Type 1 diabetes?
  • Female infertility = oh, so true :-(
  • High Blood Pressure = absolutely FALSE. I distinctly remember telling them that the only time I EVER had high blood pressure was when I was pregnant, and only in the last 3 weeks before I had my daughter. That is not “current” by a stretch.
  • Low back pain = true.
  • Generalized muscle weakness = um, sure, I guess? I said I was exhausted and tired all the time right now (mayhap because I’m not able to consume more than 600-700 calories per day and I’m not getting quite enough nutrients yet??)
  • Polycystic ovaries = true.
  • Blood clot in leg = FALSE. I have no clue where this came from. I have never had any blood clots, but perhaps this partially explains why they gave me 2 doses of Lovenox after my surgery?
  • Severe obesity = painfully true, hence, the sleeve surgery.
  • Family history of prostate cancer = FALSE. I told them my birthfather had some sort of testicular cancer at one point, so I’m not sure how that translates to prostate cancer.
  • Type 1 diabetes = true, ding ding ding, you’re a winner and got this one right!

Getting 7-8 out of 12 right isn’t bad….???? They at least have about a 60% chance of treating me properly, right?

 

 

E…a…t…i…n…g………S…l…o…w…l…y

I’m still alive! One month now post-gastric sleeve surgery, and I’m taking it day-by-day, meal by meal, ounce by ounce. I keep thinking back to all my fears with blood sugars and blood sugar management around this whole “changing my digestive system from what I knew before,” and now I can’t understand why I was so worried about lows. Honestly, lows have NOT been an issue. I’ve had the occasional, “Oh crap, my Dexcom shows 70 and a down arrow!” but I would take a few sips (literally) of a juice box, and things leveled out almost immediately.

One of the most interesting things about my “new” stomach that is taking some getting used to….food/drink hitting my system literally seconds after I consume it. I spent years figuring out when and how to take my insulin in order to have it be most effective at the time when my food would be digesting. I used square wave and dual wave boluses on my pump like it was my job (well, because diabetes IS like another job, after all.) I rarely pre-bolused before meals…I would wait until right before I ate, and then take insulin in a manner befitting what kind of food I was eating. You know, like for pizza – you take some, square or dual wave some over the next 2-3 hours, then take some more a little later, still go high, correct a bit, and then hope and pray you don’t over-correct. Stuff like that. That system and way of insulin-taking? Gone.

Now, I have to think ahead once again…take little bits of insulin (depending on what I plan to eat or drink) a good 15-20 minutes ahead of time. And I CAN’T forget to eat. I need all the nutrition I can get, and don’t want to waste an eating opportunity on scarfing down a juice box. Because, even though before this surgery, I planned my entire day around eating/insulin/exercise/diabetes, I STILL have to do that now, only adding in the caveat that my stomach will-not-allow me to consume more than a small amount of anything at a time. I get a full feeling very quickly. I cannot really “scarf” down semi-solid foods (I’m still in the pureed stage right now, so things like runny scrambled eggs are a staple.) If I try to take several bites one after the other, it feels like it gets “stuck” somewhere in my upper chest, and is VERY uncomfortable. The other morning, I was in a hurry, and ate my eggs too fast. Big mistake. I saw those eggs again very quickly when I vomited. Lesson learned, but still hard to adhere to.

Eggs and decaf coffee, breakfast of champions

Decaf coffee with Stevia & a little protein powder added into it, and a serving of an egg/egg substitute mixture with a smidge of bacon salt in them. I have to drink my coffee either 30 minutes before or 30 minutes after I eat the eggs. And I’m LUCKY if I can eat as much of the eggs as you see in this picture.

This is my biggest challenge at present: Eating slowly. I know I have to, I know it’s better for me, I know it will help me feel fuller longer (and also cue in faster to when my new stomach is getting full)…..but for years, I’ve been a “get the food in while it’s hot and while you can because your kid is going to need something soon, and then you won’t eat and then your sugar will crash, and then….” kind of person. That habit is really hard to break. But like a lot of things in life now, I’m working on it!

Gastric Sleeve Surgery and Blood Sugars

I’ve had a handful of surgeries in the past 20 years since being diagnosed with Type 1 diabetes, and there are a few tips and tricks I’ve learned that have helped immensely:

  1. I want to be the FIRST surgery of the morning. Since you’re supposed to stop eating/drinking anything at midnight the night before, it’s much easier to manage blood sugars for a short amount of time in the morning before a surgery rather than attempt to manage sugars all day on an empty stomach, risk potential lows you might have to treat with food/drink, thus negating the whole not-eating-after-midnight thing.
  2. Better to risk running high than running low. The night before surgery, I usually cut back my basal rate to about half of what it normally is. I don’t do any corrections for high blood sugar unless it starts running over 200. Then, I very conservatively correct – again, give myself about half of what I normally would to correct it.
  3. FILL OUT PAPERWORK ahead of time that says YOU take responsibility as soon as possible after surgery for your own diabetes/insulin/blood sugar management. No nurse or doctor knows how to work my insulin pump and CGM better than I do, and I had no desire to go back to getting injections at the whim and on the time-frame of nurses who don’t understand MY diabetes.
  4. Take at least 1 brightly colored piece of paper with you that states you are type 1 and notes your management regimen. For example, mine said, “TYPE 1 DIABETIC, on Insulin Pump and Continuous Glucose Monitor (CGM.) Please NO acetaminophen – it disrupts my CGM.”  This worked very well for me during this stay – had several nurses comment that it was very helpful for them to see that in my chart and know it immediately when they were treating me. (It also led to several educational moments where nurses had never seen a CGM before, so of course, I showed them and explained the whole she-bang.)
  5. Ask if it’s OK for that surgery to keep on your insulin pump port-site, and/or your CGM sensor. For my c-section, my OB preferred I didn’t have anything foreign on my skin or body, but for this surgery (since it was obviously way higher up on my torso), every nurse, doctor, and anesthesiologist I talked to said I could keep them on.

Now, onto gastric sleeve surgery …..that morning of surgery, I kept my pump hooked up  – running on 1/2 my usual basal rate – and also kept my CGM sensor on and the receiver with me until the very last minute when they were going to wheel me back to the operating room. Then, I relinquished my pump and CGM receiver to my husband for safe-keeping.

IV, Pump, and CGM, oh my!

I was running in the 180s right before surgery, which was perfectly fine with everyone involved.
Immediately post-surgery in recovery, I have no idea what my blood sugars were there – I was just trying to get reoriented and awake from anesthesia, and make sure they gave me some more pain meds. Thankfully, they got enough pain meds into me fast enough so I wasn’t very uncomfortable for long. Waking up from a surgery – always surreal for me.

Once I was in my own room and my husband gave me back my CGM and pump, I fingerstick tested (just to calibrate the CGM for good measure), and I was somewhere around 270. I knew I wouldn’t be eating or drinking anything for the rest of the day, so I wanted to be very careful about correction bolusing. I gave myself about 1/2 of what I thought I needed to bring it down to 150. Waited a couple hours. I had a decently steady downward-heading arrow on the Dexcom, so I just kept doing little correction boluses until I got down to 150, then I stopped.

Amazingly, for the next 24 hours, I had steady and decent blood sugars. Of course, I consumed literally NOTHING on the day of surgery – not even a sip of water (thank goodness I was on IV fluids, but my mouth felt like a desert.) And the following day, I could start on clear liquids, but that meant broth, water, sugar-free lemonade, and the like that had zero carbs and minimal calories. You can see my Dexcom graphs below, but it doesn’t show what I was doing with my insulin and boluses. Short answer = I kept my basal rate at close to 1/2 of what it used to be (for me, that is 1 unit per hour), and made only teeny tiny correction boluses here and there (of like, 0.5 unit)  if my sugar started sneaking upwards.

Day of surgery graph

Day of surgery blood glucose graph, from 12 midnight to 12 midnight. NO food or drink.

Day after surgery graph

Day after surgery blood glucose graph – on clear liquids only.

Now, the 3rd day after surgery, I was allowed to start on “full” liquids again, which meant the nasty protein shakes, 1% milk, sugar-free Jello, chicken broth, sugar-free Popsicles, and all that sort of stuff.
That is when blood sugar management got….interesting. The second I had a protein shake that morning with milk in it, my blood sugar RACED up to the  mid-200s. Seriously, it was like dawn phenomenon, the breakfast spike, and who knows what else all came into play at once.  You know how many carbs were in that shake? Like, a measly 13g. And the spike happened after I’d taken only maybe 2 or 3 sips, so I’d be surprised if I had consumed 1g of carbs at that point.

Spikey spikey

On full liquids, “breakfast” spike and subsequent calm-down over the course of each day. My graphs looked like this for several days, until I let the Metformin kick in again AND started bolusing at least a little something well-before I started sipping on my breakfast.

  • Note: I had not returned to taking my Metformin, but decided to start back after a couple of days of these spikes. Realization? My insulin-resistance wouldn’t just suddenly disappear after surgery, it would take time to lose some weight and hopefully get it down that way.
  • Another note: On all liquids, whatever I intake now hits my system *almost immediately*, and I had gotten into the habit of bolusing right when I eat, using dual-wave boluses, etc. Nope, NOW I need to bolus well *ahead* of eating/drinking, so that the insulin has some time to get into my system before I consume something that takes zero time to digest.
  • Crap, one more note: I waited a couple days post-surgery before I reset my basals back to the rates they were before surgery. With the weird spikey spikey happening, I guessed (correctly) that I needed a higher basal rate back again, regardless.

I hope this is all making some sort of sense. Today, I’ve actually had a pretty decent blood sugar day, and my spike this morning was not nearly as bad! I am hoping I’ve turned a corner in understanding how fast my stomach is digesting things now, and can take insulin accordingly/ahead of time to help stave off that spike. BUT, I know things will be changing in the weeks to come as I introduce “regular” food back into my diet. For reference, here is the upcoming schedule of how I am working up to eating regular food again while my stomach heals from surgery:

Bariatric diet stages post-surgery

It’s going to be a wild ride on the roller coaster of blood sugars, I’m sure! :)

Even more notes: I am NOT a doctor or medical professional of any kind, and am just sharing my personal experience. Individual bodies are different, and just because this is how MY body is working as a Type 1 post-surgery for gastric sleeve, it doesn’t mean that everyone else’s will work this exact same way! Your Diabetes May Vary. 

 

Quick Post-Surgery Update

I finally had gastric sleeve surgery (aka VSG) last week, and said goodbye forever to about 75-80% of my stomach.

Desperate times call for desperate measures (I think my next blog post should be called that) – I have TONS of material to share surrounding my surgery, hospitalization, and the recovery challenges so far) and having something like this done is no true “quick fix” to losing weight. It is a process, and a very tough one, especially when you add in Type 1 diabetes to the mix. Each day right now is an exercise in counting all the little victories. I WILL get there…..

Victory in a bottle!

See that empty bottle? THAT is my victory this morning. I drank *all 8 ounces* of that protein drink within the span of 3 hours as my breakfast. This is a GOOD thing – yesterday, it would have taken me at least 4 hours, or I would have given up and just started on the lunch one without finishing the breakfast one. My stomach is still swollen and inflamed from surgery, so it’s even smaller than it will eventually be once it’s settled down and healed completely. Getting in enough fluids each day, nutrition in the form of high protein shakes & drinks, and eating/taking all of my chew-able vitamins and minerals is yet another job on top of the other health-job I have in taking care of my diabetes. I wish I could tell you, “my blood sugars have been fantastic since the surgery!!!”….but they haven’t been fantastic. They are manageable, sort of, but running way higher on average than I like.  I have a whole new “normal” to get accustomed to, and so does my body and all it’s inter-working parts. I’m getting there, slowly but surely, and promise I will have an upcoming post on blood sugar management pre-, during, and post-surgery.

Another victory to note? NO blood sugar crashes, at least! Dealing with potential low blood sugars was one of my primary concerns around the surgery and recovery time, and so far, I haven’t had to scramble and test the limits of how-much-apple-juice-I-could-consume-how-fast to bring up a low, because I haven’t had any. Whew. Knock on wood, fingers crossed, and all that jazz.

The biggest challenge I am having right now is that I have ZERO energy. Mainly because, I’m lucky if I consume 500 calories per day. (MyFitnessPal keeps telling me I’m not consuming enough calories – like, I didn’t know that already??) I have some kind of protein drink, water, sugar-free popsicle, soup, sugar-free Jello, etc. in my hand all day long, and I literally just can’t consume more – my stomach says, “enough!” and I listen to it, or else pay the consequences in pain/burping, or potential vomiting. (Again, a victory I hope to maintain – no throwing up.)  I had my first post-surgery followup appointment yesterday, and my PA said I am doing great. I’m getting in a good amount of protein, and she says the calories and ability to consume what I need will come with a little more time – my stomach still has to heal.

And you know what? Here’s a pretty big victory. In the last 2 weeks, since I started on the pre-surgery all-liquid diet, I have lost almost 20 pounds. T-W-E-N-T-Y. It has not been an easy 20 pounds, but I am owning it, and it’s giving me even more motivation to keep on doing whatever I have to in order to use this tool of weight loss to make my life better and healthier. My stomach will never be the same again, and neither will I. I am committed, and I will do what I need to do in order to be healthy – for myself, and for everyone I love. And you know what I’m really looking forward to? Hiking long distances. Running and being carefree. Doing cartwheels with my daughter. So many things that I used to love to do, but couldn’t because of the weight. I WILL do them again, and soon!!!