Friday Findings

Today is Friday.  I just found things!

Found it!

  • Was looking in all the pockets/flaps of my diabetes checker-pack, and found the $13 I had stashed in there last Friday (the 13th.) I’d forgotten all about it! The 13s are coincidental, but funny, right? I just had too much cash in my back pocket since I wasn’t carrying a purse, put it there and promptly forgot about it. FOUND MONEY!
  • Dug into the depths of my purse looking for a pen, and found my badge from the Diabetes UnConference!! I had been frantically searching for it on the last day of the conference (thanks to all you guys who looked around with me, like it was a lost contact or something) when all along it was just stuffed into my purse, hidden underneath so many things I didn’t see it. Whew! And in it were all the contact cards for people that I’d picked up, yay!
  • Also in said purse, at the very bottom, I found various room keys from the Flamingo, where were stayed for the UnConference.  Oops, they say on the back that they recycle them. Sorry, Earth! They will now become fake credit cards for my daughter to play with, so that’s like recycling, right?
  • Was out running errands, and found some stray GlucoLift tablet samples I’d picked up at the UnConference. In all my unpacking and reorganizing, they’d ended up under my car seat somehow (??) They saved the day when I started running a smidge low, and wasn’t anywhere near good food at the time.

All in all, a successful day! Now, off to find some things to cook for dinner with all our neighbors!

Ninja Insulin #dblogcheck

You would think after close to 15 years on the pump I would know all the tricks of the trade, all the quirks of the pump, all of the sneakiness of insulin absorption…..but, nope.

I’ve come up with some blood sugar savers that really do work for me, though….like, when I change out an infusion set site, I used to ALWAYS have high blood sugars for hours afterwards. Thanks to a comment by Katy, I was encouraged to “ka-chunk” in a new site without removing the old one for a few hours, let it settle in & calm down, and then connect up the pump to the new site. Bells ringing, fireworks going off, and a ticker-tape parade later, I rarely have any post-site-change highs anymore, and when I do, they are due to other variables of life.

Sneaky, sneaky....

But lately, I’ve discovered a new brand of insulin….the Ninja Insulin. I swear, I take a bolus for a meal or correction, and go about my business, but my blood sugar remains slightly high. Then, I drink some water, or sometimes, even eat a couple grams of a carb, and whoa! Here comes that insulin out of nowhere, and suddenly I’m on a downward trend of blood sugar. It’s really weird. It’s like it’s been hanging out in the shadows of my bloodstream, just waiting for the right time to take effect. It’s a most puissant ninja.

Don’t forget to #dblogcheck today!!!!

The Cost of Good Health

I am thankful every-single-day that I have good insurance (through my husband’s work.) But it still makes my jaw drop when I see the breakdown of what just 3 months worth of test strips, lancets, and insulin pump supplies cost:

SuppliesCostPic

That does not include insulin itself, or my CGM sensors, which I’m sure would add on more crazy $$. Suffice it to say, I feel confident that without insurance, I would be paying around $1,000- $2,000 per month for all of the prescriptions and supplies I need just to stay alive. Now, could I stay alive using only insulin and syringes, and not using all the fancy technology? Sure. But you’d better believe my *quality* of life would not be the same. Having my insulin pump and CGM have helped me really rein in my blood sugars, which we all know helps keep our bodies from getting worn out so soon from so many highs and lows all over the place. Am I perfect in my blood sugar management? Heck no. But with these tools, I’ve come a long way from when I was on Regular and NPH injections when I was first diagnosed in 1994. My A1Cs were never below 9 until I went on the insulin pump. Ever since, they have been 7 or below, and for several years now, hovering under 6.5. I’d like to keep it that way for as long as possible, and hope and pray I have good insurance and can afford all of my diabetes prescriptions and supplies for the rest of my life (or until they find a cure, right??)

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.

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/)

 

 

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.