Living With Diabetes

Have chest pains and tell them that you are having them.

Okay, I'm 99.99999% sure it is gastric reflux.  I break through my medication (as they say) every fall.  Every fall my gastric reflux has sent me back to the doctors for more medication.

But I was a bit alarmed myself when I was having chest pains after lunch, and walked across the hall to ask one of my coworkers what I should do.  Moving around help, as by the time I got there, solved the problem.

But I called my primary care physician anyway.  He called me back on a real phone (in his office) last night when he got my message.

He called the pharmacy and had 300 mg Zantac waiting there for me, and I slept better last night.  We'll see how it goes.

He also wanted me to talk to the cardiologist for it and told me to go to the ER if they lasted more than 10 minutes.  So I work almost equidistant to two different hospitals so I wanted to know which one -- they never WOULD say, but that's okay.  I think I'll go to Medical City Dallas, if I have to.

The bad part -- well, the two major sympthoms of gastric reflux I am having are sympthoms of congestive heart failure -- I know that's the sympthoms my dad had before he did.  Yeah, the chest pain and the coughing thing.

I really do think it is just gastric reflux.  It sucks.

Posted by at 12:06 PM | Permalink | Comments (1)

I went and double checked, and I did finish week 9 of exercise.

The inserts are making a huge difference, yesterday I was forced to be on my feet for about an hour, and I didn't feel nearly as bad as I usually do.

Posted by at 10:41 AM | Permalink

The last few weeks have been hectic,but I've gotten my workouts in. I think I got two or three extra cardio workouts in this week -- the shoe inserts are helping.

I figured out that they feel better if I put them below the removable inserts that are already in my walking shoe.

I definately want to get at least one more set made soon. I just keep forgetting to put the extra shoes in my car.

Posted by at 7:07 PM | Permalink

Finally got my flu shot. I usually do it at my endos but they did not get theirs in time for my visit and their hours are too inconvenient.

I was able to get one at my primary care physician's at 9:00 this morning. They have walk in appointments on Saturday and I got there a few minutes early.

Amy at Diabetes Mine talked about getting hers at a local pharmacy but that does not work at all for me because the ones here usually have hours frim 10:00 to 2:00. Great if you are retired like my mom but horrible if you are a teacher.

Anyway glad to have it done especially in October.

Posted by at 11:41 AM | Permalink

It will be interesting to see what happens -- I just injected my first dose of Depo Prevera. I don't like the needle, it's thicker than a diabetic needle but not bad.

This is a lower dosage so it will be interested to see what happens with blood sugar, periods (right now, I don't have any), break through bleeding (don't have it), and acne -- occasional breakouts near time to inject, though didn't this round.

Posted by at 5:10 PM | Permalink

The knees are doing very well. It's cold and rainy -- the stuff that makes them ache and they don't. Are they perfect? No. Am I ready to stop taking Mobic? Maybe on Saturday.

However, one of my goals is being accomplished, I am more active!

I think I'm going to take a second pair of shoes with me and get another pair of inserts tomorrow.

Posted by at 5:08 PM | Permalink

This is amazing. I did dog agility last night in them, and spent the day in them. I did take a 15 mg Mobic last night BUT we have rain coming in, which usually makes me ache.

I'm not nearly as stiff as usual -- I better find my shoes though, as these are the ones my puppy likes to chew the most.

Anyway, I'm MUCH better and it's only been 24 hours.

Posted by at 9:38 PM | Permalink | Comments (1)

Life has gotten full again.  I did complete all my workouts for last week -- Week 8. 

I went to an orthopedist yesterday, not one that the endo suggested, but one I found on the Simvisc <sp> site that was close to school.  Had to leave early to see him, and one of my coworkers took my class.

I was a bit disappointed at one point -- he did a full set of xrays, and when I told him the criteria I had for fixing the knees: reduce medication and not mess with blood sugars -- his answer was shoe inserts.  I thought that a bit odd.

However -- the xrays did show a problem with weight distribution.  He sent me to a place that makes the shoe inserts in the same building and they were able to make them while I waited.

I think they are helping, I wore them doing dog agility last night and I don't think I was as stiff this morning, though I did take a higher dose of Mobic last night too.

We'll have to see how this goes.  It would be great if it worked, the inserts are only $70.

Posted by at 8:35 AM | Permalink

I am having a tough time taking Nasonex when I am supposed to. In fact, I think I forgot it again last night.

With medications, there are two problems with complanace -- making sure I actually take the drug, and making sure I don't take it twice.

With pills, it's easy. Every Saturday, I take my last dose of the week (morning and night) and I refill the pill strip. I can tell easily if I have taken the pills -- if I have, there is an empty space for that day. If not, they are sitting them and I should take them. No brainer -- I really do believe smart doctors and pharmacutical companies should provide the plastic pill containers marked by day.

Nasonex is harder. I can't tell if I took it. I've got my Treo set up with a task and reminder -- I have no idea if I took it last night, and since I didn't take my Requip, I am not sure I did. I certainly didn't tell my Treo. I also know I did not take it Monday night -- though I took the Requip.

I really do have trouble with any night time medication since I don't have a regular evening schedule.

I suspect I will end up taking Singulair as my seasonal allergy medication, since I can easily tell if I took it and can handle a missed dose fairly easily -- take it the next morning.

Posted by at 6:23 AM | Permalink

Grab A Cuppa Grand Rounds! // Emergiblog

Posted by at 6:46 PM | Permalink

Even though I didn't get home until 8:00 two nights, and 6:00 pm one, I managed to get in all my workouts this week. It helped that I had the day off on Friday too.

I'm really hoping that my knee holds together -- though the good news is that the congestion finally subsided.

Posted by at 7:26 PM | Permalink

About LifeScan: Press Releases - Counterfeit Alert

Counterfeit Test Strips Discovered in United States
OneTouchｮ Ultraｮ and OneTouchｮ Basicｮ/Profileｮ Test Strips

Check this if you One Touch (I do).

Posted by at 9:57 PM | Permalink

Get on the scale daily to keep lost pounds off - CNN.com

Losing excess weight is often easier than keeping it off. A new study shows that stepping on a scale every day, and adjusting eating and exercise habits accordingly, can go a long way in helping dieters maintain a weight loss.

Every time I've been successful I weighed pretty close to daily. Though I can get obsessed and it does sometimes bad fire.

Posted by at 9:13 PM | Permalink | Comments (1)

Saw my endo in the morning. A1C was 6.6 Primary care physician didn't seem to understand why Endo is doing the bloodwork he did (mostly kidney/liver function).

I am still congested, but not as bad and no infection, but I'm going to be competing in a horse barn this weekend -- very large barn, but it's still a barn. Endo sent me home with Nasanx. Primary care sent me home with Nasanx and Singular. I need to find out if Singular is compatible with diabetes.

Also ran dog by the vet to check out her allergies. Would be a shame if I feel better and she feels worse. She's on a different anti-hystimine.

Also discussed knee with both doctors. Endo gave me the suggestion of cartridge injection, and I'm going to look into it. If I could have a year or so without pain, sleep would be better, and probably exercise too.

A1c was 6.6. Not a bad one, but it's been better. Everything else is stable.

And the bad news? Neither had flu vaccine. Primary care was supposed to get in some today but it had not arrived, so I'm trolling for flu vaccine.

Posted by at 7:03 PM | Permalink

Got through 4 late nights in a row -- though one night WAS for me and WAS fun.

Even got all my workouts in.

Tomorrow is Endo day and Primary care doc day.

Posted by at 7:59 PM | Permalink | Comments (1)

Diabetes Mine: Interview with a Real, Live Exubera User (Under 50)

She just started using EXUBERA, the first commercially available inhalable insulin from Pfizer.

After reading the testimony, I still say "yech". I also don't think I'd do well since I have lung damage from gastric reflux.

Also, I absolutely positive cannot be on such a rigid eating plan.

But that's why MDI failed me.

Posted by at 11:18 AM | Permalink | Comments (1)

Middle schoolers participate in diabetes risk study - CNN.com

For researchers, the payoff won't come for nearly three years. But it'll be worth the wait if the study at dozens of middle schools concludes schools can help lower the risk of Type 2 diabetes in children by offering healthy choices in the cafeteria and revamping gym class.

Posted by at 11:04 AM | Permalink

This makes me nuts. Too many Type 2's are not taught how to deal with their meter readings!

Diabetes In Control - Role of Blood Glucose Self-Monitoring in Medicare Patients with Type 2 Diabetes

The Centers for Medicare and Medicaid Services is questioning whether or not Patients with Type 2 Diabetes benefit from self-monitoring of their blood glucose and should they pay for monitor and strips.

Posted by at 10:53 AM | Permalink

Not only that, they didn't see the weight gain in the Byetta group.

FYI: I went to the pump because when I was on MDI, I kept having to eat to avoid lows and I kept gaining weight. I have done much better on the pump. If Byetta had been available I probably would have tried that first. I'm happy with the pump life though.

Diabetes In Control - Exenatide As Effective As Insulin

Results from a study indicating that exenatide improves blood sugar levels as effectively as biphasic insulin aspart 30/70 (NovoMix 30(R), NovoNordisk) for people with type 2 diabetes failing to achieve acceptable blood sugar control on both metformin and a sulfonylurea. This long-term clinical trial is the second study conducted at European clinical centers demonstrating that exenatide can control blood sugar as effectively as insulin.

Posted by at 10:49 AM | Permalink

I have felt like doggy doo-doo and been severly congested since Saturday night.  I'm pretty sure it's fall inhalant allergy since Marcie feels just as bad, and we were both at an agility trial that might as well have been outside.

It was so bad I skipped out JWW runs and those are the legs I really want.  Oh, and Marcie and I did qualify Saturday morning in Standard.

Here's one way that food gets affected -- every evening when the congestion, drainage, etc. is the worse, I crave orange juice and chicken soup.  To be specific, for years I've treated severe congestion with the local fast food Chinese place's won ton and egg drop soup.  I have NO idea how to properly dose, especially since the side effect of allergy problems is a rise in blood sugar.

I wasn't too far off, but I'm glad we did the blood draw for the A1c on Thursday.

Posted by at 9:33 PM | Permalink

Amy's got a book coming out.

Diabetes Mine: Our New Book, Unveiled

So you know I've been working on a "mystery book" for a while. Well, it's time for the wrapper to come off! Even though the cover design isn't finished yet; this one's just a temporary placeholder.

Posted by at 9:17 PM | Permalink

I got the hardest day done. Actually yesterday was hardest in my opinion. No dog agility for one.

Today I hosted for a group of about 9 webmastering teachers. I provided food and the entertainment. Came home and managed to get my workout in.

I should be able to get through the week now. Tomorrow is puppy agility, and I'm leaving straight from school tomorrow, so I have relaxation time. I don't have an official cardio workout until Friday.

Posted by at 7:58 PM | Permalink

swissinfo - Roche insulin pump clears US paperwork hurdle

The "other" pump maker is back in the game. I believe it is a win-win for diabetes.

Posted by at 9:30 PM | Permalink

I managed to get in all my workouts last week. It did help that I played hookie on Thursday. I'm worried about week 7. I have three teacher workshops to do next week, plus dog class. At least we are out on Friday.

Also, I finally increase my cardio workout to 20 minutes. I'm still nursing a bad knee, and the other one is acting up too.

Posted by at 5:12 PM | Permalink

Wireless Monitoring of Diabetics - Medgadget - www.medgadget.com

With the loud objections in the diabetic community when NY City announced they were going to monitor A1C resutls, I can imagine the outcry when this gets going. Especially if not voluntary.

Posted by at 10:12 AM | Permalink | Comments (1)

This is the hardest thing in the world for me to be compliant on.  In fact, confession time, I have been treated for an eating disorder.  I have been known to binge, but nothing "worse" like purging or others.  I have also had a weight problem all of my adult life.

That being said, I was also misdiagnosed and treated for another psychological problem but it was later discovered that I was suffering from sleep deprivation.  I do believe that my eating disorders are more symphtoms of sleep deprivation than anything else. 

I do know that if I go low carb, my blood sugar is better, but makes my gastric reflux worse, which bothers my sleep.  I've been learning that keeping carbs around 120-150 grams a day I overall do best. 

Doing best means to have a minimum of gastric reflux sympthoms, keeping a blood sugar around 110 fasting, and under 180 post pranial.  I have trouble doing that though.

Why?

One is the sleep deprivation thing.  When I'm having trouble sleeping, food is the hardest thing to control.  I make the wrong choices, and I tend to eat a few more carbs at night since that does help the sleep.  At the same time, exercise is difficult because sleep deprivation makes my pain sympthoms worse. 

The next thing is stress.  I've tried all kinds of things to help me deal with stress.  The first was to change my profession from maintenance programming to production programming but while that helped the sleep deprivation, the stress in that job was higher.

Now I teach, which means I get almost total control of my hours (except for next week, but that's another post).  My biggest problem though, is that I really take my job to heart.  I know that what I do may affect my students' future.  Last year was the worst year for dealing with that, and I'm still not completely over that.  Before their major tests I don't sleep.  I also don't sleep when I worried about individual students, etc.  I know that I shouldn't let it get to me, but it does. 

Most of the time, I can look at a food item and decide that it is't worth the extra insulin, but sometimes I don't.  Most of the time I can handle the binging, but every once in a while, I just have to sit down with a bag of potato chips and just deal with the stress that way.

It's a hard balancing act.

Posted by at 10:25 AM | Permalink | Comments (2)

Diabetes Mine: Judgement Day: Disappointed

Although Amy is not quite as technology savvy as I am, I am still going to follow her lead on this. Seems that the Dexcom technology didn't help her.

I do feel though that she is "handicapped" by sticking to shots. I still think she'll do better on the pump. I sure have!

Posted by at 10:13 AM | Permalink | Comments (1)

So here's an example of how I don't sleep.  I got in from dog agility last night about 10:00 pm.  Forgot to take my Requip so it was about 10:30 before I took it.  About 11:00 pm I finally got to bed.  However, every time I laid down, I choked and coughed.  Note:  This does not work with a CPAP very well, especially with a full face mask.

For those wondering, there is a bit of a concern with full face mask that the patient will aspirate if they cough or reflux.  (Yeah, and I have that)

I got up and started fooling with a broken computer I have, which I have finally declared dead.  I also took some Tylonel PM so that the choking would stop.

Posted by at 8:17 AM | Permalink | Comments (1)

So not 20 minutes after I post, I forget to do my afternoon test.  I made a run down to the office and they were handing out free cookies from the Men's Warehouse.  Grabbed one, it was good, I usually eat a small snack this time of day anyway, etc.

However, the food was downstairs, the blood sugar meter was upstairs.

Smith's Medical (Cozmo) idea of attaching the meter to the pump is a good idea, until you want to jump into the pool (my argument against the Cozmo idea).

Carrying the meter around would be a good idea, but a pain.

Posted by at 2:37 PM | Permalink

For me, because of my Animas pump, remembering to test my blood sugar is pretty easy.  I have it set to remind me two hours after my last bolus.

HOWEVER, I often forget to test in the morning.  Almost every weekend and occasionally during the week, I'll figure that important, first test of the day.  I need to find a better way. 

I've learned to keep a spare meter in my purse, as I will occasionally forget my regular meter.  Once I even dropped it as I loaded up the car for agility.  I also keep spare meters tucked in places where I might need one.  The car, one in my gym -- and I would keep one in my gym locker if I had one, and I even have a spare at my desk at home.  If I thought I might lose my spare one, I would keep one in the classroom but so far I haven't.

Find a meter you like.  I really like the Freestyle meter (Therasense, Abbott Labs), but Medco didn't like covering it.  I took home several different types that they did like covering, and tried them for several days.  I would test off the same drop of blood.

Remember meters are NOT equal.  For example, the Freestyle meters and the One Touch meters use an almost opposite approach of putting blood on the test strip and the Freestyle method fails when you use the One Touch strip/meter and vice versa.

Also they tend to give different ranges of results.  My CDE once told me that the Freestyle average more closely matched the A1C than any other meter.  I believe, but can't prove it, that the individual types of One Touch meters read similarly, but I haven't performed an individual experiment.

By the way, one of the reasons the average Type 2 isn't compliant on testing blood sugar, is that the insurance companies do not like paying for strips.  To stretch money, I was told by my first CDE (when I was on medication), do to a testing schedule such as this:

Test fasting on Monday
Test before lunch on Tuesday
Test before dinner on Wednesday
Test at bedtime on Thursday
Test fasting on Friday
Test before lunch on Saturday
Test before dinner on Sunday

I'm not sure that is real smart, as it really doesn't tell you what is going on, but remember the common approach to diabetes in Type 2's is to throw a daily pill at it and cross your fingers and hope it works.

I personally think the "Patty LaBelle" method is good, but getting the insurance company to pay for the strips is going to be hard.  Basically eat the same meal several times and see what it does to the two-hour blood sugar.  That will open some eyes!

Posted by at 1:55 PM | Permalink

Okay, I'll be honest. I really don't like physical activity. Well, dog agility is my exception. I don't know why I like it, but I do. I do enjoy just about any type of dog training, so you'd think that walking my dogs would be pleasant, but nope.

My parents were not into playing sports, though they did take us places like roller skating or bowling. We just never did any regular physical activity.

I hated gym class as I was growing up. I'm left handed and awkard which meant that I got picked last, plus I had never really learned any gym skills. I hope PE teachers have quit the team picking thing, by the way.

When I have been successful exercising it has been extremely convenient. I joined a gym which I enjoyed until it shut down precisely because it was less than 1 mile from the house and on the way to school. I felt guilty if I didn't stop by either on the way home or to school. Plus it was close enough so I didn't have an excuse in the summer. Heck it was on the way to about 80% of my activities. Plus it was clean, the staff was friendly and they had good personal trainers.

However, when it closed, they moved me to a gym that was not on my way, was about twice as far away from the house so I had lots of excuses, plus the dressing room was on a different floor from the showers. And the workout room. I got more time on the stairs than on the equipment.

Right now, I have the best solution for me. I have a gym at the house. If it is in disrepair it is my fault (it isn't). I also have all the tools I need to be successful -- I use iShape as my personal trainer, I have a TV setup with a DVR, and I tape shows I like to watch. It's at the foot of the stairs so it is hard to avoid -- most of the time I leave the doors open even though the dogs make a mess in there.

I also get repetitive stress injuries on a regular basis. I've had carpel tunnel repair, I've had heel spurs, and I have been diagnosed with tarpel tunnel syndrome. Plus I've gone through P.T. twice now for a bad knee. Any one of the foot problems can sideline me for a while, especially when I have to do physical therapy.

I'll share some of my unsuccessful exercise attempts.

When I first started teaching school, I started walking the dogs every morning. Good plan, accept a) there were dogs that attacked MY dogs, and b) that's when I discovered my grass and tree pollen allergy. Man, I only walked about 3 weeks and I got a major ear infection. Plus my stress level was high over the attacking dogs.

I signed up for an expensive gym on the other side of town -- great place and cheap for teachers -- the Landry center, super trainers, BUT it took an extra 30 minutes to drive there, and it was an hour trip when I didn't go to school.

Posted by at 11:11 AM | Permalink

Sleep is my hardest area to be compliant. I've ALWAYS had sleep issues.

Some are genetic/environmental. My father's family has not been good sleepers, and my mother says I've always had problems with sleep. Part of the problem, I believe is that it was considered a treat to be able to stay up with my father.

Other item that leads to that was my choice of profession -- I became a maintenance programmer, and I was on call literally 24/7. The only way I got off call was to go out of town -- and even then I would often get calls. It was not unheard of for me to get a call at 2:00 in the morning, go in and then stay at work until quitting time the next day.

My medical team has conjected that my sleep apnea was caused by an automobile accident when I was 20. If so, I went over 15 years without being treated for sleep apnea. I would often wake up in worse shape than I went to bed, so I often decided to not sleep, as what was the point. Before being treated for my sleep apnea, I would typically sleep 2-4 hours a night.

That has changed since I got my CPAP machine. I checked this morning, and I have logged an average of over 8 hours a night on my machine over the past 30 days. I still have trouble going to sleep, often have trouble getting to sleep, and even worse, have touble staying asleep. Then when it is time to get up, it's hard to wake up.

This is something I would really like to fix. The Requip helps, the CPAP machine helps, and eating sugar before I got to bed helps. Few other things help significantly.

I do know the better my sleep, the better my blood sugar, and the better my eating habits.

I do try to keep my sleep as stable as possible.

Posted by at 7:05 PM | Permalink

Here's someone else who doesn't like the "cure in 5 years approach", though I have a feeling we have different reasons why.

Diabetes.Blog.com :: Are the drug companies hiding a cure?

However, the problem is not the pharmaceutical companies but the big Not-for-Profits which have methodically misled the public with their pitches for money based on the logic that the cure is five years away.

Posted by at 2:22 PM | Permalink

Some pills are relatively easy but some are difficult. Here's what I've gone through recently on a difficult pill. I'll put some suggestions for helping ALL patients at the end.

I was recently prescribed Requip. You take it 90 minutes before you go to bed. Also, you are not supposed to drive until you know how Requip affects you. By the way, it makes me drowsy.

Here's the problem. I try to go to bed at 10:00 pm every night, but two nights a week I have dog class and they end about 9:00 and I have a one hour drive afterwards. I also found that Requip does make me drowsy. A good thing if I am at home.

The first problem was remember to take the pill at 8:30. The good news is that I can set my pump to remind me to do something (though it doesn't tell me what), at a certain time. So I set my pump for 8:30.

On the nights I have to drive, I take the two pills on the exit I take to get to my house. There are enough ways to get home from there, that even if there is some type of road block I can get home before I get drowsy.

First problem -- sometimes I couldn't remember if I took my pill. Knowing that it makes me drowsy and that taking it twice would be a really bad thing -- I did it once it was not good -- I was skipping taking it.

Unfortunately those pill containers marked by the day of the week have a problem -- one they are too big for my purse. However before my last trip, I found some lovely little plastic bags that can be marked by the day of the week and time of the day. I used some of those, but they are hard to handle and you have to work at figuring out if you took the pill.

The good news, is that I came across a smaller container that is marked by the day of the week.

So here's how I ultimately solved the problem -- first, I use an alarm that is present and with me at all times to remind me, and second was the smaller container to hold the pills.

For ALL patients:

I recommend those day of the week pill containers. I use a seperate one for morning and evening. The best thing about them is that they prevent overdoses as you can tell at a glance if you took it.

For traveling, I recommend the little plastic bags. The above pill containers do come open. Yes you should take something to indicate that they are prescription drugs. I print out the pages from the mail order pharmacy I use.

Finally for weirdly timed pills, use some type of alarm to remind you. It needs to be with you at the time you need to take the medication.

A smart pharmacutical company, pharmacy, or doctor's office would purchase them and get their name imprinted on them and give them free to patients. This would even be a good thing for the ADA or DLife to produce.

Posted by at 1:15 PM | Permalink

After watching DLife, reading Ground Rounds and lots of other articles I realize that many people do not get why patient compliance is hard. Since I am your average Type 2 patient, though a bit more motiviated, I think it will help everyone understand the whole mechanism, if I write on patient compliance.

I first tried to write one big article and then got a huge major writer's block.

So I'm going to try breaking it up.

Posted by at 1:09 PM | Permalink | Comments (1)

Diabetes In Control - Insufficient Sleep Can Cause an Increase A1c by 1.9 Percentage-Points
I'm trying to come up with a post that explains my "non-compliance".

Posted by at 10:46 AM | Permalink