Insulin Madness

...so I got the results of my 24-hour urine C-peptide back today (it's a really annoying test that test your overall insulin making capacity and requires you to keep jugs of pee in the fridge...ooh sexy!). It's on the low side of normal, which provides more evidence that I am not insulin resistant. It's both upsetting and a little bit of a load of my shoulders...it always seems like no matter what I eat and how much I exercise, my sugars always tend to run a little high. I become frustrated with myself, blame myself (that I am just not doing enough), and then fall off the bandwagon because I feel like it doesn't seem to matter. It's this really vicious cycle that's caused my eating habits to become some what disordered. I keep bouncing between the new extreme diet of the week, and then pretending like my diabetes doesn't exists...but the fundamental reason for my blood sugars never being just right (even though by medical standards I have good control) is that my body needs insulin that I can't produce adequately. Needles suck, but my perpetual guilt like I've done this to myself is even worse. The test sort of proves that my diabetes isn't a result of things I've done, but rather bad luck...I am not saying that I don't have control over things (because I can control my diet and exercise), but it does say that I can stop beating myself up emotionally all the time.

One Step Foward, Two Steps Back

So there the envelope was sitting their waiting for me when I got home...A1C and TSH results. I always dread opening up that darn envelope...handshaking I rip open the envelope. It's like getting my report card in elementary school.


TSH = 0.51 (o.k. well at least that's back to normal...I've been a yo-yo between super hypo and super hyper these last 6-months...having one thryoid gland sure makes things complicated...and probably is more thing effecting my BG....for a few months I could get my blood sugar straight now matter what I did or eat).

AIC = 6.4%!!!!!!

Yeah, I know by the American Endocrinology Association I've slipped from excellent control to good control, but by Dr. B's standards I've slipped from good to pretty bad...a 6.4 is an average blood gluocose of 132...I guess the averages on my glucose meter wasn't lying (o.k. I know that should be obvious...I am in med school...)

I know I've let things slip in the last few months, have become increasingly moody and have lost a lot of my energy....the evidence confirming the way I feel was finally in. Diabetes always causes such guilt. It's quite comparable to being a student. No matter what I do at the end of the day, I feel like I should always be doing more. At the end of the day I always reflect on what I haven't done. Even if I am exercising regularly I always think, "I only exercised 4-days this week. I should be exercising 5 or 6" or "Your a med student...you should know better...you should be a better example for your patients!"

As I sat and moped and threw myself a self-pity party for the afternoon my roommate pointed out the obvious, "Maybe at the end of the day you should make a list of what you have done. You need to take more credit for the good things you do for yourself. And maybe find some other way to positively reinforce good behavior besides food!"

On that note, I am thinking about setting up a jar for myself to save for a monthly massage...everyday I gloss over that piece of chocolate $2 to the jar...

Yeah, for delicious low-carb Thanksgiving recipes...

So, I am finally getting the hang of this low-carb desert cooking...at this moment I have a low-carb pumpkin cheesecake cooking in the oven for Thankgsiving at my sister's....I don't even want to be tempted by her sugar filled pumpkin pie, so I thought it best if I come up with my own diabetes friendly deser...so far the batter taste delicous...even my non-diabetic roommate concurred (she's a pumpkin pie fanatic)...I admidetly starting to concur with a classmate of mine who has DM I, that "Anyone can have good control...all you need is lots of time to obsesse about food." I really don't want this statement to be true, but creative foods do take time....

I am a little worried about the crust though...the first pecan crust had way too much stevia (I followed their proportions on the bottle I swear), and the second batch had 1/4 the amount of stevia, which still amounted to stevia....I ran out of pecans before I could make it right...admidetly when it came time to making the batter I just stuck with packets of Splenda, despite the fact that I know Splenda add a few extra carbs (not nearly as many as sugar....but still)....anyone have any tips on cooking with Stevia, so I don't have to go through 3 batches of ingredients before I get it right?

Also, on a side note....I have officially been taking diabetes meds now for 1-year...so Happy Birthday Diabetes!

Almost Through Block 1...

So I had all these crazy ideas that I would find time to blog every day during medical school, and that blogging about diabetes would help keep me on track throughout medical school...well I am now 15 weeks through the semester and barely making my first post in almost six-months! Phewf...

Med School has brought a whole new set of challenges to managing my diabetes. Yes, my A1c a few weeks ago was 5.7%, my blood pressure was less than 120/80, I had a good HDL: LDL ratio, a nice healthy BMI, but I know the real story. The only tale-tale sign to my doctor was my slightly elevated triglycerides, but I've seen the + 200 spikes a few times a week, and the slowly crawling morning fasting sugars, which have steadily increased from 90 to about 120. Although, they may not last long enough to due to much damage to my A1c, I know they are slowly doing damage to my heart, nerves, eyes and mood. Nick can always tell when my blood sugars wacky. I get grumpy with him, and unfortunately he's been seeing it a lot more the last few weeks.

All the lunch time meetings--pizza (yes a med school frequently chooses Pizza as the lunch time meeting food of choice), burritos, cookies, and sandwiches...I know I should just always plan ahead and pack my lunch...

...Despite how much I know, I still find that stress turns me to an addict...I come home at 11pm from a long day of studying and all I want is chocolate. Every now and again I go on an eating frenzy...a recent study confirmed that studying does indeed cause people to eat more, but still this is no excuse...my brain tells me no, but my salivary glands yes. I think about retinopathy, neuropathy, and I convince myself, "Tomorrow, I start again....but tonight...." Food is always a struggle. I go to clinic and give the diabetic patients a meal plan to follow, and when I get home I sneak one of my roommates ice cream bars...as if no one sees me, it won't effect my blood glucose...I feel lucky that I can afford medications that give me a fair amount of freedom.

I've been trying to get back on the bandwagon. I've been packing 5-minute microwavable Tilapia Fish and Frozen Broccilli, I've loaded my fridge with veggies, and my spice cabinet with an arsenal of flavored stevia products, sugar free, but yummy spices such as pumpkin pie spice mix, baking cocoa powder, a Costco size box of Splenda, lots of great tasting Herbs to spice up all my low-carb meals. I've collected 20-minute or less healthy recipes that employ simple med school friendly ingredients (aka recipes that don't require more than 5 ingredients, but still taste great!)...I've even convinced my roomie to keep the chocolate and cookies hidden in her room. I plan on signing up for a half-marathon in San Diego in January to motivate to get me up before class to jog, and after hitting the climbing gym this weekend with my brother and his wife, I've finally decided that I am going to join the climbing gym up here in Sac, because it absolutely is addicting and super fun!

Recently, one of my roommates classmates was over, a second-year who has Type I...he joked and said, "Yeah, the key to managing diabetes is having lots of time!"

Next, we I have my first appointment with my new endocrinologist. I want to talk to him about injectable Byetta or Amylin...I think they might even out my post-meal spikes and curb some of my stress induced carbohydrate cravings....let's see if the med school insurance will cover it!

So there...I've gotten it all off my chest...blogging really does keep a diabetic honest!

More to come on my life in med school...but for now sleep!

I going to be a doctor! Yippie!!!

So on Thursday as I was heading out to go to a company Padres baseball game, I received a phone call. I jumped when I realized the area code was from the Sacramento area. I must be mistaken...this couldn't be UC Davis, could it? It was!

I tried to stay calm, while the director of admissions asked how my day was going and what I was up to. "Stay calm, stay calm," I kept reciting to myself...

"Oh, I am having a great day," I said, "Just heading off to a baseball game with my work."

"Well, I am about to make your day even better and offer you a place in our medical school," he said.

All I know is that I must have said "Thank You" about twenty-thousand times. Then I proceeded to start to cry...not just get a little teary-eyed...but FULL ON SOBBING with tears streaming down my face. Any bystanders would have seriously thought someone had just told me there was a death in the family. It even caused the Director of Admissions to stop and ask if I was o.k... I was in such a state of shock that I had to ask the director, repeat the directions TWICE on what steps to take next!

Believe me that evening, I threw caution to the wind when it came to my normal diabetic diet (see you knew I'd bring in diabetes somewhere). With pre-dinner Margarita, pasta for dinner, a yummy strawberry creme desert, and a glass from an $85 dollar bottle of port that I had been saving for the occasion, you'd think I would have gone into a diabetic coma...I must have had Nick secretly worried the whole evening! Oh, and did I mention the $35 cigar that Nick brought out...I don't even smoke, but it was fabulous...But the weird thing about all this...just TWO-HOURS post-dinner my blood sugar was only 101! Very strange. I expected that I must have hit 300...I even tested the control to make sure it was correct! Mmm...maybe it was the alcohol...it does have a way of lowering my blood sugar. (o.k. the above paragraph is a good example of "How not to be a good diabetic").

Anyway, almost four days have gone by and I am still in a state of shock! Yippie!!!!!

Report Card Time...

Waiting for A1C results often remind me of waiting for progress reports in high school. Today, I had my follow-up with Dr. Einhorn to find out the results of several of my blood tests and to perform a sonogram on a nodule in my thyroid....

A1C 6.6% - B
Exercise Habits - B
Carbohydrate Control - B-
Initiative and Self-Education - A
Diabetes Self-Care (following up with ophthalmologist, etc.) - A+

Yes, I need some work in some places...

On a good note, it's looking with more and more certainty that I am a Type II diabetic. My C-Peptide was elevated, so I am definitely, pumping insulin throughout my body. I really like that Dr. Einhorn is taking an aggressive approach with me. There are a lot of docs that look at me and think, "A1C below 7...you're good to go." I get really frustrated by this, "Diabetes has a progression and there's not too much you can do to truly normalize your blood sugars" attitude. For both Dr. Einhorn and I this is unacceptable. Good news to me, is that he's a leader in this area and was just lecturing to his students at UCSD about how to optimally control Type II diabetes and preserve beta cell function. Finally, the words I've been longing to hear, "Preserve beta cell function." Someone who actually believes it's possible! He looked me straight in the eye and said, "If I was your age and this was me, this is what I would do for myself."

Einhorn is putting me on a whole new medication regimen, which includes increasing my dosage of metformin and putting me on Janumet, a stiagliptin/metformin combo drug, and also adding pioglitazone to the regime. We're going to recheck it and if I still can't get my fasting blood glucose levels to close to 90 in two months, then I might start on a long acting insulin in the evening. In the meantime, I need to do my part and increase my workouts to 5-6 days a week, incorporate some serous weight training, and meet with a dietitian he recommended...

It's odd because when I have a doctor who really believes in the possibility to normalize my blood sugars, I am more inclined to work harder at it. It really is a team effort. Go team! 5.0% here I come!

Not alone...

So last week, Nick and I attended a formal reception aboard the HCMS Juan Sebastion Elcano--an old Spanish Naval Training Ship that was in town for a few days. Nick introduced me to the captain of his ship who has Type II diabetes. For some reason I had pictured him as this out-of-shape middle age guy, but he was not. I had thrown the stereotypes of a Type II diabetic upon him, even though I myself hate those stereotypes. I still constantly internally struggle with a sense of guilt--that I am at fault because it's Type II. To my surprise, his captain was not only quite fit, but was diagnosed in his early twenties like me. We're a rare breed, so it was nice to find someone with whom to commensurate.

On a non-diabetes note, the rest of the evening went really well. It was quite fun and I got to meet all of Nick's shipmates. To my surprise, Nick invited me to come to Austin with him in June for a family wedding. So all in all, I had a great evening!