Let's talk diabetes

In My Humble Opinion
41

Do any of you use stevia? I intend to try it.

I didn’t really have any symptoms (besides just feeling tired a lot in the way that Skald describes) and was diagnosed as the result of blood tests. I have type II, which runs in both sides of my family (one grandparent on each side had it, and both my mother’s older siblings). I take 1000 mg of metformin a day, 500 mg in the morning and 500 mg in the evening. I test twice a day. That was easier to get used to than I had thought it would be. I’m not afraid of needles themselves, but the idea of having to stick myself was scary. I got over it, though. I have PCOS as well, which is caused by insulin resistance.

42

My only issue with testing is a tendency to do it to much. I sometimes-- often-- have to say “Dude! You ate forty-five minutes ago! Testing now gives no useful information!”

43

Diagnosed as Type 2 nearly a year ago. I don’t remember what the level should be within a couple hours of eating but I do know that fasting (consuimng only water in the past 8 hours) level should be around 110. Mine was above 300 when I went in for a physical at the end of January. I was started on 500mg Metformin twice a day; that was upped to 850 around July and then 1000 in October. I tested this morning at 117.

Being that AC was diagnosed about 18 months before I was, I’d already started cutting out refined sugars. Diet sodas, sugar free candy (although I still allow myself the occasional Hershey bar, one standard bar with almonds has 19g sugar IIRC), Splenda in our iced tea, etc.

44

My history with diabetes is long and semi-complicated. I was diagnosed with gestational diabetes when pregnant with my first baby; I was assured repeatedly that as soon as I delivered, my blood sugar would return to normal instantly. Well, it didn’t. It wasn’t outrageously high, but it wasn’t normal, either. My doctors for the most part shrugged this off, so I did too.

For my second pregnancy, I started insulin even before attempting to conceive, just because I knew my numbers were higher than the pregnancy target range. Same thing; after the birth, my numbers stayed high-ish and my doctors didn’t seem particularly bothered. At some point in there, I finally decided to see an endocrinologist, who took me more seriously and told me I was diabetic, yes, really.

The thing is, the only time I’ve been really careful about my blood sugar and taking care of myself is during pregnancy. I had an insulin pump with baby #2 and baby #3, and was testing 10+ times per day. (Skald, I am right there with you, re “Dude, I don’t need to test again, I just tested 20 minutes ago… but what if my numbers shot up unexpectedly?! I need to know!”) Then after the delivery, it’s like, pfft, I just went back to eating crap and not exercising.

One of the really insidious things about diabetes is that you can have pretty bad numbers and still feel basically okay all the time. So when I started feeling NOT basically okay towards the end of last year, it was a wake-up call. I was feeling sluggish and exhausted 30-45 minutes after eating; I had no energy, and most alarmingly, I developed a serious case of bleeding gums and (TMI coming, folks) a yeast infection that wouldn’t clear up. My dentist and GP both confirmed that yes, these are probably the result of uncontrolled blood sugar and that a thorough cleaning (for the teeth) and an antifungal pill (for the yeast) would help, but that both problems would just keep recurring if I didn’t get my blood sugar under control. So I pulled myself together, started eating like I know I’m supposed to, started exercising again, and refilled my test strip prescription. I’ve been testing 3-5x/day. I would test more but my insurance only wants to pay for 3 strips a day and I don’t feel like fighting with them right now.

OK, so, diet. As part of my obsessive testing regime during pregnancy, I found out a lot about how different foods affect my blood sugar. What I found is that I can eat more of foods that are low on the GI index, as long as the total carb count stays under a certain threshold. (Which for me seems to be around 40-45 grams per meal, except for breakfast, which is more like 30g.) So, for example, 1/2 cup of white rice will spike my glucose way high, whereas 1/2 cup of brown rice will cause a much lower spike. But 3 cups of brown rice would be out of the question. Also, protein and fat tend to slow down the glucose spike, so I can get away with eating a little bit more carbohydrate if I’m also getting protein along with it. This is why I never, ever, just eat a piece of toast anymore. I’ll have a piece of toast and an egg, or a piece of toast with some cheese, instead. The protein is key.

Incidentally, a lot of diabetics have more trouble controlling blood sugar in the morning/at breakfast; there are some physiological reasons and theories for why this occurs, but basically you just need to know to look out for it. I tend to make my breakfast lower-carb and higher-protein than my other meals, although I don’t eat a huge amount of carbs at any meal.

I think I should probably be on medication or insulin, because my fasting blood sugar is consistently around 125-130 right now, but I’m waiting to see if my new diet/exercise regime has any effect on it before making the call.

45

I test all the time too - anywhere between 4 & 8 times a day, and I have a huuuge deductible for my insurance so that means I pay for those strips myself at least for the first few months every year. I’ve been using www.sugarstats.com to track it, and just ponied up for the “premium” subscription so I can track food & exercise as well. It’s a great website, can highly recommend it to anyone who wants to be completely anal about their blood sugar :stuck_out_tongue:

I so wish this worked for me. What you call “low carb” is what would blow me out of the water. I had 30 grams of low-GI carbs at lunch today - a huge amount for me - and I was close to 170 afterwards (126 before).

I know this means that I need to get on another drug to control post prandial numbers. Doc recommends Januvia, but also said he’d prescribe just about anything else I wanted (within reason - there’s several different drugs that make sense for post prandial control). So now I have to think about that over the weekend.

Going from zero drugs & perfectly healthy to 2 oral drugs and one injection a day has been unnerving, to say the least. The only upside I can think of is that my lovely, dear red wine actually seems to lower my numbers (but not so much I go hypo) so I can take solace in that!

46

Yeah, in these types of discussions I always try to be careful to preface everything I say with, “For me,” or “I’ve found that,” because everyone’s body is different and what works for me might not work for you.

As far as postprandial control, you’re already on insulin, so have you considered a fast acting insulin such as Humalog or Novolog to help with postprandial numbers? Insulin worked like a charm to keep my pp numbers down, while I was on it. The best part is that you can do a sliding scale and figure out how many units of insulin you need to cover a certain amount of carbs, so if you eat less or eat more at a particular meal, you can adjust your insulin correspondingly. Maybe not the best for someone with a needle phobia, though… (But seriously. No side effects! Except for hypoglycemia.)

47

Insulin is one of the options the Endo gave me, but not until I brought it up.

I’m really interested in hearing your experience with it. I’ve heard a lot of horror stories about huuuuge weight gain from the various diabetic forums, but honestly, half the reason I started this thread was because it seems like a lot of those forums are populated by people who thrive on horror stories. So it’d be good to get a more balanced perspective.

Despite the needles, I like the idea of insulin because it’s been around a long time, the effects are pretty much known, and it’s more or less a natural thing your body produces. (Well, not so much my body, but you get the idea…)

It also seems like it would allow me to have a bit more varied of a diet. I can do low-carb on a daily basis no problem. But I sure would like to find something that would allow me to have the occasional mid-size carb treat.

48

Type 1, diagnosed 22 years ago. I take Lantus and Novalog (pens) and test 2 to 3 times a day.

If I get below 120, I feel lightheaded.

I feel much better around 140.

49

I loved insulin. I started out with multiple daily injections, and then went to an insulin pump for my 2nd pregnancy. The pump is pretty awesome and if you anticipate being on insulin long-term, it’s worth checking with your insurance company to see if they’ll cover it. One injection every 3 days, plus you never have to take your insulin needle with you in a sunglasses case if you want to eat at a restaurant. And as you say, there are no side effects. It’s not hard on your liver or kidneys, etc.

I didn’t experience any weight gain with insulin. In fact, during my first pregnancy I only gained a total of 19 pounds, and within 4 weeks of delivery I weighed 15 pounds less than when I had got pregnant, and this was while using a truly impressive amount of insulin towards the end of my pregnancy. (Pregnancy hormones tend to make insulin resistance go up as the pregnancy progresses.) The drawbacks are, 1) needles, and 2) if you’re using a slow-acting insulin for overnight, you kind of have to make sure to get up and eat breakfast at the same time every morning to avoid having a low. You also might have to time your meals to catch the “peak” of your slow-acting insulin wave, depending on which type you’re using, and so forth. But I’ve tried insulin and Metformin both, and vastly prefer insulin. Metformin made me gassy and didn’t affect my blood sugar all that much. Insulin dropped my blood sugar into the normal range literally overnight.

50

My exprience with Metformin/Insulin so far has pretty much been the same as yours, although Metformin doesn’t make me sick/gassy. It also doesn’t seem to do a whole lot for my blood sugar.

Lantus, on the other hand… wow. Love the stuff, even with the needle. Not sure what you were on, but Lantus doesn’t have any peaks - it’s even other than for a slight dip at the beginning and end. I don’t have to time my breakfasts at all.

Oh, and another plus for fast acting Insulin: Endo has told me I’m gonna be on it in a few years either way, as my pancreas seems to be giving up the goat as far as insulin production. Part of me just wants to bite the bullet now and go for it.

51

Yeah, I’d do it, personally. (Not that I am your doctor or am telling you what to do; I’m just sayin’.) The PITA of having to do self-injections pales next to the awesomeness of seeing good blood sugar numbers and feeling like you can actually eat food again.

I was on NPH for slow-acting insulin, which is notoriously “peaky”. I think Lantus wasn’t approved for pregnancy or some ridiculous thing.

52

This tendency of mine never ceases to annoy me. I mean, I know that unless I’ve just crashed severely, testing my glucose 20 minutes after a meal is pretty much the same as throwing away a strip. No, actually it’s worse. Not only does it supply no useful information, but it skews my average ever-so-much. And yet I have the urge to do it. Stupid compulsivity.

53

Type I diabetic here. I developed it at 22 (just to be contrary I guess I didn’t really match any of the profiles). I’m 31 now.

I had every symptom you could imagine sudden weight loss, dehydration (I’d wake up with a mouth so dry I couldn’t speak with my swollen tongue until I drank a glass of water), sleep disruption, nightmares, swollen legs. I actually purchased a book on diabeties before I went to the doctor and it might as well have been titled “Shit Darkhold has”

Currently I’m on Novalog (or Novorapid as it’s called here) and Lantus. Personally I have a hell of a time with my insulin even though I’m on a ‘rapid’ insulin it seems to take much much longer then it should to effect me (I’d say about 1 1/2 to 2 hours for it to peak)…except for times where it doesn’t (1/2 an hour to an hour which is how it should work). I’m in a constant state of either taking it too soon before a meal and crashing or taking it just before the meal and having high blood sugar for hours while I wait for it to come down. I’m sure exercise is a big part of my problem I know when I was in better shape my absorption rate seemed more predictable so it’s lately become more of a serious goal of mine to lose a few pounds.

I test myself about 7 times a day at least. I’m pretty obsessive about checking my sugar. Now if I can only get better control. Currently I start to feel ‘low’ around 90 (or around 5 if I’m using my English monitor) because I’m pretty constantly around 150.

54

I have been type 2 for 7 years. The best thing you can do is lose weight. I lost 30 lbs. and it has helped my numbers a good amount. I didn’t use any fancy diet, just eat less and more fruits rather than junk food. I also walk or excerise more now, at least 30-60 minutes a day.

55

Generally, the best glucose control is achieved with a combination of Lantus (glargine) and Humalog (lispro, novalog, etc) insulins. YMMV

The oral gel for low blood sugar is called “glucopaste”. It resembles cake frosting but tastes artificial and just plain wrong. I personally prefer to give 4 oz of juice (regular, non-diet soda will work in a pinch) followed by some sort of protein like milk, yogurt, peanut butter. boiled egg or a nice turkey sandwich. Just carbs and no protein causes a rapid spike in blood sugar but quickly drops back off.

56

I just wanted to tell everyone that I just signed up for the Joslin Diabetes Center DO-IT program. Joslin is one of the leading diabetes clinics in the nation, associated with Harvard University.

It’s a 4 day intensive diabetes clinic that consists of one on one visits with an endocrinologist, an exercise physiologist, a registered dietitian, nurse educators and a social worker. They look at your diabetes as a whole - I just got the 10+ pages of forms I need to fill out before I go, and it asks questions about current meds, diet, exercise, mental health, your goals, stuff you have issues with, you name it, it’s on there. After the first day where you do all your one-on-ones, you spend 3 days in small group (<10 people) sessions going over just about every aspect of diabetes management you can think of. You also meet one on one with your physician every day.

The outcome of all this is a diabetes management plan that incorporates all the different aspects (meds/diet/exercise/mental health). They’ll transfer that plan to your local doctor or you can continue with Joslin remotely.

It’s pricey ($3700+ total) but according to them, most insurance covers it (and my crappy self-employed health insurance indeed says it will). That price includes you and a loved one or friend (Mr. Athena is coming with me). If it’s half as good as the info I’ve found out about it so far, it’s well worth the time, effort, and money. I called every high end diabetes clinic I could find (Mayo, Vanderbilt, John Hopkins, among others) and none of them had anything like this.

57

I hope this isn’t a zombie thread. Only 6 days since the last post.

My 9 year old daughter was diagnosed with type 1 on March 10, 2008. We were sitting around with a BG meter, and we decided to test ourselves. I tested, then my husband, then we asked her if she wanted to test. I about hit the floor - it was 580. We got her in to her primary doctor: she took her BG, and it was 530. It was like, “Okay, here’s the endo. Here’s the card: you have an appointment. Do not stop to pay the bill. Go straight to the endo.” She started on insulin that night.

She was prescribed a regimen of Levemir, Novolog and NPH: she was to have the Levemir in the morning, NPH at night, and Novolog before meals. However, we noticed very quickly that the NPH wasn’t working for her. Her endo is horrible: he kept saying that she needed more and more insulin. She was always hungry. We begged him to help us switch from a standard dosage to carb counting: he refused. So we did our own research. Yes, we were desperate, but what he had her on was not helping.

I know a lot of people who are on a split Levemir dosage instead of Levemir/NPH. We worked with it and tried it out, and by golly, it worked. We also had a lot of help from other parents who have diabetic children to figure out a carb count program for her. She’s doing much better now than previously: is taking less insulin overall, and is not always hungry. She’s almost back to being a normal child.

To tell the difference between the types, the C-Peptide test is the way to go. We found our her pancreas has shut down: she is producing no insulin whatsoever. In 6 months, her A1C went from 13.5 to 8.5. We’re optimistic the next one will be even lower.

She has her pump start next week. Our insurance covered most of it: the pump company did help us out with funds. Once she’s on her pump, she’ll be on straight Novolog, and we won’t have to worry about the Levemir/NPH thing.

Right now, our worst fight is with the school system. They went on a field trip (skating) and she left her kit at school. She is supposed to carry that kit with her everywhere she goes: she forgot it, and her teacher did not remind her. She missed the inauguration today because she had to go to the office to test. She should be able to test in her classroom. The school just wants to do a health plan, but she needs to be covered by a 504. It’s all one big, huge mess. But she’s still smiling.

58

I’m sorry that you’ve had such problems, and I hope the school authorities get a clue very soon.

What’s a 504? Also, why do they not wish her to test in the classroom?

59

Actually, C-Peptide is not a definitive answer between the two types of Diabetes.

C-Peptide does indeed indirectly measure insulin production. However, a C-Peptide alone cannot determine if you’re a Type 2 with decreased insulin production or an early stage Type 1 or something in between (LADA, etc.)

In a nutshell:

Type 1: little or no insulin production. Beta cells are dead/dying because of an autoimmune disorder.

Type 2: Insulin resistant, but also involves varying degrees of Insulin production. Some Type 2s, particularly early on, produce HUGE amounts of Insulin in order to overcome their resistance. In fact, these two things can cancel each other out, and even though there’s insulin resistance, that person is not diabetic because the additional insulin keeps blood sugars in check.

However, Type 2s can also have problems with insulin production, and indeed, as the disease progresses, many/most type 2s end up not producing much insulin. You essentially burn your pancreas out.

Because of that, a C-Peptide alone cannot say whether a person is Type 1 or Type 2. The hallmark of Type 2 is Insulin Resistance which may or may not be combined with a deficiency in Insulin production.

Type 1s, particularly adult-onsite Type 1, can proceed slowly. Insulin production trails off, and the big CRASH that happens when a younger person develops Type 1 does not necessarily happen. A C-Peptide will show that there’s decreased insulin production in an adult that is developing type 1, but it doesn’t show anything that can’t be diagnosed by other clinical markers.

And, of course, there’s a bunch of less common forms of diabetes in between the two.

The GAD-65 test, which measures antibodies, is more informative as a marker between Type 1 and Type 2. Because Type 1 is an autoimmune disease, you’ll typically have antibodies in your blood.

Yes, I’ve been reading far too many medical texts on diabetes…

60

Diabetes is covered under section 504 of the Americans with Disabilities Act. This means she has to have the same opportunities everyone else has, and they have to allow special accomodations for her. For example: she has to test her BG before a test. If it’s high, she has to hold off until she is in range: she cannot concentrate if she’s running high. She has her kit that she has to carry on her at all times: this kit includes a cell phone, which is used for emergencies. She has to test before PE: if her BG is over 300, she has to sit out. Exercise makes it go higher if it’s already over that.

Basically, the health plan covers her medical care: when she gets injections, how much, and who can give them to her. The 504 makes sure she isn’t punished for something when she has high BG. It’s not a blanket thing: she can’t get away with misbehaving in class when she’s high. She has a health plan, and it’s fine. The school system has done a wonderful job. But more needs to be done, and I need to make sure her interests are protected for future school situations.

I still haven’t figured out why she can’t test in the classroom. Every day she goes to the office before lunch to test: hubby goes up every day to supervise her. She can test, count carbs, and give herself an injection: but she has to be monitored because of her age, and we only have a district nurse who takes care of 7 schools.