A life in the day

It’s amazing to note how difficult it is to intentionally start a routine. Falling into routines is quite easy, but doing it on purpose, well… At first, you’re religious about it. I didn’t miss a morning or evening reading once. I rememberd my pills every morning. I had a small snack two hours after each meal.

I managed to be good for about a month. This weekend things started to fall apart a bit. Saturday night I came back from the fireworks show and forgot to take a reading. I know I forgot to, but I think I didn’t want to admit it to the Doctor. If it’s not that, I can’t figure out why the next morning I filled the entry in with a reading I’d taken midday on Saturday. (So, Dr. Lampugnale, if you read this, one of my evening entries was not accurate. Mea cupla.) Sunday I worked around the barn, straight from breakfast to lunch with no snack. I don’t think I overdid lunch, but it’s hard to tell for sure sometimes. I was sure I wouldn’t do that again for a while; but I did it again on Monday! Then Tuesday morning I’m pretty sure I forgot to take my pills. What kind of routine is this?! And on Tuesday night I overate, sending my blood sugar up to 180!

Gotta get my groove back.

Blood sugar: Tuesday pm: 181, Wednesday am: 125.

Blood sugar: Monday pm: 112, Tuesday am: 121.

Blood sugar: Sunday pm: 160, Monday am: 118.

Blood sugar: Saturday pm: ???, Sunday am: 110.

Blood sugar: Friday pm: 117, Saturday am: 126.

I need to read more about the effects of exercise on blood sugar. I remember being told in class that it can in fact increase blood sugar. It sounded, though, as if that was less likely than a reduction. Yet I’ve picked up some long walks before breakfast, fairly aerobic, and each time my blood sugar has increased 5 - 15 mg/dl over the course of the walk. Those aren’t huge increases, but I don’t really understand the mechanism. Is it simply increased metabolic rate stimulating the liver to release more glucose? I may have to see what happens if I try eating breakfast first.

Not much posting lately. I hit my lowest reading yet last night: 86. I really have to get some sugar pills or raisins or something handy in case I hit low sugar reactions. I imagine that if I can reduce from 136 one evening to 86 the next, I have to be prepared to go significantly lower still.

Blood sugar: Thurdsay pm: 86, Friday am: 104.

Blood sugar: Wednesday pm: 136, Thursday am: 103.

Blood sugar: Tuesday pm: 171, Wednesday am: 119.

Blood sugar: Monday pm: 170, Tuesday am: 113.

Blood sugar: Sunday pm: 122, Monday am: 111.

Blood sugar: Saturday pm: 102, Sunday am: 107.

Blood sugar: Friday pm: 121, Saturday am: 120.

Blood sugar: Thursday pm: 140, Friday am: 114.

I’ve been testing my blood sugar many times each day to see what effect eating at various times and in various quantities has on it. The most interesting result for me is that it seems I can get away with a much larger lunch than dinner. Last week, when I ate more at lunch than at dinner, my fasting levels came down to 100 - 120. This week, I’ve reduced lunch in favor of dinner and my fasting levels are 120- 140. But in each case, the readings just before and two hours after a meal have bounced around between 110 and 150, with no particular consistency.

I’m hoping not to increase my medication. I’m on Glucophage XR, 750mg/day, and I’d rather not increase the dosage. In fact, I hope I can get off of medication relatively soon. But I understand that there has been little sign of any noteable effect at doses below 1500mg/day. I think it’s because of gastro-intestinal side-effects that the dosage usually starts low and is gradually increased. If I can’t get the morning readings down below 120, I know Dr. Lampugnale is going to suggest I increase the dosage. I think I’ll really have to concentrate on having small dinners.

The other news of course, is that there has been no news. This is the first time since I started this journal that I skipped a day posting, and in fact I skipped several. But never fear, I’ll still keep my loyal listener informed of his blood sugar levels. (Oops, did I just let it slip that I’m the only one reading this, dear diary?)

Blood sugar: Wednesday pm: 104, Thursday am: 136.

Blood sugar: Tuesday pm: 153, Wednesday am: 122.

Blood sugar: Monday pm: 214, Tuesday am: 126.

The bad news is that weekends are going to be tough. Waffles with the kids on Saturday morning. Pizza one evening (and not just two slices!). Picnics, parties, the works. My blood sugar was higher all weekend than it had been during the week. And when I wokd up this morning, it was up at 131. Although it’s back down today, I’m guessing that weekly, two-day highs are not particularly good for my metabolism.

I’m not sure how to curb this. It’s easy enough to eat smaller portions and better food at home. It’s much harder to do this at the end-of-the-season baseball party.

Blood sugar: Sunday pm: 151, Monday am: 131.

A granola bar has 24 grams of carbohydrates! Damn!

Blood sugar: Saturday pm: 166, Sunday am: 120.

It’s starting to settle down for me. I doubt I’ll be doing daily entries on diabetes much longer. The big trick now is not getting too complacent about it. It would be very easy to start skipping readings, paying less attention to what I eat, slipping back to my old habits, my old diet. This is the tough part for me. To effectively change my habits, I have to get through the next two months or so without sliding backwards. It’s not going to be particularly fun.

Blood sugar: Friday pm: 142, Saturday am: 106.

Okay, so I’m still day-trading. I know that eventually, I will not try to analyze every up and down of my blood sugar. But for the moment, it’s really irresistable. First of all, yesterday. After class, we took the kids out to the movies. (Harry Potter and the Prisoner of Azkaban — my favorite so far of the books but my least favorite movie; nothing really wrong, but everything just felt somehow … off, the actors for the new roles, the changes to Dumbledore’s character, the look of the werewolf, and, Amy notes, changes to Hogwart’s physical plant.) A small bag of popcorn there, probably twice the carbs I’ve alloted for an afternoon snack. Then we did dinner at the Olive Garden. I ordered the eggplant parmesan. I managed to keep to only two breadsticks, some salad, all the eggplant, and almost none of the pasta. That was still clearly too many carbs. The evening blood-sugar was 197.

But it was back down this morning. And it has stayed down all day. For the first time, I’m doing mid-day readings. (The ones taken in class don’t count.) I just want to see how meals and snacks change the readings. Nothing but dinner seemed to make a difference. My readings over the day were 116, 111, and 117. After dinner it was 142. This may also have to do with the timing of the medication. The Glucotrol may have worn off by dinner time.

Still, this is far too much attention paid to a fluctuating number. It can’t be healthy. But I’m going to try to track it for a few more days.

Blood sugar: Thursday pm: 197, Friday am: 116.

Last day of class. I’ll try to get to an overall summary this weekend, but the biggest deal today was the podiatrist. When I asked if he really wanted me to wear shoes all the time, he was quite insistent. Worse, he seemed to think I only was considering bare feet in the house. My guess is that it might be a cardinal sin to go barefoot outside. This is the first doctor’s orders related to the diabetes that I really might not be able to follow.

I go barefoot everywhere. When I’m on vacation, I might go days with no shoes at all. I don’t know if I even know how to wear shoes to and from or on the beach.

It sounds to me that the issues go like this: diabetics have problems with nerves, especially the longer ones. So they lose sensation in their feet. Then they don’t feel the scratch, the splinter, even the nail stuck to their foot. This leads to infection. And infections in diabetics are harder to heal, especially in the extremities. This could quickly lead to gangrene, and gangrene to amputation. For the want of a shoe…

Blood sugar: Wednesday pm: 124, Thursday am: 115.

Some of today’s class was better. But there was a deadly boring video. I actually fell asleep. But shh, don’t tell the teacher.

Blood sugar: Tuesday pm: 157, Wednesday am: 130.

Well today’s class was about the same as yesterday: not overly painful, but far to slow for me. Too much teaching in a fill-in-the-blanks lecture mode, you know, the style that says, “And the number of sides on a hexagon is …?” with an imploring look and a dragged out final syllable. I wish people wouldn’t think that it is an effective teaching technique. Don’t ask for one-word answers; ask real questions, seek real feedback, and for goodness sake, don’t ask, “Any questions so far?”

The good news is blood sugar. 121 when I got up. 122 at first reading in class, 142 two hours after breakfast, and 95 two hours after lunch!

In the “it never rains, but it pours” category, my sister-in-law Charlotte, was just diagnosed as diabetic too. “Does it run in your family?” “No, but my wife’s family is rife with it.” Okay, it turns out I have four diabetic great-aunts and great-uncles. And a hypoglycemic brother. But we probably would have guessed my wife, Amy, as the likely diabetic given her family’s history.

Blood sugar: Monday pm: 181, Tuesday am: 121.

Well, today was the first day of school.

I did learn some about the actual metabolic processes, and had what was mostly review information on diet. I like the staff fairly well; one nurse in particular impressed me. But I do feel that what they covered in the seven hours could have been done in an hour and a half. As well as lectures, there was also some socializing time, meals, individual consultations, and three separate blood glucose tests.

Numbers are remaining relatively steady.

Blood sugar: Sunday pm: 142, Monday am: 181.

Class starts tomorrow, and I think my sugar may be settling down a bit, at least in the mornings. Wednesday it was 188; Thursday, 180; Friday, 183; Saturday, 183; Sunday, 184. Evenings have been nowhere near as consistent: 172, 256, 196, 210, 147. And of course with a goal of 120, I’m not really all that close. But it’s progress, and it’s much better than my initial 340 and 270 numbers. I know I still have to cut down on total quantity of food, but I want to see what diet advice I get from the class. I think quantity will only get me a bit further, and I’m going to have to figure out what foods are really appropriate.

I’m still not looking forward to the class. “Hi, my name is Scott, and I’m a diabetic.” “Hi, Scott!” I’m sure it won’t be like that, but I’m worried about not being able to pay attention if everything is spoon-fed to us.

Of course I’ve also lost four pounds in the last nine days. I can’t complain about that.

Blood Sugar: Saturday pm: 147, Sunday am: 184.

Many kind words from friends after I sent an email detailing my diagnosis.

Mike, a diabetic, has much interesting advice, some of which matches the doctor’s and some which doesn’t.

Niel, who is working on an NIH-funded study into the genetic basis of diabetes, told me to

Think of it this way. Everyone gets diabetes if they live long enough, so you’re just advanced for your age.

More nice words from many others, too.

Blood sugar: Friday evening: 210, Saturday morning: 183.

Is it still denial, if I know it’s denial? I’m diabetic. I know that. But whenever the doctor seems surprised that I don’t have one particular symptom or another, I get this hope that maybe it’s all wrong. I think she knows this too. She said something about how I’m the classic case of adult-onset diabetes. It’s not going to work, at least not yet. I am going to keep hoping while I get my blood sugar down to more reasonable levels, and bring my weight to something more appropriate. Then we’ll see.

Blood sugar: Thursday pm: 186, Friday am: 183.

The grocery store could quickly turn into a very unpleasant task. Wandering around checking all the food labels for carbohydrate levels, walking past the fruit section and all the juices, skipping many of the foods which have been my mainstays. It was certainly difficult last night, my first real shopping experience since I was diagnosed.

Blood sugar: Wednesday pm: 256, Thursday am: 180.

Okay, I’ve got an answer to my question.

Last Friday, I had asked

Dr. L told me that I was a diabetic for life. If the diagnosis has nothing to do with my insulin levels, nothing to do with any real symptoms except those that are direct results of high blood sugars, am I still considered diabetic if my blood sugars get to and remain in normal range?

The answer, which I had started to grasp, and which Dr. Lampugnale confirmed this morning is that I am not a diabetic because I have high blood sugar. I have high blood sugar because my body does not process its sugars properly. Many of the symptoms of diabetes will abate when I reduce the blood sugar to a proper level. But others are due strictly to the fact that I don’t and, barring some medical breakthrough, never will, properly process the sugars I eat, at least without the help of medication.

So the most I can ever do is manage the diabetes.

And hope for some gene therapy that might restore normal functioning.

Well, at least I know.

Well, the class I’m supposed to take on diabetes has been scheduled — four days worth of it! Is it just me, or does that seem excessive? I’m trying to imagine the schedule:

• Day 1: “This is your body. In your body, you have blood. Your blood contains hemoglobin. The nice hemoglobin carries oxygen all over your body so that you can have energy. Hemoglobin is a protein. Can you say “protein”? (That’s a teen who’s lost his amateur status. Sorry, just a little attempt at humor, folks.) The food your body uses is converted to sugars…”
• Day 2: “Diabetes is dangerous. You could go blind, have a stroke, lose your kidneys or your toes. Your blood pressure could pop your cork. Fungi might grow on your skin. Take it seriously folks. Here’s six hours of video about the possible results of diabetes.”
• Day 3: “Cut out the sugars. Cut the carbs way down. Cut out the sugars. Cut the carbs way down. Cut out the sugars. Cut the carbs way down. Cut out the sugars. Cut the carbs way down. Cut out the sugars. Cut the carbs way down. Cut out the sugars. Cut the carbs way down…”
• Day 4: “No, when you poke yourself, scream, ‘Oh!’, not ‘Ow!’ Let’s try it again. Remember, this is for your own good…”

Okay, I’ll take it seriously. But four days? What do they do for insulin-dependent diabetics? A month?

Blood sugar: Tuesday pm: 172, Wednesday am: 188.

Up and down, up and down. Blood sugar back up last night, down this morning, but not down to yesterday’s level. Definitely day-trading. I’m sure it was up because of last night’s dinner. Friendly’s does not have much for vegetarians in the first place, and for a diabetic one… uggh! No ice cream or soda — I’ve been good about that — but far too many carbohydrates, I’m sure.

Lots of nice words from friends after I sent an email announcing the diagnosis. Thanks everyone.

Blood sugar: Monday pm: 257, Tuesday am: 200.