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.

Me and My Metformin

(I can’t help thinking I should make up a song with lyrics about “Me and My Metformin” set to the tune of this classic Sesame Street video: http://www.youtube.com/watch?v=sgkYHhG18uc  It was one of my favorite memories from childhood, and shaped my attitude around good dental hygiene, I’m sure.)

As I’ve mentioned before, I started taking Metformin a few months after I had a baby because I was having crazy issues with spiking blood sugars after breakfast that nothing else seemed to fix. Metformin is usually a drug given to Type 2 diabetics, but it appears I have Type 2 tendencies with regards to insulin resistance, even though I am most definitely a Type 1. Best of both worlds. Yay.

What I failed to mention was, it was my OB/Gyn who prescribed it for me. I was seeing my endocrinologist on a regular basis (every 3 months, baby!), but he had never brought it up as something that might help my continuing saga of insulin resistance, nor as something that may have helped with fertility issues. My OB/Gyn started me out on a pretty aggressive dose – 500mg of the extended release pills, twice per day. (I did inform my endo that I was taking it at my next appointment, and he was fine with it.)

Metformin

Metformin (Photo credit: Wikipedia)

Imagine my surprise when our little girl was 6 months old, I had been taking Metformin for about 2 months, and I suddenly realized one night that I was pregnant. (Of course, I had not gone back on birth control after having my daughter – it took such extraordinary measures for me to get pregnant with her, there was NO WAY it was happening naturally. Right?) Several pregnancy tests later confirmed it. We were over the moon with joy, called the OB/Gyn and made the proverbial 8 weeks check-in appointment.

I don’t think I can discuss this right now, but in short, I had a miscarriage. That is not the focus of today’s post, and I just can’t bring up those emotions today. The point is: I believe the Metformin at least “helped” in my ability to get pregnant on my own. Also, having recently had a baby, I’m sure that was a contributing factor to kick-starting my reproductive system. If Metformin could help me have a child on my own someday, we were destined to have a long and prosperous friendship.

My relationship with Metformin has gradually changed over the last (almost) 2 years that I have been taking it. About a year ago, I felt like it wasn’t  as effective as it had been when I first started taking it. I was getting strange overnight blood sugar spikes-and-hanging-out-for-hours in the 200s for no good reason. LOTS of them. On a whim, I tried cutting out the 2nd dose of Metformin that I was taking in the evening at dinner time. (My theory was that the Metformin was possibly lowering my sugar just enough to where my liver wanted to take back control and crank out some extra sugar to get me through the night.)  Magic happened! My sugars regulated back to overnight happy places between 90-120.

Things have been great with Metformin over the past year  (A1c’s have been consistently in the 5.9-6.3 range) until recently, when the dreaded post-breakfast blood sugar spikes have started up again. A couple of days ago, I tested another theory and didn’t take the Metformin at all. I had a TERRIFIC blood sugar day, with numbers on my Dexcom showing between 65-140 for an entire 24 hour period. No-hitter day!!!

…and then yesterday I tried not taking it again (see below.) Looks like I’ve got some work* to do with me & my Metformin. Dexcom Sans Metformin, Day 2(*Post Update -the “work” is what Scott mentions in his comment to this post – it’s tough to be patient and realize that ANYTHING could be causing weird blood sugar issues, and a couple of days of numbers isn’t really a good litmus test when you’re working on a theory. Oh, and I mention this in the About section, but ya’ll know, I am NOT a doctor or medical professional of any sort, so please don’t change your medications and what-not without consulting your own medical team of experts.)

UPDATE as of 5/29/2014 – A year later, and I am still taking Metformin daily. Not sure what that weird hiccup was, but taking Metformin out of my daily regimen of diabetes management was not in the cards. Overall, it’s been a “good” diabetes year. My A1Cs have been below 7, and while there are always the occasional WTH high or low sugar days, I feel like I’ve been swimming along, and swimming well. Let’s keep that up.

D-blog week Day 1: Share and Don’t Share

I am thrilled to finally start my blog this week, which is the 4th annual Diabetes Blog Week! I’ve been tossing around the idea for quite some time, but this organized event of diabetic-blogging really spurred me into action. Today’s topic: Often our health care team only sees us for about 15 minutes several times a year, and they might not have a sense of what our lives are really like. Today, let’s pretend our medical team is reading our blogs. What do you wish they could see about your and/or your loved one’s daily life with diabetes? On the other hand, what do you hope they don’t see?

How wonderfully coincidental that I had my 3 month checkup with my endocrinologist this morning! Endo Appointment NotesNow, no judging any of his notes, ya’ll. I was honest (….except for maybe the severe hypo thing, but that 45 last week wasn’t TOO severe, right?) and he types fast while actually looking me in the eyes to show he’s paying attention, so I forgive him some of the typos. He is generally a good listener, and I’ve been seeing him for over 13 years, so we have built up a nice rapport. I always ask him about his kids, he asks me about my family, asks me about any changes or concerns I may have with my health.

What I wish he could see:
How much monthly, daily, hourly, minute-to-minute work I do to keep my blood sugars in check. Managing all my “numbers” literally feels like another job. My HbA1c was a 6.3, and I’m thrilled I’ve kept it in the lower 6 range for close to 3 years now, and even dipped into the 5’s when I was pregnant. But he always asks, “did you bring me logs today?” knowing that most of the time, I will say, “No, I didn’t have time to print them out.” (Notice how he says I “forgot” to bring in my logs in his notes. He’s just being nice.) He gives me a sly and slightly disappointed look sometimes, but tells me that if I am having trouble reining in sugars at certain times of the day, to please send him logs and he’ll be happy to help. I hope he “gets it” and realizes I’m not being defiant, it’s just that most days,  I just don’t feel like doing ONE MORE THING around tracking all my diabetes numbers. I will eventually bring in logs for him, at least once a year. Promise.

What I hope he never sees:
A trend in my logs or lab work that speaks to some other medical issue rearing it’s ugly head -diabetes caused/related or not. We know my cholesterol is running a smidge high, and has been for quite some time, but until I’ve decided I’m done trying to have babies, we are laying off the statins. I have only just started to feel like I control my diabetes instead of it controlling me. I’m not ready to give up that comfortable place and deal with something else added on. Just not yet, please.

I am working hard to maintain – and even better – my health as it relates to diabetes, weight, exercise, and everything. But it’s a constant battle. Some days I win the current battle, and some days I lose, but in the end, I really hope I can win the war and live a long, mostly healthy, and enjoyable life.