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.

CGM – Now you can have it….but one day, you can’t.

I don’t know about you guys, but I live and breathe by my Dexcom CGM. Since acquiring it a few months before getting pregnant, I’ve learned (mostly) all it’s quirks, and rely heavily on the trends and readings when making decisions about what I eat, when to eat, when to take insulin, when to NOT take insulin, and when to participate in activities – like exercise, or even driving. I can’t tell you the number of times it’s stopped me from doing something stupid.

Prime example: Before my CGM, I would “assess” how I felt when getting in the car to drive. If I thought there was a chance I MIGHT be low, I would check my blood sugar on a finger-stick meter. It might tell me something great, like 100. So, I’d get in the car and drive. Imagine my surprise when, less than 10 minutes later, I’m feeling dizzy and woozy, and luckily have stopped in a parking lot, check my sugar, and it’s 55. IF I had only had a CGM at that time, it may have shown me that my sugar was 100, but with an arrow trending down. Or showing me double down arrows which means REALLY going down fast. In that case, I would have never gotten into the car and risked a crashing blood sugar while driving. Over the years, I’ve steadily lost some sensitivity to low-sugar awareness. Sometimes, I still “feel” it….but a LOT of times, I don’t. As I type now, imagining life without my CGM? Imagining being in a car with my daughter and a low sugar coming out of nowhere with no warning? Going to sleep one night thinking everything was fine, when it really wasn’t? Well, let’s just say, I don’t want to even think about it.

Sue from Test, Guess and Go is waging a war for her husband….trying desperately to get his CGM covered under Medicare insurance. Below is a guest post from her – please read, and act!! One day, it could be you or I without the CGM…..

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Sue Berger from PennsylvaniaI am the wife of a diabetic. I’ve said and written these words so many times, that they seem to now define me. I sometimes feel as if I’m losing my own identity. This journey for me started around 1 ½ years ago. My husband, Marc, who has Type 1 diabetes and hypoglycemia and hyperglycemia unawareness, had been using a Continuous Glucose Monitor (CGM) for approximately five years and it had always been covered by the group insurance from my husband’s place of employment. In June of 2012 he turned 65 and had to go onto Medicare. A few months after that, the CGM he was wearing started to become very erratic. His doctor wrote a prescription for a new one but his supplemental insurance company, Highmark Freedom Blue, denied payment. We began the long process of Appeals.

Long, long story very short…. many phone calls ensued, doctors testified as to Marc’s need, tons of evidence was presented showing the medical need for the CGM….only to receive an UNFAVORABLE decision from a judge in February this year, basically saying no, his supplemental insurance would not pay for Marc’s CGM, and it was not covered under Medicare.

In December of 2013, Congresswoman Carol Shea-Porter (D-NH) introduced a bill into Congress. H.R. 3710 provides for coverage of a CGM by Medicare if recommended by a physician. I have been in touch with her Legal Assistant, Marjorie Connolly, and Representative Shea-Porter is doing a big push among her Colleagues asking for them to sign onto this bill.

If you go onto www.testguessandgo.com you will see my blog entitled “Join the Crusade”. At the bottom of the blog, you will see links to download a sample letter to write to your Congressperson asking him/her to support the bill. You will also see Congresswoman Shea-Porter’s letter to her Colleagues.

Why is this issue so important to me? The obvious reason is that I dearly love my Marc.

For the past year, Marc has been without a CGM and there isn’t a day that I’m not filled with anxiety. He’s had many close calls while driving and it’s only by the grace of God that he hasn’t injured himself or someone else. He’s a courier and spends a lot of time in the car and has had some pretty close calls. Our children both live in Atlanta (we live in Harrisburg, PA) and I used to be able to visit them regularly and now I have to make sure that he can take time off from work to go with me because there is no way that I would leave him alone all night. The worry is with me, and him also, 24/7.

During the time that I have been fighting for coverage of the CGM, I have encountered many other men and women who are in the same situation as Marc is in and need a CGM but can’t afford the out-of-pocket cost of the device and sensors. None of these people ever thought that after having a CGM covered for so many years by private insurance, that Medicare would not cover it. I have also met many men and women who will soon be entering the system, are presently covered by their private insurance and are worried that they will not be able to get a CGM or sensors once they go onto Medicare.

This issue is so important and the only way to change the Medicare guideline for the CGM is to put pressure on our Congresspeople asking them to vote YES to H.R. 3710.

Recently, a group has been formed on TuDiabetes called the CGM Reimbursement Advocacy Group. http://www.tudiabetes.org/group/cgm-advocacy. The purpose of this forum is a place to try to gather interest in CGM Advocacy; to share information about CGM efforts, craft common messages, link useful research and connect individual advocates.

Also, if you go onto https://www.popvox.com/bills/us/113/hr3710 you can click on Support, put in your name and email address and a notification will be sent to your Congressperson showing that you support H.R. 3710. There are comments from diabetics, wives, children and friends stating why they support the bill. I find them extremely interesting to read.

Won’t you please take the time to do these things? I can’t stress the importance of raising up our voices loud and clear and letting those in Congress know that for those who need a CGM, it’s a matter of life or death.

Thank you,

Sue Berger – writer/contributor at http://testguessandgo.com

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.