Amazing Improvement in 2 Weeks!

I'm amazed...simply blown away.  God has shown me such kindness by placing me with a Nurse Practitioner who truly knows her stuff.  She doesn't just tell me what to do - she listens to me and suggests things based on what I know about how my body responds.

It's been 2 weeks since my appointment with Carrie and right from the start I noticed a difference in my numbers.  After 2 weeks, I'm truly excited about what I'm seeing - it's not just a fluke or a one time deal...it's real, actual improvement!  After years of struggling with a seemingly hopeless roller coaster, a recent attitude change on my part, and a slight insulin tweak, I'm seeing a huge difference in my numbers for the better!  See for yourself! 

Here are the stats:

• From January 10-16 (Week 1), my average blood sugar was 197.  The red line shows my average number for this week.
• From January 17-23 (Week 2), my average blood sugar was 156.  The blue line shows my average number for this week.
• There is a 21% average blood sugar improvement between Week 1 & 2. 
• Week 1 has 33% in target.
• Week 2 has 47% in target!

Thank you all for following my Diabetic Journey, and for walking with me as I continue to take steps to improve my blood sugar numbers.  Achieving a normal A1C has always seemed like an impossible feat, but as I press on toward the goal and rest in Jesus's strength and power I see the impossible become possible.

Lowering my HIGH alert

Over the weekend I once again lowered my HIGH alert on my Dexcom G4.  It is now at 250.  I have to say, this slow introduction to the HIGH alert has helped me become even more motivated to keep my numbers under control.  I feel like I haven't been rushed but rather I've been gradually helped along in reaching my goal.  It's a nice feeling - to not be pressured or thrown head-long into an annoyingly overwhelming task.  Easing myself into things has always been my way of adjusting.  I'm so grateful that my diabetes team (especially Carrie) understands that this is a good way to start me off on the Dexcom. 

My next appointment is scheduled for October 9...a little over 2 weeks away.  I wonder what Carrie will say about my numbers.

Staying on top of things

The other day I set my HIGH alert to 300.  Next week I'll set it down to 250.  The week after that I'll set it down to 200 and leave it there.  I'm really trying to crack down on these high numbers, a little at a time.  So far, I seem to be pretty successful, and eating a low carb diet is going to help me do that.  I had to stay on top of my carb-counting yesterday while I was at a family reunion, but it ended up being pretty easy since most of the food wasn't gluten-free.

I've noticed that my numbers seem to stay pretty steady overnight if I don't eat or bolus beforehand.  This is good.

I'm currently watching my number drop - I may have counted too many carbs this morning for breakfast.  I'm down into the 70s...time to take action.

Rough Day

Yesterday and today have been pretty rough for me, diabetes-wise.  It was Dexcom Day for me, or the day I'm supposed to change my sensor.  My first sensor was on my right side and seemed to still be holding up pretty well.  I decided to try to make it last a little longer and reset the sensor session.  After a 2 hour wait to recalibrate it, everything seemed to be going fine.  Then, around 8pm, it gave me the alert that it couldn't pick up readings from my sensor.  I waited for about an hour, since it had been able to sort itself out last time.  As bedtime neared, I decided to just go ahead and start over with a new sensor.  I inserted the new sensor on my left side and waited the 2 hour time period for calibration.

Upon calibrating, I noticed that the system wasn't recognizing the correct blood sugar values as it had done the first time.  In fact, it was saying I was low when I was actually in the 160s.  Then, the Dexcom stopped showing me numbers.  I had some tea and bolused for it, and then went to bed around 2am.

I slept off and on, waking up and checking my Dexcom to see what it was doing throughout the night.  It was HIGH all night.

Most of my nights this week have been filled with waking and checking - not very restful!  I'm continually tired and frustrated.

Around 6:40, I woke to my Dexcom telling me my number was still high.  I calculated a correction and gave myself a shot.  As I rolled over to go back to sleep, I had the notion to check my number on my glucometer.  It came back at a shocking 187.  I realized I had just given myself an overdose and ran into the kitchen for more tea and raisins (they have lots of sugar!) to equal the "bolus" I'd just given.  My number stayed safe and I was able to go back to sleep.

Lesson learned.  Always check your meter!  Don't do anything without a fingerstick!  Unfortunately, lack of sleep caused a lapse in judgment this time.

It's just hard because I'm trying to conserve test strips.  I'm not sure when I will be able to get more.  I need to call the pharmacy to see if my endo's new prescription has come in. 

Roller Coaster Readings

Today is Day 6 of Dexcom readings.  I now have physical proof of the roller coaster I am riding with my blood sugar numbers.   Now I can clearly see why my numbers have been so frustrating...!!  (the red dots are my glucometer readings - very accurate!)



My average blood sugar number:  188
My highest blood sugar number:  336
My lowest blood sugar number:  68

I've been experimenting with a slight increase in overnight basal insulin because of a noticed pattern of waking up high.  It seemed to be that my number was rising around 8 am or so.

Three nights ago, I took 11 units of basal insulin, going to bed at 245 (took no correction) and woke up at 4:20 to a low of 72.  6 glucotabs and 2 hours later I was up to 173.

Two nights ago, I took 10 units of basal insulin and went to bed at 170, and woke up the next morning at 8:30 to a big fat 310 after steadily going higher throughout the night.

Last night I took 10.5 units of basal insulin and went to bed at 141.  It seems from there I stayed steady in the 130s for half the night, and then I slowly started to go lower around 4 am.

My alert woke me up this morning at 6:40 to tell me I was 70.  I treated with 2 glucotabs and waited 15 minutes.  At 6:55 I was 68.  I took 2 more glucotabs and waited another 15 minutes.  At 7:15 I was back up to 85 and rising.  I slept off and on until about 10.  It didn't feel all that restful.

And now I'm experiencing my first issue with my sensor.  It is not communicating with the transmitter/receiver.  I am waiting for it to correct itself.  If it goes for another 2 hours without resolving itself, I'll need to call Tech Support.

Stay on Target

I went in for fasting labs on Monday morning.  They were quick and painless...3 tubes full of blood and I was done.   

On Wednesday, I got an email saying that my transmitter had finally been shipped...and what's more, it had already been delivered!  I ran out of the bedroom to find that it was laying on the kitchen floor in the FedEx box, which DP had brought in before he left for work.  I opened it up and praised God for its timely delivery (it had been over-nighted to me before I knew it had even been shipped!).  I would've put it on right then and there but I was delayed by a family emergency.  ;)

Today, I went in for my 3pm appointment.  After the nurse went over the usual questions and medicine doses, Carrie came in to discuss my numbers and lab work.  The first thing she pointed out was my A1C.  It had dropped a whole percentage from 11.1 to 10.1!!  I was so thrilled!  I reached my goal for August!

She then went on to say that both my HDL & LDL cholesterol levels were normal and the rest of my lab work came back normal.  Even my thyroid is where it should be!  I couldn't believe it!  Even though my A1C is still high, I found it to be a very good health report card!

She suggested that I start my Dexcom today and set my low at 70 and not to set my high alert so that I wouldn't get annoyed at it right off the bat for going off all the time.  Every week or two I'll set it 50 points lower until I get it down to about 200.  I'll be coming back in 6 weeks so they can see how my Dexcom is doing.

I told her I'd be pressing on toward my next goal...9%!!  And 7% by the year's end.  She smiled and said, "Then you can start baby-making."  Yup!   

After watching the tutorial video, I now have my Dexcom sensor and transmitter in place.  My receiver is all set up and ready for action.  At 6:45pm, I'll do my first calibration session.  Until then, I've got a yummy dinner to make in celebration of this wonderful news and God's goodness!

My Dexcom Finally Arrived!

Yesterday, my Dexcom finally arrived in the mail. It came with a box of 4 sensors, too, but the transmitter was not included in the order. It is still being processed. There was a hiccup with the insurance company and Dexcom. They thought that I had ordered 2 transmitters and so they weren't going to cover the 2nd one. However, someone misread or misunderstood and thought that that meant BOTH transmitters were denied...so Dexcom didn't send me ANY. 

I'm still waiting to hear from Dexcom about the status of the transmitter. I tried to see if the problem originated in my endo's office but I couldn't get through in time. Thankfully I am going in on Monday and Thursday next week for labs and an appointment so I'll be able to talk to them then. Sadly, until my transmitter comes, I can't start using my Dexcom. It is a pretty cool looking device though, and it's so nice to finally have it in my hands.

Awaiting Their Decision and More Good Numbers!

I decided to call the insurance company today to check on the status of my Dexcom authorization.  They are still in process of making the decision and probably won't have it made until next week.  *sigh*  I'm depressed. 

Thankfully, my numbers have continued to remain in my target range for the past 3 days.  I'm so happy to finally be on a positive roll with them.  I don't remember them ever being so good for so long.  That's sad, but also encouraging.  I am getting closer to my endo appointment on the 28th and I'm really hopeful about my A1C.  I'm pretty sure it will be much better than May's A1C at 11.1%.  If it dips down into the 10% range, I'll have met my first goal.
 
A1C Goals:
August - 10%
September - 9%
October - 8 %
November - 7%
December 31, 2014 - 7% or lower

Of course, I won't be able to check my A1C every month (only every 3 months, I think) so my next check should be November sometime. 

Today, my numbers have all been between 166 and 127! 
12:30am - 127
1:15am - 143 (bedtime)
10:45am - 144 (wake up - it stayed perfect all night!!)
11:25am - 166 (Basal insulin given)
12:50pm - 165
4:45pm - 152

Average BG so far - 149.5!

Two Days of Decent Blood Sugars!

A full day of good blood sugars is possible!  Yesterday was one of my best days in a long time as far as blood sugars go.  This is what I’m aiming for – more days like this and better!

1:15am – 205 (no correction insulin, just basal given)
8am – 87
12:20pm – 230
3:30pm – 143
5:10pm – 123
7:30pm – 197
8:40pm – 180
10:40pm – 135
12:40am – 103 (basal insulin given)

Daily average blood sugar number:  155

Today’s numbers have been decent too:

1:40am – 134
9am – 147
11:20am – 183
12pm – 197 (no correction insulin, just basal given)
1:05pm – 214
2:10pm – 195
3:40pm – 155
5:20pm – 214
6:40pm – 149
Today’s average so far: 176

From 10-2 I was at work and doing some manual labor.  I’m kind of surprised to see that my numbers were staying around 200…I thought they would come down from the exercise.  Still, I am pleased with what I’ve managed to do as far as management…staying between 230 and 87 is major!

My Dexcom is on the way!

Today started out rough - dealing with some introvert fatigue and other minor annoyances.  I missed a call from Dexcom but called them back and left a message.  4 1/2 hours later, they called back.  I am now happy to report that...
I placed my order for a pink Dexcom G4 Platinum!  

 The rep I talked to asked how often I check my blood sugar.  I told him 5-10 times a day and he said I'd only have to test it twice with the Dexcom.  Wow, that is going to help me out even more than I thought!  It will cut down on my test strip needs!  I go through 150 of them in 15-30 days.  Now they'll last me up to 75 days!

I asked him when I would receive my Dexcom in the mail.  He said it should arrive via FedEx on Thursday!  I couldn't believe my ears!  That's just in time for my birthday!  I had been hoping that I would have it by then!  I started crying tears of joy once I got off the phone.  I'm still shaking a little from amazement...how good God is!  

Thursday can't come soon enough!

My Insulin Pump Decision

I read a blog post/article the other day that helped me figure out what I should do about my pump decision.  The author mentioned a few things to take into consideration when deciding between a pump and injections. 

1.     The cost.  Pumps are more expensive and I don’t know how much my insurance will cover (probably only half, like with my Dexcom).

2.    Pumps can have more things go wrong than syringes can.  The battery can die; kinks and air bubbles can prevent insulin delivery; scar tissue build up will prevent insulin absorption; water damage and other malfunctions, etc. 

3.    Pumps don’t work for everyone.  The machine is only as good as its user.  Being on a pump before showed me that I wasn't a very good user.   

4.    Being connected to a pump was something I didn’t like years ago…in fact, I hated it.  The tubing would get caught on things if I wasn’t careful (and I’m clumsy, so that doesn’t help matters), the infusion site sometimes got yanked out prematurely (so annoying!), and I would sometimes drop the pump or it would fall from my hands (I fumble with things a lot).

5.    I want to see how well I do with being “connected” to the Dexcom.  Even though there’s no tubing connecting me to the receiver, I want to see how well I do with changing the transmitter site every week.  Most likely I will do well because it will be showing me patterns in my numbers and I will want to stay on top of them.  I like following numbers on charts and stuff.  Once a week is a whole lot better than every 3 days! 

Therefore, I have decided to not get a pump at this time.  I will be staying on shots.  They are working for me and I see no need to switch.  I just need to choke up on my discipline and I’ll be doing great. 

My Personal Goals

Since my next appointment is on August 28 at 3pm, I figured it would be a good idea to set some goals to meet by then.  I have 33 days from now.

By August 28, I am going to try to get my A1C down into the 10% range.  My A1C in May was 11.1%, so anything in the 10% range would be an improvement.  

My big goal after that is to get my A1C down to 7% by December 31, 2014 (year’s end).  That puts me at a little over 1% per month.  I will accomplish this in several ways:

• Stay on top of correcting high blood sugars and giving accurate food boluses.

• Use the Dexcom (whenever I get it) to track my blood sugar patterns and trajectories. 

• Use my secret weapon – namely, GC Control from Melaleuca – whenever I am able to order it.  
  
  

I think blogging about these goals and my progress will help me stay accountable and diligent.  If you are a diabetic, I hope I can help you in some way.  Likewise, I would appreciate help from you!  Thank you for joining me on my journey!

Starting on the Journey - Diabetes

I had an appointment with my new endocrinologist (diabetes doctor) and nurse practitioner this morning.  After my in-office blood sugar (169 mg/dl) and vitals were taken (turns out I’m 5’ 11 3/4”!) and the nurse went through the standard medical history questions, Carrie, my nurse practitioner, came in and asked about my diabetes care routine.  She then checked my feet, pulse, and lungs/heartbeat.  

After that, she told me about some new medicines that were on the market that some Type 1 Diabetics use to control their blood sugar and asked if I’d ever been on an insulin pump.  I told her I had, several years ago, and that I preferred being “unhooked” from a pump with tubing, especially since my old endocrinologist had told me that being on a pump with my lack of discipline was dangerous for my health (when Dr. Bussey heard this, he said that was a bunch of malarkey).  

I told her about my desperate need for the Dexcom G4 Platinum Continuous Glucose Monitoring System, and she confirmed that it was a good system with the highest accuracy available.  She looked over my blood sugar numbers from the past few weeks (which they had downloaded from my glucometer), asked me some questions about them, and gave me an informational packet about the Dexcom.  She then left the room to get Dr. Bussey, the endo.  

When they both returned, Dr. Bussey made some suggestions for adjusting my insulin doses.  He said since my numbers were still running high that I should increase my overnight basal insulin by 2 units, adjust my insulin-to-carb ratio (changing it from 1 unit per 12 grams to 1 unit per 9 grams), and changing my correction factor from 60 points over 120 to 50 points over 120.

We then discussed my plans for the future regarding children.  I told him we were thinking not for another year or two down the road, especially since my numbers are so high and our finances aren't quite where they need to be.  Dr. Bussey told me that the best A1c during pregnancy is about 5 (but 6 or 7 was okay) and that the most precise way to maintain that much control for a pregnant Type 1 Diabetic would come from being on an insulin pump – however, it was not required.  I’m still undecided on the matter.  I know I at least want a Dexcom.    

My current A1c is 11% (average blood sugar of 269) – so I balked a little.  A chart on the wall across from me said that an A1c of 7% equates to an average blood sugar of 154.  6% = 126.  The lowest I remember my A1c ever being is about 9 (212 mg/dl)…5, 6, and 7 all seem so hard (nay, impossible) to achieve!  However, he assured me that getting my A1c down that low IS possible and they are going to keep me accountable as I work to get my numbers down, down, down.  They told me they wanted me to come back in 2 weeks to go over carb counting (although they are sure I know what to do) and insulin pump therapy information.  I’ll then come back at the end of August for fasting labs.

Before I left, they had me do some lab work for them (a quick and painless blood draw).  I left feeling encouraged but also a little daunted.  I know I have a lot of work ahead of me, but I hope that having a team of people who are committed to seeing me improve my health will give me the motivation I need to succeed.  Obviously the core determination has to come from my desire to prepare the best I can for the future.  I know that with God’s help, all things are possible – even the things that seem impossible.