Sunday, November 4, 2007

Happy Two Year Anniversary to Me!

On this date two years ago, I was diagnosed with diabetes. Not much reason to celebrate THAT other than the fact that I've got it pretty much under control and I'm still here and kicking. It was quite a shock because while autoimmune diseases run in the family, no family member I know of has diabetes. But as I look back, I remember being diagnosed with hypoglycemia in my teens and the doctor telling me that it would eventually turn into diabetes. I thought he was just being a prick, but it turns out he was right.

The first indication came in August 2004 after a routine blood test which was performed as part of a clinical study I was participating in. The research assistant asked me if I had been fasting prior to the blood test. I told her no, I didn't realize I was supposed to and that I had breakfast before the blood was drawn. She said it wasn't a problem--but that my glucose came back high. She said it was probably due to my eating before the testing. I chalked it up to my carbo-loaded breakfast and didn't think much about it either. Knowing what I know now, I would have realized that even after a breakfast of cupcakes and Twinkies washed down with Kool-Aid, one's blood sugar should never be 229.

But I was feeling fine--no symptoms. At the beginning of 2005, my New Year's resolution was to drop five pounds. I was in great shape already--just a bit of a poochy belly that I wanted to get rid of. I didn't really want to go on a diet--since I associate "diets" with deprivation followed by ravenous bingeing and I already worked out six days a week. So I did some research and came up with a way to improve the effectiveness of my cardio and weight-lifting. Periodization training. The philosophy is that your body gets used to a certain level of activity and plateau--so if you mix up your workout by for example doing more weight/less reps one day and less weight/more reps the next workout, you trick your body into burning more fat. Sounded good to me, so I started incorporating the method into my workouts.

After several months--nothing. I hadn't lost a single pound. But it still seemed like a good idea, so I continued doing it. Meanwhile, I was getting more and more fatigued. At one point I thought I might be depressed I was dragging so much. Then people started commented on the fact I was losing weight. I thought they were nuts, even when I could pull a pair of shorts on over my hips without unbuttoning or unzipping them. When my skinny jeans became too loose I thought, "Well, I guess the periodization training works after all!" And I went out to buy new jeans.

But the weight loss continued--even as I was eating incredible amounts of food. And I developed a real sweet tooth. I'd always loved cookies and chocolate, but now I craved Pop-Tarts and Popsicles and sweet, sugary candy. And pitchers full of ice cold water. It was a hot summer and I thought that was the cause of my insatiable thirst--which then contributed to my incessant need to pee. Every 45 minutes. This happened over several months so it weirdly became "normal." As the weight kept coming off, people would comment on how great I looked--which pissed me off. I looked FINE before! Only in L.A. can you look like an Auschwitz victim and instead of people saying, "Are you okay, you've lost so much weight?," they tell you, "You've lost so much weight, you look GREAT !" At that point I had an inkling that something was incredibly fucked up and so my usual response to these inane comments was just to scowl at the offending moron.

In addition to the fatigue, weight loss, insatiable hunger and thirst and incessant urination, I also developed muscle cramps that had me hopping out of bed in pain at 5:30 am, my hair was falling out--and, by the time I was diagnosed, my vision was blurring. Prior to getting my ass to a doctor, I started doing research on the internet. I found some information about iron deficiency and it suddenly hit me--I had been donating blood religiously every 8 weeks. I had depleted my iron stores! Yeah, right. Anyway, I started eating red meat for the iron--and started looking and feeling better. Although that's probably because meat is carb-free and not because of the iron.

When I finally went to the doctor, they weighed me. 112 pounds. I haven't weighed 112 pounds since high school I think. At a trim, toned size four, I usually weigh about 127, 128. Then when the doctor came in--she being fairly lean and bony herself--she looked at my chart and looked at me. "Gee--we're about the same weight and height. Do I look as skinny as you do?" With my scowl reserved especially for morons I said, "Yes." I ran down my symptoms and told her I wanted to be tested for thyroid problems--since it runs in my family, iron deficiency--since I had been donating blood regularly, and diabetes--since I had every freaking symptom. This was the first time she'd ever seen me in her office, so she didn't know quite what to make of me--but she had the tests run.

A week later, the office called wanting me to come back for more blood tests. My sugar was high. Fuck. So I had more blood drawn and met with the doctor a week later. My iron was low as was my thyroid. But the doctor looked at my results and told me, "You have diabetes." "Nope. It's low iron. I started eating meat. I'm feeling much better." She looked at me sternly, "Your fasting sugar was 313 and your hbA1c was 15.7. You need to see an endocrinologist today." "I can't go to the endocrinologist today--I have to go to work!" She shook her head and said, "Your blood sugar is 575 right now. You should be in a coma. You have two choices--go to the endocrinologist or go to the hospital!" I chose the endocrinologist.

At the office, they shot me up with some insulin to bring my blood sugar down and after an hour or so, I headed to the endocrinologist. When I got there, they weighed me--I was down another two pounds! She looked over my test results and said that I had diabetes. She scheduled another blood test to determine whether or not my pancreas was still producing insulin. In other words--whether I was insulin resistant (Type II) or whether I was insulin deficient (Type I). She said, "Maybe you will be lucky and we can control it with pills." I rolled my eyes, "If I was lucky--do you think I'd be here right now?" They set me up with a glucose meter and some long acting insulin called Lantus. I was instructed to test myself before bedtime. If I was under 200, fine. Over 200, I had to inject myself with 10 units of Lantus.

I also was given a prescription for Avandamet which is a combination of Avandia and Metformin which is supposed to help control blood sugar. It cost over $100! Ouch. But more painful was trying to inject myself with Lantus when my blood sugar was indeed over 200 that evening. It's not that the needles hurt--they're very thin, but it was just the ick factor of sticking it into my stomach. Thankfully, I just need to inject subcutaneously, not intravenously. The Avandamet made me swell up like a water balloon and made me feel nauseous to boot. I quit it after three days. While waiting for the determination of what type of diabetes I had, my Lantus dose kept increasing. One time my blood sugar went so high that the meter could only read "WARNING: High." I injected myself with more Lantus. Patti LaBelle says she passed out on stage when her sugar was over 500. What a wuss! Mine was over 600 and I went to yoga class.

Along the way I learned that normal blood sugar ranges from 70-120, under 100 if fasting. Normal hbA1c levels--which measures average blood glucose over a three month period--are generally under 6. My hbA1c of 15.7 was literally off the charts. Seriously, my endo has a chart of hbA1c levels and the corresponding glucose levels on her wall and it only goes up to 12. It's a wonder my head didn't explode! All I can say is all my walking and working out and yoga probably saved me from a coma by bringing my blood sugar levels down. That and peeing constantly, which is the method the body uses to expel the excess glucose.

The result for my C-peptide blood test was .5. The bottom of the range is 1.0. So my pancreas was definitely not producing insulin. The endo started me on Novolog, a rapid acting insulin for meals in addition to the long-acting Lantus. She put me on a sliding scale--but that only produced a rollercoaster of highs and more frighteningly, lows. If glucose of 575 sounds dangerous to you, try operating when it falls into the 40s. One time it got as low as 23. Actually, the first time I woke up and it was only 100, I felt a little light headed. I was so used to high blood sugar, that normal made me feel woozy.

It has taken two years, but now I've got it pretty well under control. My hbA1c has remained under 6 for the most part for a year and a half now. My cholesterol is awesome and my kidneys are fine. My eating habits are drastically different--instead of my carb-based habit of grazing throughout the day, I eat two meals--breakfast and dinner. If I'm hungry I may have some nuts or carrots or something low-carb as a snack. My one sweet indulgence is some dark chocolate. I rarely eat cookies or ice cream or cake anymore as any indulgence has to be paid for with a shot of insulin. Funny how that piece of pie doesn't seem as appealing when the price tag is an insulin injection...And my weight, which dropped almost 20 lbs. when I was sick but then escalated with a gain of over 30 lbs. as I started healing, has started to level out and get back to normal. I still want to lose that extra five pounds, though.

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