Diabetes Management

What’s so bad about sugar? – Sugar isn’t the bad guy. It’s all about not going overboard. Diabetics just have to watch how much they eat is all.

Diabetes link to Alzheimer’s Risk – Didn’t we already know this? Regardless, whether or not this is a true study, controlling your sugars is a priority. Something I need to do better.

Katie had left me this link on Facebook but it’s been lost. So I thought I’d repost it. The Spoon Theory by Christine Miserandino. This link is for those of you that don’t quite understand what my life is like everyday.

The other day, I was doing some searching for some water shoes, so I might be able to go swimming in a pool. If anyone knows me, swimming in the ocean is out of the question for me, as they freak me out and are probably not a good thing with my immunosuppressant drugs. This includes rivers and lakes. I won’t swim in them, they’re dirty, and no thanks. I know a pool is probably just as bad, but at least there’s usually chlorine in those. Anyways.

So I was looking for recommended water shoes for diabetics like me and I discovered something really intriguing to me. A lot of people don’t know about foot care for diabetics. I can understand this. There’s no reason for anyone to know about unless you have diabetes or know someone who is. However, it just seems like everyone is getting diabetes these days because of various reasons. Everyone thinks it’s just all about pricking your finger and testing your blood. Sorry, it’s a bit more than that folks.

For those of you who in danger of becoming diabetic, this post is for you. If you get diabetes, this is what you will have to live with, FOR THE REST OF YOUR LIFE. (sorry for the caps)

For me, it’s a routine. I know what I’m going to do, and it’s really automatic for me. I’ve been doing it for so long I guess it’s second nature. I’ll use the bullet method:

• Inspection of the feet – Any Thomas Covenant readers out there? Remember that routine he did where he’d visually inspect his entire body? What did they call it, VISE or something like that. Anyways, that’s what I do with my feet at the end of the night before I go to bed. However, I take it one step further and feel my feet just in case I missed anything.
• Never go barefoot – ever. Don’t do it. Why? Because you can cut your feet, you can accidentally step on anything that might just burrow into your foot. And the clincher here is, for some diabetics (like myself), you can’t feel anything with your feet. Yeah, it’s kinda weird walking. That’s why I walk with a cane. I lose balance really fast, and if I fall, that’s a bad thing too.
• Dry your feet after a shower – I know this may seem like a duh moment, but honestly, for many diabetics (like myself) we get neuropathic pain in our feet. That means you have the tingling sensation like your foot goes to sleep all the time. You know for everyone it just go away after you wake it up? Well, it never wakes up for some of us. And just the touch of a towel can be excruciatingly painful. Even sheets! You know, I don’t remember the last time I went to bed with the sheets over my feet. I always leave them out.
• Be very careful when clipping toenails – because the numbness is there, you won’t be able to tell when you clip off toenails or your own foot. I know some diabetics have someone cut their toenails for them, but I can’t bear anyone else touching my feet. It’s just too painful. Hell it’s painful just to take off my socks.
• Keep them moist but not too moist – Use some kind of lotion. Again, this may be a duh moment, but you don’t want them too moist because then you might get a fungus. (or something worse!) If your skin cracks, then you’re in trouble. Remember, diabetics take longer to heal, and because it’s on your feet, you might not know about it! Especially if you don’t do your visual checks!
• Watch for heat and cold – As a diabetic, you may as well forget about heat pads, icy hot patches, things like that. These are all bad things for you. Because of any numbness that might occur, you might not know if it’s too hot or too cold. Especially on your feet.
• Always wear socks – Did I mention this before? Yeah, it’s that important. If you don’t wear socks, then at least wear a non chafing slipper that will encase the whole foot. i.e. no open heel slippers.

What are the complications if you don’t do these things? Well, there are plenty of them. And I’ll tell you oh, they’re horrible. But you know what’s the worst? AMPUTATION. That’s all you need to know. If you don’t take care of your feet, they’re gonna eventually cut them off. It’s as simple as that. Have you heard of people losing their toes or feet to diabetes? Yeah, this is how it happens.

So hopefully, if you’re a newly diagnosed diabetic who happened to find this page and learned something, then my job is done. If you haven’t learned anything, then either you already knew about it, or you’re ignoring everything I say, in which case, you’ll find out sooner or later.

I just hope you don’t have to lose a foot to learn something.

I have to say the one year of my kidney transplant came and went last July 29th. I’ve been doing pretty good since. I guess the power of current medical technology is something else. Since the one year mark, things have been going pretty much ok. There are a few things which need to be resolved, but I’m sure things will work out eventually. I’m officially a permanent handicapper now, so I can get all the cool spots and actually be legal about it. It’s surprisingly easy to get a handicap decal. My doctor sent me a form, I signed it and turned it in and just like that I had 2 decals. Crazy I know.

I’ve also been experiencing a lot more pain from the neuropathy. I mean a lot more pain. They’re pretty much in my hands as well as my feet, and there are some days where it’s just take your breath away unbearable. My shoulder has been really killing me lately from tendonitis in the bicep and rotator cuff. Or something like that. Just another one of those things to chalk up on the board. If my medical record was transcribed onto paper, I swear it would probably be about 6 inches thick. Don’t laugh, I’ve seen medical records that thick. I did work in a hospital when we didn’t have computer medical records, you know.

What will tomorrow bring? Good weather I hope.

Today I just wanted to touch on something that’s a daily thing for me. Neuropathy. The reason I wanted to touch on this is pretty simple: I want to know if anyone else has similar issues as me. I don’t expect anyone to have the same conditions as I do exactly. I’ve already been told that it’s unique for me to have all these issues. So I’d like to hear from other diabetics and non-diabetics who have similar conditions to mine.

To start off, I have one of the most common for diabetics, peripheral neuropathy. Basically, I have issues with my nerves in my feet and hands. These damaged nerves in turn cause serious pain. It’s sort of like your foot falling asleep, and the tingling sensation you experience afterwards. Except for me, it’s all the time. On top of that, I get stabbing pains occasionally in the extremities. Well stabbing might not be accurate. It’s more like sharp pains. Like someone is sticking a needle repeatedly into my feet or legs or wherever.

I’m also experiencing numbness in the bottom of my feet. That just means the nerves have died at the most extreme tips. That’s the reason of course for me to walk with a cane because of imbalance. But the imbalance isn’t entirely because of the numbness. But that’s another story.

Next, I also have autonomic neuropathy. This means a various amount of things. Basically in myself, the brain gets confused a lot. How this happens in me is my sweating. When I eat food, I sweat. Yes, it gets to be a crazy thing. It could be 20 below while I’m eating, but I’ll start to sweat while I’m munching on my favorite grub. It can get pretty tiresome after a while.

I also have the same types of pain I have in my extremities in my stomach and chest areas. Basically the entire trunk of my body. Obviously this doesn’t really fall into the peripheral neuropathy since it’s not peripheral. But hey, it’s still the same. Basically for me, at times it just feels like I’m rolling a vat of needles. The movie Saw comes to mind.

I think I’ve touched on the major things I have due to neuropathy. I’m sure there are more that I never thought were because of neuropathy.

For those of you who are experiencing neuropathy I’d love to hear about your experiences and pains. Perhaps we could compare notes and get some home remedies from each other. Of which I don’t really have any. I’m just loaded up on Gabapentin (Neurontin).

It just seems like everything in this world is going crazy. With the oil crisis in the gulf, I just don’t know what to think of anything anymore. But I won’t talk about that here. This place is all about me.

What’s been going on? Well since I last posted, I’ve steadied out on my gabapentin. It seems that the medication has had enough side effects on me to cause some weird issues. Remember I was talking about my balance and the right side of my body? It’s suspected that the gabapentin is affecting that. Basically, what we’re talking about is that it prevents my brain from doing stuff. Therefore the weird things such as my right side of my body acting slow, the imbalance I feel, and so on. I understand it could be a cause of my headaches as well, but I don’t really see how. But hey, I’m not the doctor.

Other than that, because of the imbalance and numbing of my feet from neuropathy, I have to walk with a cane when I leave the house. Only when I leave the house because outside the pavement and ground isn’t always level, and I don’t really have much of a hold on anything out there. Pretty sucky. But my dad got me a cane, and it’s very cool, as you can see from the image to the left.

My neuropathic pain has steadied out to be painful only some of the time, and when I say that, I mean I only get the sharp pains every ten to fifteen minutes. At night, it’s still bad, and I have to get distracted by music in order to get to sleep. I’m sure there are others that must have this extreme neuropathy like me, and I’d love to hear from you. We could compare notes.

The quest to grow my hair for Locks of Love is still continuing. I don’t think it’s quite 10″ braided yet, but it’s getting close. I’m very anxious to get my hair cut back to it’s shortness.

Other than that, recently I got X-rays of right shoulder and right hip to see if there were any physical issues going on with them, since I have pain in my major joints, especially the right side all the time. However, they didn’t find anything at all, so I’ll probably end up getting a shot of steroids in my shoulder so I can heal that with Physical Therapy. Who knows what they’ll do for my hip.

The biggest concerns right now is my sugars. They’ve been running higher than normal, and I haven’t been doing anything different. I’ve gotta get together with my doctor and see what is going on with that. We shall see.

Other than that, we’re coming up on year one of the kidney transplant. It’s quite amazing. Life after transplant has been a bit different. But I’m getting used to it. Sort of.

So here comes a bulleted post. If you don’t want to continue reading after that, don’t continue to read on. Otherwise, read on!

1. So I’ve started to increase my dosage of Gabapentin (aka Neurontin) as per the neurologist. My neuropathy is just getting worse every day it seems.
2. I’ve been considering to just go ahead and keep growing my hair to donate to Locks of Love.
3. I went to get a bunch of lab tests done, and my A1C was at an all time low I believe. (this is good)
4. Lately, I’ve been having issues with the right side of my body. I keep thinking it’s residual from my stroke, but it can’t be.

So last month, I got my super flyer miles for staying in the hospital. I told Katie one day if I stay one more time, I get a free stay for a week. Like she said it’s kinda sad and funny at the same time. I swear I’ve been there enough times to recognize most of the nurses, doctors, IV team members, and mostly the lab people. The lab people stuck me enough times this last time.

Because my left arm has a fistula, they can’t do anything with it. They cannot put an IV in that arm or draw blood or anything. The left arm is untouchable. Therefore, they had to attack my right arm for labs and IV’s. You should have seen it, it was totally black and blue. I was in the hospital for four days, so that’s at least four sticks for lab tests, and one time, the IV team tried to insert a new IV and failed three times. I was severely dehydrated so it was very hard to get any needles in me. They also had to do an arterial blood gas, so that was pretty painful.

If you’re wondering, I had two things wrong with me to land in the hospital. I had Pancreatitis and Diabetic Ketoacidosis (DKA). Tons of fun! NOT.

At first, I was in moderate pain. I told Meesh to come home, I totally needed her and she came home. On her way home, the pain escalated to the point of agony. I was having a hard time even breathing. So I had Meesh call 911, and an ambulance was dispatched. I was going to have her take me to Urgent Care, but there was no way I could wait. The pain was on the verge of 10 out of 10. I mean this was the worst pain I’ve ever felt. I thought I was going to die, that’s how painful it was.

The EMT’s took good care of me and my blood sugar was 400+. I don’t remember what it was exactly, but it was 400 something. So for the first time in my life, I took a ride in an ambulance as a patient. (I’ve drove and ridden in ambulances many times as an EMT myself.)

I started to feel better. At first, we didn’t know what it was. Throughout the stay in the hospital it was determined (after an x-ray) I had pancreatitis. At first, they were baffled on the cause. They asked me repeatedly if I drank alcohol, since that’s the main factor of pancreatitis. But I haven’t drank a lick of alcohol for years. It’s not really a good thing as a kidney patient and diabetic to really drink. Especially in excess.

But after more labs, they determined the cause of my pancreas being so inflamed was DKA. I really needed to manage my insulin better.

The treatment for this was surprisingly simple. I was on PCA (Patient Controlled Analgesic – Heaven!) and npo or nothing by mouth. (Don’t ask me why po stands for by mouth…I forgot why) So I had ice chips for two days. After those two days, I was able to go on a clear liquid diet, which basically meant broth and jello. I must tell you, I never thought beef broth could taste so good. Sugar free jello was incredible.

I’m doing much better now and not planning on another stay in the hospital. Any more hospital stays from now on will definitely be planned. I hope.

So I got notified that there is no indications of any stenosis in my artery feeding my new kidney according to my CT scan. This is great news. That means no need to do an angiogram to open up the artery.

Good news for once is great to hear. On a different note…

We went to visit a nurse practitioner the other day to evaluate insulin pumps. Those are ungodly expensive but worth every penny I’d think. They can cost upwards to 5,000 bucks. That’s extreme though. I think with my insurance I would end up dishing out about 800 to a 1,000 bucks. Still pretty costly and it doesn’t include supplemental supplies like the tubing and the catheters.

I also learned I probably wouldn’t benefit too much from using it since I would have to replace the insulin every other day or so. It’s because I use anywhere from 150 to 200 units a day of insulin. Yes it’s quite a bit. Exercise and better eating will help this.

I’m going to see a nutritionist to see what she can recomend. I already know I need to eat more food that has a low glycemic index. I also know I need to become more active. With the neuropathy and back pains it’s really tough for me but I have to do it.

I think I might pass on the insulin pump only because my case is a bit different. I am very very insulin resistant. And I already spend a fortune on medicine and Medicare. I don’t think I need to add onto that. I should probably talk to my wife about it and come to a final decision. Crazy!

The other day I recall talking to one of my friends and my insulin regimen. It usually goes like this: long lasting insulin in the morning and bedtime. Short acting insulin before I eat my meals and snacks. All in all, that was about 6 shots a day. So every time I eat something, I have to take a shot. Unless of course I can manage to make a meal or snack that did not have carbs. Such as raw vegetables or pure protein. Of course, honestly, those aren’t too filling. But because of this, I told her it’s a great way to lose weight because I don’t necessarily want to eat because I don’t want to take a shot.

Yeah, that’s not really a great way to lose weight.

Honestly though, counting carbs in order to calculate how much insulin to take is a really great tool to losing weight. It makes you more conscious of what you are eating and aware of how much to eat. Portion size is really important to counting carbs. In many cases, where you think a package is only 1 serving, it’s actually 2 serving sizes. This is a tactic used by food companies to appear their food has lesser calories or fat. It’s not as if they’re lying. You’re just assuming it’s only 1 serving.

Another thing you’ll learn is that 0 does not necessarily mean 0. 0 could easily mean up to 0.5 mg or more! It’s one of those loopholes that seems to appear everywhere. I believe I’ve mentioned this before. Watch what you’re eating! This definitely goes for non-insulin dependent diabetics. Something to think about.

So as of late, things have been going good. I’m starting to really get into a routine of taking my meds and insulin at regular intervals. I’ve been getting used to doing readings every so often as well too. As of now, I’m on at least 18 different medications and two types of insulin. I’ve also been getting used to taking my vitals twice a day as well. So it’s all been getting routine.

Today was the monthly visit to the Nephrologist at University of Washington Medical Center. He’s such a great doc. Today, when we saw him he apparently heard something he didn’t like. Basically he could hear the blood pumping through my artery at my new kidney. What does this mean? There could be a collapse of the artery at that location, or there could be a “kink” in the artery because the kidney is shifting. He said in the past they haven’t really done anything about it because my bloodwork looked really good, and it wasn’t very alarming. But he said it sounded louder so it could be getting worse. He said it was better to take care of the problem while it was small instead of letting it get worse and worse then having to take care of it when it was critical.

So what does this all mean? Well, I had an ultrasound today which will hopefully help determine that. If indeed there is a big issue (a kink or collapse of the artery), then the next thing would be to do a cat scan. The cat scan will tell us exactly what it looks like and what is going on. After the cat scan, if indeed there is a big problem, then the next step would be an Angiogram. Fun. Yes, it’s similar to the angiograms for the heart. Actually it’s exactly the same procedure, except in a different location.

Lots of ifs going on there. But you know, everything is possible. We knew that eventually we would have to do something about this. Best to do it now than later I suppose. Luckily recovery is not a big deal, maybe a day or two of taking care of myself, nothing I don’t do already. I can’t do anything stressful to my body like lifting heavy objects, but you know, I can’t do that now.

So that’s what’s been going on as of late in my world of Malignant Diabetes. How’s yours?

Dealing with post transplant has been surprisingly easy for me. This is not to say it’s been easy on Meesh. Unfortunately, she’s had to deal with more than she should mainly because I either cannot or should not do it. She lifts all the heavy things, she cleans the litter box, she does all the food shopping, and well you get the idea. She does it all. And I’m so thankful to have been blessed with such an awesome support group. My parents and my sister have been tremendous help too.

Working has definitely been different for me. Before, I was lucky if I could work a half of a day without getting exhausted. Now I’m actually able to work a 9 hour day without even thinking about it. Having this transplant has been the miracle of my life, and I have everyone to thank for it, especially my sister.

Dealing with my diabetes has been a chore however. The medicine I’m taking makes it tough. I suppose I might just throw caution to the wind and just take my medicine and leave it at that but how disrespectful is that? Not only to me but to my sister? So I am working as hard as possible to keep healthy and keep my sugars in check. If that means sticking myself about 10 times a day so be it. It’s a small sacrifice to stay alive.

A word of caution to those diabetics that aren’t taking care of themselves: it’s really not as bad as you think. If I could do it all over again I would have bit the bullet and did all my glucose checks and taken my insulin.

One thing you learn, being a diabetic, is how to read food labels. One thing you must remember is simple: just because it’s not on the label doesn’t mean it’s not in there. Not everything we need to know about food is on the label. However, for the simplest things, most of us won’t have to worry about that. Another thing to remember is this: just because it says there’s 0 mg of something doesn’t necessarily mean there is none. 0 could easily mean 0.1 or as much as 0.9. In most cases, who really cares, but this is important if you really need to know exactly how much there is in something.

First you want to look at the serving and serving size. As you can see from the label to the right, this contains 2 servings per container. While what you eat is a serving to you, the label might say a serving is less than what you eat. So, looking at the servings per container is important. In this case, if you are eating 2 servings, then you’ll have to double these values you see on this label.

As a diabetic, the most important label to read is the Total Carbohydrates. This is the basis of watching just how much we eat or how much insulin to take. In general, you should talk to your nutritionist on how much you can eat. In most cases, it takes some practice to find out just how much you can eat without throwing your sugar balance out of whack. You should also talk to your physician so you know what your goals are. It’s important to know where you are most comfortable.

Note, also the sugars. Most likely your glucose levels will probably go up really fast with food high with sugar. You’ll want to avoid these. However, know that everyone is different and experimentation is always a good thing. Know what foods send you high, and what foods don’t. Knowing this could make a big difference.

Just remember these points:

• Not all food labels will tell you everything. They only report the required nutrition facts. Just because it doesn’t say it on the label doesn’t mean it’s not in there. A good example of this is Potassium. It’s not always listed on the label.
• Note the serving size. What you eat may be 1 serving to you, but to the label it could be anything. I’ve seen a label say that there was 3 servings per container, but the container had 1 serving of what we would eat. This makes a big difference when counting carbs!
• Just because the label says there is 0 does not necessarily mean 0. It could mean as much as 0.9 in the serving. In some cases, if there are 3 servings per container, and there are say 0.9 carbs per serving, that would mean there’s really 2.7 carbs per container, when it could easily say 0. That’s a significant change for someone watching their carbs!

Well, like I’ve said before, it seems that everything that can happen to a diabetic has happened to me except for amputation and I don’t plan on that one. Diabetic Retinopathy affects your vision and can cause blindness. How this manifests in me is pretty simple, I had blurred vision, or my vision was getting worse. I also had “floaties” in my vision where I would see black spots I could never really focus on, but they were always there. That was where the blood vessels had burst inside my eye, and left a residual trace.

I’m sure you’re wondering if I’m blind now. No, I’m lucky. With eternal vigilance (blood sugar checks and insulin), and laser surgery in my eye, I’ve managed to keep my sight. Although I have to admit I might have to get a new prescription, but only because I’m getting older.

There is a price to this situation however. I have a really hard time driving at night. I simply can’t see as well as say the average person can. The eye doctor told me it’s because when they laser the eye, what they’re doing is burning up parts of the eye. Yes, that’s right, they’re burning up parts of my eye, so I have less receptors to see. At least that’s how it was explained to me in simple, layman terms.

Unfortunately, the signs and symptons are sometimes never found. But if you are a diabetic, that annual or biannual eye exam is very important. Don’t pass it up. Which reminds me, I think I’m due for one in March…