the one that needs a disclaimer...

Disclaimer: I would like to point out at this time that I am NOT a person with a medical degree (yet), or a certified diabetes educator, or anything like that.  I am just a person with type 2 diabetes making my own decisions about my health.  This does not mean that I don’t follow my doctor’s recommendations and orders, it just means that I might make decisions at times that might make me look like I’m not a good patient.

Now on to my post :)

For about a week in the middle of October I stopped taking my rapid-acting insulin.  Don’t panic, it wasn’t a bad thing necessarily.  I am a type 2, I have been eating healthy-ish, I was (am) taking not only long-acting (Lantus) and rapid-acting (Novolog) insulin but I was also taking Metformin and Januvia as well. 

My Lantus dose was normal (for me), but my Novolog had gotten to the point where I was taking only a little with my meals.  One day I ate my bagel for breakfast and totally forgot the shot.  About an hour and a half later I remembered and tested, panicked, thinking I would be high, but I turned out to be lower than my fasting BG was.  Weird, right?

So I thought about it and decided to do an experiment and see if I could get off the insulin and start being just on the oral meds.  I made sure that I tested all the time and paid really close attention to what I was eating and whether I was high or low.  And I had plenty of both highs and lows, which was interesting.  What I discovered is that at this point in my life I can’t just take oral meds.  My numbers never really got out of control, and they actually stayed really steady for the first few days.  But then they just started slowly climbing.  At the end, I was having only slightly elevated fasting levels, but as soon as I ate something I would be living in the 200’s for the whole day. 

That was when I gave up.  I mean, I had the means to control it at my disposal, so I went back to it.  I have no problem being on insulin.  I have very tight control.  I am not one of those people that is scared to give it a shot (pun intended).  Yeah, I was kinda pushed onto it, and of course if I could get away from it I would.  I’d love to lose some of that weight that might be associated with being on insulin, but I don’t have a problem where I’m at today.

And now I actually have an endo and a lot of changes are being made, and I have a ton of appointments in the next couple of months.  I’ll be posting more about that in the next couple of posts too.

Somewhat of a rant.. but not quite

Partial rant coming up!

I read a lot of diabetes blogs.  Its how I got on board with my own insulin managed type 2 diabetes, despite the fact that most (like 99%) of the blogs are by or about type 1’s.  Since I’m insulin dependent (at the moment), it helped a lot in understanding the insulin and the importance of counting carbs and managing injections properly, and basically living as an insulin-dependent diabetic.

I was reading through some of these blogs the other day and managed to track back through a couple of different ones with comments about a reality tv show that involved a young man having some major issues with his T1 diabetes, who also had with a T2 father.  Lee Ann at The Butter Compartment made some comments about the show.  Lee Ann’s blog is one of my favorites, and in truth, I agreed with both of her posts about this show but she did make a comment that struck that same T2 nerve with me.  She said “…dad’s suggestion that it isn’t really that hard to manage diabetes was insensitive, and irrelevant because he presumably has T2 so what does he know? As far as I can tell, T2 is usually easy to control compared to T1, so of course he’d think that. It also perpetuated the idea that diabetes is easy to control amongst the general masses who don’t understand T1.”

Now I completely understand that there are tons of misguided people out there.  I was probably one of them at one point.  Some of the ones that really bother me are people who think:

• that all forms of diabetes are the same (which they’re not)
• that if you have diabetes (in any form) then you must have done something wrong to get it
• that if you take insulin (as a T1 or a T2) then you’re in worse shape than someone who doesn’t... like you have the “bad” diabetes
• that if you don’t take insulin you’re not a REAL diabetic
• that if you just ate right and exercised then you wouldn’t have diabetes anymore

Thinking of that last bullet point, obviously for a T1 that’s completely impossible. That last one is one of the reasons I’m so against people (T1’s and T2’s included) who seem to think that being a T2 is easier.  To Lee Ann’s credit, she did say “as far as I can tell”.  But the misconception I’ve heard, even from people who should know better, is that if I just dieted and exercised, I wouldn’t even have diabetes anymore. 

Think about this.  Exercise.  Everyone is supposed to try and get some exercise in, every day or every other day, or whatever.  If you’re a regular healthy person, you’re supposed to get some exercise.  If you’re a T1, you’re supposed to get some exercise.  But if you’re a T2, you HAVE to exercise.  T2 is controlled through diet and exercise and maybe some meds if it’s just not working.  How is that easy? 

I don’t like to exercise.  And yes, I believe that if I DID exercise, that I might not have to be on multiple daily injections of insulin.  There is the possibility that I might not even have to take ANY meds, IF I do everything perfectly.

And while it may be true that I could get to the point where I’m so awesome that my diabetes is completely controlled by diet and exercise alone, and I don’t have any symptoms of uncontrolled diabetes, I’m totally stuck.  I HAVE to exercise whether I want to or not.  I HAVE to eat carefully.  I can’t just have a piece of cake and bolus to cover the carbs.  I’m only “supposed” to test one time a day.  And if I do test and I’m high, I can’t do anything about it.  Sure I don’t have the risk of overcorrecting and going low, but I also get to just look at the number on my meter and say “Well would you look at that?  I’m high.”  And if I can’t get that high number to come down?

** I do actually know a T2 who is actually controlling his condition through diet and exercise and as far as I know he’s doing an incredible job of it.  So I know it IS possible! **

Yes, T1’s have a more “dangerous” form of this disease, I guess.  Although I don’t like that word, really.  There might be more potential issues because a T1’s body doesn’t create ANY insulin, but T2’s have just as many problems to deal with.  They have a huge chance of having uncontrolled diabetes because they usually don’t test more than once a day.  If their fasting blood sugar is fine but they’re having huge spikes for the rest of the day, they’re not even going to know something is wrong until they go in for an A1C.  And that’s a bad cycle to repeat.  And then it’s another 3 months to TRY and get it under control while not really understanding what they’re doing and just continuing on with the same poor management skills.

All diabetics should know what the actual facts of the disease are.  And while it’s getting easier for T1’s to find information and find helpful people who want to help lead them through things, the same is not true for T2’s.  YDMV (your diabetes may vary) applies for all diabetics, not just T1’s, and I think T1’s need to remember that as well.

/end partial rant

I’m not trying to step on any toes here, and I don’t want to be ostracized by the DOC for being an outspoken T2.  I would love to hear the opinions of anyone who feels like giving them.  Heck, maybe I’M following some misconceptions I don’t even realize.  :)

Disappointed

I went to a birthday party yesterday for my friend’s son. 

First, I was very glad to get to see some of my old friends that I haven’t had a chance to hang out for a while.  That was a lot of fun!

Second, I realized that since I quit smoking on January 4 (yay!!), I have not faced such a huge challenge as I did yesterday.  Almost everyone was a smoker.  The habit of smoking with these same people was pushing at me horribly and driving me nuts!  I finally at one point went inside to use the restroom because I didn’t want to just stand outside NOT smoking!  Grrr…  but yay!!!  Gotta keep reminding myself of that “yay”!

Third, I met a person in real life who wears an insulin pump!  I actually have a friend close by who just got a pump but I haven’t gotten to hang with her in a while and thus have not seen her pump.

Regarding this third point… I was disappointed that this diabetic of 24 years who has been pumping for 12 was not the kind of diabetic I’ve come to know through the online diabetic community, and I was quite disappointed. 

I realized that although my mom is a T1 and I know other people who are diabetics, I didn’t truly realize what it all meant until I was almost hospitalized with DKA and started taking multiple daily injections and keeping tracking of my numbers. 

Then I found Kerri’s blog and was so fascinated with what I was reading! Even though I’m a T2, here was something that I could relate to.  I went all the way back to some of her earliest blogs (yes I did and it was a LOT of reading!).  I learned a LOT more about my own diabetes even though it was different, and I found other people who related other things they knew, and then I started my own blog.  And although I do state in title that it’s about anything that pops into my head, it ends up being mostly about diabetes.  It’s a community that I enjoy being part of.

So even though I sometimes feel like a T1 wanna-be (more on that later), I’m still a diabetic who takes multiple daily injections of insulin and if that’s the way its going to be forever, then I’d definitely consider pumping.  And the OCD part of me loves knowing my numbers and would love to know how my BG’s trend and would love a CGMS (really?  I would love one?  yes that’s a little sad…).  So I was kinda excited to meet a pumper!  I jumped over and was like WOW is that an insulin pump!?!  And what did I get in return?  A look.  Like, wow, are you two years old?  That was the look.  So then I felt I had to explain why I thought it was cool.  And that’s kind of difficult when you’re a T2 and “shouldn’t be taking insulin in the first place whats wrong with you” (again, more on that later),  but I don’t want to stick myself with a needle all the time for the rest of my life if that’s what it comes down to, so I was excited.  How disappointing to run into someone who acted like I was an idiot.  I don’t really know for sure since I’ve never met any other D-bloggers, but I just don’t feel like that was the reaction I would have gotten.

By the way, I wasn’t actually THAT over-enthusiastic about her pump, but she made me feel like I had been!

Januvia update

I have not kept up on the blogging like I wanted to!!  I was hoping that I’d do it, but…. I’m slow…  :)  So…

Without wasting any MORE time, here is the update about my meds….

First, a quick recap…

Januvia is different than any of the other meds I take.  The Lantus and Novolog insulins I take provide me with insulin since my body’s own insulin isn’t doing its job or there isn’t enough of it.  Metformin helps my body make use of the insulin that it makes.  Januvia is supposed to help the insulin in my body react to food the way its supposed to.

I started taking 100 mg of Januvia once a day, per my doctor.  For the first week I felt a little bit sick to my stomach.  I’m still not sure if I just had a weird week or if it was the pill.  Since then I have no had any issues with it that I can see or feel. 

I have not miraculously lost any weight (bummer!), but I have also not gained any.  Again, I have no idea if this is because of the pill (doubtful).  In addition, I have been able to raise my insulin to carb ratio from 1:4 to 1:6, which means less insulin per injection, and longer time between prescription refills!

The interesting thing though, is that I really don’t know if the change in carb ratio is due to the Metformin or the Januvia.  I started the Metformin about a month and a half before the Januvia.  I don’t know how to really tell without removing one of them from the lineup though.

I will not be going back to the doc for another month, so I don’t know what the effect of the meds are having on my a1c.

After about a week I got a letter from my health insurance telling me that they allowed this prescription to be filled “to make things easier on me” but that they won’t be filling it again because it hasn’t been proven that Metformin doesn’t work for me.  Basically I felt like it was telling me that in order to allow me to take both of these medications I would have to stop taking the Metformin, get really sick for 3 months, and then that would prove it. I was like… well that just doesn’t make sense!  First, why would filling it once make my life easier?  All that’s making me do is have to talk to my doctor and possibly have a battle with my health insurance to allow me to continue with it.  What if my doc had really felt this was the ONLY thing that would work for me (instead of just wanting to see if it hells)?  Then I would be stuck without meds while they figure it out?  I would have rather they flat out say NO! and then I can fight it, without getting all excited that it seems like they’re working and then have it taken away from me!  I guess this would have been more of an issue if I was ONLY taking Metformin and it had actually failed and I didn’t have any backup plan.

I knew that that might happen though, because other people had noted that they had issues with it being covered.  And granted, its not covered WELL… its still not a generic, so it still costs me a lot of money to get it.  But if I can lower the amount of insulin I need to take and possibly even remove the NovoLog, that would be one less prescription to fill anyway!

So I contacted my doc and she contacted the insurance company and apparently everything went well, because she sent me a letter telling me that the Januvia is covered and they didn’t even have to battle! 

And I went and refilled the prescription and they refilled it without any questions.

And now, a week later, I got a letter from my health insurance telling me that they allowed this prescription but….... sigh … I guess I’ll be calling my doctor again…

new med!

So I'm going to keep track of my meds a little bit here. Mostly I want to keep a running track of how I'm feeling on new meds.

Currently I am taking:
- NovoLog: rapid acting insulin, every meal at a carb ratio of 1:4 and 1:15 for lowering a high (approximately 50/day maybe)
- Lantus: long acting insulin, 45 units at bedtime
- Metformin: pill, one 500mg pill twice a day
- Simvastatin: cholesterol pill

Today my doc prescribed one 100mg pill of Januvia. From what I can tell from reading the slip, and talking to my doc, and reading stuff online, Januvia is "a once-daily prescription pill that, along with diet and exercise, helps lower blood sugar levels in adults with type 2 diabetes." according to the Januvia website. According to my doctor (I think), it should help my body know when its eating so that it can secrete the right amount of insulin. This is not the same as Metformin which apparently helps my body actually get the insulin moving and doing things, and helps with insulin resistance.

I also found out today that insulin resistance is one of the causes of not being able to get pregnant, and Metformin is prescribed for it. So just in case, when the time comes, I'm all set :)

Anyway... while this pill is supposed to be pretty good, some of the side effects seem to be ranging from really annoying to downright scary. They include headaches (sinus mostly), nausea, diarrhea, constipation, bloating. Those are the ones that I'm not happy about. But the other ones are scarier! Like pancreatitis, or some crazy skin infection that makes your skin fall off. Really!!

Point being... I'm going to be paying close attention to how I feel over the next little while. This stuff is supposed to start working in like 2 days, and is really supposed to be incredible, lowering blood sugars for regular daytime readings by some really good amounts. Not doing much for basal rates, but if I can cut out one insulin and 5 injections, I'm game!

As long as my skin doesn't fall off!!