WWTBAM Bored

Well, that was a bust.


Several "things I know" didn't appear in my head, let alone on the typing space, until several questions later.


Being diagnosed with Type II diabetes, then told my "3 month average" blood sugar is so high (300 & something) that I will have to inject myself with insulin for at least the next month apparently did not help my test-taking any.


I asked the nurse-practitioner (I got an emergency appt with the nurse instead of the doc because I knew all this water I was drinking was a sure symptom of diabetes, & I was unfortunately right) why I wasn't falling over already & they said "oh, we worry about that with people whose sugar is over 500".

Nice to know.

damn, sorry to hear that ghost.

Will keep positive thoughts that this is a passing thing.

Damn, Ghost, that sucks. Big picture..the test will be there next year. Make sure you are.

Sorry to hear the news but thankful it is treatable.

Sorry about the test, and here's hoping your health will be much improved soon.

Glad you got checked out. Hopefully the melds will make a big difference. Sorry about the J! Test.


kay

I got timed out at the library last night just as I was continue-babbling about my sad state. And those computers really are supposed to give you a 2nd hour if no-one is waiting for a computer, & since the whole bank of them was almost empty, I know no-one was.


Thanks for the good wishes from all you folks who have given them to me.


In 2010 my 3-month average blood sugar (they base it on a batch of mature red blood cells, which take 3 months to mature, which is why its only an average) was 117. Last year, before my surgery to remove a cancerous major organ (& lots of nearby stuff that proved non-cancerous on biopsy, gee wish they'd have then put them back in), my urine showed no sugar & the blood sugar that day was normal; I forget what, but nothing to worry about.


I haven't had it taken since, 'til now. None of my specialist doctors checked it, even those, like the urologist, who do check urine for other things.


I wish a lot of things. I wish I had found out about this long before it got this bad. If I had made an emergency appt at the 1st bout of ravenous thirst, at Thanksgiving, that would have been good. I had another health problem I made an emergency appt for at the time, censored, thanks, although some here, from the new diabetes diagnosis, will figure it out; please don't post about it. My oncologist's nurse-practitioner figured it was antibiotic-related; I'd been on a week of antibiotics prescribed by my periodontist, who had just done more tooth-lengthening surgery for my lastest tooth woes.


My habits have not changed since my major surgery. Eating habits, exercising habits (what, me exercise? the NP wants "to see sweat" now, even though I walk more than a mile daily going to & from stuff). I'm a pretty healthy eater by modern standards. They now want me back on the very low carb diet I was on in my twenties. I lost weight, but was miserably hungry all the time. I'm someone who needs a few carbs. I guess they will have to be the brown-rice-kinda-carbs for the forseeable future. Which is OK.


I posit that the major-organ-removal, which wreaked hormonal havoc in other areas, had a direct effect on my pancreas. But the internet does not agree with me.


It's funny, but not funny-ha-ha; I had a strange taste in my mouth this summer. Hard to describe, but slightly-metallic would be one way. I could google nothing about metallic-taste at the time except "some meds cause this". I wasn't on any meds at the time. Now, I read the warnings sheet for Metformin, the drug they put me on (it prevents your liver from turning food ingredients into glucose, & gets glucose into muscle cells) before they decided I also needed insulin, & it says (paraphrased slightly) "if you have a metallic taste in your mouth you are in a condition of lactic acidosis, call your doctor, this could be fatal". But when I asked the NP if I could have gone into lactic acidosis without the help of Metformin or any other drugs, they blanked out on the question, kinda, but then said "no". I will nevertheless be looking this up.


Currently I sporadically have a "you have gargled with sodium bicarbonate" taste in my mouth. About that, the NP said "oh, diabetics can have a sweet or salty taste in their mouth". But sodium bicarbonate isn't salty tasting to me, despite being a salt chemically. I will be looking this up too.


My liver & kidney functions test, via blood tests, came back "normal". Which is a relief, as diabetes can damage both. So now we know, we think, it's just my maladjusted pancreas, though no-one but me wants to test that except through the blood-sugar tests. I of course am afraid of cancer. Even though what I had usually doesn't spread to the pancreas. But the NP & a doc in the practise who also stuck their head in to talk to me say that pancreatic tumors usually don't affect insulin levels. Depends on where they are, of course.


After 3 daily doses of Metfomin, my stuck-myself-in-the-finger test this morning shows a blood sugar of 318. Which is why they've got me on the insulin too, starting tonight. Its a slow-acting insulin, as opposed to normal insulin you produce like you're supposed to & the mimics-normal-insulin they give many diabetics, who have to eat after they take it or risk hypoglycemia. I'm horrified of hypoglycemia, because the jerks in the nursing home my Mom was in to recover from slow-healing probably-diabetes-caused ulcers almost killed her twice that way by trying to get her blood sugar down to normal levels by increasing her dose of "stimulates your pancreas" drug. She almost went into comas from that twice.


I told them how scared I was of this, & they've got me on insulin anyway. But the slow-acting kind. Not supposed to cause hypoglycemia. We'll see. They've got me on a very low dose of this slow-acting insulin, because they fear if they put me on a high dose even of this, I'll go into hypoglycemia.

Hoping that your numbers will improve in the coming weeks and months.

ghost:

Here with my Endocrinologist hat on. Diabetes type 2 is a progressive disease by nature, so over the course of time the ability of the pancreas to make insulin tends to deteriorate even if you are exercising and following a good diet. It is not a sign of pancreatic cancer, nor does it occur due to other illnesses such as your other major organ surgery. it is true that any other illness can make your blood glucose level higher, but this is due to the problem of your body responding less well to your insulin (the issue of "insulin resistance"). When your body can't respond to the low amount of insulin you have, then your blood glucose jumps up too high. People who aren't following a diet or exercising will have even worse difficulty.
When your glucose level is over 300 for a long period of time, then an additional problem can be occurring called "glucose toxicity" to the pancreas, so the production of insulin goes down even more. By using the insulin injections to normalize your glucose levels for a few weeks, the glucose toxicity issue can go away, and there is the potential your pancreas will start to work better. This is why your doctor and NP have indicated the insulin usage might just be temporary; we'll just have to see if there is decent recovery of insulin production after a while.
The combination of metformin (which works by reducing insulin resistance) and slow-acting (and therefore long-lasting) insulin is a good therapy choice. It is quite safe to start on a relatively low dose of the slow-acting insulin and gradually raise the dosage by 1-2 units every day or two to bring your glucose levels down to a good point without significant risk of hypoglycemia.

As always, I am available by Private Message.

Best wishes with your efforts to get your diabetes back under control.

thguy, you and tanstaafl, have been absolute pillars, sharing your knowledge and experience about issues we have.

I, for one, (of I am sure many) am so thankful that you guys are willing to help out to ease our fears, confirm our thoughts, and suggest some things we may not know.

God bless you.

thguy, you and tanstaafl, have been absolute pillars, sharing your knowledge and experience about issues we have.

I, for one, (of I am sure many) am so thankful that you guys are willing to help out to ease our fears, confirm our thoughts, and suggest some things we may not know.

God bless you.

I second that emotion. It really is a blessing to be able to get answers and thank you for taking the time to share.

Thank you so much thguy65 for putting your endocrinologist hat on in my behalf. I hope you won't think me too much of an upstart to say I knew a lot of that stuff (from my own research & my NP trying to reassure me), but not the glucose toxicity part (needless to say I look this up next); its great to hear it from a real endocrinologist though. I will bet a local one is in my future, but so far this has been handled by the NP at the practise, who has been consulting with my GP & the other GP in the practise.


I also hope you will pardon my ungrateful-looking not-thanking-you-sooner as I don't have internet access except intermittantly.


I will be eventually contacting you via private message, to fill you in on the cancer surgery details, but last time I used that I had a hard time getting it to work.


Since my blood glucose levels were checked at the end of last March, on the day of the surgery, & were normal, we can be pretty sure this has all happenned since then.


I did not have bouts of extreme thirst until Thanksgiving. I monitor my water intake because my urologist wants me drinking 64oz/day to help prevent another kidney stone. Even though it got pretty hot this summer, I usually had a hard time getting even close to 64oz. Based on that & the "blood sugar average" test on the mature RBCs which only goes back 3 months (for the rest of you; 3 months is when RBCs are mature) I could guess I was not having high blood sugar this summer, except that I'm now betting 2 very alarming bouts of dizziness, which at the time I supposed were due to antibiotics I had been put on which also made me nauseus, might have been blood-sugar related. People who were near me for the second one kept asking me if I was dehydrated, which I was not; I'd already drunk 20oz or more that day, per urologist's orders.

During the 3 bouts of extreme thirst starting at Thankgiving I easily passed 40oz by noon, after which I stopped counting.

I had weird stomach growlings in the days after the surgery; weird in that they weren't accompanied by any hunger. I just supposed that things in my abdomen were rearranging themselves due to other things being newly missing. Maybe this was related to this fall's diabetes? It went away after a few days.


What bugs me is that this hasn't been creeping up on me for years; my blood sugar has been normal all my life 'til now. What also bugs me a lot is that I am currently 45 lbs overweight, but 10 or 11 years ago was as much as 90 lbs overweight. (If anyone else on the board wants to chime in on that I can't stop you, but I've never "looked my weight"; I know people who weigh what I once weighed who occupy twice as much space as I did at that weight. I know the experts say compact fat is harder to lose, & I can tell you from experience it is, but you don't look so fat while "wearing it".)


They claim that losing 10 lbs can reverse diabetes, but I've lost 45 lbs & developed diabetes.


My blood sugar, taken in the "how to use these adult-proof devices" session, was 318 at around 10:30 Wednesday.


Even after Metformin that I started on Monday & insulin that I started Wednesday night, it was 340 at 6:00am Thursday & 7:00am today.


As of today, my NP tells me to up my nightly insulin dose from 8 units to 10 units. I report back to them on Monday & will be seeing them again Wednesday.

A bit seperately about the adult-proof devices:

As a bio major I am an old hand at sticking myself to get blood. Also, I am witness of many sessions watching my sister use whatever was provided to get my Mom's blood, as Mom also had type II diabetes; she was older than me when she developed it, & her blood sugar was never anywhere near where mine is today.

I also, from school, an early job, & treating a late kitty who needed rehydration at home while the cancer drugs kicked in, have experience at sticking syringes into vials to suck stuff into the syringe. And I knew how to use a turkey baster even before all that!

I presumed they would be giving me similar apparatus to get blood samples to test & to give myself insulin.


Oh no. You can all go to the Freestyle site (I bet they have one) to look at the blood-stick-&-meter circus, & the Lantus site (I bet they have one) to see the similar circus on the insulin pen.


I know a lot of these caps over caps over caps are for safety's sake. And other details are so that no one will hurt themself taking blood or injecting insulin. But there are so many caps over caps over caps regarding needle-points, & very non-intuitive recapping & twisting or yanking off of things to then get the damn needle off the apparatus, that you can barely get done the job you're trying to do.

ghostjmf wrote:Thank you so much thguy65 for putting your endocrinologist hat on in my behalf. I hope you won't think me too much of an upstart to say I knew a lot of that stuff (from my own research & my NP trying to reassure me), but not the glucose toxicity part (needless to say I look this up next); its great to hear it from a real endocrinologist though. I will bet a local one is in my future, but so far this has been handled by the NP at the practise, who has been consulting with my GP & the other GP in the practise.


I also hope you will pardon my ungrateful-looking not-thanking-you-sooner as I don't have internet access except intermittantly.


I will be eventually contacting you via private message, to fill you in on the cancer surgery details, but last time I used that I had a hard time getting it to work.


Since my blood glucose levels were checked at the end of last March, on the day of the surgery, & were normal, we can be pretty sure this has all happenned since then.


I did not have bouts of extreme thirst until Thanksgiving. I monitor my water intake because my urologist wants me drinking 64oz/day to help prevent another kidney stone. Even though it got pretty hot this summer, I usually had a hard time getting even close to 64oz. Based on that & the "blood sugar average" test on the mature RBCs which only goes back 3 months (for the rest of you; 3 months is when RBCs are mature) I could guess I was not having high blood sugar this summer, except that I'm now betting 2 very alarming bouts of dizziness, which at the time I supposed were due to antibiotics I had been put on which also made me nauseus, might have been blood-sugar related. People who were near me for the second one kept asking me if I was dehydrated, which I was not; I'd already drunk 20oz or more that day, per urologist's orders.

During the 3 bouts of extreme thirst starting at Thankgiving I easily passed 40oz by noon, after which I stopped counting.

I had weird stomach growlings in the days after the surgery; weird in that they weren't accompanied by any hunger. I just supposed that things in my abdomen were rearranging themselves due to other things being newly missing. Maybe this was related to this fall's diabetes? It went away after a few days.


What bugs me is that this hasn't been creeping up on me for years; my blood sugar has been normal all my life 'til now. What also bugs me a lot is that I am currently 45 lbs overweight, but 10 or 11 years ago was as much as 90 lbs overweight. (If anyone else on the board wants to chime in on that I can't stop you, but I've never "looked my weight"; I know people who weight what I once weighed who occupy twice as much space as I did at that weight. I know the experts say compact fat is harder to lose, & I can tell you from experience it is, but you don't look so fat while "wearing it".)


They claim that losing 10 lbs can reverse diabetes, but I've lost 45 lbs & developed diabetes.


My blood sugar, taken in the "how to use these adult-proof devices" session, was 318 at around 10:30 Wednesday.


Even after Metformin that I started on Monday & insulin that I started Wednesday night, it was 340 at 6:00am Thursday & 7:00am today.


As of today, my NP tells me to up my nightly insulin dose from 8 units to 10 units. I report back to them on Monday & will be seeing them again Wednesday.

The time course of your progression from normal glucose to very high levels over a matter of months is not unusual. I can only guess what may have been happening over the summertime, but you may have had levels creeping up during the summer and fall into the 200's but eventually the glucose toxicity problem made your diminishing insulin production plummet and caused your symptoms to get much worse.

It is difficult (and often frustrating) to compare your situation to another diabetic's status regarding lifestyle, body shape/weight, and medication response. I often need to tell my patients "Everybody's diabetes is different". Not everyone gets the same benefit from losing 10 pounds. The weight that you were able to lose in previous years probably kept you from reaching this point much sooner.

Keep nudging up your Lantus insulin dose every couple of days as your NP has been directing. Don't be concerned about the number of units of insulin you may end up using. The main thing is getting that glucose level down.
If you would prefer using a syringe and vial of insulin instead of the pen, you should let your NP know. Many patients still use this equipment instead of more-expensive pens.
Regarding glucose meters, there are many choices with various bells and whistles. If your doctor and NP likes the Freestyle and can use the software and data management options to help you with your glucose control, then I would follow their recommendations.

Thanks for more input, thguy65.

My NP isn't use a software option on the Freestyle meter; they have me call them daily to report my blood glucose levels. I gave up "getting the clock set on that meter per the company's instructions", but I only tried anyway because it was a new gadget & I wanted power over it; I have plenty other clocks to use to time my meter readings.

I did request a "meter that uses strips" (to catch the blood sample) because my sister had cautioned me against those with some kind of rotary deal that Mom's Medicare insurance put her on at one time; the rotary thingie gets screwed up & the insurance won't replace it until lots of time has passed, but of course the diabetic needs to take readings daily, so has to pay full price to replace it themself. My NP sounded like they had already decided on Freestyle, which uses strips, before I made this request.

Incidentally, the Freestyle meter was the once thing in all this equipment that my insurance didn't pay for (I believe because it counts as an appliance, & my deductable for appliances is $500.00) but it only costs $21.00 anyway.

As for the Lantus pens; I'd sure prefer the simple vial-&-syringe route, because then I'd be 100% sure the full dose was getting in.
With the Lantus pen (as you know; this is for others who don't) you are supposed to shoot 2 units into the outer world before dialing up your own dose, just to prove the thing is actually working. My NP did not show me that step (I got it from the instructions) & agrees I don't need to waste insulin that way, so I'm not doing it, but I don't have a lot of faith in this delivery system.

(Others; you "dial your # of units" via a twisting dial, then press down on the dial's top to shoot the insulin in. The dial dialing itself back to zero as you shoot is supposed to be proof the insulin got into your skin. You never actually see the insulin level in the pen go down, at least with the few units I've used up so far. However, a drop of fluid remains on the needle when you remove it, which in the demo was "proof the pen works". This is complicated by the demo having been a pen filled with H20 & me giving shots to a ball of paper towels, & in my demo we had a really hard time depressing the pen. I was told that was because we'd practised dialing up the dose too many times, & built pressure up. In real life, it depresses easily.)

I've paid so much for the Lantus apparatus that I'm going to continue with it until it's used up or I get better, whichever comes 1st, unless we decide it's really not working. The co-pay on a lot of the other stuff I've had to buy was $15.00/each, but for this I think it was $50.00. And the pharmacist says they prescribed me the "4 times a day" set even though I'm only using it once a night so that I wouldn't have to pay even more getting refills.

My blood sugar was down 12 whole points this morning, to 328. Big whoo. None of this is reversing nearly quickly enough for me. I know, I know, it took time to get this bad, it will take time to get better. I'm the person who gets 3-day colds, though, if I even get them at all. I'm not used to long-term illness.

They've got me on the lowest Metformin dose, 500-whatevers, & I'm supposed to up it gradually over a 4-week period to 1000 in the morning & 1000 in the evening (others: This is avoid the diarrhea that the drug can cause if given in full dosage from the start. Oh, how lovely my life has become.).

ghost:

Your NP has you on an appropriate plan of treatment, and the way they have outlined increasing your dosage on a rapid basis every 2-3 days is good.
Other diabetics unfortunately have been victims of "treatment inertia", so they end up languishing on the same ineffective amount of medication for months and years.
For patients who are comfortable doing it, I give instructions for them to raise their insulin dose by 1-2 units every couple of days on their own without contacting my office if they see the pre-breakfast glucose is still above the target level of 130.

Keep posting updates for us all so we can see when you get things improved.

Belated here. All good thoughts and vibes with t his. It's a difficult condition to deal with.

Sorry to hear this bad news on two fronts Ghost. Hope you get the diabetes under control soon.

I agree with not taking too much Metformin right away. It is a heartless bathroom bitch for some folks.

ghostjmf wrote:... However, a drop of fluid remains on the needle when you remove it, which in the demo was "proof the pen works".

This reminds me of something displayed on the "continuous health info channel" playing at my doctor's office on Wednesday. The video suggested that one should NOT immediately withdraw the insulin needle after injecting. It said this will allow the skin to absorb the entire dosage, rather than having some of it escape back out of the injection site.

On the other hand, it seems to me that the longer the needle is left in, the longer it might take the skin to close back up once the needle is removed.

Hopefully, one of the professionals here, your physician or the instructions that came with your pen can shed additional light on this.

Good luck in dealing with this.

My pen injection isn't insulin but Victoza, but I gather the idea is the same. They told me to leave it in about ten seconds to be sure it all injects.

As long as I find a spot that doesn't sting when I touch the tip of the needle to the skin, I don't even feel it when it goes through the skin and injects.

If anyone ever has to get on Victoza, work up to the full dosage slowly, and be strong about sticking to a lower dosage if it works. That stuff is expensive, and there's no need to use more than you need to.

It's the opposite of Metformin, as far as how it affects your digestive system - it slows it down to a crawl (many people use it off-label for weight loss - you just don't feel like eating for a month or so). The combination is actually relatively benign once everything stabilizes.

Estonut wrote:This reminds me of something displayed on the "continuous health info channel" playing at my doctor's office on Wednesday. The video suggested that one should NOT immediately withdraw the insulin needle after injecting. It said this will allow the skin to absorb the entire dosage, rather than having some of it escape back out of the injection site.

On the other hand, it seems to me that the longer the needle is left in, the longer it might take the skin to close back up once the needle is removed.

Hopefully, one of the professionals here, your physician or the instructions that came with your pen can shed additional light on this.

From the American Diabetes Association website:
http://web.diabetes.org/wizdom/download ... nsulin.asp
The info applies to self-injection as well as parents giving injections to their child.

Leaking from injection site. Sometimes insulin leaks out after an injection. If this happens, check blood sugar levels a little more often for the day. Consult the doctor about when and how to adjust a later insulin dose if blood sugar is higher than usual. If your child experiences leaking frequently, try one or all of the following tips to prevent leaking. For more suggestions, talk to the doctor.

Push the plunger more slowly while injecting the insulin.

Count to 5 or 10 after pushing in the plunger and before removing the needle.

Check the angle of the needle. You may need to straighten it a little (to a 90° angle).

Check the injection site for lumpiness. If it’s lumpy, choose another site.

Ritterskoop:

Vitctoza, which I just googled, is one of those "goose your pancreas to up its own insulin production" drugs. My Mom was on such a drug, but in pill form. I know you're not 89 years old, but watch out when you get up there if you're still on this or something like it; after my Mom had several crises on this, the experts, when finally called in, told us that it works differently in old people.


In my Mom's case, the people in the nursing home where she was mandated to stay until recovered from big skin ulcers decided they would up her dose of her drug until her blood sugar was at least down to 150. The result was, both times, a blood sugar around 50, not 150, & my Mom going into diabetic coma. This happenned once when my sister had taken her out of the home to a doctor's appointment; there were no food-dispensing machines anywhere in the building, at least not those that dispensed sugar-containing stuff easily absorbed by someone going into a coma, like a can of soda. Eventually my sister got another patient to give her some kind of lifesaver or something she could put in Mom's mouth without Mom choking on it, & the EMTs when they arrived got glucose into her.


The 2nd time was in the middle of the night, one of those rare nights my sister wasn't sleeping on a mat in Mom's room; a nurse called the physician in charge for permission to get Mom out of the coma, but of course they never answered the call; they were a bigwig who was supposedly "physician in charge" for 3 different homes, & never returned emergency calls. The nurse gave my Mom glucose & got fired for doing this without orders. We asked the nurse if they wanted us to back up their case & they said "forget it", so we reluctantly did. I would guess they didn't want the publicity preventing them getting their next job.


This kind of thing, where people are rushed from nursing homes to hospitals & back again, only to have it repeated, can be avoided if the nursing homes would use common sense. As one of the experts in the real hospital said, the one who told us the pancreas-stimulating drup works oddly in older people & should be changed out for a more predictable drug with them, "what does it matter if an 89-year-old-person has their blood sugar at 150 instead of 180".


I told the NP these stories about why I'm really scared of pancreas-stimulating drugs & thought it could be why they put me on Metformin 1st, but now I'm finding from thguy65 & various web sites that it's the 1st drug used, generally, anyway.


So far the drugs I'm taking are having almost no effect. My blood sugar was 139 this morning. They'll probably up my insulin dose Monday. But at least I'm in control of how much I'm putting in.

The elaborate, nearly-adult-proof procedures you have to go through to get a needle appear in these 21st-century devices assures nobody will accidentally infuse anybody else with insulin or even stick their finger hard enough to draw blood. I had to use the "press a button which releases the needle which sticks you" thingie 3 times this morning to get enough blood to appear, & this monitor they had me buy needs far less blood than my Mom's, using a more understandable needle-stick procedure, used to.

So be assured, the insulin-sticking device is similary almost-adult-proof, & doesn't hurt at all, considering I'm sticking my big fat thigh. I would travel to my stomach as gently suggested by my NP but I don't want any more scars there than have already been put there by medical science. If it ain't getting in via the thigh skin, I guess I will have to.

The nursing (rehab) homes in Dallas are just as guilty of giving too much insulin to patients. My Dad (diabetic type 2 ) was given insulin why he was there 2 weeks ago (never in his life did he need or take it) and ever since he has been so lethargic. He was given pain killers which always make his sugar levels rise and his regular pills for diabetes plus the insulin. He is home now, but still is not himself. I took him to his PCP and he didn't give me an answer. I went to see the head of the nursing home and asked why in the world would you give him insulin and they said everyone gets it. So word of warning to everyone with elderly parents, make sure you monitor all medications. Does anyone know why my Dad is so lethargic/ Does it take time to recover from getting insulin when you don't need it?