Pill pushers

I've almost given up posting here but I'll try and make it worth your while to stay and read this tale of irony and the wonderful system of market-driven medicine that passes for healthcare in the good old US of A.
Since they upped the threshold for an acceptable cholesterol level for people with diabetes I have (reluctantly) been taking Zetia, a drug recommended by my endocrinologist that comes with a nice selection of warnings and possible side-effects. One of the more serious of these is myositis and I was told that if I had any unexplained muscle pain or weakness I should contact my doctor right away. A while ago I woke up with aches in all my muscles and joints and normally I'd have taken several Advil, downed a gin before bed and generally sucked it up but I wasn't happy about taking the Zetia so I made an appointment with my Primary Care Physician.
I explained to him that I was aching all over and my stomach was bloated and he, without examining me, asked me if I was getting enough sleep as he thought it was Fibromyalgia. I joked that the cat wakes me up at 4:30 every morning and that was good enough for him. I told him that was a joke and as I was taking three medicines that made me so tired I was in bed by 9PM but to no avail - the man had his diagnosis. Fine. He then told me he was going to prescribe Elavil. It was at this point that I started to get worried.
When I first saw this doctor in December 2005 I hadn't been taking my BP medication for over a month and I had a violent headache. I saw the nurse practitioner first and when I told her about the headache and running out of Altace she thought that was the probable cause. A BP reading of 160/95 pretty much confirmed it but the doctor decided it was migraine and gave me Elvil, which he also said would help the arthritis in my wrist. I took one on a Friday evening and that was the last I remember of that weekend. Except that I was still aware of the pain - I just couldn't do anything about it. When I went back for a check up - BP down, headache gone, I told him about my reaction and that I couldn't, wouldn't ever take that drug again. His answer? I should have continued on the drug but cut the dose in half. Even though I was symptom free. Go figure.
I had expected him to write in large letters in my notes that I reacted poorly to this drug but apparently he didn't because here I was being prescribed the same thing again. So I made him write DO NOT PRESCRIBE ELVIL in block capitals on the cover and the first page of the notes so "we" wouldn't forget and added Benadryl and Valium for good measure. And what did he offer me instead? Freakin' Paxil, that's what. That's right, give someone who reacts badly to anti-depressants another anti-depressant. I'm afraid I lost my European froideur at this point. I may even have raised my voice. After all I didn't want a drug, I just wanted to make sure I didn't have myositis. His reasoning?
"I'm not prescribing it as an ani-depressant, I'm prescribing it to help you deal with aches and pains."
Does that mean that only half the people who take Paxil are taking it because they are sad and the other half because they are a little achey? And what about the potential side effects of this drug?
Needless to say I did not take the prescription but I was in such a temper I went straight to the gym and spent 90 minutes cycling and hauling weights. Then I came home and walked the dogs. Still mad, I walked across the lawn, turned my foot and popped the ligaments. The noise was so loud it sounded like a rifle shot. So I spent the next 10 days walking with a cane, wearing an ace bandage and not going to the gym. And guess what? The aches in my other muscles and joints? Gone. Maybe I'd been over-doing the fitness? Maybe I had a virus? What ever happened to "Let's do a blood test" or even "Let's wait and see how you feel in a few days". I don't know, but I am going to have to find another PCP before I end up with a serious prescription drug habit or a serious injury.

No parking

My endocrinologist's office is located in a modern ranch house on the edge of a sub-division miles from anywhere. Parking is always an issue because you are not allowed to park on the street. There are four bays out front, another ten out back, plus two disabled parking spots and space to squeeze in another three cars on the side of the drive. Seventeen spots then, plus two disabled bays that I've never seen used.
The other week I drove to the office for a check-up and every one of these spots was taken. I was about to circle the block a couple of times when a woman came out and yelled she was leaving. I figured I'd be waiting forever because it would be really busy in there, right?
Inside the waiting room were just three people: a couple and one other man. Plus me makes three cars. I was called in to get weighed and blood pressure taken, so I asked the nurse where all the patients were. There were seventeen cars out in the parking lot but there didn't seem to be even a third that number of patients. "That's all us" she said "The staff's cars".
Two doctors, three nurses, a dietician, four admin staff, a student doctor, I counted. "There's a new doctor". Three medical people for every patient? No wonder the healthcare system is so expensive.
The solution to the parking problem? They are hoping to relocate to another village another twenty minutes further away from my town. Making my nearest endo nearly an hour's drive away, with no public transport. Seriously, an hour's drive each way for a fifteen minute appointment. Not an effective use of resources - mine or the earth's.

I'm lax

amended to include cute gerbil image

I can't believe I haven't posted since the April Fool's Viagra joke. Even the whole jetlag/viagra hamster thing (there's a George Michael joke in there somewhere) back in May failed to raise a post from me.
I have been busy getting on with my life and as there was nothing much new going on with my endocrine system, blogging about diabetes fell off the end of the to do list. But a long comment (aka a press release in disguise) from the International Diabetes Federation, the Brussels based advocacy group, kicked my ass back into gear.
I took part in the first or maybe second World Diabetes Day back in Brussels in the early nineties, and it was a really quiet affair - we had a stall at a school fair, I seem to remember and handed out a few leaflets. Now it's worldwide event; in Brussels they have a two-day exhibition (in two languages, of course), and in 159 other countries people are celebrating November 14th by raising diabetes awareness.
So the banner is on the website and I'm sure most people are involved in some activity, a fundraiser or information push during November. Heck, even the Empire State Building will be lit up in blue for the day. Every little helps.

One for the Guys

As we are constantly reminded by commercial TV, diabetes can lead to erectile dysfunction. Now you could go to the doctor and get a scrip for an expensive little blue pill or you could go the cheaper route and grow your own.

Weird patterns: the sequel

After the week of bouncing between -50 and 200+ I followed Matt's advice and got up every couple of hours throughout the night to see what was happening to the old blood glucose. I'd expected that it was dropping and then bouncing back high but that wasn't the case. It stayed around 200 the whole time. I definitely didn't want to fiddle with the basal rates now.
Then on the fourth night I tested my blood before bed and it registered 132. I decided I'd had enough mid-sleep finger pricking to last a while and I was just going to forget about it. Number on awakening? 106! And it's been fine ever since.
I don't know what was going on for those 7-10 days, maybe I was stressed, maybe I'd exercised harder than usual, maybe... who knows? It's one of the more difficult aspects of diabetes that there are no absolutes, no norms and often no answers. We struggle for perfection but sometimes we have to settle for just muddling through.

Weird patterns

Number of times in the past week my blood sugar before bed has been below 65 = 7
Number of times in the past week my blood sugar before breakfast has been above 200 = 6
Number of times in the past week I have corrected my insulin dose before dinner = 5
Number of days my blood sugar has been in range during the day, other than before bed and before breakfast = 7.
Number of times in the past week I have used a four letter expletive upon looking at the numbers on my meter = 13
I can't figure out what is going on here but I'm getting mighty sick of it. Bad, bad diabetes.

Diabetes and Cancer

Great, just great. As if we women don't have enough to deal with there is this gem on the BBC news about the link between raised blood sugar and cancer in women. It used to be thought that diabetes actually protected you from cancer. This was oh, about a hundred years ago, and the reason was that without insulin most diabetics died before they got a chance to grow any cancer cells. With better care, insulin, testing strips etc people with diabetes are living to old age and, of course, are developing cancer and other diseases that "normal" folks get.
I'm not entirely buying this study. There seem to be a lot of unanswered questions: Why women and not men for instance? And statistically the age range they tested, 40-60 years, is when you would expect to see an increase in both blood sugar and cancers anyway. After all Type II diabetes used to be known in England as the type you got with your old age pensioner bus pass.
But it's true that you can use sugar to grow some funky stuff. You should see what it does to yeast. So why not cancer cells?
The article concluded with this:
"If someone is white and over 40, or over 25 from a black or South Asian background, and has either a family history of Type 2 diabetes or is overweight, they should consider asking their doctor for the simple blood test to determine whether or not they have diabetes."
I'd actually go further. Last month there was an article about the rise in Type I diabetes in children. Maybe it's time everyone is routinely offered a free screening whenever they see their doctor.

Absolutely nothing to do with diabetes

I'm sulking ever so slightly because I missed out on a trip to Brussels in January, although the man got to go and I'm going to miss out again next week; the man will once again be eating stoemp met worstjes (mashed potatoes and carrots with sausages, the best comfort food) and drinking Orval (a Trappist ale, aka unsweetened nectar) while I hold down things at this end. This sucks.
I'm often asked what I miss about Belgium and I can go on for days about it, but in the interests of brevity I'll just say: the food, the drink, the culture, the surrealism. Sometimes even the weather. For those requiring a little more depth in their answers I suggest they check out An A to Z of Belgium written by an Englishman with an obvious love for the eccentricities of the small country at the heart of Europe.
The one national trait he didn't portray is a love of collecting. All Belgians collect something, the weirder the better. I used to attend language classes (check out the above link for the entry on Language Classes - it's true, very true) with a classical pianist who had the largest collection of flat irons in Belgium, possibly in Europe. Then of course there's Jan Bucquoy's Underwear Museum, though I think it is now closed.
But here is my absolute favourite. Don't mock, the man loves his penguins.




This is why I miss home.

The other side of good

I haven't posted much recently because I've been busy and also because things have been going well - exercise is pretty much back on schedule, I've lost the lbs I put on flying around last month (does this happen to anyone else? I eat the same, I exercise the same but I put on 5-7 lbs just getting on a plane and it takes me a week to shed them again) and a couple more besides, and the health stuff has been non-eventful.
Then Thursday I came down with a real migraine. I've only had a couple in my life, mostly I just get flashing lights in the corners of my eyes and it passes after an hour or so. But this was the full-on headache, flashing lights, sensitivity to noise, throwing up, nothing-helps migraine. I retired to a darkened room and slept most of the day and night but Friday I had to get my fingerprints taken for the green card at 8:00 in a deserted mall an hour's drive away. Luckily, the man was also required to be there and could drive because there was no way I could. I couldn't even see the road let alone negotiate it. But the fluorescent lights, the government officer barking instructions and the whole biometric thing - I was on my own there. I did wonder what the penalty was for chucking up in federal government offices. Immediate deportation, perhaps?
Anyway my fingerprints only match those of known criminals 50-59% so I was allowed to leave with a stamp on my papers but my photo, oh f%$k, I look like this but with a better shirt. They make you take out your earrings and glasses and push your hair behind your ears. Then they make you approve the photo. Apparently you can have as many shots as you like until you are happy with the result. But they won't let a sick person ask their man to approve the photo. (I suppose it was kind of "Hang on, I'll just as my pimp if this one's ok").
Let's hope I never get accused of a crime, 'cos one look at that mug shot and I'd convict me straight away. Guilty.

Pretty Much a Perfect Saturday

Saturdays are usually crammed trying to fit in the chores we don't get around to during the week - picking up dry-cleaning, food shopping and pet food shopping, plus cleaning the house etc. Not exactly exciting. Otherwise someone has to finish some work related project that didn't get done by Friday pm or has a deadline of Monday am. Boring for the person who doesn't have to work, tiring for the one who does.
Occasionally, though, the stars align and we have the day to ourselves and yesterday we celebrated by taking off for the city (Manhattan). We made reservations for brunch at Artisanal, and that has to be the steal in NYC: $25 for a mimosa and two of the best fine dining courses around. Of course we upgraded with six tiny cheesy gougeres and the man had dessert, but we would have been satisfied sticking with the menu.


Then we cabbed it uptown to see Liev Schreiber in Talk Radio. This was probably the best play I've seen in twelve months and Liev Schreiber is so easy to watch. It would have been perfect if it weren't for the two selfish arses who neglected to turn their cell phones off and the lady from Long Island who apparently supplied the pumps to the Blue Man Group and sat behind us popping gum throughout the performance. Gross and selfish.
Still, we recovered our tempers with cocktails at a bar before heading home, and I can't wait to go back to Artisanal and try the flights of wine and cheese.
Mmm, cheese and Liev, what better way could there be to spend a Saturday.

Sometimes I wonder why I marrried him

Out to dinner with friends (It's amazing how many of my posts start out with that phrase. We don't spend all our time socialising, I promise you) we reach the dessert course, apple crisp a la mode, share. The husband takes a spoonful of the ice cream and starts a violent sneezing fit. Turns out he has an allergy to dairy products but loves gelato so he risked it. Apparently he does this all the time.... He leaves the table to sneeze it all out and after a while I suggest to my man he go check on our friend. His wife brushes this aside, "He'll be fine, and if he's not he's well insured". This is obviously a joke but then my man tops it with "Jane just has to inject me with insulin".
Not funny. Is he really worried that after all these years I am going to kill him off for the life insurance? Doesn't he know that I'd be the prime suspect as I stand to inherit and an autopsy would show he'd died from an overdose of insulin. Does he really think I would waste a life-saving drug that way?
If I was going to bump him off it would be because he had made me really mad and I could see in the heat of the moment I might hit him over the head with a Le Creuset pan, but give him a shot? No. What if I got the dose wrong?
I think subconciously he has a hard time dealing with diabetes, much harder than I do, but he'd never admit it.

An end to injected insulin?

The BBC is reporting that a reservoir in an artificial tooth implant could be used to disperse diabetes drugs. While I guess it would be relatively simple to use this method to replace diabetes drugs I hope that someone at Intellidrug is working on a way to make it work for insulin too. This project is in its trial phase but a possible launch date of 2010 is mentioned.
I have the perfect place for it, a bridge between my upper left molar and canine tooth. and I'd willingly swap the pain of an implant for a lifetime of shots. If they can stick regulated doses of all the other damn drugs I need in there too, I'd be really thrilled but I fear I would need an entire mouth of implants, which I think may be both scary and pricey.

The wiggle is back

Nine months or so after I first noticed the bump on my Achilles' tendon I'm finally walking normally again.
I carried two coffees to a table at a cafe and then walked back for napkins. That's when I noticed something strange - my hips were moving, and I was distributing my weight evenly on both feet. I was actually putting one foot in front of the other. In other words I was walking like a woman.
I hadn't realised how walking properly affects self-esteem because it's just something we do. But limping along these past few months had literally and psychologically been a drag. Then, just like that, from one moment to another I could move freely again with no pain or stiffness and it felt fantastic. I swear I bounced along for the rest of the day, chin up and chest out.
I'm sure that in a couple of days I'll be taking it for granted again but right now I'm saying look at me I have the sexy walk back.

How embarrassing is this?

Sunday night Super Bowl Party, a feast of football, food and fun. I'll rant about why non-Americans can't watch American football without a) going into a coma or b) going ballistic another time, but it has to do with switching to an advert every time someone does something interesting like catch a ball, or run with a ball. Tell me, if the game is only 60 minutes long why does it take four freakin' hours to get a result? But I digress.
Very aware that I have an endo appointment at 9:50 the following morning and the six weeks I had to take off from the gym for the ankle injury will have done nothing to improve my A1c, I avoid bread, rice, pasta, desserts and stick to chili, guacamole and a few potato chips. I also pass on the beer and have a gin and diet tonic. This is risky for me because diet tonic still makes me BG soar like the real stuff, but I was low before I started and I'm really counting carbs carefully tonight.
I know some thing's wrong when we get home and I feel sick, I test: 415. What? What the hell was in that chili? Fast forward to Monday morning when I hand over my meter to my endo. "So how have you been?" she asks as she hits the results button "What on earth happened here?" she squeaked. We discussed the game for a while because I couldn't account for the 415 but I wasn't looking forward to the phone call from the nurse when my blood work came back.
And yet, despite the lack of exercise and the Super Bowl pig out my A1c was 6.6. A whole .1 lower than last time. I was shooting for 5.9 but lower is always better so I'll take it. But next year I'll avoid the chili, too.

Ipod Blend

OK, I would never do this even to my generation one iPod that will only download from imac's OS 9.3, making it effectively redundant. But here is what I would like to blend in 2007

A potential nightmare

I was on the edge of sleep last night and I felt a little odd. When I checked my blood glucose it was a tad too low so I popped a hard candy into my mouth and....... the next thing I know I'm coughing, choking and spluttering. I must have fallen asleep while sucking on the sweetie.
Luckily all was well, but it did make me think, if I died while treating a hypo this way would the authorities record it as a death caused by diabetic complications?

Doing What You Have To

I finally had to give in today and do something I'd been putting off for almost a week. I've been unable to get a work out at the gym since December 1st because I can't walk fast, pedal or sit without it being literally a big pain in the butt. Consequently my BG has been rocketing skywards for the last few days. I've been correcting with extra units of Humalog to keep it in check during the day but the morning levels have been above 270 since Friday.
So this morning I took an extra 10% Lantus and like magic my BG has been below 126 ever since. I don't know why I'll take an extra bolus here and there but upping the basal rate makes me feel like the diabetes is getting worse. That's truly crazy, right?
I'm sure this is just a temporary thing until I can get back to the gym but it goes to show that exercise makes a big difference to glucose levels, mine at least.

Diabetes-friendly recipes?

I'm surfing the web looking for inspiration for this year's xmas meal when I hit upon this recipe on the dLife website. It's a Kwanzaa Pineapple Upside Down Cake. I'm intrigued because I don't have any Kwanzaa recipes in my repertoire and when I was at school Pineapple Upside Down Cake was the first thing I made in Home Economics class.
I want to see what makes in specific for Kwanzaa and how they adapted a high carbohydrate recipe to fit in with the dLife guidelines of small amounts of sugar and less than 30 grams of carbohydrates per serving. From what I remember of my cake it was pretty high on both counts.
Well, it turns out there is little difference from the recipe I know. It contains both molasses and honey and of course the canned pineapples in fruit juice. My mouth is already puckering with distaste from the excess sweetness. Then I read the nutritional information:

Exchanges per serving: 3 Carbohydrates, ½ fat
Calories 237
Calories from fat 36
Total Fat 4g
Saturated fat 1g
Cholesterol 0mg
Sodium 156mg
Carbohydrates 48g
Dietary fiber 1g
Sugar 29g
Protein 4g

You have to be kidding me. 48g of carbohydrates for a slice of cake? I could have four delicious Whole Foods Chocolate Truffles for half the carbs and 5g less sugar.
Could someone please explain to me what makes this recipe diabetes-friendly?

Mad Cow Disease May Solve Diabetes Riddle

I don't know what all the implications are but scientists at Ottawa Health Research Institute in Canada have discovered that a prion that causes Creutzfeld-Jakob disease might be involved in regulating blood glucose levels and could possibly affect the development of Type 1 diabetes.
It's probably not a major breakthrough, more another piece of the puzzle that will lead to an answer to why some of us get diabetes and others don't. And that's an important question to address when you are looking for a cure.

Sinterklaas

I'm still sore from slipping last week but it served me right for putting up the lights before Sinterklaas has visited. This is one of the traditions we bought with us from Belgium and I violated it at my peril.
The Sint (known as St Nicolas in the francophone part of the country) arrives on a boat from Spain at the end of November then treks through the low countries on his horse, accompanied by his helper(s) Zwarte Piet(s). On the evening of Dec 5 he leaves oranges, a chocolate initial and presents in the shoes of good children in The Netherlands, and arrives in Belgium on the morning of the 6th to do the same.
As most Mamas in Belgium work, families celebrate St Nicholas the weekend before but Sintaklaas always visits nurseries and schools on the right day. Only after Sinterklaas has passed through can the xmas decorating begin, and December 25th is more a family celebration than the culmination of retail frenzy.
I shall be singing these songs and a few others until I drive everyone demented and they beg me to stop. It's a happy holiday.