A1c

2018/04/05

A Really ‘Good’ Good Friday!

Friday, March 30 2018 will definitely be a date I remember and will do so with both joy and not just a modicum of pride.  I had scheduled an A1c test at the clinic; it was about time as I’ve been getting them every three months since my initial diagnosis of late onset Type 2 diabetes back on May 24, 2017.  At that time I tested a ‘14’ for my A1c and a real time blood glucose test showed 375 mg/dL.  To say I was devastated would be the mother of all understatements!  However, after a couple of days of a ‘pity party’ followed by a few days of denial I finally faced this fact, started researching the condition and began making preparations to really change my lifestyle.  It began an honest odyssey during which I learned so much while experiencing the frustrations, joys and confusion almost any diabetic knows only too well.  But the fear of insulin dependence drove my efforts; in hindsight it was amazing what fear can do when properly channeled!

By the next A1c in late August I saw a 6.0 and was ecstatic; across the next seven months I saw a 5.8 and, most recently, a 5.7.  I was pleased no end with these results as was my wonderful doctor (Dr. Joan).  As an aside I’ve always been distrustful of physicians in general and especially those espousing ‘western medicine’.  I believed far too many were in the practice only for the money and were willing pawns of ‘Big Pharma’.  I also believed most followed the ‘disease de jour’ concept and, if allowed to run enough tests, would always find a malady that had to be addressed.  Dr. Joan is none of these!  She is a warm, knowledgeable, caring and understanding physician who honestly listens to what I share with her.  I’ve never spent less time than 15 minutes in conversation with her at any of my appointments!  This is so refreshing after experiencing the ‘assembly line’ practice of so many doctors.

I expected Friday’s appointment to just be a blood draw and A1c test but it had been maybe four months since I’d seen a provider and I was encouraged to schedule such an appointment.  As luck would have it Dr. Joan had an opening just a half hour after my appointment for the A1c so I signed up.  During the exam I was weighed, had my feet examined, had my BP/pulse measured and answered a number of health questions.  When I saw Dr. Joan she was very pleased with the results.  She told me I had ‘healed myself’ regarding the late onset Type 2 diabetes and could now stop my daily blood glucose testing and just monitor as I saw fit.  I can also decrease my A1c testing to just twice a year.  The icing on this cake is the fact I have now halved my daily dose of Metformin HCl and, if my next A1c is 6 or lower, I can cease taking the medication all together! My BP measured 122/82 mm Hg which was very good given I had been seeing 160/115 mm Hg readings a year earlier when I was first diagnosed with severe hypertension.  While the medications I take helped the fact I exercise daily in the form of counting my steps and I’d worked hard to lose weight were probably the main drivers behind this decrease in my BP.  I’d shown a loss of another ten pounds across that four month period which meant by the clinic scales I had dropped almost sixty pound in the preceding year.  As Dr. Joan told me most patients my age only lose such large amounts of weight via bariatric surgery, so shedding so many pounds was remarkable in and of itself.

She was very interested in just what I was doing to have turned around my health situation so dramatically in a year’s time.  She knew about my 12,000+ daily steps but I filled her in regarding my low carb lifestyle – I eat between 95 grams and 60 grams of carbs a day and almost all are my ‘good’ carbs – and we talked about my learnings.  I shared I’d discovered I could indulge myself once a week with some ice cream with chocolate sauce without negatively impacting my blood glucose or my slow but steady weight loss.  I reiterated my ‘bad’ carbs were anything containing either starch or fructose.  The latter means my selection of fresh fruit is very limited but I do love the strawberries, blueberries and raspberries I can consume.  Sadly, any breads, rolls, crackers, potatoes, corn and similar are just plain ‘off the menu’.  But I’ve found a wonderful pasta substitute in ‘Miracle Noodles’.  Although a bit pricey they are an amazingly delicious pasta substitute and the firm also markets a variety of rice using the same component (shirataki noodles) with the same almost no calorie or carb content.

We also briefly touched on my depression which is now just a distasteful memory.  I’m still taking 50 mg of Sertraline (Zoloft) daily and will probably continue to do so for the foreseeable future.  Along with some counseling this combination appears to have vanquished the depression although mine has a history of coming and going in cycles.  Because of this I’m not about to proclaim I’m ‘cured’.  However, if taking the daily Sertraline prevents a re-occurrence, or even mitigates the intensity and duration if it does reappear, then it is well worth the cost.

Given all the aforementioned it isn’t difficult to see why I felt this past Good Friday was really a ‘GREAT’ Friday.  But more importantly, I discovered that I can take control of my physical situation and affect sweeping changes for the better.  I learned that diabetes is different for almost everyone and hence the only way to manage the condition is by putting in the required effort up front to do the research and then to meticulously monitor one’s dietary intake across months while doing daily blood glucose tests.  Sure, it is a long and often frustrating process but in doing so one will learn so much more about their body.  But perhaps most importantly I discovered I could ‘cure’ myself of a condition which affects millions of people and causes a myriad of negative side effects like increased chance of heart attacks, vision problems, foot issues and weight problems.  I had no idea I would get to this point; back in July or August of 2017 I figured I’d be testing my blood glucose level almost daily for the remainder of my life and always be concerned about my next A1c.

So if there’s anything I’d like a reader to take away from this piece it is simply this; “You are never too old to affect sweeping lifestyle changes!”  It is possible to incorporate such changes for the better and actually make them a part of one’s life.  Sure, I will never stop regulating my carb intake and I have to steer clear of those pesky starches and fructose containing foods but if one can view making such a commitment as a pledge to a healthier lifestyle it eventually becomes acceptable.  Of late I’ve told a few folks that getting that late onset Type 2 diabetes diagnosis in May of 2017 was probably one of the best things that ever happened to me; most cannot understand how I can make such an assertion.  It is simple to me; doing so forced me to seriously examine my lifestyle, face up to my situation and dedicate myself to making sweeping lifestyle changes which have allowed me to lose weight, shape up, eat healthier and feel so much better.  So who says ya can’t ‘teach and old dog new tricks?’…   

2017/07/01

Diabetes: Desperation or Deliverance?

As some of you may have noticed my blog postings dropped to zero across June; to be quite frank I’m unsure this trend will not continue.  On May 24th I received the results of a routine blood workup and the results truly threw me for a loop!  My previous blood screening was on March 30, 2015 just prior to reconstructive surgery on my severely fractured left radius and ulna; it showed no abnormalities other than some very slightly elevated cholesterol values.  However, the latest results showed an A1c value of ‘14’ and a blood glucose (BG) value of 383 mg/dL; my A1c in the previous blood sample was ‘5.5’!!  I was crushed to learn I now was a diabetic dealing with late onset Type 2 diabetes.  Just three months earlier I was diagnosed with hypertension and had been working via meds and lifestyle changes to get that under control.  But now I was hearing from my doctor I had two months to get my BG values down into the 95 mg/dL to 115 mg/dL range or we’d be having ‘the i-word’ discussion.  To say I was in shock would be a bit like calling Denali a ‘big hill’.

For three days I remained in denial just unable to grasp what this meant and paralyzed by the concept of being insulin dependent.  Then I finally retreated from my fog, decided I had no choice and immediately started clearing the house of all high carb foods especially those composed of simple carbs.  I needed almost a week to complete this process during which my canine companions feasted on ice cream, peanut butter and crackers among other items.  From some friends who were dealing with the disease and from a couple of diabetes forums on-line I began my education regarding the disease while awaiting the arrival of my Bayer ‘Contour Next USB blood glucose meter’, lancets, test strips and similar.  To my surprise I learned managing diabetes starts with managing one’s carbs; calories just don’t factor in.  I’d tried the Atkins Diet in the 90’s without success as I just couldn’t handle cutting my carbs (CHOs) to double digit grams per day.  While I have a real sweet tooth I discovered far more than sweets I craved starch while on the diet; I truly missed breads, rolls, corn, peas, most kinds of squash, potatoes and, of course, the sugars from apples, bananas, oranges, pears and similar foods.  Knowing this I girded my loins to once again face their absence but this time I was driven by the fear of becoming insulin dependent rather than just trying to lose fifteen pounds.

I’ve now put in a month of monitoring everything going into my mouth – yes, even water and no CHO foods – and 24 days of morning testing of my BG levels.  About two weeks into this lifestyle change I met with a nurse at the local clinic to review all my data.  Being rather AR coupled with a love of analyzing data via spreadsheeting and graphing I had kept fastidious logs and she was very pleased.  I talked with her about dietary options, ‘substitutes’ for high CHO foods and how this was going to become not just a diet but a complete lifestyle shift.  I’d already made such a dramatic lifestyle change when, after starting my hypertension meds, I began a program of stepping and within seven weeks had worked myself up to between 11,500 and 13,000 steps/day, every day.  Now I was faced with another major lifestyle shift; the days of unfettered or even controlled consumption of simple CHOs were history!  I made these lifestyle modifications not because I wanted to but because I had to do so.

For me, and I’d bet this is true of other ‘new’ diabetics as well, the most frustrating thing about the disease is its ‘person specific’ nature.  Sure, ya know you have to monitor and control your daily CHO intake but just what is a ‘good’ amount of daily CHOs?  I found some info on a medical hospital website suggesting for someone of my size and weight somewhere around 140 grams CHOs/day was a good number; I set this as my target.  Hah, eating this many carbs kept my BG levels in the 160 mg/dL to 180 mg/dL range!  I visited a couple of online diabetes forums and found many attendees claimed to being forced to drop their daily CHO intake to under 50 grams CHOs to really make a dent in their numbers.  Seeing this I decided to set my daily limit at 40 grams CHO/day.  Success!!  Within five days my morning (fasting) BG levels were in the 95 mg/dL to 125 mg/dL range which for me was a huge shift.  For the first time since given the diabetes diagnosis I was feeling I could beat this disease through just diet and exercise.

Then I learned of the ‘person specific’ piece of the puzzle.  I’ve come to recognize managing the disease isn’t just about total daily carb intake; it is also about the kind of carbs, how your body deals with said carbs and even when you eat these carbs.  Because of this I’ve started a ‘Do Not Eat’ list of foods I’ve learned will really spike my BG values.  My first experience with this concept was when I was just craving something sweet so I had two tablespoons of Jif Extra Crunchy Peanut Butter in the evening.  At the time I was trying to hold to an under 140 grams CHO/day target; those two tablespoons contributed 38 CHOs and I finished that day at 151 total grams of CHOs.  But, much to my chagrin, when I did my morning ‘stick’ the next day my BG had jumped from 254 mg/dL to 283 mg/dL!  I was flummoxed until I remembered hearing that everyone is a bit different regarding how their bodies handle certain sources of carbs.  I had just seen evidence that my body couldn’t deal with all the sucrose in the Jif!  That remains entry number one in the aforementioned ‘Do Not Eat’ list.  This also reinforced the importance of logging everything one eats in excruciating detail until you have a good understanding of foods with ‘good’ carbs versus those with ‘bad’ carbs.  I’m also beginning to understand that time of day can play a definite role in the next morning’s BG reading when consuming carbs.  I can get by with a single slice of bread but only if I eat it early on like right after I do my morning stick which is around 07:00.  If I wait until noon or later it will elevate the next morning’s reading.

And, finally, there’s the natural variability of one’s system to toss into the mix.  I’ve seen a couple readings which were elevated for no discernible reason.  Wonderful, on top of all the other puzzle pieces we can now add the dreaded ‘unk-unks’ (unknown unknowns)!  But this is all part of managing diabetes.  One must be very aware of one’s dietary regime and understand the impacts – negative and positive – that our food choices have upon our bodies.  Just a month into this lifestyle shift I already look back fondly to the days I just tried to stay roughly aware of my daily calories in an effort to exert a modicum of control over my weight!  But I’ve also learned about the very real damaging effects diabetes can produce and I want no part of those along with insulin dependence.  So I’m struggling to manage my late onset Type 2 diabetes through diet and exercise along with Metformin HCl.

To this point it appears I am succeeding although I still struggle with ‘peaks and valleys’ regarding my daily BG levels; I often joke the graph is beginning to resemble a profile of The Alaska Range.  Most of this is due to my continuing learning process regarding what are my body’s ‘good’ carbs versus ‘bad’ carbs.  Sadly, this is a very tedious and slow process but if one wishes to learn about the aforementioned one can only change one variable at a time regarding foods, total daily CHOs, time of day consumption and similar.  For now I appear to be able to hold my daily CHO intake to a minimal 40 grams; this means a very restricted diet and often leaves me feeling a bit weak and spacey in the morning as well as dealing with fatigued legs when I start my stepping.  But I can push through these inconveniences and if I just eat something like a few ounces of fresh strawberries these symptoms disappear.  At such a level my weight loss, originally initiated when I started doing 9,500+ daily steps, has really accelerated.  I desperately need to lose more weight both for the diabetes and especially for the hypertension.  However, I do not believe I can hold this daily CHO level for a long time – and it probably wouldn’t be healthy even if I could – so my current plan is to continue this limit across the next few months while I learn what constitutes my ‘good’ carbs versus ‘bad’ carbs.  And who knows, maybe I’ll even drop another 15 to 20 pounds!

If there’s any real value to this lengthy piece I hope it will encourage others out there dealing with Type 2 diabetes to really try to manage the disease via lifestyle changes.  If I can do so – and believe me, I’m the poster child for ‘age accentuated inertia’ – then anyone can!  At least, for those who are younger, you are more flexible regarding making major lifestyle shifts.  A friend and fellow diabetic shared something with me which really resonated; she said ‘as diabetics we do not seek what works but rather what doesn’t work’.  This is so spot on!!  If my morning BG level is in the acceptable range I probably will not review what I ate the previous day but if it is above that 125 mg/dL limit I will pore over my food logs seeking an explanation.  To this point I’d have to say the desperation brought about by my diabetes diagnosis has now turned into a kind of deliverance; deliverance from an unhealthy lifestyle and habits.  If I can live out my ‘golden years’ in better health and with more lust for life simply by eating better and exercising more than my diabetes diagnosis could truly be my deliverance…