Cheeseburger nightmares

For those of you playing at home, I have been trying to test out the limits of my pancreas to see if I really need the insulin I've been injecting. If you read my last post, you'll see I had just finished a cheeseburger and fries and my BGL had shot up, and I was getting some pretty strong palpitations. Unfortunately, my BGL stayed elevated for 3 hours and those palpitations lasted all night.

The graph above is the last 3 days BGLs, the first spikes was the cheeseburger. You can see my BGL had returned to an *OK* number by morning, though not a normal fasting BGL (the trick is to always aim for NORMAL BGLs... and don't let anyone tell you otherwise!). While a vanilla DE (diabetes educator) would love these numbers (all under 10.0, none dropping very low) I was too happy. Worse than that with each meal I was getting a sudden hit of adrenaline about 10-15 minutes after eating causing very uncomfortable palpitations and a really irritability that bordered on a panic attack.

Not-so-good while it lasted

By the time this morning roll around, I thought I had better jump back on the wagon and get back to a low carb diet and see if that was the cause of my adrenals going mental. I had some scrambled eggs with butter and crème fraîche (oo fancy!) and set off to work. I didnt get palpitations straight away, but about half an hour later I was getting that uncomfortable feeling in my chest. Bugger, time to admit defeat and take some insulin (even though I only got up to about 7.7). I then spent the day wrestling my numbers into line. Tonight I had a family Christmas dinner and had a little wine and cheesecake and other naughty (but nice) treats. I spiked a little (8.8) but did not get the palpitations.

Thoughts

What have I learned? Still nothing conclusive. All I know is that I can't cover even simple low carb meals with my own insulin stores, but that still doesn't prove anything regarding my type 1/2 conundrum. Where to now? Start up on the insulin again *sigh* and wait until after Christmas this hit up my GP to see what tests he can think of. Maybe another glucose tolerance test but this time with c-peptides or insulin levels. I'm not sure. I just want to get a really good picture of what's going on to inform me of my treatment options. I don't want to take metformin unless I need to, just like I don't want to have to take insulin unless necessary.

A day off insulin

I survived! If you read my late night post yesterday, you'd know that I have been frustrated with a lack of answers from my diabetes team. This frustration and curiosity (and being sick of injecting insulin) prompted me to give myself a day off insulin injections. A type 1 diabetic with no beta cell function would quickly find their blood glucose rising, putting them at risk of a potentially life threatening condition (ketoacidosis).

Today's BGLs

The first test was my morning reading (fasting BGL) and I was nicely surprised that it had stayed stable throughout the night. I wanted to give my pancreas a chance to contribute once again, but didn't want to stress it out too much, so stuck with low carb meals today. Breakfast was scrambled eggs, and lunch was BBQ, salad and coleslaw. Neither of these saw a big BGL spike. In the afternoon you can see the effect of a bit of exercise on my BGL (gardening). It wasn't much of a workout, but I felt really washed out after and didn't feel hungry (or very well) so didn't have dinner.

This evening I did some stress walking (also known as last minute Christmas shopping) which went ok, then in solidarity of my wife's pregnancy cravings, I partook of a cheeseburger and medium fries. You can see that it only took an hour to send my BGL up to 9.9 then down to 9.0, and not shown, 9.4 at 2300hrs. Incidentally I got shocking palpitations after eating the Maccas, which was an uncomfortable side effect.

Summing up

From today's numbers, I am producing enough insulin to cover low carb, reasonable meals, though not enough to quickly cover fast acting carbs (bread and potatoes). The question is: what does this mean? My feeling is that I may be closer to a type 2 than type 1, but we'll see.

Next step

I won't take any insulin tonight or tomorrow and will keep a close eye on my BGL. I will change up what I eat tomorrow and include some "HEART HEALTHY WHOLE GRAINS" (you have to say it like that... it's the law). I'm back to work, so I won't let my BGL go too high or else it may make me irritable, and I like to let my patients irritate me without help from a deranged endocrine system. Wish me (and my patients) luck!

Self Experiment 1: no insulin, modified diet

After a week of medical/nurse appointments that haven't given me any further clue as to what type of diabetic I am, I have decided to become a guinea pig and test out what my pancreas can and can't do. From my last post, you'll know that I have a normal level c-peptide alongside a fasting glucose reading. When a c-peptide reading is taken is important as insulin levels would normally fluctuate based on carbohydrates eaten. All my fasting c-peptide has proved is that I have "normal" insulin production when fasting, it has no bearing on if my pancreas can kick into high gear when eating (Phase I insulin response).

So tonight I haven't taken my long acting insulin (my almost-bedtime BGL is 5.7mmol/L). If my pancreas can be bothered, I should be able to maintain roughly the same level until morning. This is the first test. Then, tomorrow, I won't take any bolus insulin before meals and see how my BGLs go. I will still aim to eat a low carbohydrate/high fat regime (it's yummier anyway). My hope is that I have sufficient insulin production capacity to cover tomorrow's meals without me spiking too high after.

The main goal is to remain hydrated. Because I am producing insulin, I am at a lower risk of not taking exogenous insulin, but I'll be keeping a close eye on myself just in case. This is exciting (no needles tomorrow), goodnight all!

90 day diabetic

90 day update

Here is a look at the last 90 days of my glucose readings. You can see the big bounces at the start of the graph while my levels came under control. The one super low reading was an error on my machine but can't be deleted so you'll just have to take my word for it.

Results definitively proven vague

I went back to the endocrinologist at the start of the week and got my latest HbA1C result (the one that is a rough 3mnth average of BGL control). I was able to get mine down to 6.3% (6-7% is considered good diabetic control) considering my initial reading was 12.7% only three months ago, this is a massive difference. 
What was the vague result? Well, I had a c-peptide level taken as well and that came back at a "normal" level. Hmm? What does that mean? I'm glad you asked.

C-Peptide

When the pancreas (my least favourite organ right now) makes insulin, it does some fancy chemistry to fold the preinsulin molecule rapidly and efficiently using the c-peptide molecule. When finished, the preproinsulin molecule splits and the insulin part goes off and does its thing and the c-peptide is left behind to float around in the blood stream for a little while and then gets scavenged by the liver. Sooo... if you have a working pancreas, you will have detectable levels of c-peptide. It's not particularly useful to measure insulin levels as there is no difference between my own insulin and injected insulin.
What does a normal c-peptide level mean for me? Nothing really, it just makes things confusing. I already know I show no signs of type 1 specific autoimmune antibodies (again doesn't always mean much), but type 1 diabetes is typically a disease of beta cell destruction and insulin production cessation. Great news, I'm producing my own insulin, I'm cured... or just type 2... or what? Well, I'm not cured (a bag of Skittles proved that), I may be type 2 or I may be in the type 1 honeymoon (I think I talked about honeymooning in an earlier post... get educated somewhere else). Either way I now have more questions than answers, and an expensive specialist that isn't too interested in finding out. 

Where to now?

Not sure. It's time for self experimenting I guess. I can try oral medication for type 2 and see if that works, I can try stopping insulin and see if that works, I can insist on getting genetic screening to see if I have an in between form of inherited diabetes (MODY),or I can do nothing and see if I wake up and tell you about the weirdest 3 month dream I've just had. 

If you have any better ideas, comment below!

You're handling it very well

"You're handling it very well"

Am I?

I don't really know. If you mean my control is good, then thanks, though it's becoming more apparent that my pancreas is trying to help out still, keeping my levels more steady than they would otherwise be. I don't feel I'm in control, I feel like a mess, a big, conflicted, sugar-free mess (with that nasty after taste too). Everyone seems to have a horror story or a miracle cure. I worked on an amputee ward as a nurse, your horror stories are nothing to what I've seen poor control do. As for miracle cure, I will smile serenely and thank you for that wonderful news.

I thought I was handling it well, but I'm over it. To hell with diabetes and insulin and carbohydrates and med companies and doughnuts and everything else! Screw the injections and the highs and the lows and the cost and the fuzziness and the shakes and the exhaustion.

I have to book an appointment to see the endocrinologist in the next couple of weeks. Maybe I'll feel better when he tells me it was just a dream and to wake up and have some carbs.