At the time I knew I had diabetes. I had the classic symptoms. I was thirsty and hungry all the time and I was constantly having to urinate due to me drinking so much (and I was drinking to quench the thirst that couldn't be quenched). The doc did a blood test and my A1C came back firmly into the uncontrolled diabetes level. Since then I've been taking daily blood sugars to track my diabetes while he put me on metformin, increased the metformin twice, put me on byetta, and then increased the byetta.
Outside of medication I made some changes to my life. First and foremost I just simply tried to limit how many carbs I ate. If there was a choice of bread or meat, I'd take the meat. If it was potatoes or beans, I'd take the beans. Cookies or fruit? Go for the fruit. I didn't fully take the carbs out as I knew that would be near impossible for me. I just love bread and potatoes and corn. I was already self limiting sweets, but I never ever fully stopped eating them. The next step was to pick my battles. Everybody here should know by now that I live with my mother and am trying to help her out as much as I can. Well one of her loves is cooking and baking. I didn't even want to try and take that way from her or change her habits. So I just ate whatever she put on the table for dinner. As a wife and mother who came to age in the 70s, her cooking habits are firmly in the 'meat and potatoes' area. She also had to fight cholesterol for my father in the 80s and 90s and beyond, so she limited the meat and focused on the potatoes and pastas. So... yeah. I get quite a bit of carbs from mom. I still limit it... I eat less or no bread at dinner, I take extra helpings of the meat and less of the potatoes, but the menu is just not diabetes friendly. So my battle would be where I could make the most impact.
At the time of visiting the doctor the first time my other meals were a 'breakfast' before going into work and a 'lunch' at work. I put the air quotes around those as they were more or less mirrored meals. I would make up two sandwiches, some chips, some cheese, and some sort of sweet desert. The desert would often be left uneaten, but I always had it as an option. The biggest offender in all of that was the bread. 8 pieces of bread every single working day. Yes, there are other problematic things there but I'm only discussing my diabetes and how to manage IT. So at first when I wanted to make the biggest impact I stopped eating all of that for breakfast and lunch. I switched to an almost NO carb meal. Salad with meat and boiled eggs. I love salad and since I was looking at carbs and not fat content, I was free to use my favorite dressing.... Blue Cheese. I had good lettuce, shredded carrot, cheese, peas, black olives, bell peppers, cucumbers, onions, and pepperoni or roast chicken pieces as well as at least one hard boiled egg on the side. That is MY kind of salad and I loved them.
And then... I hated them. You try eating a salad like that twice a day five days a week. It gets beyond tedious and there just isn't a lot of variation. Sure, I changed up the dressings, but it was fundamentally the same thing. I tried different lettuce configurations (baby arugula, spinach, romaine...), different vegies in the salad and different meats in the salad. But none of it worked. It only took about a month for me to get so damned sick and tired of the salads that I was buying food out of the vending machines for lunch at work. And THAT food is a diabetic nightmare. The sandwhiches with all that bread would be better... so I changed back to that. But with all the medication I was on, my overwhelming hunger diminished and I could eat a healthy portion. Breakfast and lunch got pared down to a single sandwhich each. No chips, no sweets, no extra cheese. I could change up the meat every week from ham, smoked ham, black forrest ham, maple ham, honey ham, turkey, smoked turkey, garlic turkey, honey turkey, chicken, bbq chicken, buffalo chicken, herb chicken, roast beef, london broil, pastromi, salami, turkey pastromi.... the list goes on and on and on.
Overall my blood sugars and A1C numbers improved and while I was on a max dose of metformin I figured I was doing all right. Then late last year the numbers started looking worse. We (my doctor and I) went three months to see if it was a seasonal thing, but they just got worse. That's when we went on the twice daily byetta injections. The numbers leveled off, but not as good as they were. Then this summer happened. Both my doc and I agreed that I wouldn't need to come in after three months, and just set the next appointment up for 6 months. I didn't do a daily blood sugar check and instead just checked it every so often. I noticed the numbers go up but I held out hope that I was just catching myself on bad days.
It wasn't just bad days and they didn't stay at the elevated numbers. To set the stage, you normally want to see blood sugar numbers in the morning between 80 and 120 mg/dl. That would either say non diabetic or at least well controlled diabetic. My 'good' numbers were in the high 100s, but me and my doc were okay with that. I got concerned when they were started to stay in the low to mid 200s. Then the mid to high 200s. Then the high 200s to the low 300s. High 300s. And the last couple weeks I've seen numbers creeping up into the 400s. At work, where I help manage about 20 diabetics and their insulin intake, a blood sugar over 400mg/dl means calling the doctor. Regular sugars over 400 mean an appointment with the doctor as they obviously have to change the prescription. Over 500? That's in the medical emergency range.
The day before I saw my doctor for that 6 month appointment I had a morning blood sugar of 489mg/dl. Understand, I hadn't changed my diet or activity level. My body just wasn't doing as well without any external change.
So that's the stage set for diabetes. Before I get to the doctor's appointment, let's catch up on the migraines.
In general we don't know what causes migraines. There are a lot of treatments, but none of them are really good. Treatment's obvious goal is to eliminate all migraines, but that's not always possible. I was having migraines every week ranging from mild (I could stand them but it was bad) to severe (hide in a dark room and just cry). They would last between a few hours to just over a day. I had a couple over the past decade that had lasted several days and those were bad enough to make me consider suicide. Seriously.
At the point I first saw the doc, I didn't even consider that these were migraines. I just called them headaches. Sometimes a big dose of tylenol and motrin would eliminate them, sometimes it would just help with them, and other times it didn't do a damned thing. The doc called a spade a spade and said that these were migraines. Since my blood pressure was on the higher side of normal he prescribed propranalol. It's an old school blood pressure medication (beta blocker) that has shown to have good effects in reducing the frequency of migraines. And oh my God did it ever work. I went from multiple migraines each week to only a few migraines each month. It all but eliminated the minor migraines and only the worst ones broke through. He also prescribed some Imitrix. That's a medication you take when you have a migraine and is supposed to lessen its intensity and it's length. It didn't work for me. It didn't touch the migraine and gave me nausea so bad that I didn't ever want to take it again. I did try it twice just to make sure it wasn't some environmental product, but both times were the same... the migraine stayed bad and the nausea made it just worse.
So we stopped the Imitrix and just upped the propranalol. I'm now on the max does of that as well. Over the past year though, the migraines have grown worse. They are more intense and they are more frequent. I in no way think that the propranalol isn't working.... I still only get them about once a week and many of them are tolerable... but I had one a couple weeks ago that lasted three days. That was near the suicide level again.
I should add, just to complete the medical picture, that I'm on other medications too. Being a diabetic, I'm at a higher risk of cardiac problems so it's recommended that I take a statin for my cholesterol (lipitor every night), and that I take a blood pressure medication. I tried lisinopril, but I was one of the few people that got a common side effect of a dry constant cough. So we stopped that and I'm now on daily cozar. In addition to those semi diabetic medications I'm on wellbutrin twice a day. That was initially to help me quit smoking, but it didn't help in that regard. What it did work at was keeping my depression at bay. So with my doctors obvious blessing, I now just stay on it year round. And then this past year I had some stomach problems (projectile vomiting at night). I saw a specialist, he snaked a camera down my throat to look at my stomach and saw that I was burning away the lining. So I'm now also on a daily dose of prilosec to keep that from progressing into cancer (seriously... damage those cells enough and they won't just make me puke, they'll become cancer). Lastly, I also take a fish oil pill to help with the cholesterol.
So that's me before seeing the doc. I'm sure I didn't exactly help out his day as he was hoping for a standard 6 month checkup. More or less... none of our goals were being met. The diabetes was out of control and the migraines were getting worse. So we tackled the diabetes first. He had planned on just ordering a standard A1C test that I could have gotten in their in house lab. Instead he would now have to order a couple insulin specific tests. Both of which requires a 12 hour fast before taking them. We're going to wait and see what the results of those are. If it shows that I'm making enough insulin but just not utilizing it correctly, he can prescribe another diabetic medication. Glucotrol. We've avoided this one before as it ACTIVELY reduces your blood sugar level. In other words, if my blood sugar was fine and I took this medication, it would send me into hypoglycemia. Go low enough down that scale and you end up in a diabetic coma that can lead to death. Yeah... I didn't want to be on that type of medication. It's more or less one step away from true insulin. But hey... if my blood sugars stay in this current range I'm going to lose my feet, my hands, my eyesight, my kidneys.... I'll die anyway. Now if it shows that I'm no longer making enough insulin, I'll have to go on daily insulin injections. As good as my doctor is, he's not comfortable managing that level of diabetes. And I agree... there are specialists to make sure that dangerous medication is just right. So I'd also get a referral to an endocrinologist.
On the migraines, he was equally stumped. Outside of propranalol and imitrix, he wasn't comfortable treating the migraines and believes its worth going to a neurologist. That sounds scarier than it is... I imagine the neurologist will do an assessment, might take a peek with a CT scan to eliminate a couple probable causes, and then just go onto the more intense migraine medications. Most of those medications have severe side effects and it will be trial and error to see what ones work best for me. They're almost all also used for seizures and neurological problems. The worst part for me is that they all have blood sugar problems. Some increase it, some decrease it, and some just fuck with it both raising and lowering it on different days. In other words, they'll all make managing my already bad diabetes even harder.
So that's where I'm at. The referral was made to the neurologist, but it might be 4 months before I can get into see them (they're very busy). It will be one of those appointments where they tell me what their earliest opening is and I will move heaven and earth to make sure I can fit it in. Once we get the lab results back the doc will call me on the diabetic plan. Either glucotol, or insulin and a referral to an endocrinologist.
You know that saying "Well at least you have your health!"... yeah, I don't even have that now. I'm not depressed enough to desire suicide over this (yippee for wellbutrin!), but there are plenty of times that I just wish I'd get that life ending disease and get it over with. Massive heart attack, cancer, stroke... something that will be sudden and just end it.
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