Saturday, 2 June 2012

Adventures in Healthcare

Do me a favor.  Take the tip of the 3mm plug from your earbuds and press it into your tummy for 10 seconds.

Well, for about a year my glucose numbers have been climbing.  And making good food choices over bad food choices isn't really making a difference. So according to the endocrinologist, it's time to start on some insulin.

Technically, I'm a Type II diabetic, meaning, primarily, that my body makes insulin.  This is as opposed to a Type I diabetic, which is what they used to call 'juvenile' diabetes (as in Juvenile Diabetes Research Foundation) because it usually is detected early in childhood.  Type I diabetics are insulin-dependent--their bodies either don't make or make insufficient insulin to keep up with dietary and metabolic needs.

Insulin is a hormone produced in the pancreas. It's job is to attach to receptors in cell membranes, which opens channels in the membrane for glucose (sugar) to be transported into the cell for use in metabolism (for those of you who want more detail, go back to organic chem and review the ATP cycle).  Obviously insulin is necessary for normal life processes at the cellular level.

Type II diabetics are typically treated with 'insulin sensitizers' (among other things) because there's plenty (usually) of insulin in the body, but for whatever reason, it isn't opening the channels.  So what insulin sensitizers do is make cells more ready to accept insulin.  Again, for more (and more informed) details, go look it up.

(One of the myths is that a high sugar/starch diet causes diabetes. It doesn't.  But high sugar/starch diets may contribute to insulin insensitivity, particularly if you're already a Type II or on your way to being one.)

Okay, so here's the story.  On Tuesday at my regular endocrinologist appointment, I got put on glargine insulin, a long-acting (time-release) form of insulin(-like stuff).  I just read the Wikipedia article on the stuff and I sort of understand how it works.  But basically it's a form of insulin that gets 'unpacked' slowly and distributed through the body, rather than going straight in (as 'regular' insulin would) and starting to open glucose channels in every cell it hits.

We've been talking about this for a year or so, when my glucose started climbing.  My HbA1C (also known as glycosolated hemoglobin, basically just a long-term average of glucose levels) was at 8.4, having climbed steadily from a 'normal' 6.4 a few years ago, up to a just over target 7.1 a couple years ago, and, well, higher since. 

What's odd is that my 'daytime' blood sugar readings, when I take them, are normal.  Mostly my post-meal numbers are in the 7-10 range, sometimes a little higher, depending on what I ate.  But my morning 'fasting' numbers, have been absurdly high. They should be 4-7. I haven't seen anything below 8 in a couple years. Often they're up near 14 (although this is complicated by the fact that this is often around noon, after I've been up and around and active--and caffeinated--for several hours).  But the point is, too high.

So my new instructions are to inject myself with glargine insulin at bedtime.  This is kind of cool.  There's a glass vial of the stuff that goes into a pen. There's single-use needle things that screw into the tip, you dial up the dosage, jab yourself in your belly fat (well any fat will do, but belly fat was recommended by my nurse clinician--there are very few pain receptors in the belly and, well, my belly fat is probably the thickest in my body, meaning there's a lot of room to shove some liquid into). 

Started at 8 'units' (still working out what the units are, but basically you turn a thing on the pen to the 8 and it spits out the right amount of stuff through the needle), with instructions to watch the effect in the morning, and increase 1 unit up or down not more than every three days until I start getting 'normal' morning readings. (According to the nurse clinician, 8 is sort of a 'normal' starting dose, and that some people need to go up to 20.)

So this morning was day four, and I've been steadily in the low-to-mid 8 range all the way. This is *such* an improvement I'm very excited by this. I could probably stick here if I actually started getting some decent exercise, but what are the odds of that? (Okay, now that the weather is finally cooperating, I might start trying again.)  Anyway, tonight I'll jump  up to 9 units and see how that goes for a few days. But the point is, I'm suddenly doing much, much better with this stuff.  And I have a new toy to play with. More sharps to figure out how to dispose of, of course, and you can almost always get better compliance out of me by giving me a new toy.

For those of you squicked out at the thought of jabbing yourself with a needle--the needle tips here are super, super fine (much smaller than the finger-jabby lancets I use), and 6mm long. The needle jab doesn't hurt (usually I don't even feel it). What is uncomfortable is the plastic collar around the base of the needle, which, because I'm squishy and hold the pen against myself probably more firmly than I need to, presses into my skin several millimeters. This is the earbud demonstration I started with. That's what it feels like.  After the injection, you can see the little 'hole', only because that's where the collar was, not where the needle was.  So uncomfortable, but not really owie.  And kind of cool--toy, and all.