Moving!

I have an announcement to make!

I'm very excited to say that I've been invited to blog over at Diabetes Daily!

David and Elizabeth Edelman have built an awesome home away from home over there, and I'm also following in the footsteps of two of my good friends and favorite bloggers, Amylia Grace and Bernard Farrell.

While it is hard to pick up and move after such a long time here, it was an offer I simply could not refuse.

And after all, the only thing that is changing is the URL (address) of the blog. Same Scott, same posts, same ride. Please join me for future posts at my new address http://www.diabetesdaily.com/johnson/.

Please update your subscriptions and links. I'm leaving this up and running for archival purposes, but all future posts will be at diabetes daily.

Thanks!

It feels like THE MISSING LINK

Symlin.

I can't express how beneficial this medication has been for me so far.

Where has it been all these years? How have I made it so far without it?

It's been somewhere around three weeks so far, maybe a little more, that I've been using it.

Week one was on the pen, and it sucked. The nausea, the shot thing again, the new and unknown timing of digestion and how to match the insulin to it.

It's all relative, and I'm sure the pen is a great improvement over the vial & syringe.

Week two and three I used a second pump with Symlin in it. Yes Kathy, Gary Scheiner (rock on G-Man!!) was a big influence on my decision to try pumping Symlin. I worked with him for some pointers on it and to clarify some of the questions I had. I also got past the nausea (mostly) during this time.

After two weeks (or so), I can say that so far I love this approach. That the convenience of having my Symlin in a pump so outweighs the drawbacks of a second "set" of pump stuff. I'll talk more about why in a different post soon.

Making it convenient for me to use plays a HUGE part of using it consistently. Using it consistently plays a HUGE part of reaping the benefits I've noticed.

Those benefits include a significant decrease in appetite, as well as very "gentle" BG curves. It's amazing really. I'm almost hypnotized by watching my post meal blood sugars. I've never seen anything like it. Steady, steady, steady, then a slow and gentle rise, but not too high, then back to target. All slow and gentle curves.

It's like I've tamed the roller coaster.

The appetite connection is huge too, and that alone would be worth it for me. For the first time in as long as I can remember, I feel satisfied after eating less.

Satisfied and less are two very important words to me right there.

I'm in love with my Symlin, and can totally feel that my body has missed this important hormone for a long time. It seems to be, so far, a very useful tool in my diabetes management toolbox.

Time will tell if my struggling A1C's and weight will show any positive progress. I'm pretty sure they both will...

SMART(ies)

I think I'm set for a while...

Thanks for the heads up Scott Strumello!

Symlin So Far

It has been almost two weeks since I started experimenting with Symlin.

While it has been pretty scary adding another variable into the mix, the benefits I've experienced show that this tool has some real potential to help me.

To be honest, while I've been cautious with this new tool, I've also not done it justice in really trying to figure it out. I've not been logging my results, and have been just watching it "on the fly" after meals.

The caution comes from stories in the OC of post meal low blood sugars that were very hard to treat. Those stories scared me, particularly because I have a heck of a time with over treating lows in the first place. I am frightened half to death by the thought of eating TONS of stuff to (over)treat a low, and none of it digesting when I need it to!

I take my Symlin dose before I eat (20-30 minutes), and take the same amount of insulin but extend it over 90 minutes or so (thanks to some expert advice). My blood sugars after eating stay almost absolutely flat for about two hours, then gradually rise up, peaking at a not-always-reasonable number.

I need to play around more with that, but given some time and attention I'll get it figured out.

The way my blood sugar stays so flat after eating simply amazes me. I almost chuckle in amazement when I check my blood sugars for those couple of hours. Hypnotized by something that seems downright impossible based on my previous 27 years of living with diabetes.

I've experienced a fair amount of the nausea that can happen while re-introducing this hormone back into my system. It hasn't been horrible for me, but definitely there. With this it has been hard to know if the perceived appetite suppression is simply because I feel yucky, or if I am really feeling satisfied earlier.

The key to getting past this nausea will be to stick with it consistently. I am assuming that, like other medicinal side effects that it will go away (or get less severe) after some time. Is that true for this medicine?

I also talked previously about how I disliked the actual shot part of it. Silly, I know. But real for me (and that is what matters). I haven't done shots in over 10 years. I'm spoiled by pump therapy. So I adapted (like we do), but maybe not in the way you might think (getting used to shots again). I put some Symlin in an old pump and strapped it on!

There is a price to pay in dealing with another thing on an already crowded belt-line, and another infusion set (with tubing). But I need to make it easy for me to use, so I can stick with it. If I dread taking the shot I'll find excuses and justifications for not using this tool.

It's been a full week with the Symlin in a pump, and I think I like it. It's another option for me, and I like options. You have to remember, this is not my source of insulin, so I don't NEED to wear the pump 24/7. I take it off when I exercise, and I don't wear it when I sleep. Only when I want easy access to my Symlin. And I've always got my pen for when I don't want to wear the second pump.

There's also the supplies to be concerned about. If I stick with it I'll be using twice the cartridges and infusion sets. That may become an issue over time.

It's been good so far, but it's only been 6 or 7 days (on the pump). Time will tell what approach works best for me, and it may be a combination of a few different approaches. I also need to be more active in logging my information so I can tweak and adjust how I'm using this new tool and make the best of it.

To wrap things up I have a question for those using Symlin. What happens if I take my symlin dose and then my meal is significantly delayed?

My Dream Come True? Or Totally WTF?

A buddy I work with found these in a vending machine at a bowling alley. He just HAD to buy them for me.

No, I haven't tried them yet... If they were Cheesy Tots in a bag I'd be all over them. Maybe. :-)

Someone's Idea of Torture?

I recently found a picture I took late last summer with my craptacular camera phone.

In this picture you can't make out what I was seeing with my eyes, but let me tell you, it sent a shiver of fear up and down my spine. The picture first, then I'll explain...

I know, I know. You can't see a damn thing. Honest, it's not even worth investigating.

Allow me to set the scene for you.

I was shopping for a cheap suit. I went to one of the local department stores (which will remain nameless), and started picking things off the "budget" rack. I took the clothes into the fitting room to try them on.

I slipped off one of my shoes and glanced down at the floor. As the light bounced off the back of my eyes and my brain registered the data that was coming in, my heart nearly stopped cold in my chest.

Needles (well, actually pins) everywhere. Every damn where. For every square inch of carpeted floor there were between 3-5 pins laying there. Almost so bad that I didn't have anywhere to safely put my diabetic feet without risking an accidental stabbing.

I slipped my foot back in my shoe (after snapping a quick camera phone picture for all of you!) and left the fitting room without trying on a single thing. It just was not worth the exposure.

The clothes were too expensive anyway.

A New Variable and Mixed Feelings

Have you ever been excited about something and dreading it at the same time?

I recently had my endo appointment. A1C is up, which caught me off guard. But considering we've just made it through the holiday season and all that jazz I guess I can't be too surprised. Still bums me out a bit. There's always something to work on isn't there?

At my last appointment back in November I pitched the idea to my endo about Symlin, and he blew it off and started rambling on about Byetta. I didn't push it too hard because the Symlin Pen was not yet available.

Well, that has changed, and the pen is now available.

I got my doc to write a prescription for the pen (and pen needles - don't forget those!). It took a few days for my pharmacy to get their hands on the pen form, and another day or so for me to get back to the pharmacy to pick it up - but I have it now.

Once I actually had the pen in my hands, I had some very mixed feelings about it. Honestly, I was very scared to add yet another variable into the mix. There was some hope that it would eventually help things, but I was almost overwhelmed by the notion of all of the "trial and error" it would take to get to that point!

Bernard did an excellent write up on how he uses Symlin. There is also a TON of information in the Symlin Users Forum (thanks Scott S.!) on TuDiabetes.com

After a few days of reading, researching, and internal waffling about what to do, I decided there was only one way to figure it out! So I took my first dose.

After about a week I have seen some very promising (incredible!) results, but also a lot more high BG's.

The highs are because I'm starting slow and being very cautious with my insulin doses. Given some more time I will figure out the right balance and timing.

This is going to sound funny from a veteran diabetic - but I am really hating the shots. I've been spoiled by insulin pumps for over ten years, and doing these shots again really bites. Boohoo me, right?

It has also been hard to remember to take the pen with me. I usually have everything I need right in my pump case. There have already been a few times where I intended to use it, but either forgot the pen at home or left it on my desk when out at lunch.

I'm actually playing around with the idea of wearing one of my old pumps and pumping my Symlin (thanks Sarah!).

The physical logistics are a bit intimidating to me though. I'm not yet completely sure I want to deal with a second infusion set and device on my belt. Add some sort of CGM technology to that assortment in the relatively near future, and I'm wearing a LOT of stuff (both on my belt and sticking into my subq tissue).

I'm just not sure I'm ready for all that yet. I have to weigh the pros and cons, and have more dialogue with the little guys on my shoulders.

I'll keep you all posted as my adventure unfolds!

Scott Has Been Here (dot com)

Are any of you familiar with "Where's George" ? Maybe you've gotten a one dollar bill with that website stamped on it? It is basically a fun website where people can go to see where their paper currency has been. The bills can be tracked by their serial number, and if many people register the same bill you can literally see a map detailing where that bill has been.

A coworker of mine was recently talking with me about how she found a test strip in the inside of her sock one day. She said it was not even a "recent model" strip - but one from a meter she used long ago! "Must have gotten in the laundry somehow" she explained.

We chatted about the crazy places these test strips end up, and the little nod of recognition when you see a test strip out in the wild. An acknowledgement of another living with diabetes somewhere out there, not too far away.

We joked about a "Where's George" type of thing with test strips rather than paper currency. Somehow microscopically printing a website address and identifier on each test strip, then people that find them can go to the website and record a sighting. Picture a Google map with little red dots where people have found one of your test strips.

Don't think too hard about the logistics of something like this, the fact that these discarded test strips are bloody, and technically litter, and that we don't leave them all over on purpose.

Just let your imagination run with the idea of what your map would look like after a couple months, or a year, or a couple of years.

Measuring Handfuls

I have another bad habit that I would like to share with you all.

I often grab handfuls of food here and there. Most often after I eat an unbalanced meal that leaves me craving something more, and most often I am pouring dry cereal into my hand and eating that.

Maybe it's like a desert of sorts.

One night after I ate my dinner and was munching on cereal I found myself thinking on things. As I was stuffing my mouth full of unbolused for carbohydrates, I wondered just how many grams could it possibly be.

So I checked.

I pulled out my Eat Smart Nutrition Scale and punched in the figures for the Honey Nut Cheerios and placed a typical handful of them on the scale. For each "handful" of cheerios I was inhaling, I was eating about 8 grams of carbohydrates.

Stunned, I sat there and thought about how many handfuls I would mindlessly eat in one sitting. Four? Five? Eight? Holy crap batman!

Then I starting thinking about how long I have had this habit, and how often I would do this. Way too long and way too often.

It makes total sense if you think about it. I wouldn't take me many handfuls to fill up a cereal bowl full of cheerios.

Here I thought (or tried to convince myself) that what I was eating didn't really add up to much and wouldn't matter. Now that I am aware of just how many carbs I am eating when I do this, it has been much easier to avoid the habitual behaviour.

Funny how the context of things can skew our perceptions sometimes.

Funny how the reality of things can help us adjust our actions.

Silly Self Conscious Moment?

My family and I were recently at one of the YMCA's in the area.

My wife and I were walking around the track. It's up on the second level and goes around both the basketball gym on one half and then the kids recreation area on the other half. It's a good setup because at all times when we're up on the track we can see the exits of the kids recreation area and actually see the kids for half of the trip around the track.

The kids recreation area is pretty cool. It's a big room with some short basketball hoops and balls, then a big section of padded floor (what I picture gymnasts using?) and a bunch of big cushy gym mats. The floor is kind of springy, so the kids usually build a big pile of the gym mats, then back up and take off! They run and jump into the pile of mats. It's a blast!

They are doing a lot of construction at this YMCA (which, I guess, justifies why they keep raising the rates). Because of this construction they temporarily moved a group of stationary bikes into the kids rec room.

There was a guy riding one of these bikes when we were there. This guy was pretty intense. A late middle aged man. Thin, not an ounce of fat on him, and though his muscles were not big, they were just flippin' ripped. You know, where you can see the strands of muscles along his shoulders. He looked to be in great shape, and judging by the way he was attacking that poor stationary bike, he worked hard to get there and even harder to stay there.

Every time we went around that part of the track this dude was looking at us. It was quite uncomfortable. I kept joking with my wife that he was checking her out, and she kept joking with me that he was checking ME out... It was weird, either way.

After we had been walking for a while I started feeling funny. Sometimes when you are exercising it can be hard to tell if you are feeling funny from exercise, or if it is a low. I checked my blood sugar, and even though I reduced my breakfast bolus, I was low. And still had a boatload of insulin on board from breakfast. Doesn't it always seem like a boatload of insulin on board if you're low (and not enough when you're high)?

I didn't think that all of my breakfast had digested, but I couldn't just wait for it. I had to treat the low. I had a full tube of glucose tablets in my pocket, that is 40g of carbs. If you can believe it, according to how much insulin I had on board, that wouldn't cut it. It might have given whatever undigested breakfast time to catch up, but I also wasn't done exercising. I didn't want to risk being low again in a little bit. So I check my wallet. It was a great day - I had a five dollar bill and a ten dollar bill.

While my wife kept walking I went looking for the vending machines. I had my mind set on a nice cold bottle of OJ or apple juice. But because of the construction there was only one vending machine in the whole building, and it was a snack machine (not a drink machine). It also would not accept a fiver. I begged the ladies at the front desk for change, and got some one-dollar bills. Back to the vending machine for a bag of skittles. After I got my fix I started chowing down and went back to the entrance to the gym.

Those parents out there will understand that I didn't want to let the kiddos see me with a bag of candy when I didn't have any for them. So I stayed near the door to the gym while I ate my skittles and waited for my blood sugar to come up. A slight sweat on my head and a wet spot in the middle of my shirt. Breathing hard. I was tearing those skittles up. Cramming more into my mouth at one time than my teeth and tongue could manage. Damn low bg.

Out of the corner of my eye I see spinner dude, heading right for the door. The one I'm standing in. Great. The irrational part of my mind (read: majority) starts running wild.

I can only imagine what he's thinking. "Look at that fatass. He was just up there trying to work it off, and now he's here eating candy faster than his mouth can handle it. Pitiful."

I stepped to the side and avoided even looking in his direction as he passed by.

The moment stuck in my head. He didn't know I didn't have a choice. I had to do it.

As irrational as it may be, even with the health club fitness nut mentality that some people have, it doesn't mean he was thinking that.

Even if he was - who cares? It was literally all in my head. But that's how my head works sometimes. Especially when I'm low.

A Leaker!

Did all of you read G-Money's post from yesterday? The one titled "Times .10"?

I had to chuckle to myself as I read this part:

Until I woke up kicking the blankets off of myself. Covered in sweat I grab my machine to check. 52. I have 4 glucose tabs and immediately thought of the name of this post.

Do any of you bloggers think about how you are going to blog a situation as it is happening? Is this some kind of sickness? I saw a T-shirt that said, “I am going to blog about this” and I think I should wear one. I can have a scary low and think, “What should I name this post!” Do you guys have that happen?

The reason I chuckled is I had just experienced one of the situations he describes.

I was at work and glanced over near my computer mouse. I spotted a big streak of blood on my desk! I know I recently checked my blood sugar, and my finger must have kept on bleeding after I licked it clean.

A LEAKER! I quickly inspected my fingertips but they were all clean. I had to look at all of them because I couldn't remember which finger it was, even though it was not even 30 seconds ago...

So with this nice long red streak of blood drying on my desk, the first thing I thought of was taking a picture for the blog! So yes G-Money, I think just like you! It's all for the blogosphere man!

As my eyeball took in the scene, I'm mentally composing the frame for the picture. Scanning the area, trying to figure out the angle, how close to zoom in, flash or no flash, etc.

But you know what? I realized how FILTHY my desk is!!

The debris stuck in the cracks of my mouse (right in the space between where you put your palm and where the buttons are), all the little office-place dust bunnies, the food crumbs, pencil streaks, staples, and dried Diet Coke droplets on my desk.

So instead of taking the picture I cleaned my desk. Sorry folks, no blood pictures from me this weekend (well, it is only Friday, so there's still a couple days left to make a mess...).

Quotes, Motivational Messages, and Practical Jokers...

I work in a typical cube farm. It's a big workspace with probably a few hundred people, all separated into little "cubes".

One awesome lady has a dry erase board on the outside wall of her cube. She will put up quotes or motivational messages that I really enjoy.

Every once in a while someone else will take it upon themselves to add a funny anecdote or smart assy remark to the message.

I simply could not resist snapping a phone camera pic of this one...

Dilated!

Today was my annual diabetic eye exam. Glad to report there's nothing to report.

Doc said that on a scale of zero to ten (zero being perfectly healthy) I am a 0.01. Music to my ears.

I don't know why, but every time I go in for this appointment I feel like I'm waiting for the hammer to drop.

Thanks to mom & dad for some good genes, because lord knows my blood sugar management needs a lot of work!

I Don't Want to Know...

I know that food is my downfall. I know that food is the root cause of most of my diabetes management woes. I know that I need to know more about food.

I know that the Glycemic Index is a pretty important aspect of food. It is a measurement of how fast certain foods raise blood sugar.

David Mendosa has been talking about the glycemic index for a very long time, and I'm sure that he is where I first heard of it. David has been writing about diabetes for about as long as I can remember reading about it. I view his information as very credible and well researched, and I encourage all of you to take a look at his website and to subscribe to his blog.

About a month ago I caught a burst of health related motivation. I rushed off to the bookstore determined to pick up a book on the glycemic index. I was motivated to learn all that I could about this important measurement about food.

As usual, I was so juiced up and excited to learn, I didn't buy ONE book, but rather three or four. Rather than doing the smart thing, spending a little bit of cash and buying a single book to see whether or not it was useful to me, I spent a bunch of cash and bought a bunch of books. I'm really good at not being smart about stuff when I get excited about it.

You know how much of the first book I've read so far? About twenty pages. And it has been painful. I can't get into the book, but that is no fault of the book. I just don't want to know. I'm not motivated to keep reading.

I'm trying my damnedest to ignore the fact that I need to change my food ways.

I can finish a huge computer book in a single weekend. I can polish off a book about kayaking or geocaching in a few days. I can read a novel at bedtime, little by little, and find that it keeps me up later than I should be up. Books that suck me in and don't let me put it down.

A good book about helping me change my dietary habits - my brain just refuses to get into it.

I am so completely amazed at the depth of my food issues. This is one fight that I am having real trouble fighting.

I would rather ignore the problem altogether and have some doritos. What good comes from rebellion of this sort? None! So why is it so hard to stop?

"Uncle! Uncle!!"

It is, quite simply, a tradition for me. For as long as I can remember, and for as long as I'm around, Christmas eve will have at least one constant.

I know the characters. I know the props (even down the the cloth fake dog tail stuck in the door...). I know the lines. I've got my kids repeating parts of the story. I've been known, at any time, to pop a VHS tape in that I recorded during the 24-hour marathon on TBS. I swear I could watch the movie non-stop, forever.

I know there are others of you out there. And the rest of you probably hate the movie. That's the way it goes with this type of thing.

A sign of my addiction to this movie is that I've been able to draw analogies between the movie and my life with diabetes. I would probably score that one in the "Bad Signs" category...

In this case it is Low Blood Sugar.

And his buddy, Rebound High.

Their only pleasure in life is stalking and tormenting victims at every opportunity.

You see that? Low Blood Sugar working to pry a submission to its evil will (which is to eat everything in sight, even if all you need is a single gram of carbohydrate...), and Rebound High patiently waiting for his turn later...

They are the best of buddies, these two.

But it is always Low Blood Sugar that starts the trouble.

But we all know what happened...

Happy holidays everyone!