Dr. Update

I thought you would like to know how things are going and what the doctor said when I went in for my follow-up visit on Monday, 7 October 2002. It actually wasn’t so much a follow-up visit as it was a visit to discuss the results of a battery of tests I had done the previous Thursday due to fears of complications. I had swelling in my feet and legs Monday, Tuesday & Wednesday last week– a sign of potential kidney trouble. I still have swelling, but it is localized to just my ankles at the moment and a significant reduction at that.

The tests proved my kidneys to be fine and dandy. (We are still awaiting the results of a second test to confirm the health of my pancreas.) The swelling apparently is from lack of proteins in my blood stream and other bodily fluids. That’s not to say that I am not eating enough proteins in my diet, just that my kidneys are not processing them correctly at the moment. I guess it’s on the bottom of a long list. At any rate, the doctors don’t seem concerned. Indeed, they closed the appointment with, “OK. See ya’ in 6 weeks.” Six week! Are you kidding? I thought I was on a “fast-track” healing schedule. In six weeks I want(ed) to be trashing my finger pricker & insulin needles. Ugh!

However, I am sure you will appreciate the “brain-work” they loaded me with before leaving. I have been switched to different insulin – one with a quicker action time and less time effect on the body. This is the one that I take to cover meals, not the long acting Lantus that I take at night. The new one is called Novolog. Now here’s the fun part: I take a variable number of units with meals based on a percentage of carbohydrates I consume at said meal plus 1 unit for every 50 basis points I am above BG: 140. To make it more fun, each meal’s percentage is different: 8% at breakfast, 5% at lunch & 10% at dinner. Thus if I test BG: 156 @ 8:AM and have breakfast with 62.5g of carbohydrates then I would take 6 units (5 for the 6.25 * 0.8 + 1 for the 50 range above 140). Obviously I chose my numbers for example with care so that it would work out to an even number. In real life, that doesn’t happen and I have to round up or down based on a little guess work. Fun, eh?

One other interesting point about the dose of this insulin: because it works so quickly, you must calculate these totals and inject BEFORE you eat and you'd be wise not to leave uneaten food on the plate as the over-coverage will cause a post-meal crash. Neat o’.

The doctors said that they would have never given a formula to anyone “normal”. But because I keep such thorough notes and daily logs detailing all of my food intake and corresponding BG scores, they thought I could handle it. On average they usually tell some one to take X units at breakfast, Y units at lunch and Z units at dinner. They are then responsible to eat only so many carbohydrates per day over those three meals.

This is not the case for your agile minded Mr. Brown, complete with hip-side Palm organizer. He gets algebra and “carte blanche” to eat what he wants, when he wants. The really cool thing is that it works. On Tuesday I started using the formula to cover meals, but with the Regular insulin. I have not started using the Novolog yet because I have to get new syringe nibs for the delivery device – a pen-like thingamajig. With the formula, I started the day at BG:90, had 3 units with 36gCrbs at breakfast and was BG:92 two hours later. That’s perfect!

The added benefit to this new regimen is that I will be on far less insulin each day. On Sunday the 6th of October for example, I had 33 units (16 of which are the night-time Lantus). This was already about a 40% reduction from the levels I was on when discharged. But by Thursday or Friday, I should be on approximately 25-28 units with fewer (if not 0%) risk of crashing – something I have grown tired of doing. I have still been crashing about twice every 24hours despite the daily reduction in insulin levels.

Keep your fingers crossed and maybe I’ll kick this thing. I might be dreaming as the doctor is saying, “Let’s see where you are in six months.” Ah! 6 Months! What??? I thought you said six weeks – but that was just for a return check-up. Oh well. I will persist in my endeavors to be stronger that it. With luck, I will control my blood sugars, my mind & body and not the other way around.