Diabetes

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Flecainide … Thyroid … Potassium

My cardiac ablation at the end of September 2020 immediately stopped the fast beat sequence (SVT, or supra-ventricular tachycardia) that was happening, but no early ventricular beats (PVCs) occurred during the entire procedure. My latest EKGs show sinus rhythm with junctional escapes and some early atrial beats (PACs), but no PVCs. I’m still making adjustments for my thyroid, cholesterol, and blood pressure; also my glucose has been higher lately, along with about a 15-pound weight gain since July.

Flecainide

After my 30-day follow-up visit, my electrophysiologist started me on Flecainide 50 mg twice daily, which is a “sodium channel blocker”; after a month I think I’m more normal most of the time and at least my irregular beats are not really noticeable any more. I also have a 3-month follow-up with my cardiologist soon so I’ll see what he says.

Thyroid

My latest thyroid test shows that it’s still low on 50 mcg levothyroxine. At least my TSH dropped from 65 down to 12, but that’s still high, which indicates that my actual thyroid is low (but “less low”). So my endocrinologist wants me to take 2 tablets on Saturday and Sunday, and just 1 Monday-Friday; this would be average about 63/day over a week rather than increasing my dose up to 75 because the last time they did that my thyroid went too high. So I will check it again in 6 weeks.

Potassium

My last metabolic panel showed a high potassium (5.6), aod they had me do another one 2 days later but it was still high (5.7). So the cardiologist wants me to stop my lisinopril 50 mg, and start taking amlodipine 5 mg for high blood pressure instead, and then check my potassium levels again in about 3 days.

Amlodipine

Several months ago my Crestor was increased from 10 to 40 mg to aggressively get my cholesterol and LDL down (because of my recently-discovered coronary artery disease – high calcification in 3 arteries). This latest lab saw a huge decline in cholesterol to 107 and LDL to 31. Because I have been having hip aches and stiffness since my Crestor has increased, they suggested to try cutting the pills in half for a while to see if that improves my hips, and it does seem to help already. They figured there was now more room to relax the statin dosage without causing the cholesterol to rise much.

Insulin

And my endocrinologist is increasing my Tresiba fast-acting insulin at bedtime from 9 to 10 units, and changing my carb ratio from 12 to 10 grams per unit of Novolog at dinner (like it is for breakfast and lunch). Of course, the Thanksgiving holiday and leftovers didn’t help much, and I’ve probably had more snacks that I should. So I just need to double-down and really get my glucose levels back in-range again like I had done for a while earlier this year. It’s always a constant struggle.

So we’ll see how these changes work.

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Type 1 Blood Tests

My endocrinologist recently ordered blood tests to determine C-peptide levels (corresponding to insulin), as well as 5 antibody tests associated with Type 1 diabetes, which is an autoimmune disease.

These were my results that show I definitely have Type 1 (LADA) diabetes, and NOT Type 2!

  • C-Peptide: <0.2 (Low), Expected: 1.1-4.4
  • GAD 65 Antibody: > 141.0 (High), Expected: <5.0
  • Insulin Antibody: 13.3 (High), Expected: <0.5
  • Zinc Transporter 8 Antibody: 59.4 (High), Expected: <15.0
  • Islet Cell Cytoplasmic Antibody, IgG: <1.4 (Normal), Expected: <1.4

I also had a thyroid test, thyroid stimulating hormone (TSH), that was was high indicating I have low thyroid and so will start taking 50 mcg Levothyroxine.

  • TSH, Third Generation: 6.230 (High), Expected: 0.400-4.100

There is an interesting article about LADA on the diaTribe web site.

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Type 1 LADA!

Based on the blood tests ordered by my endocrinologist, I definitely have Type 1 LADA (Latent Autoimmune Diabetes for Adults) diabetes (and NOT Type 2)!

And I have low thyroid and need to take 50 mcg Levothyroxine.

And I have B-12 vitamin deficiency and need to take a pill for that. They said that often occurs when someone has been on Metformin for over 5 years. They had already told me to discontinue the Metformin at my last visit.

I got a prescription for Baqsimi glucagon nasal spray, if I have any emergency from very low glucose where I might be unconscious (my wife can squirt it up my nose).

They also discontinued Trulicity GLP-1 agonist weekly injection that my PCP had started 6 weeks ago (before I saw the endocrinologist).

They gave me information to review regarding insulin pumps like OmniPod or t-slim. We also talked about possibly getting a smart insulin pen with dose tracking and calculator, but will wait until another visit to decide on that since I might not need it if I get a pump.

They reviewed my log for the last 2 weeks, and made an adjustment for carb ratio at dinner so I’ll take a little more NovoLog at that meal.

Because of the coronavirus, my next visit in 2 weeks will be done via the phone after I send all my information from my log and Dexcom Clarity details from my CGM.

I have setup my Dexcom CGM this afternoon and after the initial warm-up period will start continuous glucose monitoring every 5 minutes with graphs, alerts and alarms.

I am so glad that I finally saw an endocrinologist!

Dexcom G6 CGM
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Dexcom G6 CGM

Diabetes

I was diagnosed with Type 2 diabetes in October 2006, and started insulin therapy several years later. I have just been seeing my primary care doctor to manage my diabetes. That included quarterly office visits to review my A1C lab test for my 3-month glucose average. Also I had annual comprehensive, metabolic, and lipid blood and urine tests to check my cholesterol, liver and kidney function, etc.

Trulicity

My hemoglobin A1C had been increasing over the last year (6.9, 7.5, 8.0, 8.4%). My PCP wanted me to try Trulicity, which is a GLP-1 agonist weekly injection (non-insulin). That works in the small intestine when food is detected, and the hormone works three ways: it signals the pancreas to release more insulin, liver to produce less glucose, and stomach to slow digestion.

Hyperglycemia

My PCP said Trulicity should lower my A1C from 1.4 – 1.8%, and wanted me to stop both my Lantus long-acting basal insulin at bedtime, as well as my NovoLog fast-acting bolus insulin for meals. So I stopped all my insulin “cold turkey” and started my first Trulicity injection, and my glucose sky-rocketed immediately to over 600 mg/dL with highs constantly in the 300-500 range. I was really worried about the hyperglycemia (high glucose) because of potential long-term complications, and even thought I might need an ER visit.

Insulin (again)

I sent messages to my doctor about my readings during the first few days, and he suggested trying the NovoLog at meals because it might take a while for the Trulicity to kick in. I’ve read that it might be several weeks (or months) before it becomes effective. So I did that, but it still didn’t help much. Then I told him about that, and he said maybe it would be more beneficial to use the Lantus at bedtime instead of the NovoLog. So I tried that for a while without any improvement. So I resumed taking my NovoLog at meals also, and did 30 minutes on a treadmil at the fitness center daily to see if that might help get it down.

Ketones

I checked my blood for ketones that are produced when your body burns fat for energy when there isn’t enough insulin to get the glucose into your cells; it ranged from trace to small, rather than negative, but at least it was not in the moderate to high range which would indicate diabetic ketoacidosis (DKA) that is very serious.

Endocrinologist

I was starting to lose confidence that my PCP could really help me manage my diabetes. So two weeks ago, I decided that I finally needed to see an endocrinologist, and I am so glad that I did. He increased my Lantus insulin from 10 to 16 units, although it has since been reduced to 12 units now since I was having some lows during the night. He also discontinued the daily Metformin pills that I had been taking because he said they wouldn’t help me any more. Recently my glucose has stabilized quite a bit.

Type 1 LADA?

He thinks that I might actually be Type 1 LADA (Latent Autoimmune Diabetes for Adults), rather than Type 2. He ordered blood tests to measure my antibodies to determine whether I have Type 1: C-peptide, GDA 65 Ab, Islet Cell Ab, Insulin Ab, and Zinc Transporter Ab, along with a TSH thyroid test.  I will review the results at my return visit tomorrow.

CGM

He also ordered a Dexcom G6 CGM (continuous glucose monitor) for me that I received a few days ago and will activate tomorrow as well. This uses an applicator that inserts a sensor in your abdomen that samples your blood glucose every 5 minutes and transmits the results to an iPhone app; a Dexcom receiver is also provided as a backup. It shows the current G6 reading with a history graph and up/down arrows that show trends, and also provides alerts and alarms for lows and highs that will be especially important while I sleep. And I won’t be checking my glucose with fingetsticks 10 times a day.

Photos

I have included some photos of the Dexcom G6 that I received, which includes a user guide, transmitter, receiver, and 3-month supply of sensors with applicators.  I will let you know how my visit goes tomorrow.

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Hello Again

Well, it’s been a very long time since I have contributed to my blog, which I started way back in 2014. My last post was in December 2018 so it’s actually been over a year.

I had a habit of regular posting, emphasizing the music that I love so much. But the break was longer than I expected because I have been very busy, and this had to take a back seat for a while. Of course, once I wasn’t thinking about the blog all the time with what I might post next, which artists, albums, playlists, etc, it slipped from my top priority and it became hard to just get started again.

Anyway, I think the time is right now to resume my posting, and I will be sharing more music with you. Of course, I have continued listening to music all the time, identified some artists and albums, and even created some playlists in the meantime that will be coming your way.

As I mentioned, it’s been a very busy year for me, so I thought I would share a little of that so you know what I have been doing while I was silent. First, I have been learning iOS, Swift, and related technologies over the past few years, and I have been totally preoccupied developing my iOS apps for diabetes. I also realized that I had a lot to learn, and needed to read books and articles and watch videos.

Initially I focused on reading Apple Health data captured by my One Drop Mobile app, which includes my blood glucose, insulin, food, and exercise. I wanted to provide a more structured way to view and analyze my diabetes data than a simple log with basic analysis. I applied additional statistical analysis with summaries for daily, weekly, monthly, quarterly, and yearly periods, with the ability to expand into more granular detail. I added graph and calendar views, as well as reports.

That was actually looking pretty good, but I decided to explore what I could do for more focus on my food, so right now I’m working on My Diabetes Meals. It also incorporates Health data for glucose before and after meals, as well as insulin and exercise, but shows how they relate to each meal. Since I capture a photo for each meal, I match those images in the Photos library with their associated meal. This allows you to see what you ate, along with its carbs and calories, any insulin, and its impact on your glucose.

I’m a member of Diabetes Meal Plans, and find their weekly meal plans, recipes, and information enable me to focus more on low-carb food to treat my type 2 diabetes. So I wanted to incorporate their weekly plans and recipes into my app. This was quite a challenge, but the effort has been worthwhile. It will benefit other DMP members, and perhaps encourage others to become members too.

My younger son (now 46) has been living with us for over a year. He broke his ankle in March (overweight and skateboarding!), and was helpless for 3 months. Then in September, my older son (49) broke his ankle too, which set him back during his recovery but at least he could work from home.

My mother died in May just short of her 99th birthday with all my siblings there (except my younger sister who’s teaching at a NJ university in China). My father had died back in 2013, and we recently had inurnment burial & graveside service in January for both my parents. It was nice to have the whole family gather and spend time together all weekend, with all my siblings, their children, and some grandchildren.

In November, I had prostate “vaporization” surgery to remove the middle of my enlarged prostate and recovery took several months. Then I’ve had an upper respiratory infection with significant cough that just wouldn’t go away for more than 6 weeks, but I feel that’s now under control and getting better.

So, here we are, and I will give this another go. Hope you are all doing well.

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Diabetes Quarterly A1c – Apr 2017

I met with my doctor yesterday for my quarterly type 2 diabetes follow-up visit, which included reviewing my recent lab test results. My new A1c was 6.9%, or estimated average glucose (eAG) 151 mg/dL, which measures my average blood glucose over the past 3 months.

It has improved, down from 7.1 in Jan and 7.0 in Oct 2016. I was slightly disappointed because I thought it might be more like 6.4% because my Avg BG were 136 (Jan), 137 (Feb), and 132 (Mar). However I need to remember that this is lower than the American Diabetes Association (ADA) target 7.0% (eAG 154).

My doctor said he can really notice a difference with my strength training over the past 3 months. Also I lost an additional 5 pounds since I’ve reduced my meal carb targets. And I now only take 8 units Lantus long-acting basal insulin at bedtime instead of 10 since I was getting more overnight lows like 44 and several in the 50’s and 60’s. My Humalog rapid-acting bolus insulin at meals is less too, when I need to take it at all.

Overall he thought I’m doing great with my diabetes management. He can see how much my One Drop | Premium subscription has helped too.

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One Drop at LaunchFest

The One Drop diabetes management solution was launched two years ago, and I was one of its early users. I started using their free One Drop | Mobile app for iOS on my iPhone in June 2015, and have now been using the One Drop | Premium subscription with the One Drop | Chrome blood glucose meter, unlimited test strips, and One Drop | Experts diabetes coaching since December 2016.

Here’s a recent presentation at LaunchFest by Jeff Dachis, CEO and Founder of One Drop, on their diabetes platform, status, and progress.

One Drop by Jeff Dachis at LaunchFest 2017 – 10 min 4 sec

 

One Drop Breakfast Taco BG Challenge
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One Drop Breakfast Taco BG Challenge

Recently I participated in the One Drop Breakfast Taco BG Challenge during the South by Southwest (SXSW) festival in Austin. Watch us check blood glucose, estimate carbs, take insulin, eat breakfast tacos, and check again.

Video

SXSW 2017: Breakfast Taco BG Challenge – 12 min 34 sec