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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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

 

One Drop | Premium
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One Drop | Premium

UPS Delivery Box

Yesterday, my One Drop | Premium package was delivered by UPS. This was so exciting, I had to take a bunch of photos with my unboxing and discovery of my wonderful new gadgets to help manage my Type 2 diabetes.

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The Unboxing

I was so impressed with the packaging, which makes a big difference. Actually it is now available directly from Apple online and in their stores (where it fits right in). When you open up the delivery box, there’s a folding chrome box inside a partial white wrapper surrounded completely by clear vellum.

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Inside Covers

After first removing the vellum protective wrapping, you see the write box with chrome protruding on the right. When you slip off the write cover, you see an all-chrome box.

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The white cover sides include the One Drop logo and image of the Chrome meter, as well as feature summary, highlights of the contents, and general information:

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Chrome Glucose Meter

When you remove the white cover, it reveals an all-chrome folding box, which opens up into two half boxes, showing the sleek One Drop | Chrome meter on top of the right side.

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Lancing Device and Carry Case

After lifting up the tab on the left side, it shows the chrome lancing device and vegan leather carry case on the left of the meter.

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User Manual

The underside of the left cover includes a Quick Start, and under the meter there is a Owner’s Guide.

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Unlimited Test Strips and Lancets

When you lift up the section that contains the Chrome glucose meter, you see two chrome boxes, each with 50 blood glucose test strips, as well as a package of 10 lancets to use with the chrome lancing device for finger sticks to get a drop of blood to test with the meter.

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These are just the initial 100 of unlimited test strips and additional lancets that will be delivered based on my usage for my Premium subscription service.

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One Drop | Chrome

After removing everything from the box, here’s what it all looks like. Everything fits great in the carry case. Very cool! It’s gorgeous. It’s a nice size for my pocket, and I’m proud to show it off when out and about where I need to test my glucose (like at restaurants).

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Christmas Tree

It’s looks great under my Christmas tree with other presents. It’s my favorite present and I will love it all year long, especially with the unlimited test strips (which will save me lots of money).

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I feel so fortunate to be one of the early recipients of these wonderful new devices to help manage people manage their diabetes. I have benefited significantly over the past year that I have been using the One Drop | Mobile app on my iPhone, and this will make that experience that much better, especially with the availability of the One Drop | Experts program available from within the app for any ongoing guidance and support.

Now I need to upgrade from my old iPhone 5 to an iPhone 7 so I get automatic activity tracking, and might just need to get an Apple Watch since One Drop is also available there.

Thank you, Jeff Dachis and the entire One Drop team for achieving this fantastic milestone to improve diabetes care worldwide!

One Drop | Experts Advisory Board
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One Drop | Experts Advisory Board

In April 2015 One Drop launched the One Drop | Mobile app for Apple iPhone, and later for Apple Watch and Android. It allows people with diabetes to log and analyze glucose, food, meds and activity all in one place, set diabetes management goals, track their progress, and integrates with other apps via Apple Health. The One Drop | Mobile app is available free worldwide for Apple iPhone and Watch from the Apple App Store via iTunes, and also for Android at the Google Play Store.

Earlier this month they announced FDA and CE mark approval and availability in US, UK, and EU of the One Drop | Chrome blood glucose meter with unlimited test strips for One Drop | Premium, the first-ever monthly subscription service to provide affordable, accessible diabetes care with One Drop | Experts that provides 24/7 live in-app support from diabetes experts.

One Drop | Chrome is available at Apple online (under iPhone Accessories > Health & Fitness > Health Monitors) and in retail stores, as well as the One Drop Store on their web site. My UPS shipment was scheduled today but was delayed getting on the plane in Louisville so now I have to wait until tomorrow for it to arrive!


One Drop | Premium includes the following:

  • One Drop | Chrome with Unlimited Test Strips: A sleek, compact blood glucose meter that use Bluetooth wireless technology to transmit data directly to One Drop | Mobile app for iOS and Android, as well as a chrome lancing device and vegan leather carry case. Unlimited blood glucose test strips are delivered on-demand directly to subscribers — no prescriptions, no insurance, no appointments, and no hassles.
  • One Drop | Mobile: Award-winning, cloud-based diabetes management solution delivered entirely via mobile app on iOS and Android, including fully-featured Apple WatchOS app for logging and analyzing diabetes data on the go. Provides the only diabetes management platform that offers comprehensive health data analytics, peer-support, and expert support all in one place.
  • One Drop | Experts: Diabetes education and coaching program delivered entirely via One Drop | Mobile app. Experts (Certified Diabetes Educators) have real-time access to subscriber data and are available 24/7 to provide guidance, support, and anytime care via in-app chat.

They also announced the One Drop | Experts Advisory Board and its six inaugural members with healthcare professionals and clinical researchers as well as people living with diabetes – including me! I am honored to be invited and thrilled to participate on the One Drop | Experts Advisory Board.

Click the image to see the One Drop announcement for more details.

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See http://onedrop.today For more information.

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Roasted Red Pepper Soup with Mozzarella

Tonight I made Roasted Red Pepper Soup with Mozzarella using a recipe from Betty Crocker Diabetes Cookbook (page 138), which was served with whole wheat toast and I also had Chardonnay with the meal.

Tomorrow our grandkids visit for a long weekend with us, so our meals will be driven by our guests, and I will resume cooking next week after they leave.