Thursday, October 19, 2006

Are we there yet?

I've been busy! Just kidding, not really. I found a new primary care doctor. He seems to be working out great, but it's hard to tell for sure with only one visit. I haven't heard back from the Diabetes Care Clinic, so I asked him to refer me to the endocrinologist he normally works with. I heard she went to Harvard and she's really nice.

I talked to a pump rep and ended up attending a Minimed class on Tuesday. It was listed as CGMS and one hour, but it was actually "Advanced Pump Skills" and it went 2.5 hours. I was amused that all the diabetics had to wait to eat dinner. I didn't really learn anything new in the class, though, and the length meant that I didn't have time to stick around afterwards and have my questions answered. For example, is clogging really something I would need to be concerned about, since I don't have a basal right now? I already asked people if I could program a pump to do what I do and the short answer is not really. I could try doing a dual wave bolus, but it might not have the same action profile, or I could do it manually but I would still have to remember when to bolus. I did the pump school online, but I haven't done the finetuning one yet.

I reviewed my insurance coverage again, and discovered that their policy actually says you must have a positive GAD65 test or a C-Peptide below 1.2 (range: 1.1-5.0). I think the chances of the former are pretty slim since I've had three negative ones. Clearly they don't care about the other two types of antibodies. I don't know how soon I'll reach the second one; my last one was 2.4 in June. Of course it should be lower now that I'm on insulin. I just don't know if I want to wait a year, though.

I finally met someone online who had a progression similar to mine! She had hypoglycemia originally (so did I), she then had really high postprandials but was diagnosed as Type 2 (me, too). Her C-Peptide was a bit high (mine, too). Then at some point (I should find out when), her fastings started going up and she lost that, too, pretty quickly. She went to a new endo when her fastings went up. She had another C-Peptide then and it was 2. The endo said she was definitely a Type 1 and put her on insulin. Two months later, she was on a pump. Her GAD65 was negative and she never had another C-Peptide since the endo thinks it's pointless. Scary how similar that sounds; too bad I can't see her endo. So, it looks more and more like I might have LADA. If so, I can expect that at one point, my control will deteriorate pretty quickly so that I need a basal insulin. Since I can already see patterns (like the afternoon hypoglycemia I still have even with no active insulin), I don't know how enthused I am about Lantus. I think I'd do better on the pump.

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