Let's say you have a close friend that has a problem with lows. For one, they tend to get combative when low and will start arguments or say really mean things (I mean, the things they think but shouldn't say type of things, not things they don't actually think). They get angry if you try to get them to test, and refuse to test again after treating. They don't like to carry supplies with them, and will often leave the house without even taking a meter, and usually don't have anything along to treat a low with. (Despite this, their control is not that bad, if you don't know about what happens during lows.)
Now let's say this also happens while the person is driving. Needless to say, testing before driving is right out. They get angry if you realise they are low and try to get them to pull over. Or if you, as I did recently, refuse to get back in the car until they test and treat, then get angrier when you insist they test again before leaving (still low). I know the anger has a lot to do with the being low, but there is obviously a serious issue in there. I guess I feel like even if they don't, I have to take my own safety seriously. (I have given up on trying to be concerned about them because it's not welcome). In the past, I have refused to go anywhere with them driving, but eventually I was unable to stick to it, because I don't drive. Plus occasionally there will be periods where they start acting more responsible.
No amount of cajoling or lecturing will make this person listen to me. Any hint of concern just annoys them. I finally just resigned myself to always carrying five times as much sugar as I would need, and always having lancets so I can switch them out and they can use my meter. That is, if I can talk them into it. I think there are two things going on here - 1. the belief that there's no need to be prepared, because nothing "wrong" is going to happen, despite all the evidence to the contrary, and 2. the idea that they're not impaired while driving with low bg, which I can say is untrue.
So...what would you do? Assuming you are still going to be friends.
Thursday, August 21, 2008
Wednesday, July 30, 2008
Dude
I was kidding. Ha! Ha! Ha...ha...ha? Ha?
So I'm told people can't tell when I'm joking. Not really sure what to do about that.
So I'm told people can't tell when I'm joking. Not really sure what to do about that.
Monday, July 28, 2008
my new career as a crank
I was reading a post on CWD for parents about "who were you before D?" It's interesting. For me, it's hard to answer. Before diabetes, or before diagnosis?
The years just before diagnosis for me were a haze of chronic fatigue, repeated illnesses, slogging through college classes when I couldn't concentrate, because otherwise I'd lose my health insurance. I was lucky to have an excellent GP, a professor of medicine who took me seriously and wanted to get to the bottom of it. With every new diagnosis, a new piece of the puzzle fell into place, but still something was missing. I say this a lot, but diabetes was just the last diagnosis. Once I had that, the last big mystery was solved, and I dropped out of school because I didn't need their higher level of coverage anymore. (My GP had already left for greener pastures).
So before diagnosis, I had been barely treading water for quite awhile. I'd always had most of these things and just learned to live with them, but I started to get really sick when I started my Master's degree in 2002. I wasn't diagnosed with diabetes until 2005, when I was 27. People seem to define themselves in terms of their careers, or their aspirations. My aspirations were things like getting through the next day, or even the next hour, and my career motivation was what I jokingly referred to as, "get to work or you're fired."
I don't define myself by my career. There was a time when I really wanted to be a librarian (surprisingly while working in a library), so I went to library school. By the time I got there, though, it just didn't seem as important. I arrived at a much less accessible campus than where I did my undergrad, and discovered for the first time in my life that I'm disabled. I know, I know. It had just never occurred to me before. As they say, life got in the way, and I fell behind in my career because I wasn't up to a full time job. I spent several of the last few years unemployed, because I can't do physically demanding jobs anymore (or fake it well enough), and people are pretty puzzled by my resume since I didn't take the usual career path. I would still love to go back to school and seriously take all those classes, but I don't have the stamina.
On the other hand, I am lucky now to be in a better situation so that I can sit at my computer all day without it being excessively painful. I'm in much better health now. On the other hand, I'm not young anymore. I hear some groaning out there, but it's true. I've always loved to learn and to research. So now I spend my time researching diabetes. I got so frustrated when I was first diagnosed and couldn't find any information that made sense. I even went to the medical library and checked out all the textbooks, but they didn't make sense, either. Now, I get it. They didn't make sense because people just didn't know any better. Of course sliding scale regimens are great! Of course Lantus is scary and untested and not safe for pregnancy or small children! If you're laughing, consider that many people believe it because the long term studies haven't been done yet on these new things, so they couldn't possibly recommend them to patients. Seriously. Hands up, how many people want to go back to R and NPH? Anyone want to convince an angry toddler that they have to eat more carbs to feed the NPH?
Before diabetes, I was just someone who liked to learn, and somehow now I've become someone who likes to learn about diabetes. Someone sarcastically asked me recently, "what, do you just research diabetes all the time?" I laughed, because...I do. I've learned the hard way that the other things I used to do were too stressful, or I didn't really enjoy them, whereas now I have something to do that's interesting and important. I will stop when doctors stop telling people they have "borderline diabetes," to lose some weight and see them in three months. I will stop when people understand one kind of diabetes, maybe even two! I will stop when people know that there is still no cure for Type 1. I will stop when large organizations stop telling people they need to eat more starches to treat Type 2. So, yes, I spend all my free time learning about diabetes and annoying people on the internet. There you have it.
The years just before diagnosis for me were a haze of chronic fatigue, repeated illnesses, slogging through college classes when I couldn't concentrate, because otherwise I'd lose my health insurance. I was lucky to have an excellent GP, a professor of medicine who took me seriously and wanted to get to the bottom of it. With every new diagnosis, a new piece of the puzzle fell into place, but still something was missing. I say this a lot, but diabetes was just the last diagnosis. Once I had that, the last big mystery was solved, and I dropped out of school because I didn't need their higher level of coverage anymore. (My GP had already left for greener pastures).
So before diagnosis, I had been barely treading water for quite awhile. I'd always had most of these things and just learned to live with them, but I started to get really sick when I started my Master's degree in 2002. I wasn't diagnosed with diabetes until 2005, when I was 27. People seem to define themselves in terms of their careers, or their aspirations. My aspirations were things like getting through the next day, or even the next hour, and my career motivation was what I jokingly referred to as, "get to work or you're fired."
I don't define myself by my career. There was a time when I really wanted to be a librarian (surprisingly while working in a library), so I went to library school. By the time I got there, though, it just didn't seem as important. I arrived at a much less accessible campus than where I did my undergrad, and discovered for the first time in my life that I'm disabled. I know, I know. It had just never occurred to me before. As they say, life got in the way, and I fell behind in my career because I wasn't up to a full time job. I spent several of the last few years unemployed, because I can't do physically demanding jobs anymore (or fake it well enough), and people are pretty puzzled by my resume since I didn't take the usual career path. I would still love to go back to school and seriously take all those classes, but I don't have the stamina.
On the other hand, I am lucky now to be in a better situation so that I can sit at my computer all day without it being excessively painful. I'm in much better health now. On the other hand, I'm not young anymore. I hear some groaning out there, but it's true. I've always loved to learn and to research. So now I spend my time researching diabetes. I got so frustrated when I was first diagnosed and couldn't find any information that made sense. I even went to the medical library and checked out all the textbooks, but they didn't make sense, either. Now, I get it. They didn't make sense because people just didn't know any better. Of course sliding scale regimens are great! Of course Lantus is scary and untested and not safe for pregnancy or small children! If you're laughing, consider that many people believe it because the long term studies haven't been done yet on these new things, so they couldn't possibly recommend them to patients. Seriously. Hands up, how many people want to go back to R and NPH? Anyone want to convince an angry toddler that they have to eat more carbs to feed the NPH?
Before diabetes, I was just someone who liked to learn, and somehow now I've become someone who likes to learn about diabetes. Someone sarcastically asked me recently, "what, do you just research diabetes all the time?" I laughed, because...I do. I've learned the hard way that the other things I used to do were too stressful, or I didn't really enjoy them, whereas now I have something to do that's interesting and important. I will stop when doctors stop telling people they have "borderline diabetes," to lose some weight and see them in three months. I will stop when people understand one kind of diabetes, maybe even two! I will stop when people know that there is still no cure for Type 1. I will stop when large organizations stop telling people they need to eat more starches to treat Type 2. So, yes, I spend all my free time learning about diabetes and annoying people on the internet. There you have it.
Monday, July 14, 2008
everything police
I guess I don't have much to say lately. My endo appointment went well. Well, the actual appointment - the day wasn't so great. It's July and I got a call from my grandmother a couple weeks ago. She wanted me to fly out and surprise my mother who was visiting her the next week. The problem with that (besides the timing) being that I haven't spoken to my mother since July of 2005.
They say she's doing better now, after going to rehab (again) six months ago. She's been trying to contact me pretty much the whole time, but six months ago the 3 am phone calls stopped and more reasonable attempts were made. Still, I don't think people change that much in even six months. I don't know if I'm up for the journey, either. I put a lot of time and effort into helping her before because she managed to keep me alive for 18 years (you can't hear me, but that's kind of a joke because really it was more in spite of her), but it was all for nothing. My family are all mad at me because they seem to think it's my job to keep "helping" someone who refuses to fundamentally change. They think I'm bitter and unfair and it couldn't possibly have been as bad as I say. They don't even know the half of it, actually. I'm not even bitter about it, just pragmatic.
Do I really want someone back in my life who is going to constantly nag me in a completely unhelpful manner? Who judges my life choices and always criticises no matter how I succeed? Someone who's only seen me once in the past ten years and never saw me eat for ten years before that, but thinks it's perfectly acceptable to repeatedly tell me I got Type 1 diabetes because I "eat a lot of junk food?" (For the record, I don't, and never really have). Someone who can't stop herself from commenting on my personal life (or what she thinks it is, which is totally off base) in public, often, and loudly? I mean, intellectually I know that what she says has nothing to do with me or my reality. It's all about her, her insecurities, and her fears. She actually knows what causes Type 1 diabetes, but she can't mentally allow me to be who I am because she feels like it's somehow a judgment of her. Knowing that doesn't make it any easier to actually be around her, though.
Still, there is a family event coming up where I know we would have to be there, and I'm already having trouble picturing her constant nutso criticism and me not just getting up and leaving. With the diabetes, I have kind of a short fuse when someone does it in person, while I'm doing stuff. I am totally willing to talk about diabetes, but not while I'm actually doing it and need to think about what I'm doing. My mother is like the Everything Police. Then, the usual techniques don't work, either and tend to exacerbate things. If you try to shame her about what she's saying (in a Miss Manners style), she just gets more agitated and insistent. Family situations are also a huge trigger for her, and I find them difficult to deal with as well, because I kind of feel like people are trying to force me into a role I never even had. Coming up on three years now, and this is what's on my mind.
They say she's doing better now, after going to rehab (again) six months ago. She's been trying to contact me pretty much the whole time, but six months ago the 3 am phone calls stopped and more reasonable attempts were made. Still, I don't think people change that much in even six months. I don't know if I'm up for the journey, either. I put a lot of time and effort into helping her before because she managed to keep me alive for 18 years (you can't hear me, but that's kind of a joke because really it was more in spite of her), but it was all for nothing. My family are all mad at me because they seem to think it's my job to keep "helping" someone who refuses to fundamentally change. They think I'm bitter and unfair and it couldn't possibly have been as bad as I say. They don't even know the half of it, actually. I'm not even bitter about it, just pragmatic.
Do I really want someone back in my life who is going to constantly nag me in a completely unhelpful manner? Who judges my life choices and always criticises no matter how I succeed? Someone who's only seen me once in the past ten years and never saw me eat for ten years before that, but thinks it's perfectly acceptable to repeatedly tell me I got Type 1 diabetes because I "eat a lot of junk food?" (For the record, I don't, and never really have). Someone who can't stop herself from commenting on my personal life (or what she thinks it is, which is totally off base) in public, often, and loudly? I mean, intellectually I know that what she says has nothing to do with me or my reality. It's all about her, her insecurities, and her fears. She actually knows what causes Type 1 diabetes, but she can't mentally allow me to be who I am because she feels like it's somehow a judgment of her. Knowing that doesn't make it any easier to actually be around her, though.
Still, there is a family event coming up where I know we would have to be there, and I'm already having trouble picturing her constant nutso criticism and me not just getting up and leaving. With the diabetes, I have kind of a short fuse when someone does it in person, while I'm doing stuff. I am totally willing to talk about diabetes, but not while I'm actually doing it and need to think about what I'm doing. My mother is like the Everything Police. Then, the usual techniques don't work, either and tend to exacerbate things. If you try to shame her about what she's saying (in a Miss Manners style), she just gets more agitated and insistent. Family situations are also a huge trigger for her, and I find them difficult to deal with as well, because I kind of feel like people are trying to force me into a role I never even had. Coming up on three years now, and this is what's on my mind.
Wednesday, June 18, 2008
Urf
I got a phone call a few days ago about my labwork. The nurse said it was "perfect." Since they won't give the actual numbers over the phone, I didn't say anything, but I had my doubts. Anyway, my cholesterol was excellent now (although my HDL was lower), which is great. Last time I was in the normal range, but just out of the diabetic range, if you know what I mean. My A1c was much like last time: abnormally low. I don't know why this has been happening, just for the last year. The endo didn't seem too concerned about it, since we know what my A1c *should* be, and that's not really worrying. It's just confusing to other doctors who of course first want to know what my A1c is, and then I have to explain it. Not that I really have an explanation. Anyway, I just read this about donating blood yesterday in the Diabetes In Control Newsletter:
The donation of red cells does indeed have an effect on A1c levels. Since the test measures a type of hemoglobin in the red blood cell that attaches to glucose, the amount of red blood cells in the blood has a direct correlation to A1c levels.
We already know that patients who have a high turnover in red blood cells, such as those with sickle cell anemia, have an artificially low A1c, because they are making a higher number of new red blood cells. This is similar to what happens when red cells are lost due to a blood donation. A normal donation may require up to four weeks of new red cell production and a double donation may take eight weeks.
It takes about 8 weeks for new red blood cells to attach to glucose and raise the A1c to pre-donation levels.
A1c levels can actually be decreased by 4 to 8% for the first 4 to 6 weeks after a donation, and if a double donation A1c can be as much as 16% off for even a longer time.
Based on this information it is important to tell your patients that they should have their A1c done just prior to the donation, and more importantly we should ask if they have donated blood when they see us for an appointment.
Information from Practical Diabetology June 2008
Richard Benjamin, MD, CMO American Red Cross Blood Services
I don't donate blood. I don't have anything obvious, like sickle cell. I do have recurring anemia and have to take iron or it comes back, but they've never really found an underlying cause (other than the most obvious one). So it sounds like the problem could be too high turnover of red blood cells? I guarantee I am not secretly running low or anything. If anything it should be higher than any past A1c, just due to progression. Oh, and if I saw this A1c for a Type 1, I wouldn't say it was "perfect" - I'd be quite worried.
The donation of red cells does indeed have an effect on A1c levels. Since the test measures a type of hemoglobin in the red blood cell that attaches to glucose, the amount of red blood cells in the blood has a direct correlation to A1c levels.
We already know that patients who have a high turnover in red blood cells, such as those with sickle cell anemia, have an artificially low A1c, because they are making a higher number of new red blood cells. This is similar to what happens when red cells are lost due to a blood donation. A normal donation may require up to four weeks of new red cell production and a double donation may take eight weeks.
It takes about 8 weeks for new red blood cells to attach to glucose and raise the A1c to pre-donation levels.
A1c levels can actually be decreased by 4 to 8% for the first 4 to 6 weeks after a donation, and if a double donation A1c can be as much as 16% off for even a longer time.
Based on this information it is important to tell your patients that they should have their A1c done just prior to the donation, and more importantly we should ask if they have donated blood when they see us for an appointment.
Information from Practical Diabetology June 2008
Richard Benjamin, MD, CMO American Red Cross Blood Services
I don't donate blood. I don't have anything obvious, like sickle cell. I do have recurring anemia and have to take iron or it comes back, but they've never really found an underlying cause (other than the most obvious one). So it sounds like the problem could be too high turnover of red blood cells? I guarantee I am not secretly running low or anything. If anything it should be higher than any past A1c, just due to progression. Oh, and if I saw this A1c for a Type 1, I wouldn't say it was "perfect" - I'd be quite worried.
Tuesday, June 10, 2008
Administrivia
Someone recently asked me, "don't you ever have any good news?" Of course, that was after she called me over and told me in detail about all the terrible things that had happened to her, and then asked me a lot of questions about our (now ex-)landlord. So, I don't know.
I was supposed to see my endo on the 6th (after making the appointment six months ago), but two days before, they called me and said she won't be in that day, so it got changed to the 25th. I took a big hit for that paycheck-wise, because when you take time off, you not only lose the pay, but you lose the health insurance subsidy normally paid by the employer. It was too late to work those hours, and I'll have to take more time off on the 25th, so it was pretty significant. Anyway, I figured I had plenty of time to review my labs, so I called the receptionist (the lab at this place doesn't do copies). She said cheerfully that the doctor hasn't reviewed them with me yet, so I can't have a copy until the 25th. I asked if she was sure, because I'd never heard of anything like that, and she said yes. Okay. The more I thought about it, the more confused and annoyed I became. Doesn't HIPAA say you have to be allowed access to your medical records? I wanted to see the results before my appointment so I could get an idea of what was going on and because I'm totally anal like that.
I called back, and this time I told the cheery receptionist I thought they couldn't do that. So, she transferred me to the nurse, who made more sense, but said all the wrong things. She said it's the doctor's policy not to release labs without reviewing them. She said I don't have to wait until the 25th, just until the doctor is back in the office in a week and that normally this is never even an issue. Then she said, "unfortunately, you picked the week when the doctor is out of town." Aargh (like I picked the week). She said they do this because they had a problem with patients misinterpreting the results. Well, okay, but I think the law allows them to do that, and I don't think I'm that patient. Although now they'll probably all think I'm difficult.
I really love my endo, but I have a really low tolerance for this kind of administrative stuff. I may have to look into other options. I mean, does anyone see why this is annoying?
I was supposed to see my endo on the 6th (after making the appointment six months ago), but two days before, they called me and said she won't be in that day, so it got changed to the 25th. I took a big hit for that paycheck-wise, because when you take time off, you not only lose the pay, but you lose the health insurance subsidy normally paid by the employer. It was too late to work those hours, and I'll have to take more time off on the 25th, so it was pretty significant. Anyway, I figured I had plenty of time to review my labs, so I called the receptionist (the lab at this place doesn't do copies). She said cheerfully that the doctor hasn't reviewed them with me yet, so I can't have a copy until the 25th. I asked if she was sure, because I'd never heard of anything like that, and she said yes. Okay. The more I thought about it, the more confused and annoyed I became. Doesn't HIPAA say you have to be allowed access to your medical records? I wanted to see the results before my appointment so I could get an idea of what was going on and because I'm totally anal like that.
I called back, and this time I told the cheery receptionist I thought they couldn't do that. So, she transferred me to the nurse, who made more sense, but said all the wrong things. She said it's the doctor's policy not to release labs without reviewing them. She said I don't have to wait until the 25th, just until the doctor is back in the office in a week and that normally this is never even an issue. Then she said, "unfortunately, you picked the week when the doctor is out of town." Aargh (like I picked the week). She said they do this because they had a problem with patients misinterpreting the results. Well, okay, but I think the law allows them to do that, and I don't think I'm that patient. Although now they'll probably all think I'm difficult.
I really love my endo, but I have a really low tolerance for this kind of administrative stuff. I may have to look into other options. I mean, does anyone see why this is annoying?
Monday, June 09, 2008
Meme
a. Type your answer to each of the questions below into Flickr Search.
b. Using only the first page, pick an image.
c. Copy and paste each of the URLs for the images into mosaic maker.
1. What is your first name?
2. What is your favorite food?
3. What high school did you go to?
4. What is your favorite color?
5. Who is your celebrity crush?
6. Favorite drink?
7. Dream vacation?
8. Favorite dessert?
9. What you want to be when you grow up?
10. What do you love most in life?
11. One Word to describe you.
12. Your flickr name.
#6 isn't actually my favorite drink, but it is my photo and it came up on the first page. Heh.
Tuesday, May 06, 2008
Huh?
The other day I was surprised to read someone with Type 1 saying, "diabetes will eventually kill me, anyway." Then a lot of other people agreed.
Really?
Am I the only one who doesn't think diabetes will eventually kill me?
Really?
Am I the only one who doesn't think diabetes will eventually kill me?
Thursday, May 01, 2008
In one ear and out the other
I've met some new people lately, and had to tell them I have diabetes. For the most part, it's gone well, but this one woman I think is convinced I have Type 2 for some reason. I'm not sure, though, and I don't really even want to get into it.
Her: You have diabetes?
Me: Yes, I have Type 1 diabetes. *explains what that is for 5 minutes*
Her: Wow, you have a lot on your plate.
Me: I guess so.
Her: I have this friend, but she has juvenile diabetes and boy, does she ever have it hard. *explanation*
Me: ...
I don't really want to say "juvenile diabetes" because I think that's why so many people are convinced that 1. only children get it and 2. it goes away once they stop being children. Still, it seems like even people that should get it, don't.
Her: You have diabetes?
Me: Yes, I have Type 1 diabetes. *explains what that is for 5 minutes*
Her: Wow, you have a lot on your plate.
Me: I guess so.
Her: I have this friend, but she has juvenile diabetes and boy, does she ever have it hard. *explanation*
Me: ...
I don't really want to say "juvenile diabetes" because I think that's why so many people are convinced that 1. only children get it and 2. it goes away once they stop being children. Still, it seems like even people that should get it, don't.
Tuesday, April 29, 2008
Friday, April 18, 2008
Monday, April 14, 2008
Raise your voice
I am raising my voice for Type 1 diabetes, although I admit this content has appeared before. I think it's important, though. It's about LADA (Latent Autoimmune Diabetes in Adults).
This information comes from research, but mainly from experience and reports from out "in the field."
LADA is autoimmune diabetes just like regular Type 1, but it is often misdiagnosed as Type 2. That's because it occurs in adults over 25 and because the onset can take 6-8 years. (While regular Type 1 can occur at any age, the onset is sudden).
How to tell the difference between LADA and Type 2:
- Positive antibody test -- while a negative antibody test is not conclusive, a positive result indicates Type 1 or LADA.
- Weight -- Type 2s on the thinner side are very uncommon except in certain genetically susceptible subgroups of Native Americans, Asians (South Asians, Japanese), Hispanics, Scandinavians, and African Americans. It would be unusual for someone very thin or underweight, and/or in great athletic shape to develop Type 2.
- Family history. Someone with a long family history of diabetes is more likely to have Type 2, although it could be argued that many of these could be unrecognized cases of MODY.
- Weight loss -- Unexplained weight loss before or around diagnosis is associated with Type 1 or LADA, not Type 2.
- Ketones -- Moderate or high ketones are rare in cases of Type 2 and generally only occur in people who have had Type 2 for a very long period of time and no longer make insulin. Moderate or high ketones at diagnosis tend to indicate Type 1 or LADA.
- Progression to insulin -- LADA results in insulin dependence much sooner than Type 2, even within a year of diagnosis. This is working from the outmoded belief that insulin should be prescribed when it's no longer avoidable, though.
- Response to oral medications -- LADA does not respond well, or for very long, to medications used to treat Type 2.
- C-peptide -- This level will decline rapidly as compared with Type 2. In some people in the very early stages of LADA, C-peptide may actually be elevated and seem to indicate Type 2. However, the ensuing quick decline in C-peptide is indicative of LADA.
- Insulin resistance -- LADA is not associated with insulin resistance, although see C-peptide.
- Triglycerides and blood pressure -- these are usually elevated with Type 2, but not usually with LADA.
- Low carb doesn't work -- Assuming none or only moderate overweight, going on a low carb diet does not work to control blood sugars.
- Hypoglycemia -- anecdotal evidence suggests a history of hypoglycemia prior to diagnosis might be associated with LADA.
- Inconsistent blood sugars -- The honeymoon phase in LADA can last several years. During this time, the beta cells often work or not work somewhat intermittently.
Why does it really matter if it's LADA or Type 2?
- Seriousness -- Sadly, Type 1 is often treated more "seriously" and aggressively by doctors and insurance. It can be difficult to get adequate treatment or have insurance pay for the right treatment unless one is classed as a Type 1 rather than a Type 2 (insurance companies only believe in two types of diabetes). Insurance companies will often only cover insulin pumps for Type 1.
- Treatment -- People with LADA should be treated like early Type 1s, not like Type 2s. Early treatment with insulin is believed by many to reduce the workload on the beta cells and preserve their function longer. This is important because retaining some insulin production for as long as possible reduces hypoglycemia and the risk of DKA. Also, background insulin can for most reduce the unpredictability of the beta cells working intermittently.
- Danger -- LADA is subject to the same dangers as Type 1. A few people are diagnosed in DKA (usually as Type 1), but after treatment have a sort of "remission" due to the extended honeymoon period. Still, DKA can occur on rare occasions if insulin production suddenly stops.
So how can I tell if I have LADA instead of Type 2?
- positive antibody test (you can stop now) or low C-peptide?
- quite thin or active and in good shape?
- unexplained weight loss?
- no insulin resistance?
- have you had moderate or high ketones?
- low triglycerides and normal blood pressure?
- high or variable blood sugar despite oral medications and/or low carb diet?
- quick progression to insulin?
This information comes from research, but mainly from experience and reports from out "in the field."
LADA is autoimmune diabetes just like regular Type 1, but it is often misdiagnosed as Type 2. That's because it occurs in adults over 25 and because the onset can take 6-8 years. (While regular Type 1 can occur at any age, the onset is sudden).
How to tell the difference between LADA and Type 2:
- Positive antibody test -- while a negative antibody test is not conclusive, a positive result indicates Type 1 or LADA.
- Weight -- Type 2s on the thinner side are very uncommon except in certain genetically susceptible subgroups of Native Americans, Asians (South Asians, Japanese), Hispanics, Scandinavians, and African Americans. It would be unusual for someone very thin or underweight, and/or in great athletic shape to develop Type 2.
- Family history. Someone with a long family history of diabetes is more likely to have Type 2, although it could be argued that many of these could be unrecognized cases of MODY.
- Weight loss -- Unexplained weight loss before or around diagnosis is associated with Type 1 or LADA, not Type 2.
- Ketones -- Moderate or high ketones are rare in cases of Type 2 and generally only occur in people who have had Type 2 for a very long period of time and no longer make insulin. Moderate or high ketones at diagnosis tend to indicate Type 1 or LADA.
- Progression to insulin -- LADA results in insulin dependence much sooner than Type 2, even within a year of diagnosis. This is working from the outmoded belief that insulin should be prescribed when it's no longer avoidable, though.
- Response to oral medications -- LADA does not respond well, or for very long, to medications used to treat Type 2.
- C-peptide -- This level will decline rapidly as compared with Type 2. In some people in the very early stages of LADA, C-peptide may actually be elevated and seem to indicate Type 2. However, the ensuing quick decline in C-peptide is indicative of LADA.
- Insulin resistance -- LADA is not associated with insulin resistance, although see C-peptide.
- Triglycerides and blood pressure -- these are usually elevated with Type 2, but not usually with LADA.
- Low carb doesn't work -- Assuming none or only moderate overweight, going on a low carb diet does not work to control blood sugars.
- Hypoglycemia -- anecdotal evidence suggests a history of hypoglycemia prior to diagnosis might be associated with LADA.
- Inconsistent blood sugars -- The honeymoon phase in LADA can last several years. During this time, the beta cells often work or not work somewhat intermittently.
Why does it really matter if it's LADA or Type 2?
- Seriousness -- Sadly, Type 1 is often treated more "seriously" and aggressively by doctors and insurance. It can be difficult to get adequate treatment or have insurance pay for the right treatment unless one is classed as a Type 1 rather than a Type 2 (insurance companies only believe in two types of diabetes). Insurance companies will often only cover insulin pumps for Type 1.
- Treatment -- People with LADA should be treated like early Type 1s, not like Type 2s. Early treatment with insulin is believed by many to reduce the workload on the beta cells and preserve their function longer. This is important because retaining some insulin production for as long as possible reduces hypoglycemia and the risk of DKA. Also, background insulin can for most reduce the unpredictability of the beta cells working intermittently.
- Danger -- LADA is subject to the same dangers as Type 1. A few people are diagnosed in DKA (usually as Type 1), but after treatment have a sort of "remission" due to the extended honeymoon period. Still, DKA can occur on rare occasions if insulin production suddenly stops.
So how can I tell if I have LADA instead of Type 2?
- positive antibody test (you can stop now) or low C-peptide?
- quite thin or active and in good shape?
- unexplained weight loss?
- no insulin resistance?
- have you had moderate or high ketones?
- low triglycerides and normal blood pressure?
- high or variable blood sugar despite oral medications and/or low carb diet?
- quick progression to insulin?
Wednesday, March 26, 2008
Meme
I was tagged by Minnesota Nice.
Six Word Memoir Rules:
1. Write your own 6 word memoir
2. Post it on your blog and include a visual illustration if you'd like
3. Link to the person that tagged you in your post and to this original post if possible so we can track it as it travels across the blogosphere
4. Tag 5 more blogs with links
5. And don't forget to leave a comment on the tagged blogs with an invitation to play!
I like stuff. Okay, some stuff.
Bet you weren't expecting that! And yet, it's so true. Anyway, I tag Emm, Tiffany, Rikki, Mel, and Christine.
Six Word Memoir Rules:
1. Write your own 6 word memoir
2. Post it on your blog and include a visual illustration if you'd like
3. Link to the person that tagged you in your post and to this original post if possible so we can track it as it travels across the blogosphere
4. Tag 5 more blogs with links
5. And don't forget to leave a comment on the tagged blogs with an invitation to play!
I like stuff. Okay, some stuff.
Bet you weren't expecting that! And yet, it's so true. Anyway, I tag Emm, Tiffany, Rikki, Mel, and Christine.
Saturday, March 22, 2008
Photographic evidence
I've kind of hit a plateau with Diabetes 365. I haven't missed any days, but I'm feeling less enthused about it and it's been longer and longer between uploads. Mainly it's that I don't think my photos are very good and what was okay for an occasional shot looks different when you have hundreds of them. To some extent I am limited by equipment, but also I just don't know a lot about photography or shooting objects.
For some reason, I feel strangely drawn to the original 365 project, 365 Days. On the one hand, I feel it's kind of weird to take photos of yourself, but on the other hand, I have very few photos of myself from the past seven years (because I am the only photo taker) which I find kind of disappointing. In a way, it seems strange, because I grew up in a family that despite its numerous issues took photos of absolutely everything. I guess that's the way it goes, though.
I feel like doing a new project will actually infuse new life into my older project, instead of taking away from it. I'm still trying to decide, though.
In other news, recovering from the flu and still quite tired, but my toe is better and the government sent us some of our money back.
For some reason, I feel strangely drawn to the original 365 project, 365 Days. On the one hand, I feel it's kind of weird to take photos of yourself, but on the other hand, I have very few photos of myself from the past seven years (because I am the only photo taker) which I find kind of disappointing. In a way, it seems strange, because I grew up in a family that despite its numerous issues took photos of absolutely everything. I guess that's the way it goes, though.
I feel like doing a new project will actually infuse new life into my older project, instead of taking away from it. I'm still trying to decide, though.
In other news, recovering from the flu and still quite tired, but my toe is better and the government sent us some of our money back.
Tuesday, March 18, 2008
Purses
I've been meaning to mention this for awhile, but the place where I get these kinds of purses:
is now making a smaller model for all those of you who can get by with a smaller bag (not me). Here is the smaller one which comes in a lot of colors:
I really like the inside of the smaller one, but I just have too much stuff to carry, so I got another larger one. I love them, and I'm pretty hard on bags.
is now making a smaller model for all those of you who can get by with a smaller bag (not me). Here is the smaller one which comes in a lot of colors:
I really like the inside of the smaller one, but I just have too much stuff to carry, so I got another larger one. I love them, and I'm pretty hard on bags.
Monday, March 10, 2008
Enough already
Well, around Thursday I started getting really tired - much more tired than I had been. On Thursday night, I tried to go into the store to buy one thing and discovered I was so tired I could barely make it out of the store again. Like my limbs just wouldn't go. I also had joint, muscle, and nerve pain. Joint and nerve pain is pretty standard for me, but this was way worse. I only get all over muscle pain if I try to do something, like clean something, give the cat a bath, etc. Since I just *had* given the cat a bath on Wednesday, I figured it must be that, even though it was much worse than usual. The pain didn't go away, though. The surprising thing is how high my pain level is given all the painkillers I'm taking (for me). I've also been sleeping 10-12 hours a night and still feel so tired all the time that I can barely lift my arms, or anything else. I don't feel like eating at all.
Anyone else see where this is going? Well, I didn't until today. I heard my husband coughing because he stayed home from work sick (which he NEVER does), and something "clicked." Duh, I have the flu. How does one have the flu for five days without noticing? Well, I normally have chronic pain, I've had chronic fatigue (not CFIDS) in the past, I normally have all these transient things, I'm on a lot of painkiller for the whole teeth thing, and my body doesn't really do fevers because I have an autonomic nervous system disorder. I'm not coughing, but I've had the flu once before, and I didn't cough then, either.
At least if this is day 5 for me, it should be over soon. My husband is definitely getting the short end of the stick here, since he's never sick and isn't used to this sort of thing the way I am. It's too late for him to get Tamiflu, unfortunately.
Anyone else see where this is going? Well, I didn't until today. I heard my husband coughing because he stayed home from work sick (which he NEVER does), and something "clicked." Duh, I have the flu. How does one have the flu for five days without noticing? Well, I normally have chronic pain, I've had chronic fatigue (not CFIDS) in the past, I normally have all these transient things, I'm on a lot of painkiller for the whole teeth thing, and my body doesn't really do fevers because I have an autonomic nervous system disorder. I'm not coughing, but I've had the flu once before, and I didn't cough then, either.
At least if this is day 5 for me, it should be over soon. My husband is definitely getting the short end of the stick here, since he's never sick and isn't used to this sort of thing the way I am. It's too late for him to get Tamiflu, unfortunately.
Wednesday, March 05, 2008
More and more
Well, I got a recommendation for a good dentist. Drawback: he's 18 miles away. I didn't really care; I've seen enough bad dentists in my life. They were able to get me in on Monday, too!
I took a copy of my panoramic x-ray, although the receptionist said it was basically useless. Well, as it turns out, the dentist kept referring to it, the assistant made notes on it, and I had to convince them to give it back to me (since it's my copy) when I left. Anyway, I was telling the assistant I thought #14 had a cavity on the panoramic. She scoffed and said it would have to be the "world's largest cavity" to show up on that. Then she did a full set of x-rays - luckily I had taken the good painkiller, because no one's ever successfully gotten a full set out of me before. My mouth is too small, apparently. They also measured my gums. Again with the painkiller. I will have to remember that in case I ever have it done again. I did really like the dentist, though, and he also does implants.
Well, the result of the x-rays is that I have the world's largest cavity in #14. I also have multiple cavities in every tooth I own. I wasn't too surprised by that, since I have weak enamel and my teeth are too soft. It's just something that you're born with. Anyway, I have to have a root canal, so they referred me to an endodontist.
The endodontist wasn't able to get me in until the 17th! Still, that might even work out better for me (despite the obvious drawback of waiting) because I can't get any more time off. They're having me come in next week for an "evaluation." They said that during the evaluation, they decide whether a root canal is actually needed. I think I burst out laughing when they said that.
I took a copy of my panoramic x-ray, although the receptionist said it was basically useless. Well, as it turns out, the dentist kept referring to it, the assistant made notes on it, and I had to convince them to give it back to me (since it's my copy) when I left. Anyway, I was telling the assistant I thought #14 had a cavity on the panoramic. She scoffed and said it would have to be the "world's largest cavity" to show up on that. Then she did a full set of x-rays - luckily I had taken the good painkiller, because no one's ever successfully gotten a full set out of me before. My mouth is too small, apparently. They also measured my gums. Again with the painkiller. I will have to remember that in case I ever have it done again. I did really like the dentist, though, and he also does implants.
Well, the result of the x-rays is that I have the world's largest cavity in #14. I also have multiple cavities in every tooth I own. I wasn't too surprised by that, since I have weak enamel and my teeth are too soft. It's just something that you're born with. Anyway, I have to have a root canal, so they referred me to an endodontist.
The endodontist wasn't able to get me in until the 17th! Still, that might even work out better for me (despite the obvious drawback of waiting) because I can't get any more time off. They're having me come in next week for an "evaluation." They said that during the evaluation, they decide whether a root canal is actually needed. I think I burst out laughing when they said that.
Monday, March 03, 2008
And again
Well, I went to see my internist on Friday and he was appalled I didn't get any treatment from the dentist (and even worse, it's his dentist). So he wrote me a Z-pac just in case and told me Darvocet could be cut in half. I tried it at night first and it seemed okay, so I tried it during the day. It makes the pain somewhat bearable.
At one point I discovered one of my teeth (#14) is more painful than the others. It already has a lot of fillings. I looked at it more closely and it looks like it's cracked. Frankly, I would be glad if that's the problem if it's just a matter of a root canal and filling it in. It's not like it's in the front. You can see it on the x-ray here if you want. Compared to #3 it looks like it might have a cavity.
So after taking the painkiller I had some time to think. Why did the dentist refer me to a prosthodontist for a serious dental and health emergency? Now, I do need to see the specialist eventually, but for this? I called his office and they confirmed they don't handle this kind of work. So it looks like I need to find another dentist! I don't want to go to just any dentist; I've had all kinds of bad luck in the past. I will check around.
I'm almost tempted to try to go back to my old dentist in Bellingham. None of *his* crowns have fallen out of my mouth, and he was always excellent. He's apparently having some legal troubles right now, though (nothing I'm that concerned about) so I'm not sure if he's still practicing. Also, he's not open on the weekends so I'd have to get up to Bellingham during the day (I don't drive) and that's a lot of time. So I don't know.
At one point I discovered one of my teeth (#14) is more painful than the others. It already has a lot of fillings. I looked at it more closely and it looks like it's cracked. Frankly, I would be glad if that's the problem if it's just a matter of a root canal and filling it in. It's not like it's in the front. You can see it on the x-ray here if you want. Compared to #3 it looks like it might have a cavity.
So after taking the painkiller I had some time to think. Why did the dentist refer me to a prosthodontist for a serious dental and health emergency? Now, I do need to see the specialist eventually, but for this? I called his office and they confirmed they don't handle this kind of work. So it looks like I need to find another dentist! I don't want to go to just any dentist; I've had all kinds of bad luck in the past. I will check around.
I'm almost tempted to try to go back to my old dentist in Bellingham. None of *his* crowns have fallen out of my mouth, and he was always excellent. He's apparently having some legal troubles right now, though (nothing I'm that concerned about) so I'm not sure if he's still practicing. Also, he's not open on the weekends so I'd have to get up to Bellingham during the day (I don't drive) and that's a lot of time. So I don't know.
Sunday, March 02, 2008
And now for something a little
2 March 2008 Day 146
Originally uploaded by lilituc.
Here I am with Gary Scheiner (in what has to be the most unflattering light ever). He was great, though!
I spent this weekend at the Children With Diabetes Focus on Pumping conference. It was very interesting. One of the pump reps remarked that it was such a different atmosphere from the usual - where everyone "gets it." That sums it up pretty well.
I don't know if the larger conferences are the same way, but it was definitely focused on parents of children under 18. Many of the speakers and reps were adults with Type 1, and a couple of the parents were, but otherwise it seemed like I was the only one there without a child. Yet while the focus was more on children, I could still apply the information, knowing the differences between management of children and adults.
My husband decided to sign up for a TrialNet study, since his father has Type 1. They take a blood sample, test it for antibodies, and will let him know the results in 4-6 weeks.
Thursday, February 28, 2008
Toothache, headache
There's nothing to get me riled up about healthcare like dental care. I only have dental insurance until the 29th. For those of you outside the US, dental insurance is not as exciting as it sounds. Common plans pay 50-80% of "covered" expenses, and there's an annual maximum they will pay, like $1000 or $2000 (that's for your whole family). Consider that one root canal and crown costs $1200-$2000.
Anyway, I've been having this excruciating pain in my mouth (top and bottom) for two days. It's unclear where the pain is coming from, if it's related to the surgery I had in December, what. Then yesterday a crown broke off and fell out of my mouth, all by itself. It's not even near the painful area! So I did what any American is supposed to do - I went to see my dentist as soon as he could get me in. (Woe to those who don't have a regular dentist.) He said the crown took too much with it and can't be put back, so I'm looking at another $2500 implant in addition to the one I already have to get.* What about the pain? Well, he didn't even want to do an exam. He said that as a general dentist, he doesn't feel comfortable treating me, and I need to see a specialist. The specialist can't get me in until next week, when I won't have dental insurance, and like most dental professionals they expect to be paid the day of service or they won't perform it.
What this means is that I don't know how long I'm going to be living with this kind of pain. I can't afford to see a specialist and pay all of it out of pocket. Once again, I can't chew, and even when I can, my chewing is impaired by all the holes and other things in my mouth. It's not surprising the tooth with the crown broke when you look at my teeth - they're extremely soft and they've always been. So I have these problems.
What gets me about this sitation is that 1. dental work is so expensive and there's not really any facility to help. (Don't even get me started on how Medicaid "covers" dental work). I can't go to a dental school or low income clinic, although in other places for other people that may be an option. The care you receive there may not be the same, though. Then there's 2. why is the mouth not considered part of the body? This pain won't let me eat or sleep and makes it difficult to drink. I have ketones, which yesterday were moderate. My bg is acting really stubborn. I woke up at 3 am really nauseated and had to throw up (no, not low). If I didn't stay on top of the ketones, I could end up in the ER, which I'm sure my health insurance would tell me isn't covered because it's my teeth.
Someone from Australia asked me why I didn't just go to the dental clinic and tell them it was an emergency. Do you really have those there? I wish we had them.
* Getting an implant is a long process - they have to remove the remaining tooth, seat the implant, wait 6-8 months, and then put the crown on it. I can't get a bridge or anything else due to the condition of the other teeth in my mouth. Both of the problem teeth are in the front of my mouth.
Anyway, I've been having this excruciating pain in my mouth (top and bottom) for two days. It's unclear where the pain is coming from, if it's related to the surgery I had in December, what. Then yesterday a crown broke off and fell out of my mouth, all by itself. It's not even near the painful area! So I did what any American is supposed to do - I went to see my dentist as soon as he could get me in. (Woe to those who don't have a regular dentist.) He said the crown took too much with it and can't be put back, so I'm looking at another $2500 implant in addition to the one I already have to get.* What about the pain? Well, he didn't even want to do an exam. He said that as a general dentist, he doesn't feel comfortable treating me, and I need to see a specialist. The specialist can't get me in until next week, when I won't have dental insurance, and like most dental professionals they expect to be paid the day of service or they won't perform it.
What this means is that I don't know how long I'm going to be living with this kind of pain. I can't afford to see a specialist and pay all of it out of pocket. Once again, I can't chew, and even when I can, my chewing is impaired by all the holes and other things in my mouth. It's not surprising the tooth with the crown broke when you look at my teeth - they're extremely soft and they've always been. So I have these problems.
What gets me about this sitation is that 1. dental work is so expensive and there's not really any facility to help. (Don't even get me started on how Medicaid "covers" dental work). I can't go to a dental school or low income clinic, although in other places for other people that may be an option. The care you receive there may not be the same, though. Then there's 2. why is the mouth not considered part of the body? This pain won't let me eat or sleep and makes it difficult to drink. I have ketones, which yesterday were moderate. My bg is acting really stubborn. I woke up at 3 am really nauseated and had to throw up (no, not low). If I didn't stay on top of the ketones, I could end up in the ER, which I'm sure my health insurance would tell me isn't covered because it's my teeth.
Someone from Australia asked me why I didn't just go to the dental clinic and tell them it was an emergency. Do you really have those there? I wish we had them.
* Getting an implant is a long process - they have to remove the remaining tooth, seat the implant, wait 6-8 months, and then put the crown on it. I can't get a bridge or anything else due to the condition of the other teeth in my mouth. Both of the problem teeth are in the front of my mouth.
Subscribe to:
Posts (Atom)
