D-DAY - Living with Type 2: 2018 Update, New Meds, New Results

An ongoing look a life as a type II diabetic...

Last year at this time, I was in the 8 range for my A1C readings and pushing 160-190 on my glucose readings. My weight wasn't going anywhere, either, so in June, I sat down with my doctor and discusses my options.

I had been taking a combination of Metformin and pioglitazone to control my glucose, plus supplementing those with broccoli sprout extract. 

I hate the pioglitazone because it doesn't do a lot for my readings...a very temporary drop of 10 points or so...and has the troubling side effect of weight gain. It also increases your risk for bladder cancer.

My personal research showed that SGLT2 Inhibitors also lower your numbers and have a common side effect of weight loss.  This class is where you find the likes of Trulicity, Farxiga, and Jardiance.

The bad side effects of this type of drug, where it triggers your kidneys to flush out excess blood sugar through urination, is dehydration which can lead to a urinary tract infection. 

Still, it sounded like something that would work for me...I'd just have to make sure to stay hydrated.

Before my June appointment, I check with my insurer to see how much these meds...which currently have no generic equivalent...would cost. Jardiance, for example, without insurance would be well above $500 for a 1 month supply. With my insurance, Trulicity would be $100 a month and Jardiance $35.

My doctor preferred the once-a-week injection of Trulicity but I preferred paying the lower amount for the pill form of Jardiance. He said he'd consider it after he reviewed the results of this visit's tests.

Low and behold, the lab got the instructions wrong and didn't do a A1C test...the main test to check on a diabetic's progress. The doctor told me to come back in for another blood test. After being stuck 5 times for the last test, I wasn't thrilled with that prospect. 

Metformin, twice a day, and one Jardiance in the morning

I told him I'd wait until the next 3 month checkup and would appreciate it if he'd make the call to the pharmacy for the Jardiance.  He was agreeable to this so I started the new Jardiance regimen (at 10mg a day, the lowest dose).

I haven't gotten any UTIs yet but I do get very thirsty and dehydrated at times. I now have a liter sized sports bottle that I bought in Calgary last year. This gets filled once in the morning, drank from during the day, then filled again at dinner so I drink two liters of water a day.

As you can imagine, I need to know where the nearest restroom is at all times but, otherwise, it's a small price to pay.

In addition, I had my first hypoglycemic incident when I took my midday metformin at a local diner after ordering. The food didn't come out for 45 minutes and I got real woozy until the manager gave me a glass of orange juice.  I'll never take metformin again with having some food handy.

Fast forward to October, it's time for my next checkup.  A1C has dropped to 7.4. Still too high but headed in the right direction. My weight has finally started to drop again, another 5 pounds came off bringing my total weight loss from diagnosis (three years ago) to 30 pounds. My blood sugar numbers have dropped back to the 120-140 range, with occasional forays down below 100 and up to 180.

For now, it's not a perfect score but it's headed in the right direction. The doctor agrees, too, so we'll keep this regimen in place and keep monitoring every few months. Since this is a progressive disease, there will come a time when we'll need to adjust again but I'll enjoy this level for awhile.

(DISCLAIMER: This series about Type II is not meant to apply to everyone. This is what works for me, you need to consult with your own medical professionals to find out what will work for you.  My goal here is to simply give you hope that once you're diagnosed, life as you know it does not have to end...you can still enjoy life and the treats it offers.)

Darryl Musick
Copyright 2018 - All Rights Reserved

D-Day - Type II: Better Living Through Chemistry

Yeah, it's been awhile since I've done one of these posts and even longer since I updated the other blog that they appeared on (just don't have time to maintain multiple blogs right now, hopefully that will change in the near future but that's a topic for another time). So let's catch up...

Until last fall (in 2016), I'd been able to maintain a sub 150 blood glucose reading and a 7.0 A1C score fairly easy with diet and exercise alone. Then, I was hit with a double-whammy.

First, I neglected to get a Flu shot and came down with a bout of it late November.  That put my system out of whack and my liver tried to overcompensate and lost it's calibration for awhile.  My numbers shot up to over 200 and over 9 for the A1C.

Just when I was managing to get those numbers to inch down again, I came down with a nasty cold in January which had the same effect.

I couldn't get those numbers down fast enough for my regular check up in March so the doctor put me on metformin, pioglitazone, and a statin. Suddenly, I was the one with all the prescriptions at the pharmacy (I already picked up a monthy supply of test strips, needles, and lisinopril for my blood pressure) and another date with the doctor in two months to see how the new medicine routine effected me.

One thing that concerned my was the pioglitazone. First, most diabetics start off with just metformin, why the extra pill? Second, my doctor said the number one side effect was weight gain.  I'd fought pretty hard to lose 25 pounds and didn't look forward to adding a medication that promised to wipe that out.

So, I faithfully followed instructions and by June my daily readings dropped down to the 150-160 range and A1C to 8.4 plus I had gained 4 pounds.  My doctor advised that I start insulin injections and lose weight.  I told him I wanted to hold off as long as my numbers were trending downward and we made a date for September to check progress.

After that visit and the weight gain, I was a little beside myself, especially with the weight gain that I'm sure was a result of the pioglitazone. To test that theory, I stopped the pioglitazone for a week. At the end of the week, I was down four pounds.

That seemed like some progress.  That same week, I started seeing news about the promising effects of broccoli sprout extract on blood glucose readings in studies. It was easy and cheap to order some via Amazon so I thought "what the heck" and ordered a bottle to see what happened.

Taking the broccoli extract did wonders. Along with the metformin but without the pioglitazone, taking it brought my daily readings down to the 100-140 range. At the September checkup, my A1C was back to 7.1 and I'd lost another pound, bringing my post pioglitazone weight loss to five pounds.

While the formal studies are ongoing, my experience with it seems to support the general thesis that it does work very well in helping to reduce glucose levels. It has also allowed me to stop taking the pioglitazone for now, which only seems to make me gain weight.

Another thing I've noticed is that the metformin in particular, and with the broccoli adding to the effect, is that I cannot eat as much food as I used to. At first, I have the same appetite but if I eat a full portion like I used to, I will get physically ill.  After several episodes, I'm learning...and my body is learning...that smaller portions keep me feeling better.

I'm hoping this effect will also help me peel off a few more pounds. It also means I'm taking quite a bit more leftovers home from restaurants so it helps me save money as one meal turns into two.

While type II diabetes is a progressive disease, so far it seems like I'm able to keep it down with the current medication, diet, and exercise routine (I walk at least 10,000 steps a day and work out two days a week).

This year, I made sure I got my flu shot early and am working hard so that the next check up in January will show some more concrete results.  We'll check back after that to see.

(DISCLAIMER: This series about Type II diabetes is not meant to apply to everyone. This is what works for me, you need to consult with your own medical professionals to find out what will work for you.  My goal here is to simply give you hope that once you're diagnosed, life as you know it does not have to end...you can still enjoy life and the treats it offers.)

Darryl
Copyright 2017 - Darryl Musick
All Rights Reserved

D-Day - Living With Type II: Eating Whatever I Want

It is true, even with Type II diabetes, I can eat whatever I want. The caveat is I can't eat it whenever I want or have as much as I want.


The thing with this disease is that you need to closely monitor it. You're trying to keep an even keel, staying withing the optimum range of blood glucose levels.


Since I'm a big fan of protein, that's not too much of a problem for me. In fact, sometimes my meal is a little too protein heavy and I need to munch a handful of candy to get back into range when my numbers get too low.

While that has not been a problem, probably the hardest thing I've had to learn is to not eat between my scheduled meals. That means eat a reasonable breakfast then nothing till lunch. Another balanced meal in the middle of the day, then nothing til dinner.  A couple hours after dinner, I allow myself a small snack.


That's it.  Nothing more.  No Girl Scout cookies from the secretary next door.  No tootsie rolls from the dish in my attorney's office. Ixnay on the oreos my credit union likes to have out on a platter.

Once in awhile, though, I can break out of that routine.  If I haven't had dessert for awhile, I might allow myself a slice of cheesecake after dinner, especially if it's a protein rich meal that I know will not affect my glucose level too much. A slice of cake on my birthday or maybe a cinammon roll once every couple of months to get my Sunday morning going or a Milky Way from the gas station to keep me awake on a very long drive.


The key, of course, is keeping an eye on how it effects me. As long as my numbers are consistently good, a rare spike in the glucose for a treat will not harm me.  I just have to remember, if I'm going to cash in some chips for that rare treat, make sure it's something that's really worth it.


(DISCLAIMER: This series about Type II is not meant to apply to everyone. This is what works for me, you need to consult with your own medical professionals to find out what will work for you.  My goal here is to simply give you hope that once you're diagnosed, life as you know it does not have to end...you can still enjoy life and the treats it offers.)


Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

D-Day - Living with Type II: The Sweet Spot

I'm lucky in one way, I don't really have a sweet tooth. 

It's not that I don't like sweets, I do. I enjoy a good Milky Way bar, had some real good ice cream not too long ago, cheesecake with a good raspberry topping sounds good to me, and I love Jelly Bellies. But it's just not something I crave.

My wife and son seem to live for their desserts while I can go quite awhile without them.

Still, when you have to watch your sugar, things get a little amplified.  I can't just take a swing down to the snack bar and grab a bag of Sugar Babies when the hunger appears or take a simple snag out of the donut box one of my attorneys just brought in.

Once in awhile, though, I do like to have an indulgence and I've found two times I can give in.

First, and this has been very rare since my diagnosis, when my blood sugar takes a precipitous drop. For example, a month or so ago, my blood dropped down quickly from the 120's down to the 80's after a protein-heavy meal.  

That's the sign to grab a few Jelly Bellies...purely for the quick response back into the zone, mind you. A sweet, tasty response at that.

Second, I've noticed on my blood profiles and regular testing that my glucose levels drop the most in the afternoon between lunch and dinner. Frequently getting down to the low 100's or even 90's.

This is my sweet spot.  Not that I really want a whole lot but if I do get a craving, I plan that candy or dessert indulgence for my after lunch let down.

Another reason to remember that the diagnosis is not a death sentence or the end of the fun.

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

D-Day - Living with Type II: Great Helpers in the Fight Against Diabetes

As I go along on the journey of a diabetic, I learn what my friends and foes are in the food world.  I've talked about some of the foes in the past, let's meet some friends.

First, I have to give recognition to two of the best places to find diabetic friendly food, Costco and Trader Joes, I can find quite a bit in those aisle.

Eggs are full of protein and are pretty diabetic friendly but the yolks add a bit of fat and a good dose of bad cholesterol, which can bring some other complications to a diabetic.  I've got good numbers from my latest checkup except that my cholesterol has creeped up just above the red line.

I could eat eggs morning, noon, and night. I love them and would eat two a day.  A bit much so I found these Kirkland egg whites at Costco. Now, I replace one of the eggs with an ounce of this which is not a great sacrifice at only 25 calories, no fat, 5 mg of protein, and 75 of sodium.

It's tasty, easy, and pretty cheap. One container of a similar product at Trader Joes costs about five dollars. A six pack at Costco is less than ten and the other containers freeze very well.

Also at Costco is this jerky, which has half the sodium (330 mg) of comparable jerkies, 60 calories, a half gram of fat, 5 grams of carbs, and 9 protein.

Along with this Havarti cheese from Trader Joes, an ounce of jerky with half an ounce of cheese is good for a quick twenty point reduction in my glucose level.

Bread is not what is considered friendly for diabetics, it's true, but this multigrain bread from Kirkland loads those carbs so slowly that it almost seems neutral.  I made a grilled cheese and ham using it (recipe coming soon!) that actually lowered my glucose by 8 points. It's 140 calories per slice, 1.5 grams of fat, 210 mg. of sodium, 26 grams of carbs, and 6 of protein.

Speaking of ham, I use the low fat and low sodium variety made by Danola or Trader Joe's Healthy Ham for a really good dose of lean protein that really gives a satisfying kick to dishes such as this omelet as well as that sandwich. A slice of that ham has 20 calories, 180 mg. of sodium, no fat, no carbs, and 5 grams of protein. I use half a slice in either the omelet or the sandwich.

It's a journey but I'm glad I'm finding some treasures along the way. All of these foods have gone a long way to be tasty and keep me from feeling hungry. Hope to have some more to share with you soon.

Darry
Copyright 2016 - Darryl Musick
All Rights Reserved

This Week's Menu: French Omelet and Spring Ham Salad

We're trying to be healthy and diabetic friendly this week with a couple of meals that actually lowered my glucose, one (the omelet) by almost 40 points!

The omelet is a super tasty and very filling entree that can be served for any meal.  The salad is a bit lighter but still very tasty and satisfying.

Recipes are at the links below.

BRUNCH: French Omelet

LUNCH: Spring Mix Salad

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

French Omelet

This can be for breakfast or brunch. Heck, we've even had it with dinner where it can be paired easily with a lighter red like a Beaujolais.  It's called a French omelet because it's a dish I came up with after visiting the local market in the South of France (if you ever want to really get inspired to cook, try going to a French farmers market).

It's easy to cook, although some items may be a bit of a chore to find. For instance, in France, they have incredible dark purple asparagus and another purple elephant garlic that you just can't find around here, so I've substituted shallots and regular asparagus.

It really does taste better in France, which will amaze you after you find out just how good this version tastes (spoiler: it's really good).

INGREDIENTS (for each omelet, increase as appropriate for more)

2 eggs 
1 teaspoon half and half
1/2 ounce goat cheese
salt
pepper
nutmeg
2 links of merguez sausage (may be available at Whole Foods or other gourmet markets)
4 spears asparagus
1/2 bulb shallot (chopped fine)
2 tablespoons olive oil

Chop the asparagus into half inch pieces. In a 12 inch frying pan, heat up one tablespoon of oil.  Cook the asparagus for about 5 minutes, stirring frequently.  Add the shallot and cook until just translucent.  Set the mixture aside in a bowl.

Chop up the sausage.  I like to freeze them first and cut with a tomato knife which makes it easier to get clean cuts.

Brown the sausage in the pan, put in the bowl with asparagus and shallot.

In a bowl, mix the eggs and half and half. Add a dash of salt, pepper, and nutmeg before whisking.

You're going to use your sausage, asparagus, shallot mixture and sliced up cheese in as a filling.

In an eight inch pan, heat up the other tablespoon of olive oil. Pour in the egg mixture when hot. Using a spatula, lift up the edges to let the liquid mixture fill in under the cooked egg. When just a little liquid is left on the surface, put in the filling across the center. Fold the far edge over. Let sit for about 10 seconds and flop into a plate.

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

LUNCH: Spring Ham Salad

This is my go-to meal for a quick, easy, amazingly tasty, satisfying, and healthy lunch.  Super easy to throw together, low carb, good protein, and good fats for a meal you'll never feel guilty about eating.

INGREDIENTS

2 cups spring salad mix
6 or 7 cherry tomatoes
1/4 oz. shredded Mexican cheese blend
1/2 oz. sliced ham
1/2 tablespoon olive oil
1/2 tablespoon balsamic vinegar

Simply put the salad mix in a bowl, sprinkle the tomatoes, cheese, and ham over the top.  Mix the oil and vinegar and use as the dressing.

For this one, I'll even include the nutritional info...

Calories - 176
Protein (grams) - 9
Carbs - 15
Fat - 9
Sodium - 218
Sugar - 5

Glucose Effect:
Pre-meal level   - 127
Post-meal level - 118

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

D-Day: Sounds Scary But It Can Be a Blessing

The big news this week is that, according to a UCLA study, nearly half of Californians are either prediabetic or have undiagnosed diabetes.  Sounds scary and, if you ignore your own probability, it is.

I never really thought about it until I was diagnosed but, I have to say, it's been more of a blessing than a curse for me. Think about it...the biggest prescription to early type 2 diabetes or prediabetes is to eat.

You just have to eat with a purpose, a passion, and reason.

With constant testing, you quickly learn exactly what you can eat (a lot more than you think), how often, and what you need to limit or avoid.

I've learned that three foods have the biggest effect on my blood sugar...regular pasta, white rice, and flour tortillas.  I've also learned how to eat around them...whole wheat pasta, brown rice (or none at all since I don't really care for it anyway), and smaller or corn tortillas.

With that in mind, I'll start sharing some of the meals that have had little or no effect on my sugar...unless it's to lower it.

Steak and eggs...had this dish at the Bull Pen in Redondo Beach, California, which also came with sourdough toast and hash browns. I only ate half of the hash browns but finished everything else. Raised my glucose 20 points.

The prime rib dinner at the Bull Pen only raised it 40 points.

Our lasagna recipe, using whole wheat pasta raised my blood sugar 20 points, as opposed to the over 90 points a regular pasta would.

My wife made some beef stew in the crock pot the other day. Came out fantastic and the effect on the glucose was neutral.

So there's a few dishes that are delicious and great for a diabetic like me.  This weekend, I'll have a couple of dishes that actually lowered my glucose level...one by a lot!

Do you have any diabetic friendly dishes you want to share?

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

D-DAY: The Journey of Thousand Miles Starts with Ten Thousand Steps

I kind of look at diabetes management as a triangle. Sort of like the fire triangle where you need three sides...heat, oxygen, and fuel.

For diabetes, I see it as food, exercise/weight loss, and monitoring.  I've talked about food and monitoring in the last couple of posts, today it's exercise.

I go to the gym twice a week for weight training. My doctor has told me to ease back on that and replace it with a more aerobic exercise. If you follow me on Facebook, you'll know that my biggest form of aerobic exercise is walking.

My wife's a runner.  She loves it. Me? Not so much but I do like walking.  I've been walking daily for a few years now.

At first my minimum walk was a mile a day, which could be accomplished by doing a creative lap of the office complex where I work. Didn't seem like enough, so I started branching out.

Now, I do the 10,000 step regimen where I try to make sure I do a minimum of 10,000 steps a day, which works out to about 3.5 miles. 

One problem is that I get bored easily with exercise and I need some motivation.  Each day, I like to strike out from my office in a different direction.  For the motivation part, I like to take pictures as I go along and post them to my Facebook.

There's not much more to it, just walking and shooting.  I can tell it's helped. I feel healthier and I've lost 25 pounds in a year.

In the meantime, I've been assembling quite a portfolio of life in downtown Los Angeles, as you can see by some of the examples in this post.

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved

D-DAY: The Spatter Specialist

An ongoing look a life as a type II diabetic...

Today is a blood profile day. That means readings throughout the day to gauge how the glucose levels in my blood fluctuate at different times and to see where it spikes and dips, which can point to flaws in the diet during those times that needs to be addressed.

First, a little preparation.  Since I don't get an unlimited supply of lancets and test strips, that means no tests for a couple of days before or after so I can have enough to do this day...a minimum of six tests, one before and after each meal.

Second, have a napkin around at all times or else the spatter will look like the set of Dexter. Well, not quite, but it's going to get bloody in here.

So, with preparations in place, off we go...

First test is my fasting from the night before and pre-breakfast test...150.  That's right at the top of the range and is thanks to a phenomenon knows as the Somogyi Effect. 

Diabetics can be frustrated that after fasting all night, their morning reading is higher than their bedtime reading.  This is because the liver, sensing that there is a drop in blood sugar over an extended time, will release more to replenish the system (it's also called a Liver Dump. The Somogyi Effect is named after the researcher, Dr. Michael Somogyi, who identified it.

As long as my morning reading is within range and doesn't spike to, let's say 200, I'm not going to sweat it.

Breakfast is a bacon (1/4 slice, chopped up) and cheese omelet with 8 ounces of 1% milk which works out to 17 grams of carbs; 13 fat, and 25 protein.

The next test comes two hours after breakfast.  OK, another poke, more blood, and...112! Great number and usually the case with breakfast. My liver realizes it's not going to die and lets my blood sugar drop back down to a reasonable level. (see pic above)

In between breakfast and lunch, I go for a walk. My diabetic education nurse says a half hour walk can lower your blood sugar by 40 points. I can't find that exact number but many studies have shown that a walk can lower your blood sugar and A1c readings. Still, without any ingestion of food or liquid, my reading goes up 4 to 116.

So much for walking lowering the reading but it's still healthy and I'm sure it will help in the long run

Lunch is a bit more elaborate than the previous meal. A slice of last night's meatloaf with 1/4 cup of roasted potatoes, a few roasted cauliflower bites, and three pieces of fruit (apple, banana, and orange).  Two hours later the reading is 132. That's a great reading...a big, filling lunch only raised it by 16 points.

Dinner, after a quick reading of 107,  is a salad I've been meaning to try, a spring mix topped with some chopped ham and shredded cheese. I got some super fresh and premium olive oil from a ranch we visited last week so I'm making my own oil and vinegar dressing with that and some balsamic from Costco. I also cook a scrambled egg and have a glass of milk.

Post dinner reading is 140, a 33 point gain which I will take any day.

A glass of milk, some jerky and cheese for my after Jeopardy snack and my bedtime reading is 142.

This is how those readings work into a blood profile for the day. As long as that line doesn't go over the top, I'm good. If it does, as long as it comes right back down, I should be OK, too.

I'm able to stay in the zone quite comfortably today. True, I have to pass on the cupcakes and donuts my colleagues brought in but I still feel that I got enough food that was tasty and satisfying. I started the day right up against the upper limit of that zone, dipped down towards the bottom, and came back up towards the end.

My fingers are like pin cushions by the end of the day but these occasional blood profile days are very educational to see just how the food I take in affects the sugar in my blood. I will be playing with that mix on upcoming blood profile days to see where I can push it a little (afternoon seems to have room for just a little indulgence) and where I need to take a step back.

By the way, the next morning, my fasting reading was 141.

Darryl
Copyright 2016 - Darryl Musick
All Rights Reserved