Wednesday, November 30, 2011

Serial headaches update

Well, over the Thanksgiving week I was barely in my classroom and I didn't have the headaches. Upon returning to work on Monday and Tuesday, I immediately had two wicked PM headaches for both days. It was painfully clear that it was more about that place than anything else. I began to feel that it was more obviously centered in my sinuses and jaw bone, and I called my doctor to see if I could get in to see him.

Instead of seeing him, I was able to talk to his nurse briefly, and they thought it was either a sinus infection or TMJ. His nurse was on the sinitus diagnosis and I went along with it. I'm taking antibiotics for 10 days. If that doesn't help, we will look at taking valium at bedtime to see if it will change things about my jaw movements while sleeping. I don't have any reason to agree with either of these diagnosis. I think this is the product of a short, incomplete telephone conversation. I wasn't able to describe the absence of the headaches while on holiday, and I wasn't able to talk about how the time of day is so clearly a factor. At this point it's probably just a good idea to be ruling things out...

I felt like while I was back at work I had some burning in my upper nasal region which might indicate an irritant or allergy. I used to take something called Flonase (fluticasone) all the time to keep my sinuses and nasal passages from getting inflamed and leading to infections. It was an allergy-infection preventative. I think maybe it would be good to get back on that. I think the feedback I received from my blog readers was more thoughtful and on targe than what my doctor gave me, because it was in response to my 4 weeks of research, not just the simple complaint of chronic headaches.

As a side-note, I always ask which anti-biotic is being prescribed. I have taken a few strong ones that had an impact on my glucose levels. Off the top of my head, I think Levequin was one of them. I won't take it.

Friday, November 25, 2011

Headaches Hiatus

Well, almost as quickly as I made my list of possible causes, my headaches faded away. The few things that I changed: 1) got back on Alpha Lipoic Acid and 2) adjusting my basal insulin. I'm still seeing some unpredictable things happening with my daily BG, but it's not as consistent and not accompanied by a headache every day.

I am happy to say that I've been having tea and cider every day and it seems to be a non-factor. This week my time spent in the school building was limited, but even the days I was in all day, I didn't have headaches. It's only been about a week of good fortune, but it seems like it's going to continue.

Saturday, November 19, 2011

one big headache!

I have a conundrum. I have had daily headaches for the past 5 weeks or so. They are significant headaches, not nagging, more like harassing. I don't remember when they started exactly, but I do remember being surprised when I didn't have a headache on Oct. 22nd. I would guess that it had gone on consistently for about 7-10 days prior to that. They start in the early afternoon and ramp up to their worst before dinner. After dinner they usually seem to fade away.

Additionally, around 2pm I have been developing insulin resistance and my glucose rises to about 200 and stays there until 12midnight. During the night it slowly eases back to normal and is always 100-120 normal when I wake up. According to my sensor, it never goes hypo.

One theory to consider is that the headache and the glucose rise are related, and that they are triggered by the Somiyogi Effect.  I have had periods when my basal insulin wasn't right overnight and I would go low and then bounce back on a "rebound" for about 6 hours of BG at 180-250 (AND a regrettable headache usually hangs around for several hours).
The only reason it doesn't fit in this situation is that I am using a sensor and have records on where I've been on the glucose spectrum. I don't see many readings under 100 during the day. During the middle of the day I might get to 85 on the sensor (which means the actual real time BG might be lower). It's not an adrenaline event, like serious hypos tend to be. The times in the past that I have suffered the Somiyogi Effect it has included a signature headache that was unshakeable for about a day. It was the kind of headache that no pain-reliever could put a dent in.

So... I have considered a few factors and done a few experiments to see if I could stop them.

1) Food: I wondered if intermittent fasting was causing some sort of hormonal event that triggered cortisone or something that might bring a headache and insulin resistance along. I tried eating breakfast, more carbs, more protein, etc. and nothing has seemed to help. The headaches have been the most consistent thing lately...

2) Hydration: I am guilty of neglecting my hydration on days that I am busy at work. I am certain that there have been days that I've given myself a headache from dehydration. However, I have made an effort to drink plenty of water throughout the day many days in the past 2 weeks, and haven't seen a difference.

3) Tea: I noticed that the routine headache was also synchronized with my 2nd cup of strong tea for the day.  Some research on the web showed that some people are sensitive to black tea and get the achey neck and head that I was having. I stopped drinking tea altogether for a week, and I still had headaches (maybe a different type?). However, when I drank tea, they seemed to get worse, or be compounded. Inconclusive... I really love my black tea.

4) Supplements: A while ago, (maybe a month?) I ran out of Alpha Lipoic Acid, and have been living without it. It is a insulin mimetic that reduces my insulin requirements. I expected to increase my basal, but didn't really notice anything change, except this insulin resistance in the PM hours. I have gotten another shipment of ALA and am taking as I had before. I'm looking to see if my BG levels out and stays constant all day, as it did from Aug-Oct.
I have heard that low-Magnesium can cause headaches. So I added Magnesium to my list of supplements. I also added vitamin D and A.

5) Workplace: On Oct. 22nd I realized that I hadn't had a headache that day. It was a day we had a field trip, and I hadn't spent the day in the building where I normally am. I also didn't have tea that afternoon. Maybe something is wrong with my school building? *This weekend, I was waiting for the headaches to hit at their normal time, and they didn't. My BG did rise, as it has lately, but I didn't have the headaches. Right now this seems to be the most likely cause of the headaches... but, unfortunately, it's the issue I have the least ability to solve. I am wondering what types of factors in my school building could cause the headaches. During the weekend I did consume tea and cider with no ill-effects. 

6) Eyes: I had my vision checked this summer and didn't have a significant change in my prescription. When I wear my contacts all day they start to bother me, but I've been off the contacts for a while.

7) Cider: I have been having a nightly pint (or two) of home-brewed hard cider for roughly the same amount of time that this has been going on. It didn't occur to me to consider it as a suspect until I was working through this list. I may have to take a few days off to see if it's a possible culprit. Last winter it was also my beverage of choice and I don't remember anything strange during that time... then again, my BG control wasn't amazing then either.

So, that's my list. I am wondering what I'm missing. If I am a typical T1 diabetic, I have a tendency toward autoimmune problems. I wonder if I could be doing something to aggravate my immune system and create some sort of domino-effect. Could I be a migraine person, sensitive to dark chocolate, coffee and red wine?

Tuesday, November 15, 2011

Book Review: The Book of Better: life with diabetes can't be perfect....

I received a review copy of the Book of Better by Chuck Eichten, published by Three Rivers Press. I read it in a weekend and it was an easy and interesting read.The illustrations are humorous, the graphic design is offbeat and contemporary. Just the design alone kept me turning pages.

Chuck Eichten is a diabetic, writing from 30 years of experience as with Type 1. He claims to have made many mistakes and wants to share what he has learned with the literate world.  He writes in a light, colloquial style, using words simply and well. Chuck is a creative director at Nike, and has the experience and access to make this book a much more interesting design than most books about health topics.

The overall focus of the book seems to be to encourage those with diabetes to strive for small improvements in their health, and feel good about it. In the process, Eichten, discusses how to deal with frustrations, treatments, and hope for the future of the disease.

I have been diabetic for almost as long as the author, and have come to a similar perspective about striving for the best, while not beating myself up over things I can't control. I was on board with his perspective on that. The first chapter spent quite a bit of time on dealing with that perspective, and I found myself getting antsy to move on with facts or ideas that were new to me. I'm a voracious consumer of factual information about things, so I was anxious to hear some new stuff.

He did get onto some information that I connected with. He discussed how to deal with treatments, food, fitness, family members, the proverbial cure, and even diabetic eating disorders. He is realistic about how difficult the diabetic life can be, but he has a positive approach to dealing with various aspects of it.

My personal response to Chuck's ideas. 
So, the opinion and info that I found most interesting was his emphasis on the importance of the insulin pump for best treatment of diabetes. I was slow on the uptake for getting one, and it has taken me 3-4 years to become a full believer in the device. The summer before last, I even took a break from the pump and did multiple daily injections all summer. I just wanted to get away from it for a while. Sadly, I never got close to the control that I had with the pump, even after 3 months of trying pretty diligently. Now, with my continuous glucose monitoring system, I feel like I am happily dependent on them in my pursuit of best results. I agree (with Chuck), it's the best treatment we have right now. It gives flexibility to make your life better. And..., I definitely agree with him, that the word "pump" is a lousy word for something we might have to love and rely upon.

Another thing that Eichten emphasized in The Book of Better is the need to exercise consistently daily. He doesn't use the word exercise, though... he refers to it as moving. He advocates the need for consistent movement, every day. This is an area that I have found difficult since I started trying to do what's best for me. While I enjoy the reduced need for insulin when I exercise, the consistency is always lacking for me. Also, when I do live more actively, I find that it introduces a new variable for me to keep tabs on. I think this is one of the things that I feel the need to take to heart and add to my daily regimen. If it's daily, it won't be a variable anymore, it will be routine. A BETTER routine...

Toward the end of the book Chuck discussed the future of diabetes treatment and it was was a surprisingly comprehensive summary of the latest developments in a short number of pages. I liked that way he summed it up with graphics and minimal verbiage. I learned about the gradual movement toward a "closed loop" system, starting with an overnight-only system. Also, the development of insulin that only works when blood glucose is above the normal range sounds fascinating too.

Overall, I found the Book of Better to be a great book. I'd recommend it to any diabetic or loved ones of diabetics. The slow, therapeutic start eventually paid off with good doses of experience-based fact and opinion throughout. Positivity and hope was a clear thread that pulled the book together. Something we can all use a shot of once in a while.

Monday, November 14, 2011

Probably Nothing to Celebrate...

I went to take my "at home" A1C test and realized that I threw away the essential electronic testing portion, and only had the chemical receptor part. I bought another test and thought I'd trick it into doing 3 tests for me and use the chemical receptor part from my defunct test. Well, I did and the results were kind of hard to believe. It showed me at 5.6. I think it was an error because of the fact that I was using parts that weren't calibrated for each other.
I mean, I expected to see improvement, but that's just too much. I was hoping for some action in the 6s. I am headed for non-diabetic numbers, but I don't think I'd be getting it yet. I was tempted to repeat the test, but I think I'll just let this number ride for a while maybe the positive vibe will impact my habits for the better.

National Diabetes Day?

I just found out today, that today is National Diabetes Day. It's very cool that there is a day devoted to our situation, but I wish I had more notice... so I could work a profound post or something. Anyway, I still have diabetes and I just finished reading a book that came in the mail on Friday. I'm going to review it as soon as I can. I've already finished it.

Thursday, November 10, 2011

Insulin Mimicking Supplements

I've been wanting to write about a couple of things, but have been more busy than usual. I'm half way done writing an interview for Diabetes Resource Page, and I'm putting together an employment resume for the first time in about 10 years. I am going to see if I might do some additional teaching at the local community college.
I thought I'd just quickly discuss something that's been going on. I've had a strange pattern going on with my sugar levels lately. I have been seeing my numbers start going up at about 3pm and get up to 250 before leveling off and then responding to insulin overnight. I have a theory that it's caused by the fact that I ran out of Alpha Lipoic Acid Sustained Release. I normally take it on a daily basis. When I ran out it took about 2 days for it to totally wear off and I started seeing this happen. I think if I were to stop using it altogether, I would need to sort out a new basal rate to fix it. But, I'm going to order it and keep using it. I think it's a very useful supplement. In the meantime, it's a pretty bizarre thing to have happening. I had gotten so used to seeing my levels stay under 150 after meals.
I will report back if getting back on ALA fixes it.
There are a list of supplements that are supposed to make your body use insulin more efficiently, and process sugar better. Here is a list:
Alpha Lipoic Acid
Evening Primrose Oil (enhances of the effect of ALA)
Vanadyl Sulfate
Gymnena Sylvestre
Chromium Picolinate

So far I have only been using ALA and EPO (recommended by Dr. Bernstein), and they definitely seem to work to reduce my insulin requirements. I plan to try the others as well.

Friday, November 4, 2011

Sensor life

 I use Minimed's Revel Pump with the CGMS system that comes with it. I had to wait for about 2 years for insurance approval, but now it is included with my necessary pump supplies.

I have learned from another diabetic blogger, JonahDiabetic, that glucose sensors can be used for longer amounts of time than expected (Dexcom can go 10+ days). I have normally discarded them after their time was up (3 days). Sometimes if I was too busy to change them, I'd cheat an extra day out of one by resetting the sensor link and get some extra time out of it. I was on board with the 3 day time limit because I was worried about tissue damage associated with having it in place longer. Last year, I would notice inaccurate readings or discomfort at the sensor at about the 3rd day.

I have found that since I have been achieving much better control, my sensors last longer and my skin at the site is not irritated as much as it used to be. I have a theory that getting lower average glucose numbers has improved my body's ability to deal with foreign intrusions into my skin.

I have also been able to extend the time on my infusion sites without seeing any decrease in it's effectiveness. In times past, I had noticed that sometime between 2 and 4 days the site would stop working well and I'd have to change the infusion site in order to get my insulin to fully work again. Lately, I have been keeping the site working until I refill the reservoir, which is about 5-6 days. All told, I can go a whole work week on one sensor and infusion set, and then the weekend I either go without a sensor, or start a new one.

I'm not sure it's all glucose control that's giving me more time. I'm eating a diet high in quality fat, and believe that my level of systemic inflammation has been lowered by improved glucose control. I'll be curious if this trend tracks this way long term. Right now I'm pretty happy about not needing to puncture myself as often. I'm not a big fan of sensor changes, and the first day of calibration readings.


I forget what they call those promotional items (swag?) that get sent to visible people on the web... but, anyway, I'm getting something for free.
It is a newly published book on the diabetic life. I was contacted by the publisher and am going to receive a copy of the book soon. I hardly consider myself a high-powered blogger... but, of course, I'll read it and report out here.
Here is a companion website for the book. I like that he is a T1 diabetic writing from 30 years of experience and that he's a creative director. 

As long as I'm at it, I think I'll also offer some thoughts on other books related to diabetic issues that I have read. That will give me something to chew on for a while.

Thursday, November 3, 2011

Using the data

Since I discovered that Minimed added Mac compatibility to the Carelink website, I've been pretty religious about downloading my pump/ sensor data and looking at it carefully. I don't really think I'm too great at analyzing data, but it's pretty interesting to see patterns, etc.

The first time I had my graphs and charts I adjusted my overnight to AM basal and it immediately flattened out my levels and improved my morning blood glucose. It was a small tweak, but it made a noticeable difference. I think getting the basal correct is one of those major things that has a positive rippple effect. In reality, I didn't really add basal insulin, I just moved it from the afternoons to the morning and I fixed both a high trend in the AM and a regular dip into the hypos in the early afternoon. My overall basal actually went from 24 to 22.

Some stats:
Right now my average BG for the past month has been 136-139. I'm hoping to see that reflected in an at home A1C test in mid-November.

I'm currently taking 29 units of Novolog a day, with 22 units being basal and 7 in corrections and boluses.