Just doing my duty

Last year I committed to writing monthly about living with diabetes, just to keep myself in line. For me, it's like the weekly weigh-in at Weight Watchers. I've skipped a couple of months and, sure enough, I have slid back into mostly ignoring it. The disease is so easy to forget when you don't have any symptoms. Add to that the temptations of the holidays and the desire to enjoy all the goodies like everyone else, and you have a recipe for trouble.

I've stopped testing again, but will start again tomorrow morning. I'm pretty sure the news won't be good, and I doubt my cholesterol levels went down over the past couple of months. I did not keep my appointment in December for a blood test. Really, what was the point, considering?

I'm still doing the daily cinnamon and oatmeal breakfast, and taking metformin. I ditched the Avandia and Vytorin because of the side effects. Of course, now they're saying that Vytorin actually makes things worse, so good riddance to that one.

I've switched vitamins to Centrum Cardio, which is supposed to reduce cholesterol, and I take fish oil once a day. Tried soy milk. Hated it. If spiders gave milk, that's what it would taste like.

We've just bought an elliptical trainer, which should help with exercise, and I pack myself a healthy lunch for work. Family dinner and evening munchies are still my downfall. Those and chocolate.

And so it goes.

Sugar and spice

*Fair Warning: This is going to be a diabetes update. So if you hate listening to old people natter on about their health issues, now would be the time to make a run for it.

Forgive me, Body, for we have sinned. (Yes, we. This is, after all, mostly your fault.) It has been a month since my last confession. Since then, we have eaten any number of sweet things and carbs (though far fewer of them than we wanted). We had pizza twice and one big honkin' grinder that I still recall fondly. We gave in to the free latte and muffins at work last week. And we have again drifted away from regular testing, as we do not enjoy stabbing ourselves all that much. I am truly sorry, and I promise to resume testing and to stay away from the goodies. For your part, Body Dearest, you could try not to freak out when we backslide, OK? OK.

About the sugar

I finally went in for blood work in mid-September. My A1c was 7.7. For the uninitiated, normal is 4.0-6.0 and over 8.0 is big trouble. Measures of kidney function indicated "an elevated risk for diabetic neuropathy." Worse, it seems that if the sugar doesn't kill me, the cholesterol will. So now I need to work on that, too, and take Vytorin every day. The fun never ends.

Now, there are three main parts to lowering blood sugar: education, diet and ::shudder:: exercise. So I could (a.) read a lot and eat stuff or (b.) bounce around and sweat. I say Go with your strengths. That would be A. If that alone doesn't do the trick, I may actually have to join a gym. I'm not that desperate yet.

Here's the spice part

Following a bad experience with Avandamet, I have begun to pursue alternative and herbal options for controlling blood sugar.

There is a surprisingly long list of natural substances, spices and foods that are purported to work and that have been clinically tested for effectiveness, side effects and interactions. Prevention Magazine has one or another "diabetes cure" every issue, so it's a good place to start for ideas. One source I found particularly useful for followup is Alternative Cures That Really Work, by Ronald Hoffman, MD and Barry Fox, PhD. The book ranks each item for effectiveness, one to five stars. It also summarizes the studies done on the substances, gives dosages, and lists side effects and drug interactions.

Among the most familiar and accessible alternatives is cinnamon. I already had that in the pantry, and I like it, so that's where I started.

USDA studies have found that the water soluble components of cinnamon significantly reduce both blood sugars and cholesterol. It can be taken as ground spice or made into a tea. A quarter teaspoon of the ground spice is effective, but anything over half a teaspoon can be toxic over time.

Also on the lists of proven sugar and cholesterol regulators are oats and walnuts. So, every day for a month now my breakfast has consisted of oatmeal with the quarter teaspoon of cinnamon, an ounce of chopped walnuts, a few raisins for sweetness (only 5 or 6 - they're sugary)and low fat milk.

I really think this new breakfast regimen has helped. My morning testing levels are in the mid-140s now; that's still too high, but it's down significantly from 160s a month ago and 200s the month before that.

I am eating healthier overall, I make an effort to be more active, and I still take the metformin, so the "foodaceuticles" are obviously not the only factor in the lower numbers. Still, I'll take all the help I can get.

I'd also love to try prickly pear cactus, which is supposed to be extremely effective, but it is damned hard to come by in Indiana. Believe me, I've looked. Failing that, I may try adding fenugreek, another spice that scores well.

Mind you, I have run all this past my doctor. He has had training in herbal medicine and is sympathetic to my experiments, as long as I'm still taking prescribed meds too. Our goal is to reduce the amount of medication I need, not to replace it.

I suspect that a lot of what alternative treatments do is to give back a sense of control to the patient; they may work primarily by placebo effect. I'm OK with that. I'll take it over Avandia any day.

Links you might like
* Herbs, Vitamins, and More for Diabetes, WebMD
* Cinnamon May Help Treat Diabetes, CBS News
* Diabetes Mine (great blog)

True confessions, part 2

Not long ago, it became clear that diabetes is getting the better of me. So I called my pharmacy to get a refill on testing strips: "Um. The last time you refilled this was 2004. We need a new prescription if you want insurance to pay for these."

Hell yes I wanted insurance to pay. So I called the doctor's office and got the nurse. Several minutes on hold later, she's back: "Doctor wants to know if you've been seeing someone else about your diabetes?"

Uh oh. "No... why?"

"Our records show we haven't seen you in the office since 2002. He's not going to call in anything else until you come in to touch base."

Busted. "Oh my, has it really been that long?" I know damn well it has. "OK. I have a day off in two weeks. Let's make it then."

In the meantime, I improved my diet considerably and dropped a few pounds, but the readings were still too high. Metformin wasn't doing the trick anymore, and I began to worry that there would be insulin injections in my immediate future.

Doctor day came. (As always, I sat in the waiting room for over two hours. It's a major reason I avoid the place, and a rant for another time.) He wanted some blood tests, of course. And then there was good news and bad news: The good news was, he didn't even mention insulin. The bad news was, he prescribed a drug that contains both metformin and Avandia, Avandamet.

Say what? Hold the phone, dude. I put on my politely concerned face: "Hmm. I think I heard something about that drug on the news, doctor... ?" Specifically, that the stuff kills people. An animated presentation ensued, wherein the doctor assured me, with great conviction, that the studies were flawed and the people running it are untrustworthy, and that the drug is absolutely safe. I got free samples and orders to return next month.

Back home, I ran a Web search on Avandia. The first related links to pop up were listings of lawyers offering to help me sue the pants off its maker, GlaxoSmithKline. Not a propitious start. Still, I found that many patients have no problems with the drug and that the FDA has left it on the market, albeit with a boxed warning. And after all, what's the point in going to doctors if you aren't going to trust their judgement?

So. It is now two weeks into my adventure with Avandia. The blood sugar levels are exactly where they were before, no improvement at all. I've had a lot of the symptoms listed as possible side effects, but the thing with me is I have those symptoms all the time anyway, as a result of other health and aging issues. There's no way to tell which thing is causing what, so I just suck 'em all up and keep swimming. At least, I did until today.

Last night I woke up with a nosebleed. I have never had a nosebleed in my life. Since the Avandia is the only new thing, I thought of that first. Another Web search did not turn up nosebleeds as a side effect, but I did find posts on message boards from other people claiming they too started having nosebleeds at night after starting Avandia.

On the other hand, I have been stuffy lately, and I take aspirin every night, so it was too soon to judge. I dutifully downed my morning dose and made a note to myself to call the doctor Monday.

And then, about two hours later, another nosebleed. This time, it started while I was in the car. Thank heaven I wasn't driving.

OK, it's only twice, and it could still be a coincidence, but I've had enough. I'm more afraid of this drug than I am of the disease. Plus, they have the exact same worst-case scenarios: stroke, heart attack and death.

There's got to be a better way.

Could surgery cure diabetes?

According to this article just released at AlphaGalileo.org, a form of gastric bypass surgery seems to cure diabetes in 98 percent of diabetic patients receiving it.

Duodenal exclusion surgery removes an area of the gastrointestinal tract that apparently triggers insulin resistance. The normalizing effect happens too soon to be attributed to weight loss.

It's too soon to say what the ramifications of the discovery will be, but an international team of doctors has performed the surgery on seven type-2 diabetics and are monitoring the results.

The website is new to me, and appears to be reputable. (I stumbled onto it while trying to find out if there is anything I can have for lunch. I'm starving, but my sugar levels are too high to eat. It seems Metformin ain't cuttin' it anymore.)

True confessions

Carly at Ellipsis has been writing lately about being told she has diabetes and about how she is dealing with the shock and anxiety of it all -- an experience I recall all too well from my own diagnosis in 2001. Her attitude is amazing, and if you too are diabetic, I highly recommend you stop by there and say Hi. At her suggestion, I'll be posting here once in a while about my own challenges with it. I'm hoping it will help keep me on track.

As alarming as that first diagnosis is, the really insidious thing about this disease is how easy and how tempting it is to ignore.

In the beginning, you probably go to a diabetes class, where they do their best to scare the bejeezus out of you. It really ticked me off at the time, but now I know why they do that. At first, everyone around you is solicitous and sympathetic, you're testing four or five times a day, and you're paying attention to every bite of food you take. But in time, you start to slip.

Your readings are nearly always fine, so you stop testing. And nothing happens. You forget your meds once in a while. Nothing. You succumb to the homemade cake your boss serves up at the office meeting, and you go out for ice cream with your family. Still nothing. You feel guilty at first, but you don't feel sick. Eventually, you just pretend you don't have it at all, and so does everyone else.

If you're really lucky, like me, the universe gives you a thump on the head before it's too late: In the space of a few weeks, Carly turned up with diabetes, and she mentioned a friend of hers who ignored it too long. A coworker had to quit because of complications. A neighbor I don't really know died of it. My mom began to have sugar lows requiring ambulances in the middle of the night. A favorite TV show episode gave diabetes to a main character, who said, "But I feel fine." And the TV doctor replied, "That's what's going to kill you."

The universe can be such a nudge.

So I rummaged out my glucose meter. The calibration fluid and strips had expired. I mean, seriously expired. I called the company for the fluid. "How often do you test?" the operator asked. "I haven't been testing at all." The operator skipped a beat. Then she said she would send me a complimentary tube of 50 test strips. Those things are $40 apiece, so I took this as a sign that the universe was pleased.

Within a few days, I had my kit all spread out. Poked the obligatory hole in myself. Dipped the strip in my blood and waited. Reading: 291.

This is so not good.

To be continued.