Thursday, July 10, 2014

Why All the Morning Highs?

sunriseSometimes diabetes doesn’t make a lot of sense.
Think of those mornings when you wake up to find your blood glucose looking as if you’ve been up all night eating cookies. What’s up with that? You’d think that not eating for those seven or eight hours would give you lower blood glucose, right?
Such morning highs are common in people with diabetes, but one of the reasons has a particular name: the dawn phenomenon.
The dawn phenomenon is a natural rise in blood glucose between 4 and 8 a.m., which happens because of hormonal changes in the body. All people have the “dawn phenomenon,” whether they have diabetes or not.
People without diabetes would never notice it happening, as a normal body’s insulin response adjusts for this. However, because people with diabetes don’t have normal insulin responses, they may see an increase in their fasting blood glucose.
This is primarily because people with diabetes produce less insulin and more glucagon than they need. The less insulin produced by the pancreas, the more glucagon the pancreas makes as a result. Glucagon, in turn, signals the liver to break down its storage supplies of glycogen into glucose. This is why high fasting blood glucose levels are commonly seen in patients with type 2 diabetes.
The effects of dawn phenomenon vary in each person, and your blood glucose may be higher on some mornings than on others. But not to worry—there are steps you can take to get those numbers down and start your days more comfortably in your target blood glucose range.
Treatment for dawn phenomenon depends on how you treat your diabetes. If you take insulin, you may be able to adjust your dosing so that peak action occurs closer to the morning rise in your blood glucose. If you have type 2, diabetes pills provide options as well, as you can add metformin to reduce the liver’s glucose production.
Eating dinner earlier in the evening and engaging in some light physical activity afterward, like going for a walk, can also help.
If you have diabetes, chances are you’ll experience the occasional high morning blood glucose. That’s not something to fuss about too much. But if it happens regularly, then it’s time to call your doctor.
Have you ever experienced the dawn phenomenon? How did you manage it?

Wednesday, May 28, 2014

Going onto metformin

I told my doc today about the hypos from glyburide and he put me on metformin which I should have been on in the first place.

What is metformin?

Metformin is an oral diabetes medicine that helps control blood sugar levels.
Metformin is for people with type 2 diabetes. Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.
Metformin may also be used for purposes not listed in this medication guide.

Important information

You should not use this medication if you are allergic to metformin, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).
If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin.

Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.Before taking metformin, tell your doctor if you have liver disease or a history of heart disease.

Before taking this medicine

Some people develop a life-threatening condition called lactic acidosis while taking metformin. You may be more likely to develop lactic acidosis if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your individual risk.
You should not use this medication if you are allergic to metformin, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).
If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin.
To make sure you can safely take metformin, tell your doctor if you have any of these other conditions:
  • liver disease; or
  • a history of heart disease.
FDA pregnancy category B. Metformin is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether metformin passes into breast milk or if it could harm a nursing baby. Do not take metformin without first talking to your doctor if you are breast-feeding a baby. Metformin should not be given to a child younger than 10 years old. Extended-release metformin (Glucophage XR) should not be given to a child younger than 17 years old.

How should I take metformin?

Take metformin exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.
Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions.
Metformin is only part of a complete program of treatment that also includes diet, exercise, and weight control. It is important to use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.
Do not crush, chew, or break an extended-release metformin tablet (Glucophage XR). Swallow the pill whole. Breaking the pill may cause too much of the drug to be released at one time.
Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. Visit your doctor regularly.
Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change.
Your doctor may want you to stop taking metformin for a short time if you become ill, have a fever or infection, or if you have surgery or a medical emergency.
Ask your doctor how to adjust your metformin dose if needed. Do not change your medication dose or schedule without your doctor's advice.
Your doctor may have you take extra vitamin B12 while you are taking metformin. Take only the amount of vitamin B12 that your doctor has prescribed.
Store metformin at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of metformin may cause lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking metformin.

Metformin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to metformin: hives; difficult breathing; swelling of your face, lips, tongue, or throat. This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as:
  • muscle pain or weakness;
  • numb or cold feeling in your arms and legs;
  • trouble breathing;
  • feeling dizzy, light-headed, tired, or very weak;
  • stomach pain, nausea with vomiting; or
  • slow or uneven heart rate.
Call your doctor at once if you have any other serious side effect such as:
  • feeling short of breath, even with mild exertion;
  • swelling or rapid weight gain; or
  • fever, chills, body aches, flu symptoms.
Less serious metformin side effects may include:
  • headache or muscle pain;
  • weakness; or
  • mild nausea, vomiting, diarrhea, gas, stomach pain.
This is not a complete list of side effects and others may occur. Call your doctor formedical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)

Metformin dosing information

Usual Adult Metformin Dose for Diabetes Mellitus Type II:
500 mg orally twice a day (with the morning and evening meal)

Extended Release:
500 to 2000 mg orally once a day (with the evening meal). Maximum daily dose is 2500 mg.

What other drugs will affect metformin?

Tell your doctor about all other medicines you use, especially:
  • furosemide (Lasix);
  • nifedipine (Adalat, Procardia);
  • cimetidine (Tagamet) or ranitidine (Zantac);
  • amiloride (Midamor) or triamterene (Dyrenium);
  • digoxin (Lanoxin);
  • morphine (MS Contin, Kadian, Oramorph);
  • procainamide (Procan, Pronestyl, Procanbid);
  • quinidine (Quin-G) or quinine (Qualaquin);
  • trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra); or
  • vancomycin (Vancocin, Lyphocin).
You may be more likely to have hyperglycemia (high blood sugar) if you take metformin with other drugs that can raise blood sugar, such as:
  • isoniazid;
  • diuretics (water pills);
  • steroids (prednisone and others);
  • heart or blood pressure medication (Cartia, Cardizem, Covera, Isoptin, Verelan, and others);
  • niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others);
  • phenothiazines (Compazine and others);
  • thyroid medicine (Synthroid and others);
  • birth control pills and other hormones;
  • seizure medicines (Dilantin and others); and
  • diet pills or medicines to treat asthma, colds or allergies.
These lists are not complete and other drugs may interact with metformin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Aint it the truth?

Thursday, May 22, 2014

A man and his appetite

      There are many things that feed the male matcho ego. Cars. I could imagine when man first invented the wheel, he must have had one hell of an adrenaline rush over that, because it fed his male matcho ego, and look what the transportation industry had done with it today. That ego evolved!
   I won't go over an entire list of what feeds the male ego for the sake of this blog. I will, however, touch on how food and a large appetite plays on it.
   Men are pigs by nature. It's instinctive for us to eat and eat a lot. The more we can eat, the more matcho we are. There is even a television show I have seen called Man vs. food. That show glamourizes an overeater. We usually get large portions and go back for seconds. The night of the attempted food poisioning of Los Angeles laker basketball Kobe Bryant, he ate a double greasy cheeseburger. I saw a pic of it. It looked yummy and nasty all at the same time. Kobe can whoof those down no problem because he is an athlete. Non diabetic.
  In certain areas of Italy, there is an old fashioned tradition of having a large meal prepared for a new boyfriend that the daughter is excited to introduce to the family. It's a literal banquet of carbohydrates. Speghetti with rich tomato sauce, lasagna with tons of cheese. This is a polite way of accepting the new boyfriend as one of the family. When the mother of the family offers a plate to the new boyfriend of the daughter, it is polite of him to eat it all. And trust me, these mothers pile it on!! Huge bowls of speghetti and huge slices of lasagna. If she offers you seconds, you better take it! That would be rude for the new boyfriend to refuse or say he's full. Very bad for diabetics.
  Anyway, the point of me rambling on about the male and his eating ego, is that I have taken  notice to portion control and carb counting. For lunch today, I got 1 slice of whole grain bread and only 7 and a half ounces of macaroni and cheese. With water. Dammit I am still hungry! Why could I not eat a freekin peanut butter and jelly sandwich and a glass of milk with that?

Bad reaction to glyburide

   I do not like big pharma. I don't trust big pharma. My doctor prescribed 10 mg daily dose of glyburide (2 5mg pills a day). I have had hypoglycemic reactions to the glyburide. I tried half dosing it, same thing.
  I have been off of glyburide for months. Trying to control my diabetes with diet and exercise alone. Well, I have been reading a lot about how important it is to take your diabetes meds. So I started again this morning. Took 1 5mg pill with breakfast. 1 hour later, I'm feeling dizzy and weak. Check my bsl and it's at 44!!! Good god that's the lowest I have ever recorded it!!
   I raced into the kitchen and poured myself a 10 oz glass of fast acting glucose orange juice and downed it like a dehydrated man in the Sahara dessert. Then I found those peanut butter and jelly uncrustables in the freezer and ate one of those. As I type this, I still feel a bit shakey, but better. Hypoglycemia scares the crap outta me.
  So, I am throwing my glyburide in the trash and I shall tell my doctor and D-team that I am not taking the meds anymore. Just diet and exercise. I hope i am making the right choice.

Wednesday, May 21, 2014

Missing Certain Foods

        Oh how I get cravings for milk! Good ol cow's milk mmm. Grade A pastuerized homogenized vitamin D cow's milk. Don't get me wrong, I love the flavor of vanilla almond milk, but I live with people that purchase and drink cow's milk. And lots of it. I used to be part of that manargere, but now it's mostly about almond milk. It's hard for me to open the fridge and see that good ol 2% half gallon starin you in the face. And don't get me started on half and half over sweetened crushed granola. And peanut butter flavored milk shakes in the summertime drooool! This has to be kept in moderation.
  I saw an elotero this afternoon. An elotero is a man that sells corn on the cob. Elote is spanish for corn on the cob. The man usually has the corn cobs in a big metal pot, which he puts inside a shopping cart. He fills the pot with hot water (where this water comes from, we do not know). Were the cobs pre-cooked? Did he grow the corn in his backyard? It's not FDA approved, that's for sure!
  You can find him walk the streets of suburban neighborhoods throughout Los Angeles county. He attaches a bike (circus clown) horn to the shopping cart and honks it every few feet. When yo hear him coming down the street, you can wave him down and he will sell you a cob for $1.00 USD. You have the option of having him put on mayonaise (applied with a spatula from an industrial sized Best Foods jar). Also squeeze Parkay and grated parmesean cheese. It comes on a napkin wrapped stick and they are out of this world delicious. I miss them so much. I want to eat 2 or 3 right now. Too many carbs. Too damn many carbs!

Why it's important for me to vent about my diabetes

Why it's important to vent frustration about diabetes

Saturday, May 17, 2014

Living with fluctuations

  It's not easy to wake up with a GL of 150+. Can't eat breakfast dammit. I gotta exercise.  Ok, so I exercised and got it down to 100. Since my GL seems to be a bit touchy already, I'll have oatmeal with cinnamon and splenda. Cup of coffee too. 1 hour later......293??????? What the hell? It was oatmeal for cryin out loud! More exercise.  
   Ok, I got it down to 150. It's getting hot, and exercise in heat is not good for my diabetes. I'll just drink water till noon. I'll have a nice salad and a glass of 1% milk for lunch. 1 hour later...200!!! Dammit! it was a freekin salad!!! Too hot for exercise. Gotta let the high GL do it's damage. Grrrrrr....
  Waiting until around 6 to eat dinner. I'll have roast chicken with lemon juice, and steamed califlower and broccolli. Iced tea. No starch tonight. 1 hour later...210!!! Grrr I can't win for losing.
   Night time. Oh God, help me. I'm hungry for something sweet!! Ok just 1 glass of amond milk with vanilla and splenda. I don't even want check my Gl it's so frustrating.
   Not all days are like this. Most are good controllable days. But there are some days when my disease fights back. I don't know why. Tommorow will be better.

Wednesday, May 14, 2014

Medmar helping with A1C?

I got my A1C results today: 6.7!!!!!

 That's the lowest it's been since I have been diagnosed with T2 diabetes. Here is the catch: I have been eating C&H sugar! That would jack it up to above 10. I think what is helping is the medmar but i'm not sure.

Thursday, May 8, 2014

Almond Milk

I enjoy the taste of Almond milk, vanilla extract and splenda. I use this as a "dessert". Sometimes I use it as  a snack or to fill a sweet craving. My dietician approves :) I use it on my cereal or in my coffee. Some Thai restaurants use it in thier iced tea.


Fasting BGL (upon awakening) 

Before breakfast  
What did you eat for breakfast?
How many carbs?  
1 hour after breakfast 
2 hours after breakfast

Before Lunch
What did you eat for lunch?
How many carbs?
1 hour after lunch
2 hours after lunch

What did you do for exercise? For how long? How many miles did you bike or steps did you take?

Before dinner
What did you eat for dinner?
How many carbs?
1 hour after dinner
2 hours after dinner

Snack (or dessert)

Bedtime (just before your head hits the pillow)

Fasting BGL should be measured after at least 8 hours of sleep 

Wednesday, April 30, 2014

Losing friends through diabetes

 Those are the letters I have written on my diabetes case. It stands for "Left foot, right foot, heart attack, death" That is the most common set of diabetic complications for people that will not take care of their diabetes. I have had 2 friends that were over-eaters with diabetes. They never surrendered to the lack of power they had over food, and as a result, I have to visit them at the cemetery. 
  Daniel Von Bargen, the actor who portrayed the character of Mr. Kruger on the hit television series Sienfeild, attempted suicide after learning that he would never work in Hollywood again because he was scheduled to have some toes amputated due to his diabetes. He was 61.
  So yeah, you betcha this is one serious disease. It shortens some life spans. The good news, is that if you take care of it, you can live a bit longer. But once the complications set in, they cannot be reversed. And the older you get, the closer you get to complications.

 This post is in memory of the 2 friends I had that died through LFRFHAD. Rest in peace, the war is over.

Medical Marijuana

  Medical marijuana is quite a popular headline in the news today. Ok, I admit, that back in the 70's when I was in high school, sure, pot was fun to experiment with. But the marijuana of today seems to be 100 times stronger than the stuff I used to smoke back then.
  Every now and then, I'll cave into a food craving and do something stupid like eat corn and mashed potatoes. 1 hour later my BSL is in the 300's and I am being told to go to ER for insulin. But I have found that when I spike up, if I smoke some weed, 1/2 hour later, my BSL is back down to 100. And it stays there. Even when I get the munchies and continue to pig out, it still stays in range.
  Now don't get me wrong, I am not condoning marijuana as any type of alternative for insulin or pills. I have noticed that it works for me. I am not going to smoke marijuana on a daily basis to keep my blood sugar in check. Diet and exercise can do that. But, if for whatever reason I do spike up again, I know that MM can help aleviate the high BSL.

Getting back on track

Ok I made myself a goal. It's almost May 1st, 2014. I have 10 years without a cigarette today!!!

  If I can go 10 years without a cig, I can get my A1C down to < 7.0! I am going to try the low carb high fat way of eating. I shall eliminate all breads and grains and especially corn and potatoes. Milk will have to go too. I am going to miss these foods at first, I know. I will increase meat and vegetable protiens and my fat intake as well, and monitor it all very carefully. I hope I enjoy the taste of almond milk.