Diabetes, life and all that - personal diary

[pavlosn]

Even my disappointment with my increased hba1c count is another case of logic versus emotion.

Was it reasonable not to expect a worsening of Hba1c when starting from a 133 position and reducing medication by over 40%.

I know that any doctor would be happy with my latest hba1c and lipid counts. Objectively they are very good, maybe even excellent.

Yet I do feel disappointed with them.

My eyes are seeing 138 where I saw 133 last time and it seems that the visual stimulus has I direct link to my emotions that bypasses my brain.

But I do trust my brain more.

Maybe the reason I am disappointed is because to quote @miked, I am still trying to reach the finishing line. I am still, even after five years with this disease, trying to win the i winnable war.

But if I have not won the war, I have not lost it either.

I am still here!

The sun is out.

There is a blue sky above.

And I am still here.

And I am still healthy.

And I am still fighting.

Pavlos

 

[pavlosn]

@miked @tim2000s
I think you have helped me make up my mind.

I will go back to the prescribed amount of meds and concentrate on the weight loss as was my original plan.

I would rather not have to do it with lingering doubts that I may be undermining my own efforts by cutting meds prematurely.

Stubbornness is all very good but it should not be at the expense of one's good sense.

I can always try to cut meds again at a later stage if I then consider it beneficial.

At the end of the day only one thing counts and that is staying healthy.

Everything else is but means to an end.

Thank you for your advice.

Pavlos

 

[douglas99]

When did you decrease your dose?

 

[pavlosn]

When did you decrease your dose?

End of November roughly.

I am not blaming all of the increase in hba1c on that, but I would like to take it out of the equation.

 

[douglas99]

Within a fortnight or so of the test then.

If it made a change, it would be marginal.

It takes a few days for the change in meds to affect your system.
There would probably be an effect at any time, as the metformin affects the way your liver reacts to the demand for BG, and until your body readjusts to the new normal, you may see a blip. So you may see one anyime you reduce the dosage in future.

I've reduced meds, and we've always given it at least two months before any Hb1Ac, simply to let the peaks and troughs settle, before getting a meaningful figure.

And there is still measurement tolerances to consider.

I would suggest the figure is close enough, and probably has little to do with the meds. apart from maybe your bodies reaction to reducing them temporarily. The HbA1c and the change were too close in time.

There are two scenaros for me, if I could presume to offer my viewpoint.
Now is a good time to reduce them, and suffer the excesses of christmas, then you'll go back for the HbA1c on a consistent regime, and at the worst possible outcome, which will give you the worst ceiling you'll ever get to. Good or bad.

Or take them consistently up to your Hb1Ac, then decide whether or not to cut them immediately after the test, and give it a fair run until the one after that.

 

[pavlosn]

@douglas99

What you write makes perfect sense.

In all likelihood, there is no significant difference between 33 mmol and 38 mmol given limitations in hba1c testing accuracy.

It's just that it usually takes a bit of time for me before what I think about something can outweigh what I feel about it. As I said acknowledging my feelings, even writing them down, is my way to manage them and align them with what my logic dictates.

I am feeling a lot more relaxed about the whole thing now, and would be happy to go with either of your suggestions.

To be honest my main issue with the reduction of meds is that I feel a little uneasy that I did it without consulting my doctor first.

I have a very good relationship with him and respect and value his professional opinion. My concern is that he may mistake my cutting down on meds without his consent as a sign of disrespect.

So, on balance, I am going to go with returning back to the level he has prescribed, concentrate on continuing to control my glucose and hopefully reducing my weight further and then will discuss the matter of meds with him in January when I see him next.

Thank you

Pavlos

 

[pavlosn]

My test counts today, while still on the lower metformin dose:

4,2 fasting

5,9 two hours after breakfast of two fried eggs, bacon and some cheese and about four strawberries

4,3 before lunch of a bowl of vegetable soup and some raw carrot.

6,8 an hour after lunch.

4,6 before dinner of pork with mushrooms in wine sauce and

6,1 two hours after

Had two crackers (6g carb)and some cheese as a late snack as starving

Pavlos

 

[Mike d]

@miked @tim2000s
I think you have helped me make up my mind.

I will go back to the prescribed amount of meds and concentrate on the weight loss as was my original plan.

I would rather not have to do it with lingering doubts that I may be undermining my own efforts by cutting meds prematurely.

Stubbornness is all very good but it should not be at the expense of one's good sense.

I can always try to cut meds again at a later stage if I then consider it beneficial.

At the end of the day only one thing counts and that is staying healthy.

Everything else is but means to an end.

Thank you for your advice.

Pavlos

Perhaps talk to the doc and see what he thinks ??

My best

Mike

 

[pavlosn]

88mg/dl or 4,88 mmol/l this morning

Weighed myself at 87,7 kg, this is a loss of 14,3 kg or 31,5 pounds over the last three months

That green healthy BMI band is getting ever closer

And more importantly, so is Christmas

Pavlos

PS still on the lower metformin dose, as yesterday's counts were quite encouraging.

 

[Silver Hammer]

Here's one to consider when thinking about metformin and if you should up the dose or indeed be aiming to eliminate it entirely. This article appeared on the main website Diabetes News back in August:

http://www.diabetes.co.uk/news/2014...ld-help-extend-lifespan-for-all-92959331.html

It appears to have some remarkable extra benefits which if you can take it without any adverse side effects would seem to support continuing to take it whatever your HbA1C reading is.

I certainly intend to continue with metformin for as long as I can at what the doctor I think described as the therapeutic dose of 2000mg per day that I am on at the moment, whatever my readings are. I believe that it provides some assistance to the bigger differences that you can make yourself with the right lifestyle choices for the control of T2, with some "fringe benefits" which are not often discussed or appreciated.

Maxwell

 

[pavlosn]

Today's glucose counts

Fasting/before breakfast 88mg or 4,88mmol
2hours later 85mg or 4,72 mmol

Before lunch 84mg or 4,66 mmol
2 hours later 102mg or 5,66 mmol

Before dinner 73mg or 4,05 mmol
2 hours later 98 mg or 5,44 mmol

Went to my son's school's Christmas show tonight

I will try to upload video later

Pavlos

 

[pavlosn]

Another day of low counts yesterday as I am trying to build up a bit of a head start ahead of Christmas.

Breakfast: 4,66 to 5,61

Lunch: 4,21 to 4,55

Dinner: 3,83!!!! to 5,27

Probably my lowest ever series of six counts in a single day.

Have a busy day ahead as my mom is having a cataract operation in the morning and I need to drive her to the hospital for that. She needs to be the at 6:00am so it's an early start for me today.

Let's hope it goes well for her today. She had a similar operation about a few months ago on her other eye so at least she knows what to expect.

The problem is that my dad was not very well yesterday at the home, he is running a fever and not being very cooperative and my mom was talking about returning to the home after the operation to care for him, which I don't think is a particularly good idea for her to do.

I will just have to trust the nurses at the home to look after him today while I am with my mother, and then go up to see him myself as soon as I can. I am hoping that the nursing home will call me if there is an emergency in the meantime.

Let's hope he is better today and I don't have to spend time with both my parents in separate hospitals today.

I really do not enjoy hospitals, not even visiting there.

Even when my wife was pregnant with our son and we had to go in for her prenatal scans, I had trouble sleeping the previous nights for all the stress. Quite how I managed to be in the operating room for the birth (Caesarian!) , I will never know. I am just glad I did manage it.

I do remember the doctor warning me that if I fainted then they would have no time to pay any attention to me as they would be too busy delivering the baby. Which is when I mentioned that a chair to sit on, would not be a bad idea; at least then I would have less of a distance to fall!

Pavlos

Ps morning sugar at 5,33mg

 

[Mike d]

Let's hope it all goes well for all concerned. Sure hope so. Great figures for you Mike

 

[pavlosn]

Sometimes things just happen when we least expect them and emotion can creep on us taking us unawares.

I took a walk in the park behind the Makarios eye hospital this morning , while waiting for my mom to have a cataract removed from one of her eyes,

when I found myself retracing steps I have not taken in over thirty years.

Without meaning to, I found myself for the first time since graduating in 1984 at the grounds of my old school, the English School, Nicosia.

A school also attended by my father before me and my brother after me.

What started as a walk, a bit of exercise, ended up being a pilgrimage as I wondered round the school taking in all the changes since I was here last.

A whole building has gone, it had to be taken down as it was declared unsafe and in it's place a brand new science building now stands

There is a monument erected in 2000 commemorating the school's centennial year

But most things have hardly changed.

The "Old building" dating from 1938 is thankfully still there

The main entrance to the school is essentially unchanged. I have my dad's graduation picture from back in the fifties, proudly holding a sports shield up as house captain, taken at these very entrance steps.

My own graduation picture was taken some years later at this amphitheater.

One familiar sight after another

The assembly hall, looking more high tech but considerably less grand than I remember it

The arts building, looking almost as if I stepped out of it only yesterday.

The main playing field, the color of the spectator's seats is now yellow instead of the green I remember but still essentially looking the same, if a little run down.

All these familiar sights packed the emotional impact of a sledgehammer, choking me and bringing uninvited tears to my eyes.

I kept expecting the familiar sound of an old teacher's voice or, God forbid, of our extremely strict old headmaster.

I kept expecting the faces of old schoolmates to appear.

But no.

These days my schoolmates would have little reason to be here, not unless one of their kids was now attending the school.


These young faces all around me were all wrong.

And how young they all looked!

Mercifully, they paid little attention to me.

I am not sure what they would have made of the sight of a middle aged man walking round "their" school, with silent tears streaming down his face.

Then again, maybe it was not such an unusual sight to them. Maybe they just learned to turn the other way.

I just hope they appreciate what they have and how quickly it will all be just a treasured memory for them as well.

Pavlos

 

[lizdeluz]

It's been a tough day for you.
I haven't been back to my school. I've gazed at it from outside. I have strong and fond memories of it, though: it had quadrangles, which echoed and were hot and sunny to sit around in the summer. It had a 'new-fangled' language-laboratory which used to scare me half to death! And a lacrosse shed, where I somehow always managed to select the worst stick there - well, that's my take on it.
These days, you'd have trouble wandering round any UK school, due to security.
Your school buildings look really impressive.

 

[pavlosn]

Its been a long day.

It's also been a very good day.

My mom's eye surgery appears to have gone well and my dad thankfully was better today and did not require hospital care.

The return to my school may have been unexpected and unplanned, an emotionally charged trip down memory lane at a time when I was under stress with concern for my parents, but it was also a pleasurable one.

I am not sure why I found it so intensely moving.

I am not even sure what my tears were about. Were they tears of sorrow for friends of yesteryear, for the unforgiving and relentless passage of time, for the proud young house captain that was my dad, now an ailing old man in a care home, robbed of his vitality by a series of strokes? Were they tears for me?

I do not know. Perhaps they were for all of them, perhaps for none.

What I do know is that not all tears are bad.

And these were definitely good tears.

The sort of tears that wash our sole clean and help to remind us that we are still alive, still capable of strong emotion, that we have not yet lost all sensitivity, have not yet been rendered numb and unfeeling. That we are still human.

Some may see my tears as a sign of weakness.

I consider them a strength.

So yes, today has been a long day; a tough day, but also a very very good day.

Pavlos

 

[NotSoSweet2]

Woke up around 6:00 am this morning at 133mg/dl or 7,4 mmol after going to bed at 7,0 mmol just past midnight.

I managed to walk (indoors as it has not stopped raining in the last 24 hours or so) for about 2,5 km and that brought my levels down to an almost acceptable 6,1 mmol. As you can imagine, waking endless laps of the 30 paces or so that separate our front door from the furthest point of the house directly opposite, is not the most enjoyable walk I have ever taken but at least it proved effective.

These numbers are uncharacteristically high for me; Something in the low to mid 5s being a lot more typical.

So last night was a disaster from a diabetes point of view- I must have spent at least five hours above 7 mmol.

I can't really say that I regret it though as it really was an excellent night hosting a dinner party for friends.

View attachment 9454

Being a diabetic guest at a dinner party is easy, you can more or less just choose to ignore the worst offending food. If you are the host things are tougher as you are supposed to encourage your guests to enjoy the food and so more or less lead by example in sampling the various dishes.

Yesterday was also my turn to be Gordon Ramsey ( without the Hell's Kitchen temper tantrums) as I am always head chef in our kitchen when cooking for friends. My wife's cooking skill just about extend to boiling an egg, but that is only if you like your eggs hard boiled. Asking for a soft boiled egg would probably qualify as grounds for divorce in her eyes.

She did make a grand job decorating the place and setting out the table though.

View attachment 9455

So I can not even blame someone else for the food selection:

- Spicy roasted pumpkin soup, with herb croutons , Greek yoghurt and toasted sesame seeds

View attachment 9456

- Sautéed king prawns in butter with chilly, garlic and fresh coriander
- Blanched red cabbage with blue cheese and crispy bacon salad
- Mixed leaf salad with cherry tomatoes and fresh pomegranate seed in balsamic dressing

View attachment 9457

-Boef bourguignon
-Creamy mushed potatoes with three cheese topping
- Roasted broccoli with a soy sauce and sesame oil dressing with toasted sesame seeds and chili flakes

Selection of deserts ( bought in or brought by the guests)

Cheese platter

Coffee with selection of chocolates

So an all round disaster for my sugar levels but I night I very much enjoyed nonetheless.

I will have to be extra careful now though.

One bad night is not going to kill me but I need to make sure it does not get to be a habit.

Earlier in the day the wife and I got to finish wrapping the son's Christmas presents, while he was away taking a mock exam for the private school entrance examinations he will have to take next year.

View attachment 9458

They ended up looking so attractive we decided to stick them under the tree already rather than hiding them away until the night before Christmas.

My son did notice them on his return but I just explained them away as yet more of his mom's elaborate Christmas decorating and he pretended to accept that.

I am sure that at 11 he is aware that there is no Father Christmas, although he has not actually said so out loud.

Anyway, having to exercise some restraint and self discipline and wait until Christmas morning to open the various parcels will probably do him good. I think knowing that he will face his mother's wrath for spoiling her carefully laid out display of color coordinated and lovingly wrapped parcels will help him stay true! Lol.

The rain stopped now and I can see sunshine through the window so I am about to go on one of my proper walks.

After all I have sugar to burn.

Pavlos

It all looks lovely and very festive, love the personal touch of colour coordinated gift wrapping (really creative and individual).

Wishing you and your family all the best for a wonderful Christmas and New Year.

 

[lizdeluz]

Its been a long day.

It's also been a very good day.

My mom's eye surgery appears to have gone well and my dad thankfully was better today and did not require hospital care.

The return to my school may have been unexpected and unplanned, an emotionally charged trip down memory lane at a time when I was under stress with concern for my parents, but it was also a pleasurable one.

I am not sure why I found it so intensely moving.

I am not even sure what my tears were about. Were they tears of sorrow for friends of yesteryear, for the unforgiving and relentless passage of time, for the proud young house captain that was my dad, now an ailing old man in a care home, robbed of his vitality by a series of strokes? Were they tears for me?

I do not know. Perhaps they were for all of them, perhaps for none.

What I do know is that not all tears are bad.

And these were definitely good tears.

The sort of tears that wash our sole clean and help to remind us that we are still alive, still capable of strong emotion, that we have not yet lost all sensitivity, have not yet been rendered numb and unfeeling. That we are still human.

Some may see my tears as a sign of weakness.

I consider them a strength.

So yes, today has been a long day; a tough day, but also a very very good day.

Pavlos

Yeah, there's nothing wrong with tears. I like your idea that they are a sign of humanity, I feel that's definitely true. And to be human is definitely a great gift.

Sometimes though, in my case, they're caused by low blood sugar! My monitor doesn't tell me the direction of my blood sugar. This evening, I suddenly became aware that I was feeling sad and uneasy for no reason. I did a check and was 5.2. So nothing wrong. However, felt tearful and dark and did another test at 00:01 and this time was 3.8, too low.

Hmmm, anyway, life is as much a roller coaster as is diabetes, and finding explanations for joy or sadness is not an exact science. My Dad is in a care home also, Mum passed away 4 years ago, aged 90. Dad is 97! He was a cornet player in the Royal Marines, and has always and still does enjoy music. Though it was fairly gradual, I found the transition, from the former father-daughter relationship to the current one, quite difficult. Luckily I can share that role with my older sister. Dad still has his good sense of humour, and often quips that his only problem in life is that he has nothing to complain about!

 

[pavlosn]

It is true that shifts in our sugar levels can affect our emotions.

I am normally quite a patient person but I find I become very irritable and short tempered when running high sugar levels and very anxious and panicky when running low.

It is not an easy thing to accept that one's behavior, one's own character even, can change because of an imbalance in one's glucose levels.

The opposite is also true, in the sense that strong emotion can affect our glucose levels, elevating them through the action of stress hormones, adrenaline and cortisol, that suppress the production of insulin to prepare as as for for "fight or flight".

It is certainly difficult to see one's own parents grow old and invalid. It seems that change is something we are conditioned to resist and part of us wants things to always remain just as they were. But alas time really waits for no one and really is the great robber in the end.

Quite apart from feeling sorry to see then be less than they once were because of our genuine feelings of love for them, the sight of an ailing parent has very real and difficult implications on our own reflected vulnerability and mortality.

What I mean by tears being a sign of humanity is that they are an expression of a strong emotion and to be human is to allow oneself to feel.

I am not advocating that we should allow ourselves to go to the other extreme of allowing emotion to completely take over, that we should become prey to our emotions but I do say that there should be a part for emotion in our lives.

When we were little this came naturally, requiring little effort on our part.

But it seems that as adults we spend years building barricades for ourselves against emotion or at least against the expression of emotions.

We see emotion as a weakness and its expression as unseemly somehow.

We expect to be responsible and in control at all times and become almost suspicious of anyone being emotional.

The very word emotional has come to be equated with irrational and to be given negative nuances of meaning.

Yet build enough defenses against your emotions and in the end you are insensitizing yourself against feeling, turning the world into a dull grey monotonous background of sameness.

Emotion adds the necessary brushes of color that make our lives more interesting.

Rather than try and block emotion, I try to acknowledge it as a first step to understanding and managing it.

As with many things in life, it is a question of finding the right balance.

We are both rational and emotional beings, so we need to find the right balance between these sometimes conflicting parts of our nature to function properly.

It is an unfortunate reality of our disease that the dark specter of depression is one that is often associated with it.

I am not an expert on the subject but I would have thought that trying to stay in touch with our emotions and allowing ourselves to express them at appropriate moments, releasing the pressure valve in a way, may be a better way to keep depression at bay than trying to block our feelings in, or worse still, trying to deny their existence.

The subject of emotional management and diabetes is a fascinating one and one to which insufficient attention has been paid to, in my opinion.

If we are our own principal care givers, which undoubtedly most of us are, then the matter of our own mental and emotional attitude towards our disease becomes of paramount importance in our efforts to control it.

The pancreas is responsible for giving us our disease but the mind and the heart are what are most important in fighting it.

Pavlos

 

[Mike d]

Agreed. My take on it is this ... we MUST be dispassionate to some degree lest we fall into an existence where the lives and health of others take precedence over our own. That is (annoyingly) part of the entire cycle of life. That doesn't make one callous or uncaring ... it's a protection mechanism.

Some people are great at it (I know a guy who has TOTALLY surrendered his own life to look after his wife and he always referred to his "til death do us part" marriage vows) but I see the toll it's taken on him. He is my definition of a hero. So are the others who selflessly give up their time for others without reward.

How maturity and age gives us the insight into middle age and beyond I owe to my parents. We are part of a moving and breathing ocean of life, and if I hold one thing as true, you should quietly accept you are but one of the waves and the final shore of peace quietly awaits.

Mike