h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Hello SC,
Over at the atelier you asked if I have any tips to try and stop the rollercoaster BG levels that we can get.
The biggest thing is testing. Test, test and test again. Test before eating, test after eating (check to see if the BG skyrockets or not), test overnight to make sure you're not going hyper or hypo. It's the only way of knowing how you and the food react to each other. All this is easier said than done and I don't like the thing of testing overnight one bit!
Are you on insulin? If so which ones. How the insulin acts over time can be a biggie, if it peaks at just the wrong time you can be hit for six in either direction (as well as the usual caveats about taking too little or too much).
I hope I can help, even if just pointing you in the direction of some more information here on this great wide interweb thingumajig, it's where I've found most of the information for me from.

I do test as often as possible, but as I've been going to the County for my health care (for free, as I'm on disability and sporadically employed), I'm only given enough strips to test once a day. Any other testing I do is with strips I pay out of my own pocket for, so I test on average only twice a day. The County health care folks won't cough up any more strips, even though I'm on meds (that they prescribed!) which have skyrocketed my BG levels -- Lasix being the biggest offender, but Benazapril and Metropolol aren't helping much, either, in that regard.

I have had very good control of my diabetes with an HA1C of 6 to 7 -- excellent to good control, until I had a heart attack last year. Now it's been going up to 8 -- which counts as only fair!

I was diagnosed in '76, which is half my life ago. I take insulin, two types (NPH and Regular) -- I find I have better control that way, and it's more flexible if needed. I'm thinking that once I get insured again, I'm going to try a stricter multidose regimen -- Lente and Glargine. One long duration basal dose, with a very fast acting pre meal dose of Glargine based on the meal's carb count. I have a friend who's been diabetic as long as I have, and he uses the Glargine -- seems very satisfied with it.

Do you have any other ancillary health problems connected with your diabetes, Phil? I find that dealing with those is usually the kicker.

Wouldn't helped to mention I have Type 2 diabetes...

I blame my cats -- they were distracting me, yeah, that's the ticket...

The deliberate rationing of test strips sucks big time. It happens over here as well where type 2s are told they don't need to test often. Like hell, of course they do! Especially if you're taking insulin.
One thing I think is if you can get off the NPH and Regular and onto a more 'modern' (just because it's new doesn't mean it's better ) insulin regime. Lente/Glargine/Detemir are all long acting insulins that should give you a better basal profile (longer and flatter) than the NPH which has quite a high peak of action running out before 24hrs are up. Do you take just one shot of NPH per day? When I was using it I was splitting the dose and taking the same dose split over two shots.
With the regular, you do take it around 30mins or so before eating. It has a slow ramp up before it starts working and a long tail. The fast analogues (Lispro - Humalog, Aspart - Novalog and one other I can't recall the name of right now) start working a lot faster so you can take them just before a meal. They also have much shorter durations so you don't get bitten by the long tail dropping you low quite so much.
Do you also take some medication for the insulin resistance of being a type 2? (though the stuff to decrease insulin resistance is contraindicated where there are heart problems )
The only other thing known to decrease insulin resistance is exercise and weight loss (again hard when there are the complications following on from the heart attack).

What a lot of writing there!
So far I've been lucky to escape any diabetes complications (though I've only been diagnosed for nearly 6 years now - a mere stripling!) I have been persuaded by my GP that I should take a statin at low dose as a precautionary measure. I also take Omeprazole to reduce the acid in my stomach after a few days in hospital caused by gastric reflux.

I take two NPH injections, splitting the dose -- otherwise it's not enough (12-14 hrs, IIRC). The Regular I take because I can't afford Glargine (it's the faster one you couldn't remember, I think), and the County doesn't spring for it. I used to take Metformin, but I didn't like it, as I felt sluggish all the time, and you're correct, it can't be taken by heart patients. There *must* be another one out there by now, though -- Metformin was the "latest thing" over 12 years ago.

I'm getting so frustrated, though! I had such good control, and now I'm having zippo luck at getting back to that. I have a harder time walking now, for one thing, which makes the exercise thing harder. I think when I get back to work I'll join a gym (there are THREE within 3 blocks of my place!). I'm experimenting with what to eat when -- this week, I'm not eating any starches after lunch, and my biggest meal at noon. And if that doesn't work, I'm going to salad and greens only, besides whatever protein...wish me luck.

You didn't say, but it sounds like you're Type I. I also noticed from some of your posts at the Atelier that you do some hiking, and are pretty active. What do you take to cover yourself for low BS issues?

No, Glargine is Lantus - http://en.sanofi-aventis.com/group/products/p_group_products_meta_lantus.asp , very slow, though I didn't get on too well with it when I had a try of it. The other fast insulin I was trying to remember (I've looked it up now ) is Apidra, Insulin Glulsine made by Sanofi Aventis (the makers of Glargine).
The drugs used to lower insulin resistance (actos and avandia) are contrindicated for those with heart problems so they're a no no for you as well
It is so frustrating isn't it. It can go from good to bad to good again seemingly at random. A few weeks back I was feeling over the moon as I had about a week when I was getting almost perfect numbers at each test.
If only I could repeat it all the time!

I am type 1. Carrying round all sorts of gubbins all the time. To cover for emergencies I've got a packet of glucose tabs with all the stuff and if I know it's going to a long walk then I'll take more. It doesn't always work and I have ended up in some pretty hairy situations (like when I went for a long hike on the moors, after having had lunch and my normal insulin dose - silly me). When we go away I'll normally pick up a packet of biscuits to carry with me.

How is the trying to get yourself healthy enough to get to back work?

For the most part, I am healthy enough to go back to work, except for the walking. Since I do computer drone type stuff, not much walking required, thank Bob!

However, I do temp contract work, and they can't or aren't willing to line up jobs for me, when I've got so many dr. appts. I have a lab draw and a diabetes appt. this month, and 3-4 dr. appts and a lab draw next month. After that, crossing my fingers, that should be it. It'd better be, since the disability will be over then. I'll have to sign up for unemployment and it's about $100 bucks less a month. What I'm getting now isn't enough to manage on, as is, so employment had better follow quickly!

The big deal is "what do I tell an employer?." If I tell them I had a heart attack, I'll be pariah. Better, I think, to keep with the agency, or one of them, anyway. The one I was working for may not send me out for a long term job, so I'll go with another one of the ones I'm signed with. Accounting, yeah, that's the ticket!

Keeping temping for a while sounds like a good option if the agencies are good and keep you in work.
I know all about the appointment hell. Come and get your blood taken, come back to get the results, come and have a chat about this, that and the other. Come up to hospital (got that next month, noon time appointment, neither use nor ornament, got to take a day off work for it).

A couple of internet links for your perusal - http://www.mendosa.com/ a good site talking about all sorts of diabetes/food related things (lots of info on glycemic index stuff) and the newsgroups alt.support.diabetes and alt.support.diabetes.uk - http://groups.google.co.uk/group/alt.support.diabetes.uk/topics I've put the UK groups link in as I think there is a bit less trolling, flaiming and spamming goes on there. I've learnt a lot from reading there, there are some good people who have been there and done it in terms of what diabetes can do to you (although it's nominally a uk group there are posters from over the world, Aus and the US to name a couple).