What’s normal for whom?

IMG_0845It’s an interesting question, but one that really misses the individual nature of distress.  I’ve stopped asking that question at this moment, and focused on the distress that I’m experiencing.  Much of it is a very expected reaction to losing body part function (not unlike losing one’s islet function, only this time it might be my eyes or my foot, or even more essentially – my heart.)  Not might, but probably in the latter case.

I’m pretty sure depression is the norm.

Anyway, I managed to get out of bed, and there was a some acting out as I spent $15 at the grocery store on items that I never otherwise buy – an avocado, a big Hershey’s symphony bar, some part-skim mozzarella cheese, and a bottle of caffeine-free diet soda (which I usually substitute diet fruit juice for these days).  It’s relatively cheap therapy – the shopping part – with health consequences, I suppose.

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The chocolate, probably the worst offender on the list, presents with 39g of fat (that I admittedly don’t need), 30 mg of cholesterol, 180 mg of Na, 63 g of carbs, and 600 calories, if consumed in its entirety.  And it was.  The part-skim mozzarella is surprisingly low in sodium, if not fat.  It’s probably not that different from the cheese that I make (the label says “all natural”).  Fat, for whatever reason, makes me feel better.  Maybe it is needed to synthesize the right “happy” neurotransmitters in the brain? Just a theory.

I decided to pack the pups up and go out for a hike – away from all of this.  The only thing that I could find that would work for a bike ride was the Cattail Country Club golf course.  It was too dark to golf by the time we were there, so we hopped on the the little buggy path with the bike.

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We did 2 1/2 laps around the main hole without getting off the bike (there were some decent hills for a bike that does not have low gear), and then did the loop around 1/2 the course on the other side of the tunnel under Georgia avenue, where I had to get off the bike for 3 precarious descents because my brakes aren’t in great shape, and 3 other climbs because the ascents were too hard.  Still, I finished the last 1/2 of the original hole with the pretty steep hill at the end without getting off the bike.  I guess it was 4 pretty hilly miles.

On the way back, I ran across another Urgent Care clinic, and stopped.  My blood pressure (systolic) was up around 150/80.  Maybe from being upset.  It usually recovers more quickly after exercise.  This time I was able to get a script for some Lantus and pen needles without too much of a problem.  A 45 min. wait, and a doctor who treated me respectfully, asking me a few questions about the diabetes, listening to my heart, and looking at my legs to see if there was edema.  He mentioned that there was another formulation of lisinopril that has a diuretic in it, and talked about following up with an endocrinologist.  I shared with him what I thought the right order for things was:

1) immediate better management of the diabetes bringing my blood sugars down from an average of 180 mg/dL to a lower level with fewer lows (where I tend to overcompensate).

2) the evaluation by the cardiologist with my hemoglobin A1c, and cholesterol values in hand, and some records of better blood sugar values on Lantus.

3) an appointment with an endocrinologist who specializes in the complications of diabetes who will have seen this over and over again.  By then, the endocrinologist will have the assessment from the cardiologist, and may want to do a renal evaluation before putting me on a diuretic.

We talked about phasing in the Lantus – giving the “once daily” injections in the evening, starting with 1/4 of my total daily insulin need in units of Lantus, and working up to 1/2 of my total daily insulin need in units of Lantus, while I lowered the amount of regular insulin that I took in the day by the corresponding amount.  My regular insulin will eventually only be used for meals, but I will need 3/4 or 1/2 of what I was taking before depending on how much Lantus I take.  So, on day one, Lantus will be 10 units, and a 12 unit shot of regular would become 9 units.  On day 2, Lantus will be 15 units, and the same shot of regular would become 7 1/2 units.  On day 3, Lantus will be 20 units, and the same shot of regular becomes 6 units (probably only if I need it  – that is I eat 6 units worth of sugar).  Most scientifically trained doctors do not want big changes too fast.  They prefer a gradual phasing in; it is generally safer.

Since I’ve been on it before, another way of doing things which I am comfortable with, is to give 1/2 of the amount of my average daily dose of regular insulin in the form of a single Lantus injection in the morning, monitoring my blood sugars all day long, and only eating a little if I feel shaky.  Once I’m comfortable that the basal level and insulin is correct, spend 1/2 a day on regular insulin shots again, and switch to the evening time for the daily injection of lantus, at this point, only giving regular insulin in a carb compensated and as a blood sugar treatment response with 1/2 of the meal dose that I would treat with currently, or 1 unit for every 40 mg/dL over 100 mg/dL that my blood sugar measurement shows, plus whatever I need to cover a meal (1 unit for 10 g carbs).  It will vary for every individual, but most diabetics will be able to do this safely once they work out what works for them.  The rationale for the evening time injection is that the insulin won’t taper off just as you go through the nighttime early morning peak “dawn phenomenon”.

All in all, the doctor’s visit was pretty quick and painless once I found a system that could process me.  The visit normally costs $147.  I think it is worth it not to wait to get on the better insulin.  Probably not worth going to jail over, although on some deep level, it still feels like “selling out.”  At least the place is small.  It is a doctor’s office, not a place for IV’s or operations.

Everything shifts for me between 3 modes:

1) stability where I can do things with the computer, explore culture and languages, science, learn, exercise, take care of my health.

2) anxiety where everything is focused on the immediate, what’s happening this week, where am I going to put my head down tomorrow.  In this state, exploration and exercise continues, and some writing continues, but the ability to manage my health deteriorates, as I focus on simply coping.  There is no development of language, science or culture.

3) Camping or living out of a car.  In this mode, the questions become “Am I likely to freeze or overheat? Where will I get the resources to provide for myself and my pack? Where can I go where I will not be harassed by other people and the police?”  There no longer is any medical care, especially as I internalize the fact that no one wants to see us.

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