At the Dentist Today

It was time. Six months seems to have passed very quickly! Always a painful experience for my bank account.

Fillings today. Looks like I'll be fasting the rest of the day.

Ouch! Based on the cost of today's dental experience, I should be fasting for a MONTH! Well, Jesus fasted for 40 days, so... I've GOT this!! Well, moving forward, if I just plan on a 30-day fast every 6 months, that should help mitigate the costs of my routine dental care. The benefits to my weight loss and blood-sugar control are just a bonus!

All I really need are avocados and almonds, blueberries and broccoli with butter, and coffee with cream and coconut oil. And eggs. Lots of eggs.

The only thing I really love about my dental care provider is the delightful ethnic diversity, from the Latina receptionist to the Asian and middle eastern dental assistants and hygienists, to my female Indian dentist!

Dentist-induced migraine. Thank God for sumatriptan. It was also a challenge today to manage my chronic neck pain (due to arthritis), given the contortions I was forced to maneuver into during the course of a cleaning and two fillings. I will *definitely* plan to have CBD and THC on hand before my next dental appointment!

Losses

Today my friend Ryan Bell posted this:

"Some losses are a song interrupted. Some run their course and make coherent sense but sudden ruptures are deeply unsettling. Like a chord unresolved, it irritates and agonizes, not necessarily even because you loved the song so much, but because that's not how music is supposed to work. Like a story that ends midstream, it offends our highly trained narrative ethic."

This is especially meaningful to me as I am struggling with the first anniversary of my devastating loss last year of losing my biggest web client, which represented 20% of my income. And way more than 20% of my life.

What does this have to do with my diabetes journey, with my Year Without Carbs? Maybe nothing. Maybe everything. I am two weeks into The 30-day Richard Osborn Challenge, which is to see how close I can get to 10,000 steps a day. I was doing this last May and almost made it when everything came to a grinding halt on May 25. I have not walked since then, not until May 1 of this year when I began again. I'm not doing anywhere near 10,000 steps but I am putting on socks and shoes, taking a water bottle, finding a hat and sunglasses, and getting Barley dressed for the excursion. Some days I even manage to take along my iPod.

I'm also starting the second week of The New Atkins for a New You challenge and have survived seven days without half-and-half, almonds, and raspberries. Not even one. This is first time I've felt even remotely ready to take on this challenge! So far, no morning migraines, Dawn Phenomenon is minimal, and I haven't yet choked on any medication, swallowing pills with almond milk instead of half-and-half. Gawd, I miss half-and-half, though! But I will survive.

Off to a Slow Start

This first month of 2016 has passed awfully fast! I did well the first week, going out for a walk every day, wearing my pedometer, and averaging 2,121 steps a day. (Only 7,879 steps to go!) Then it started raining and I started on nonstop migraines. For 20 days out of 31, I had debilitating migraine episodes. This put me behind with my work which increased my stress, increasing the migraine pain and interfering with sleep. In addition, I began having severe arthritis joint pains in my hands--worse than I ever remembering having before! It was so bad that I contacted my doctor and got a prescription for Tylenol with codeine and an early refill on my sumatriptan (generic Imitrex). She also ordered an x-ray of my hand, with a co-pay of $65.

On the positive side, I decreased my average fasting blood sugar from 122 to 109, my overall blood sugar average from 120 to 112, my daily calorie intake from 1143 to 1046, my average daily carbs from 33 to 25, and decreased my average daily insulin from 19u to 12u. My weight did not increase or decrease, sad to say.

I have continued to use berberine (500 mg/day) instead of metformin and have enjoyed days without Depends.

I am seriously seeking out a way to get medical cannabis for both my migraines and arthritis pain.

Two Months to Go

I still have my ups and downs. Some days I'm ecstatic to have blood glucose readings—even fasting—under 100 and to see the scales show less than 150 lbs.! Other days I'm distressed and discouraged to see blood glucose spikes too far above 140 and the scales again over 150. At the moment, I do not have a migraine; but I'm sure they will return.

I'm still continuing to adjust my insulin dosages based on my meter first thing in the morning and last thing before bedtime, and that seems to work well. I'm always delighted when the reading is low enough that I don't have to take any insulin at all. Oh, and another very recent thing is that Kaiser is now prescribing 6mm syringes, which makes the shots less unpleasant.

At beginning of October, I decided to try an experiment in a desperate attempt to eliminate or at least lessen the severity of the daily diarrhea caused by 2500mg/day of metformin. I had previously asked Dr. Chan about the timed release metformin as others had said that was giving them some relief, but said she didn't think it would make any difference. (My guess is that it's more expensive for Kaiser, so they discourage their doctors from prescribing it.) Still others claimed that increasing their fiber intake helped with that. So, quite arbitrarily, I decided to cut my metformin in half, taking one 500mg tablet with breakfast, another 500mg tablet with supper, and a 500mg tablet at bedtime, hoping against hope that it would keep my liver from spewing out too much glycogen in the night. At the same time, I began taking Metamucil fiber capsules (psyllium husk) with my morning and evening meals. It did help! Though it just lessened the severity and did not eliminate the problem completely. Not unexpectedly, my blood glucose numbers went up a little; whereupon I immediately made conscious effort to increase my fat and decrease my carbs, even at risk of triggering migraines. It seemed to me that I would have migraines anyway, regardless of what I did or did not do. And the numbers went back down to where they were before I reduced the metformin. So my new macronutrient goals are 82% fat, 8% carb, and 10% protein.

I also began taking a low dose of alpha lipoic acid (recommended by some of the diabetes doctors) and that's when I began having fasting blood glucose numbers under 100. Except for today.

The one thing I'm stressing about right now is that my weight loss seems to have plateaued. So the only thing that makes sense to me is to be more diligent about my 1200/day calorie restriction. (I can't even think about getting back on any exercise program right now! Especially with all the pain in my right hip during this past week after my one-mile walk in church shoes through the city streets of San Francisco last weekend!)

So I'm planning to be brave and stop all metformin for this month and take berberine instead, 500mg at morning and at evening, with bedtime metformin if I feel like I need it. Will continue to take the fiber capsules and alpha lipoic acid in a higher dose. We'll see how it goes....

Over Halfway

It's been several weeks since my last blog post here, mostly because I've been on vacation, plus consumed with getting ready for vacation and then recovering from vacation once we got home! Also because things have pretty much leveled out on a plateau. A plateau that I'm not satisfied with, but have to accept nonetheless.

I had some difficulty getting my new prescription of thyroid medicine, so I'm still on my six-weeks trial of the new dosage.

I've given up any hope of getting any real success stories from the NEWSTART® Insights Facebook group, except for what the admin Ron G. says about his own experience. They have discontinued their monthly conference calls due to lack of attendance, which is not surprising given their lack of promotion for that endeavor. When I suggested that maybe "attendance would have been better if the event had been promoted extensively," Ron's campy response was, "You can lead a horse to water but you can't make them drink." To which I replied, "But I think most of the 'horses' didn't even know there was water!" I am continually amazed at the lack of technical savvy within the Weimar bunch. What does it say about an organization who cannot attract personnel who are adequately qualified to meet their need for a credible web presence?

Well, on the personal front, I have passed the seven-month point in my Year Without Carbs; so it's time to reflect and evaluate a bit. I have pretty well established a dietary daily protocol with 100g of fat, 30g of carbs, and 45g of protein. Within 1200 calories per day, that's 75% of calories in fat, 10% in carbs, and 15% in protein. While I was admittedly disappointed that my A1C has not decreased, I am more than pleased that eating low-carb high-fat has definitely positively affected my weight loss. In seven months (from January 4 to August 2), I have lost 17 lbs. I am no longer obese! According to my calculated BMI, I'm now in the top end of overweight. Another 20 lbs. to go and I'll be in the top end of normal. Woo hoo!

Some of my diabetic low-carb high-fat colleagues say that I should decrease my daily carb intake to no more than 20g per day, but I get migraines whenever I go below 30. And I have decreased my twice-daily insulin dosage to less than half, so that's something.

I still need to ramp up my exercise program. My current excuse is, "When the weather gets better." Other "excuses" include things currently happening in my personal life that are impacting all the luxurious "free" time I had the first few months of the year to spend on just taking care of myself and my diabetes.

But life must go on!

End of May

Today ends five (5) months on a serious low-carb high-fat lifestyle. My weight continues to flucuate up and down, but the overall trend is still down. I'm not going to set new goals for next month. It seems that every time I set a new low for carb intake, I have a rash of migraines—10 to 17 consecutive days—until my body adjust to the new carb goal. So I'm keeping my calories and macronutrients the same as last month: 1200 calories, fat 100 g, carbs 30 g, protein 45 g, and fiber 20 g. My average blood glucose did not decrease significantly, staying at about 125. What I need to focus on in June—and probably for the rest of the summer—is exercise. I'm doing better! Taking Barley out for walks more and making an effort to ride my trike. It's just so discouraging lately with all the cold, overcast weather we've been having!

I had a diabetic retinal screening last week, and received this standard-answer report the following day: We are pleased to inform you that review of the screening images taken in the Diabetic Screening Clinic did not demonstrate any diabetic eye disease. We recommend that you continue to work with your primary care physician to obtain optimal blood sugar, cholesterol and blood pressure control. Please remember that optimizing blood sugar, cholesterol and blood pressure will help you minimize the chance of losing vision from diabetic retinopathy. I recommend repeating the diabetic retinopathy screening photos in two years.

I should be going in for bloodwork in a couple of weeks. Last week I got an email message from my Kaiser practitioner (a Pharm.D. who my primary care physician assigned to me several years ago when my blood glucose was running high). I'd like to include our entire conversation:

Dr. P: It looks like you are due to get some nonfasting blood test. Please get them done at your earliest convenience. Also, are you still taking your cholesterol medication, simvastatin? It looks like you last refilled 9/2014. Did you have any problem with it? Do we need to switch to another better cholesterol medication for you?

Me: Yes, it has been over a year since I had an A1C. I also need to have a fasting complete lipid panel, thyroid test, and kidney and liver function tests. I have not had a fructosamine test since 2011, and tests for calcium, magnesium, and potassium since 2009 (when I was hospitalized 5 days for kidney failure). I stopped taking simvastatin a few months ago when I realized that I have not had a high cholesterol test since 2001. I'm more concerned about triglycerides, though, and am still taking Slo-Niacin as prescribed for that. I would like to get the blood work done during the second week in June as I have a very heavy workload during the first week. Please let me know if I can get all these tests at that time.

Dr. P: Thank you for your update. Your doctor has already ordered all your blood tests below except calcium and magnesium. Unfortunately, I am not authorized to order these two items. Please follow up with Dr. Chan to add that to your blood test. I would encourage you to resume simvastatin as recommended. Studies have shown that simvastatin can prevent heart attacks and strokes even if your bad cholesterol (LDL) looks good. We are putting all patients on statins now. Do I need to order that for you? Please let me know.

Me: Thank you for the update regarding the order for my blood tests. I will contact Dr. Chan for the ones you are not authorized to order. I do not wish to resume statins at this time. My main concern is that it will make my diabetes worse and is not good for my liver and kidneys.

Dr. P: Your blood sugars were good being on simvastatin. I doubt simvastatin will increase your blood sugars. However, I am more concern of putting yourself at higher risk of heart attack and strokes. Slo-niacin may affect your liver as well but it does not protect your heart. I highly recommend you reconsider resuming simvastatin or switch to atorvastatin that can protect your heart and lower your triglycerides.

I did not respond to Dr. P's last message, but I did email Dr. Chan with: Dr. Poon recently contacted me that I am due for bloodwork. I responded to her: "Yes, it has been over a year since I had an A1C. I also need to have a fasting complete lipid panel, thyroid test, and kidney and liver function tests. I have not had a fructosamine test since 2011, and tests for calcium, magnesium, and potassium since 2009 (when I was hospitalized 5 days for kidney failure)." She responded back to me: "Your doctor has already ordered all your blood tests except calcium and magnesium. Unfortunately, I am not authorized to order these two items. Please follow up with Dr. Chan to add that to your blood test." So I am contacting you to verify which blood tests have been ordered for me. If possible, I would like A1C, complete fasting lipid panel, thyroid tests, liver and kidney function, Fructosamine, Calcium, Magnesium, and Potassium. I would like to get the blood work done during the second week in June. Please let me know if I can get all these tests at that time.

I did not mention Dr. P's insistence on statins. I shall wait to hear from Dr. Chan this coming week.

Keto Flu

I felt really yukky on Sunday. I did not want to eat or drink. I had to force myself to get out and take a walk before it got too dark. My blood sugar was elevated in the late afternoon and evening in spite of eating almost nothing. And I couldn't stay out of the bathroom. I felt better on Monday and even better today. Now that I look back, I'm wondering if I had "keto flu." I haven't yet used the Ketostix so I have no idea if I'm in ketosis or not, except that I'm experiencing a lot of what the others say it's like. I have no desire for sweets or starches any more. Not even the dark chocolate that's been in my desk drawer for a couple of months. I have more energy and feel more upbeat in general. I'm sleeping better, and I haven't had a migraine for four and half days. Yea, me!

Migraine Returns

After 19 consecutive days without a head-splitting migraine requiring medication, I had a migraine in the middle of the night (about 4 a.m., I think). Well, that was 19 days that were gifts. Fortunately, I've had enough time to accrue another month's supply of sumatriptan.

The only thing I ate yesterday that was unusual (for me) was tuna in olive oil, mixed with full-fat mayonnaise and dill pickle relish. Oh, also I had only 10 grams of carbs yesterday but I was "within budget" for fats and protein. Could have had more fiber, maybe, which would have added carbs. And I ended up, amazingly, with under 1100 calories. But I was never hungry. I ate until I was full, and I ate what I loved (including zucchini and a buttered almond bun).

It was just one of those days.

May Day

April was a hard month in many ways. I started out on Easter Sunday with a horrific cold that lasted a week. I had 11 days of migraines for the first 15 days of the month. I felt under increasing pressure to get the tax returns done in time. And of course I had all the usual web client work, including three email newsletters that I had to get out during the week that I was so sick! Then Linda had her oral surgery on the 15th and I needed to be available for her as needed.

My daily average glucose readings fluctuated a lot but did not essentially change from the first of the month to the last. My fasting blood glucose also remained pretty much the same. I stayed within my goals for calories, carbs, fat, protein, and fiber. My macronutrient percentages held steady. I've been able to increase my daily walking time for the last two months. The only thing that has changed significantly is that I've lost 5 lbs. over the past four weeks! And I'm really jazzed about that.
Still, I'm adjusting my goals for May to 1200 calories a day, 100 grams of fat, 30 grams of carbs, 45 grams of protein, and 20 grams of fiber, for fat-carb-protein ratio of 75%-10%-15%. Sounds reasonable to me.

Another significant occurrence was that, after some suggestion and research, I began taking herb capsules of butterbur on April 16 and, to date (16 days later) have been migraine-pain-free. Keeping my fingers crossed.

I've done a lot of thinking and reading and researching this past month and more work on my Adventist Vegetarian Diabetics blog, to supplement the Adventist Vegetarian Diabetics Facebook group. I'll go into more details about that on said blog.

I've also kept up with the other Facebook groups: NEWSTART Insights, Reversing Diabetes, The Vegetarian Low Carb Diabetic Healthy Diet Society, The Vegan Diabetic, and a few others which I check infrequently.

Last but not least, I've become better friends with Judie Lee Fizer who I "met" in the NEWSTART Insights group in February. And this is all part of my diabetes journey, my Year Without Carbs.

Easter Sunday

Last week I began my fourth month of serious low-carb high-fat lifestyle. During March, I lowered my average blood glucose from 139 to 127, and my fasting blood glucose from 138 to 128. I lowered my average daily calorie intake from 1470 to 1375. My average daily carb intake went from 49 to 36 grams. My weight decreased from 171.2 lbs. to 168.8 lbs. Not great but every little bit is encouraging.

Based on these numbers, I have set new goals for April of calories 1400, fat 117g, carbohydrates 35g, protein 53g (maximum), and fiber 30g. Percentage goals are 75% fat, 10% carbohydrates, and 15% protein.

I still have frozen shoulder. I still get migraines approximately 15 days out of every 30.

My biggest challenge is still exercise. I only averaged 21 min. daily, where it should be a minimum of 30 minutes. Now that the days are longer, I really have no excuse! Except today when it is raining.

In mid-March, I "attended" a conference call put on by Weimar NEWSTART with the topic of exercise. The presenter confirmed Weimar's belief that 10,000 steps (or 5 miles of walking) daily is required for optimal health. I asked what would be the equivalent of bike/trike riding in either distance or time, and I was told that was not an appropriate question for me to ask. I think because no one really knows for sure! My internet searches on this question have brought me answers just as nebulous. So, if/when I can remember to attach my pedometer on my next trike ride, I'll note how many "steps" get recorded on my usual trip of two times around the mobilehome park. I already know that my typical walk with Barley around 4 blocks is only about 1500 steps and takes 15 minutes. Sure, I know I should double that to get in 30 minutes, but my feet just won't go any farther! My highest steps day was 2888 steps on a Tuesday when we went to Farmers' Market and then shopping at the mall.

Today I'm recovering from a 12-hour migraine which has morphed into a scratchy throat, sneezing, and runny nose. Getting ready for a holiday visit with the kids this afternoon!

NEWSTART® Insights

I need to just start this day completely over! Woke up with a migraine, could not get into computer for an hour and half, and then discovered that my trusty Joomla editor was not working and the rest of the day was consumed with that! The first re-broadcast of City Church Online failed, and the only respite I had was listening to Dr. Richard Bernstein's webcast for an hour. However, just before giving up for the night, I checked Facebook one more time, and there was an invitation to join a newly created group, NEWSTART® Insights! The admin, apparently who is the face of the Newstart Lifestyle Program Page, took me seriously when I posted on their page earlier this month and suggested they should have a discussion group for alumni. Well, let's see what this brings....

https://www.facebook.com/groups/1541563009464167/