A Look Back at the Year

Tonight is New Year's Eve, and we've just come back from an early party at the senior citizens' group. I was lucky that there were big bowls of green salad on the buffet table, so I filled my plate. Then I topped the salad with 1/4 c. of potato salad, just to see what would happen. In addition, I had a bite-size cheesecake treat and 2 oz. of red wine at "midnight" (which was actually 9 p.m.). Two hours later, now at home, my blood glucose reads at 107. Of course, I did walk a total of three blocks to get to the party and back, so I'm sure that helped some. Now I will take 5 units of Humulin (insulin) and a 500 mg berberine capsule.

I have decided to continue the berberine (1500 mg a day) through the month of January while I ramp up my walking protocol. We'll see what happens. This weekend I am beginning reading the book, Walk With Ease, written for people with arthritis. It outlines a 6-week program to establish a lifelong walking routine, beginning with just 10 minutes a day--or once around the block--3 to 5 days a week and working up to 40 minutes. I can do this! When I have reached my time goal, then I can start thinking again about steps.

In 2015 (based on my own records), I reduced my average daily blood glucose from 147 to 118. But, obviously, average daily blood glucose based on the readings I take at various times during the day, does not equate to A1C, which is said to represent average blood sugar over a 3-month period. I figured that because, in reality, I must have had blood sugar spikes at times during the day when I did not take a reading with my blood glucose meter. The biggest disappointment is that my A1C did not go down. Not at all. It has stayed at 7.0, which is an actual average blood glucose of 154.

The best thing that happened was that I lost 22 lbs between January 4 and December 27. I went from 1800 calories a day to 1100, and I dropped from 124 grams of carbohydrates per day (which was well within ADA guideliness) down to an average of 27 grams at the lowest point, with an average of 33 grams. And that--the combination of low calories and low carbs--is the "magic" that causes weight loss, even though it did not seem to lower my blood sugar.

I stopped taking simvastatin and glipizide early last January (for reasons detailed in my earlier blog posts). I temporarily stopped metformin in November and replaced it with berberbine, and the jury is still out on that one. Eliminating metformin has greatly reduced my need for Depends whenever I leave the house.

During the year I have continued with Migrelief (a combination of magnesium, B-2, and feverfew) and added butterbur, in my ongoing attempts to reduce frequency of migraines. I added B-12 in case I'm low due to eating mostly vegetarian, and I added iron so I would still be eligible to give blood at Optiscan (a local research facility that develops instruments for diabetes). In the fall, after reading Dr. Ron Rosedale's book, The Rosedale Diet, I added alpha lipoic acid, which, interestingly, didn't seem to affect my blood sugar readings but--whether coincidence or not--I have had fewer instances of migraines since I've been taking it!

Another disappointment is that my cholesterol has gone up instead of down. However, I keep reading articles about how the total cholesterol measurement is not as crucial as the ratio of total cholesterol to HDL (the "good" kind). And that I should be more concerned about my triglycerides than cholesterol.

One surprising positive last summer, after 6 months of eating low-carb high-fat, was that my thyroid test showed that I now need a lower dosage of thyroid medicine. Both my liver and kidney functions have improved slightly. My calcium, magnesium, and potassium are all in the normal range; so I'm apparently not malnourished on a low-carb high-fat lifestyle!

I've been told that cholesterol will remain high while one is losing weight. I've also read that there are certain drugs that prevent one from losing weight, such as beta-blockers, which I'm taking for migraine prevention, and antidepressants (so I've stopped taking Paxil).

I began 2015 with the full intention of finishing reading Richard K. Bernstein's Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, but got bogged down in the material about intense body-building exercise. It didn't seem as relevant to me as other lifestyle issues. I read Jimmy Moore's Cholesterol Clarity and Keto Clarity. I have downloaded numerous cookbooks and recipe books (mostly free for my Kindle) and purchased one hard copy of Jimmy Moore's The Ketogenic Cookbook. I'm now in the middle of reading Dr. Eric Westman's New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great.

My intention for 2016 is to continue eating the way we have been eating: low-carb, high-fat, moderate protein. I'm pretty confident about that. My added focus (which I fully intended to get serious about after Kampmeeting last summer but didn't) is exercise. Starting with walking. I have put a new battery in my pedometer and have made a list of upbeat music to load into my iPod for my walks. If last year was the Year Without Carbs, this year will be the Year of Movement!

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.

From January to February

So...I've completed four full weeks of a food journal, with grams and percentages of carbohydrates, fat, and protein, and continuing with recording blood glucose readings and insulin dosages. I'm feeling more than a little depressed right now because I've gained weight instead of losing, even though my blood glucose numbers are coming down a bit. I've averaged 1548 calories per day and 62 grams of carb, so I think I'll set my February goals for 1500 calories (down from 1800) and 68 grams of carb (down from 100). I can do this!

However, I also need to really focus on the exercise. My goal was 30 minutes a day and I averaged only 16. I have to get serious about this. I also need to be more mindful of water and intentionally drink at least 32 oz. a day. Besides coffee. My right frozen shoulder also need deliberate attention. I bought a new heating pad and a 4-ft. dowel to use with shoulder exercises. It's getter worse, not better, so I want to work on fixing it, if I can.

I have taken my last simvastatin today. It's sort of scary; but I've had way below 239 for total cholesterol for several years—regardless of what I ate. So I'm going to be brave now. On the flip side, I've started taking my 500mg of metformin at bedtime again. I feel that's a better option than the glipizide.

I'm going back to MyFitnessPal for my food journal now that I've had a month with CalorieKing. I'm disappointed that my CalorieKing software does not reflect the most up-to-date food information as found on the CalorieKing site. I like the software because it gives a nice pie chart of the macronutrient percentages, but I'll just have to imagine it in my head with MyFitnessPal. I've also signed up for a free account with GlucoseBuddy, now that it's available for android (as well as iPhone) which is supposed to track glucose and insulin and has graphs.

I've been adjusting my insulin to my numbers, so I'm not actually still on 40 units in the morning and 50 units at bedtime. During January, I averaged 38 in the morning and 32 at night. Meaning, of course, that I'm nowhere near reducing the Dawn Phenomemon. Frustrating. But everyone says that it's the last to go. With Glucose Buddy, I should be able to better see an average of my blood glucose readings.

I'm pleased that a few new members have joined Adventist Vegetarian Diabetics, and I'm spending more time on The Vegetarian Low Carb Diabetic Healthy Diet Society, although I do enjoy reading all the success stories on Reversing Diabetes. I'm also taking mental note of what I read on NEWSTART Insights. It's totally vegan, of course, and very strict about no (processed) oils or sugar. They prohibit even extra virgin olive oil and unrefined organic coconut oil, yet they advocate generous amounts of legumes, whole grains, and fruits. I haven't yet found any members who have shared their "success stories" of reversing diabetes on a strict vegan diet. Even with walking five miles a day.