Back from the Endo

Here's a report on my latest doctor visit.

The good news is that my High Sensitivity C-Reactive Protein, a measure of cardiac disease was .56 mg/L. This is extremely good. Under 1 is "low."

The not so good news is my A1c was 6.0%. I had stopped taking Levemir six weeks ago because I was not seeing consistent results and the fasting bgs I was getting without it didn't seem to be significantly elevated over those I'd been getting with it. My impression had been that the last vial of Levemir I got from the pharmacy was weak, but they wouldn't replace it and my copays are high. So my not using Levemir might explain the slight rise, though the difference in my fasting blood sugars was only about 10 mg/dl. My post-meal numbers have been testing in range and had even been a bit lower than usual as I was experimenting with Prandin which was giving me quite a few hypo readings in the 60s.

Everything else was fine. My total cholesterol was, as usual, very high, since I have that "large fluffy LDL" genetic variant. My dad also had this gene. He tested with a total cholesterol of 340 in the 1970s and lived to be 100 without any meds until his late 90s. As soon as he started a statin in his 90s, he became depressed and experienced a steep cognitive decline. My HDL was 72 and TGs were 110, which is a bit higher than usual for me but still fine.

My biggest problem has been that I have been gaining weight like crazy, even eating mostly low carb without insulin for 2 of the last 3 months and still eating a lot of low carb meals. I've only been using insulin or prandin for one meal a day. Even so, after dieting carefully for 8 weeks--eating only 1350 calories a day, weighted and logged with software--and losing 7 lbs, I managed gained back every pound I'd lost in four weeks of eating more normally, but more than 100 g a day and 1700 calories.

So I'm going to give Metformin ER another try. It doesn't so much of anything for my blood sugar, but through the years as I was taking it, I didn't gain weight. So I'll give it another try.

I had stopped taking Metformin as it was giving me burning pains in my upper gastric area. Testing found no sign of ulcer, but the burning pain was quite unpleasant. I hope whatever it was causing this has cleared up, as I had taken Metformin without problems for 3 years before that and it had made it very easy to maintain my weight even after I started insulin. In fact, I lost weight the first year I was using fast acting insulin with my meals, even though I was using twice as many units as I have been using during the past month.

One last interesting note. I discovered (on my own, not from the doctor visit) that the reason I was seeing those Prandin lows may be because I was eating fresh grapefruit to fight off a nasty cold. Turns out Prandin is one of those drugs metabolized with cytochrome P450 enzymes which get blocked by grapefruit. So when you take Prandin with grapefruit the body can't remove it from the blood stream.

This is probably why I saw the lowest blood sugar I've ever seen--in the 50s--last week. Usually my body just counterregulates lows right back up, but with the grapefruit Prandin affected me like a sulf which meant I was chugging carbs and still dropping low. Usually Prandin only works for an hour or so, but with the grapefruit it had my poor old betas pouring out insulin for about 3 hours.

That's enough about me. Now back to discussing topics of interest to everyone!