My latest A1c

In a previous blog entry, I mentioned that I was nervous about my regular quarterly A1c test, which I had last week. It was a fasting test that checked my A1c, cholesterol, triglycerides, albumin, liver and other things. I visited my endo this morning for the results.

And?

Everything is absolutely fine. The best news is that I’m still in the 5% club. Whew! I was expecting my A1c to be at least 6%. Given the leg injury, the surgery, the leg inflammation that went on for a few weeks, and the lack of exercise (hopping about in crutches may have built my arms and shoulders for the summer tank top, but my physical activity was almost non-existent), all contributed to my difficulty in getting a grip on my blood glucose. I decided to lower my carb intake while recovering in order to: one, control my BG and two, not gain weight. It worked.

But, still, one has to wonder. Given that my BG was generally higher right after the injury and surgery and was unruly for the following few weeks, I was shocked at my A1c. How could it be in the 5% range? I tried to process this today, and came up with three possible explanations:

1.     I read in a diabetes board that the A1c tends to favor the last few weeks of the 3-month period preceding the test. I have not confirmed the basis of this claim, but it may explain my bizarrely magnificent A1c result. As my leg was healing and getting better, as my A1c test date got closer, my BG was also getting better.

2.     The A1c is a 3-month average. It does not measure each day’s levels, much less hourly levels, or even every pre-meal and post-meal (or snacks) level.  Now, I do not test 8-10 times a day, but while I was recuperating, I did more “meal spot checks” than I used to do. Many of those tests showed a generally higher BG level. But, if my 3-month average was less than 6%, and I know that my testing meter showed many high results, then it stands to reason that I also had generally more low BG levels than I thought. I believe it helped that I cut my carb intake, so my post-meal BG was more manageable that I had imagined. And as I said, my BG was improving as my leg was healing. Hence, the average could indeed be lower than I expected.

3.     l could have a blood condition that results in my getting an unusually low A1c. That’s a possibility except that when I was eating massively high amounts of carbs, my A1c was correspondingly high. Although I have not taken some possibly expensive tests to sort out a possible blood condition, I’ll rule this out for now.

There may be other reasons I haven’t thought of yet. But I decided not to spend so much time thinking about it or imagining it was a deceiving fluke. I’m just glad to have good test results.

My endo was so impressed that he offered to cut my metformin from 1,000 mg a day to 750 mg a day. I happily said “No, thank you.” We tried 750 mg once before, and I was extremely unhappy with that dosage because I had to be really careful of what I was eating and drinking, much more than the 250 mg. difference would suggest. So, if one additional pill lets me indulge a bit more, then I’m happy to swallow it. Mind you, I’m not talking about eating whatever I want. But just enough for me to enjoy life without massively depriving myself or being bored with eating, while at the same time keeping a handle on my BG within a comfortable level (around 140 mg/dL post-meal).

So, as I’m writing this, I’m celebrating with a glass of Sauvignon Blanc.  My apologies if my writing slurred.

My first sort of run

I wasn’t planning on posting two entries within a few hours of each other, but I had my first walk-run (that is, more walk than run) since I injured my leg last March, and I can’t help but share how wonderful I felt. I have been patiently walking these past few weeks, itching to run while I built up my leg muscles which literally shrunk while my leg was in a cast. My PT said that I’m perfectly ready to run, as long as I remember to stop if I feel pain. So, today, I did just that.

MInd you, I ran gingerly and slowly, and I was a bit wobbly. But I felt no pain at all so I was very much tempted to run faster and longer, but the phrase “NOT too far, too fast, too soon” kept flashing in my mind. I decided to back off, after all I have all the time in the world to return to full-time running. There’s no need to rush. I must say though that I felt so so soooooooo good to run again, even if it was short.

After my walk-run, hubby and I walked 20 minutes to our favorite cafe and walked back, and my legs felt fine. I’m keeping my fingers crossed that my legs will still be fine tomorrow or the day after (you know, no delayed onset muscle soreness). But I don’t care about that. After hopping about in crutches and limping for a few weeks, a few minutes of running was just absolutely marvelous.

Motivating myself to run

I love to run. Running is zen in motion. It’s the closest I get to nature on a regular basis (I run along a river). It releases stress and clears my mind. I’m not just all about running, though; I also do many other activities.

But there are days when I do not want to move at all. When I wake up on a cold winter morning, I sometimes want to just stay under the covers than brave the wind, and sometimes snow, or worse rain. When it’s a hot humid summer day in Tokyo, typically in July and August, and maybe September, I often want to just sit in front of the fan with a big tumbler of cold water. June is about to descend on Japan, and that means days and days of rain, again reason to want to stay in. Even when its spring or autumn, my favorite times of the year, there are myriad things that can distract me, such as chores, work, social life, a stack of DVDs, and a stack of books, to name a few. Sometimes, controlling diabetes is not enough to get me going.

So, I have accumulated little tricks for those times when I know my back will refuse to separate from the bed or my butt will prefer the comfort of the couch.  Here are 5 of my favorites.

Some things that get me to run

1.         I pay myself. Once upon a time, I read about an actress who recovered her svelte body within a couple of months of giving birth. A number of the online comments were variations of “If I were paid to exercise and eat well to look good, I’d look like her.” My knee-jerk reaction was “Well, why don’t you pay yourself then?” Immediately followed by “Wait, why don’t I pay myself?” So I started paying myself 500 yen for every 30 minutes of exercise. I dedicate a new piggy bank to something specific (funding an expensive trip, or sponsoring a cause). One year, I outfitted myself with my very first ski wear, skis, ski boots and goggles, plus new running shades, plus shades and goggles for my husband, from my piggy bank. Another year, the monetary rewards went to charity.

2.         I sign up for a race. I need to train for a race, and I’m not the only one. Many runners do the same. I also try to combine travel and racing (not necessarily a marathon). This idea came to me when I ran the Marathon du Medoc. Not only did I run through summer and raced, but I had a grand time dressing up (it was a costumed run), meeting new people, and seeing new places.

3.         I look at magazine photos of Dara Torres. I hope I don’t sound like a pervert. But she motivates me to stay fit. Have you seen how good and fit she looks? I keep magazine photos of her Got Milk ad at the office and at home. She looks like she can kick ass and I’m sure she does. However, I admire more than just her physique; I am inspired by her achievements – five Olympics, and she missed a chance for her 6th only by less than a tenth of a second!

4.         I buy running apparel. Some women love jewelry, others adore clothes, and many more collect bags and shoes. I collect running apparel. If I could live in my running clothes and shoes, I would be very happy to. I’m always excited to run to show off my new tank top or shorts.

5.        I wear my skinny jeans. Few things can get my butt out the door more effectively than a pair of newly laundered, freshly ironed skinny jeans. I’m sure I don’t have to explain why.

What about you? I’d love to hear how you motivate yourself to exercise.

Diabetes by any other name is?

Note: This is a longer version of something I posted at a diabetes forum.

Two mothers with young children who have Type 1 diabetes launched a petition to change the names “Type 1 diabetes” and “Type 2 diabetes” to names that reflect “the nature of onset for each form of Diabetes” in the hope that this will clarify the confusion that the public has between Type 1 Diabetes and Type 2 Diabetes. This confusion is usually seen as disadvantageous to Type 1 diabetics because they are lumped with Type 2 diabetics.

I’m a bit late here since the petition was started about a month ago, and there have been active discussions in the DOC. But this has been bugging me, and since I did not have this blog a month ago, I hope I’m forgiven for giving my 2 cents’ worth, belated as it may be. I do not wish to be controversial here, and I do not wish to alienate people with Type 1 diabetes, but I just want to make a practical suggestion to the search for new names (if that search is ever undertaken).

I will not go into the pros and cons of the change of name itself as presented by the petitioners (that will only lead me to a long discussion on whether anyone has 100% identified the causes of diabetes). I only want to say that if anyone wants to change the names to achieve the objectives stated by the two mothers in their petition, then please remove the word “diabetes” from the new names. If the medical-powers-that-be-who-give-diseases-their-names were to retain “diabetes” as the new names proposed by the petitioners suggest, then their efforts will be in vain. Let me give a simple illustration:

At a doctor’s clinic (after the name change):

Stranger (to a mom of a Type 1 diabetic):  Hi. How old is your boy?

Mom: He’s eight.

Stranger (who turns out to be very nosey): Why is your boy here?

Mom: He has diabetes.

Stranger (who obviously does not know any better): Oh, he just needs to diet and exercise. 

Mom: He doesn’t have that kind of diabetes. He has BCA.

Stranger (now scratching his head): What?

Mom: Autoimmune Beta Cell Apoptosis Diabetes.

Stranger (now vigorously scratching his head, with his brows raised, too): Come again?

Mom: “[BCA] is a chronic, autoimmune disease in which the body’s immune system destroys the insulin producing cells in the pancreas. [BCA] is never caused by diet or lifestyle, the onset is rapid and it cannot be prevented or cured” (adopted from the explanation for the petition). [She then continues to enlighten the stranger as to what BCA is and how different it is from Insulin Resistance Onset Diabetes or IRD, the new name of Type 2 Diabetes.]

Stranger (not sure what is going on in his mind at this point): Oh I see.

Now, if you replace BCA with “Type 1 Diabetes” or “T1D” then the conversation above is what is going on right now, starting with media. So, changing the names doesn’t really help in this sense.  But if one were to remove diabetes completely from references to Type 1 D or Type 2 D, then you won’t have the confusion.

If diabetes is kept as part of the name, then to stop the confusion, one ought to stop using the generic words “diabetes” and “diabetic” in introducing oneself; rather one can say “I have (or he has) BCA” for instance. There will be no (or at least reduced) judgment or prejudice, and people who do not know what it is will simply ask “What is BCA?” But if this were a solution, then we can actually live with the current names – all we need to do is stop saying “I’m (or he’s) diabetic,” but instead just say “I’m a T1D (or T2D)” or “I have Type 1 (or Type 2) diabetes.” This will signal to the listener that we are referring to a specific type of diabetes.

Of course whatever the name is, we still need to educate the public, especially the media, about the different kinds of diabetes (Type 1, Type 1.5, Type 2, MODY, LADA; and now people are talking about Type 3). The basic task remains.

Britain’s Got Talent (2013)

After one week of diabetes blog marathon, I’m taking a break from diabetes. That means indulging in one of my favorite guilty pleasures – Britain’s Got Talent. I abhor reality shows, and am usually not enamored of talent shows. But I’m such a huge BGT fan. Blame Paul Potts. No other [Country]’s Got Talent can compete with BGT. Not that I’ve seen many other [Country’s] Got Talent competitions, but from what I’ve seen so far on youtube, the British one has the best talents and judges (especially David Walliams).

To those who are not aware (where have you been?), BGT showcases talents from Britain and the UK (that means Britain and Northern Ireland – if you are confused, as I was, click here). But it also accepts talents from the rest of the world. I’ve just seen the Hungarian shadow-dancing group called Attraction which just wowed me, and the head-spinning acrobatic dance act from Martin & Marielle (or is it Marielle & Martin?) from the Netherlands.  But the British talents just keep blowing me away.

Truth be told, I’m a big fan of British performers, from film, to stage, to TV, to music, to anything else artistic. It’s not just because I’m married to a Brit and have a number of Brit friends. I just find so many brilliant but under appreciated Brit shows, movies and talents. I have not seen any original British TV show or movie that has been successfully adapted to another country. The adaptation usually loses the grit, reality, discomfort, perspective and talents of the original, and is a very sad and often hallow though glossy parody of the original, and loses everything that made the original great.

Speaking of British talents, the world should be introduced to the brilliance of Benedict Cumberbatch. I’ve been following him since I saw him play Stephen Hawking. He’s in some great movies like War Horse, Atonement and Tinker Sailor Soldier Spy. His TV series Sherlock is a spectacular update on Sherlock Holmes. I especially mention him because, while  participating in the Diabetes Blog Week, I meet other B.C. fans (do you know some fans call themselves Cumberbitches, but I’m not using that term here :)). As you can imagine, I’m waiting impatiently for Star Trek Into Darkness to be shown in Tokyo, although I may have to wait a few  more weeks, if not months. Don’t ask me why a cosmopolitan city like Tokyo is usually late in showing non-Japanese movies, but you can watch a much-anticipated big budget film in Bangkok or Manila months before it gets shown in Tokyo.

I’ve digressed, haven’t I?

Going back to this year’s BGT, there’s an 11-year old girl of Philippine descent who made it through the auditions. Based on her accent, she must have been born in the UK, or moved to the UK at a very young age. She has the voice. My only complaint is that she sang Jennifer Hudson’s One Night Only – my complaint is not directed at the girl but her parents. Do her parents realize what their daughter was singing? But she has a great voice and is a great belter.  I hope she makes it all the way to the finals.

I am excited to see the remaining auditions, and then the semi-finals and finally (no pun intended) the finals. I need my dose of BGT. You see, based on my records, it seems that my blood glucose goes down every time I watch a clip from BGT.

I just wish I can vote.

Three D blogs I enjoyed

My brain is still trying to play catch up with the reading I’ve been doing this week and will have to do in the coming weeks, as I pour over the hundreds of diabetes blog posts put up this week. It’s not only my first time to join the Diabetes Blog Week, but it’s the first time I even heard of it and read the many entries. I’ve already met some lovely people this week. I tried to read as much as I can and visit as many participating blogs as my time allowed me. But I was not successful.

So today’s blog topic of choosing three entries or three blogs to share is a tough job. Where do I even begin? Even if I had the time and energy to go through every post and visit every blog, choosing any three would be next to impossible. Now I know how judges in movie festivals, talent shows and most other competitions feel. How do you choose from a large pool of worthy entries?

With the foregoing limitations in mind, I am happy to mention three representative blogs that I enjoyed a lot this week.

Rockin’ Ink Star. I am not a mother and I’ve consciously decided a long time ago not to be one. But I admire men and women who choose the path of parenthood and I especially admire parents with children who have additional challenges in life, whatever form that challenge may take. I have been reading a lot of blogs by parents of children with type 1 diabetes, and this blog is one among several excellent ones. Not only do I get an insight into what a Type 1 diabetic child goes through, but what his or her parents also experience. Michelle’s thoughts as a new blogger on diabetes also resonated with me since I am new at blogging about my own diabetes. I also admit that I am thoroughly envious of her artistry and writing.

Six Until Me. The first post of Kerri that I read was her “pledge to run like a velociraptor is chasing” her. I thoroughly enjoyed it. I’ve since read a few more posts and I want to read more. Her posts are funny, positive, insightful, and very open. I am really looking forward to reading 8 years of her archive.

The 9 Inch Plate. I’ve come across blogs by people who have diabetes or their parents, but Carol’s is the first blog by a spouse of a diabetic that I’ve come across. I’m so happy to have stumbled upon this because I’m hoping that I’ll get some insight into what my husband goes through. My husband and I are fairly open to each other, but I’m sure he doesn’t let me know all the things that frustrate or upset him about my diabetes. I’m not the only one living with diabetes; he (being married to me) has to live with the great D too. I am thoroughly enjoying Carol’s blog, not to mention the featured recipes.

I, with my feet up on the table and with a glass of wine or brandy in my hand, will be spending a lot of nights in the coming weeks in front of the computer reading the various wonderful blogs I’ve been introduced to this week.

Thanks to Karen for this wonderful blogfest, and to everyone who participated. It’s so good to know you.

Diabetes Haibun

Disclaimer: If anyone reading this is a haibun expert, please do not condemn my poor attempt. I’m learning, maybe badly, but one day I’ll get there. (If you want to know what a haibun is, click this link. For samples of haibun, click this one.) 

One sunny Sunday morning, as the day progressed towards noon, I went out for a long run. Although I was at that time training for a marathon, that run was not in my training schedule. I was into my second week of intensive self-testing, and that morning my BG was running high. I learned first hand how tremendous stress and lack of sleep (blame my neighbor) can raise my BG to high heavens.

          light head, dark mood brewed

          sugars floated in my veins

         the run comforted

I must have run too much because the next thing I remember was weaving across the running path. I saw spots, my skin was damp and cold, and my vision started to dim. I whipped up my OneTouch Ultra Mini. Whoa! It read 50.

          BG dipped too low

          went running without sugar

          cut banana helped

My BG settled to a comfortable level. I monitored how I felt as I ran back. I did not prick my finger again but unscientifically relied on my “feeling” and “sense”. I was lucky to have no more episodes during the run. I tested again when I got home.

          My BG behaved

          Hubby fried eggs and bacon

          Perfect end it was

It’s been a few years since that day. A lot of things have happened to me. But I’m still here, and so is my D.

          Snow melts, flowers bloom

          Leaves fall, nature’s cycle dooms

          While D marches on

Freaky Friday switch

Note: I decided to approach today’s blog topic in reverse, by starting with the DOC’s influence on how I treat people with other chronic conditions and then moving on to a Freaky Friday switch (we have been asked to select another chronic condition that we would have in exchange for our diabetes).

Being part of the DOC has been a huge benefit to me. I did not know anyone with diabetes, except for my father and we live in different countries. Until lately, I had no personal interaction with anyone with diabetes. I learned by lurking in various diabetes fora and reading the T2D blogs that I could find. Really, I got more from the DOC than it ever got from me.

Although the DOC and being diabetic have their contributions, how I treat people with chronic conditions (including myself) was and is principally molded by personal experiences with family and friends who have different forms of cancer. Thus, instead of a Freaky Friday switch with another chronic condition, I want to introduce you to three individuals with whom I would have no problem trading places with. They are at the top of my list of heroes, and I want you to know what they have taught me as they face their cancer.

Who are they?

First, my mother, Rosita (or Rosie to her friends). This would be a very tricky switch as she passed away in 1997 after a ten-year battle with breast cancer. When she was diagnosed in the 80s, the internet as we know it today did not exist and everyone, including women, considered breast cancer shameful. Breast cancer was a hush-hush topic no one talked about. My mother bucked this shame nonsense, and told everyone who listened that she had breast cancer so that she can get information that could help her live longer for her children. She was also not stingy on sharing knowledge. She taught me not to live in fear of breast cancer, although every research emphasized my own risk simply for being the daughter of a breast cancer patient. She very early on chased away my “breast cancer hypochondria” as I imagined every lump in my body to be cancer. She never forgot to smile and laugh, to remain curious and interested in life, and to be kind to others. Breast cancer was there, but she owned it.

Second, a neighbor and friend, Yumie. She is a woman in her early 30s who owns an izakaya (Japanese pub) in our neighborhood. Before she even hit 30, she was diagnosed with lung cancer. She is still receiving regular bouts of chemo, which sometimes saps her energy and leaves her feeling ill. But I have not heard her complain. I have not seen her wallow in self-pity. I’ve not seen her angry at the cruel joke life played on her – she never smoked. She always greets everyone with a beaming smile and enthusiasm, even when she is exhausted from her chemo session the day before. She actively blogs (in Japanese) to share her experiences and encourage others. Lung cancer is hanging on tenaciously but she is stubbornly fighting back.

Third, my husband’s friend, Peter, who is in his 60s. A few years ago, he was diagnosed with leukemia. He underwent chemo which zapped the cancerous cells in his blood. But after a couple of years, his kidneys failed (a risk of the chemo, something which he was aware of). He needs regular dialysis now. But he is as buoyant, optimistic and playful as ever. He jokes a lot about his circumstances. When his dialysis was reduced to a manageable two or three times a week, he and his wife continued to travel. They even managed to find clinics in various parts of Thailand so he can continue his dialysis as they visited the country. He is now back at the hospital for more treatments, but you would not know it if you spoke to him. His voice may sound tired, but his friendly and jolly mischievousness remains. He may have leukemia but leukemia does not have him.

I will be very proud to step into their shoes and be them for a Freaky Friday. My worry is not for me but for them – I wonder what they will learn from me.

Did you put sugar in my cappuccino?

Two of my GP’s first instructions to me after my diagnosis was one, ditch sugar, and two, not to use sugar substitutes.

No sugar or gum syrup in my coffee and tea. No cookies, cakes or pies. I understood ditching sugar, but staying away from sugar substitutes as well? Were they harmful to my health? That wasn’t it. My GP’s reason was very simple – he wanted me to wean myself off sweets. If not, I will have a major long-term struggle adjusting to a life of diabetes. Sweets surround us, diabetic or not, everywhere we go. Whether I like it or not, I will be constantly tempted at dinners, parties, networking functions and other social events. I would be constantly tempted just by the sight of sugar. He knew how much I loved sweets. Whatever the reason, at that time, I was willing to do what my GP wanted.

Deal with sugar first. Piece of cake! But I underestimated my severe addiction to sweetness. The fact was I did not know how addicted I was to sugar. Like the great Hercule Poirot, I used to put 3 teaspoons of sugar in my coffee. I loaded my tea with gum syrup, and drowned my strawberries in condensed milk. I snacked on chocolates – except bitter, dark chocolate.

The following weeks were hellish. My experience must have been close to what Renton in Trainspotting went through. All right, that’s an exaggeration. But I am not exaggerating when I tell you that I would rather run through the Sahara Desert in summer than cut out sugar.

Especially in my coffee. I drink coffee by the bucket and, as I said earlier, with a lot of sugar. How could anyone drink that bitter black liquid without any sweetener? Without my sweet coffee, I was the quintessence of meanness, spite, and cantankerous attitude. I was able to keep Ms. Hyde at bay in the office but not at home. My dear husband bore the brunt of it (I tell you, I’m nominating him for sainthood).

Then, one Sunday afternoon, while my husband and I were at one of our favorite restaurants, I asked for cappuccino. I spat out what they gave me because it was sweet. I complained to our server and explained to him that I was detoxing from sugar. He assured me that they do not put sugar in their cappuccino and that it’s the same recipe they used the last time I was there. I forcefully insisted it was sweet and that therefore they put sugar in it. My husband, who was obviously embarrassed by my allegation, intervened. He tasted my cappuccino and assured me that it harbored no sugar.

Unbelievable. My taste buds changed. Sweetness no longer had control over me (well, most of the time). I knew then, without doubt, that I can control my Type 2 diabetes.

I still want sweets sometimes, but I’ve not put sugar in my coffee or tea since, and I’ve developed a fondness for dark, dark chocolate.

Dying orchid

How I feel when my blood sugars are quite high or too low