Dexcom has had my back (of my arm) for a few months now and it has gone really well. My anxiety has improved quite a bit now that I’m not constantly wondering what my blood sugar has been up to. While I wasn’t expecting that, what I was expecting was to find patterns to my blood sugar, and magically know how to address them…

ahem

That has turned out to be a lot more difficult than I thought!

Some things I have pretty good control over, like noticing that I’m under-counting carbs, or timing my pre-bolus to better match my insulin action profile. But what I still really struggle with is my basal.

My blood sugar starts going up at night, even when I don’t eat, making bolusing for dinner confusing. Right now it’s 5:20, my blood sugar is 167, I haven’t eaten anything in 4 hours and my lunch was low-carb (and a small portion). Ugh! When I do eat dinner, my blood sugar spikes, come down nicely with my meal bolus only to rebound hours later, much higher than can be attributed to protein.

On the flip side, dawn phenomena is kicking my ass every morning. The inevitable rise begins at 2-3am, and by the time I wake up I need stupid amounts of insulin to bludgeon it back down. Even if it’s not too bad waking up “only” 150 or so, if I don’t correct, I’ll shoot over 200 as the morning goes on.

I’ve tried increasing my basal to amounts that I am just really uncomfortable with and I end up with lows in the afternoon. I want to keep my insulin at a minimum, but with MDI I just don’t have enough control to do so, and keep my blood sugar where it belongs.

This was a really long way to say that I am now the proud owner of an insulin pump! My endo thought it was a good idea, no convincing required, which was really nice. Just another confirmation that seeing someone who is used to T1’s is giving me better care, even though I’m a lowly T2.

I could go off on a rant about my insurance (UHC) only covering Medtronic, but the short story is that after looking at the pumps, I bought myself a Tandem t:slim X2. It can upgrade its firmware, so that next year when integration with my Dexcom G5 is ready, I can just download the update. They also are working on a hybrid closed loop system, which I am really excited to try.

I would have gone with the t:flex, which is large enough to hold three days of insulin, but Tandem isn’t planning on adding any of the great X2 features to it. So no CGM integration, no upgrading, no hybrid closed loop. Very disappointing to see that the latest technology isn’t available for the only T2 friendly pump, but unfortunately it’s not all that surprising either…

The pump arrived almost two weeks ago, but I’m still waiting for training. There’s been a bit of a hold up trying to get the pump settings from my endo, and Tandem won’t do the training without them. Being the dork that I am, I have already programmed it with some defaults gleaned from Pumping Insulin. But I’m not willing to piss people off by starting without training. Also I think help with my first infusion set, and getting a bunch of samples from the trainer, will be worthwhile.

I’ll report back on how things turn out. Wish me luck!

My Dexcom G5 arrived this week! It was a 3 month battle of wits against the medical machinery and victory is so so sweet.

My thoughts are a jumble. I could go into details on how it was to first setup and use. I could show you some graphs of my first few days, and over-analyze them. I could go over the pros/cons of using the receiver vs. my iPhone and all of the tech in-between. But that’s not what is sticking in my mind right now.

You can pry my CGM out of my cold dead hands

This is how I felt after just one day with a CGM. Having access and insight into the beast that I have been fighting for six years… I have no words. Wait, scratch that!

Every diabetic should have access to a CGM

Full stop. Regardless of of age, type, or treatment. To know that a device exists which tells you exactly what your blood sugar is, every minute of the day and night, and shows you when it is rapidly charging in the wrong direction, and gives you a nudge when your blood sugar requires intervention, and then deny a diabetic access to it… it does not compute. But that is a rant for another day.

For the moment, I am sticking to my usual routine, eating and injecting just as I would have without a CGM, just to see how it was working and establish a baseline. So far what I am learning is that my puny seven tests a day were painting a very incomplete picture. There are a lot of high swings that then camp out for hours, with me thinking that my insulin had done the job. It is impossible to tease out what’s due to a weak basal, poor carb counting, conservative i:c ratios, delayed protein spikes, dawn phenomena…

Over the next few weeks I plan on performing a series of controlled tests to replicate and isolate troublesome patterns. Also rereading Think Like a Pancreas and Practical CGM are in order. It’s tempting to just get really strict and overachievery to force my graphs to look pretty, but that won’t help me in the long run. These tests will identify my basal requirements, the proper i:c ratios, insulin duration (hint: it ain’t nowhere near 5 hours), sensitivity factor throughout the day, etc. With this info I can manage things day in/day out, instead of only when I am intensely motivated.

Wish me luck!

I saw an endocrinologist and CDE for the first time this week, after being diagnosed for 6 years. Predictably, they recommended blood glucose and carbohydrate targets that I completely disagreed with:

• 45g of carbohydrates per meal
• A1C of 7%
• 2 hour post-meal blood glucose of 180

As a “Bernsteinian”, however poorly I manage to follow his advice, my gut reaction was to argue and somehow convince her … of what I’m not sure. I started by saying that I preferred the American Association of Clinical Endocrinologists (AACE) blood glucose targets, hoping that as an endo, that would hold some sway or unlock her “informated patient mode”. Err, not so much. Instead I was rewarded with a wry look and lecture that the ADA and AACE targets are the same… le sigh

Then I reminded myself why I was there, to get a prescription for a CGM, and decided to shut my trap so that I didn’t ruin my chances. After waiting two months for this appointment, I was not going to blow it with this new doctor.

So I doggedly steered the conversation back to the CGM, over and over, until finally she agreed to write a prescription, if I first met with a CDE to learn more about it. I promptly agreed, letting her know that I had taken the entire day off, and that I would be happy to meet with the CDE today.

Back in the waiting room, the receptionist promised to “squeeze me in” and I cooled my heels for 2 hours. Reflecting back on the less-than-stellar first impression of this new endo, I found myself becoming bitter. Afterall I had chosen this place, the Kovler Center for Diabetes at the University of Chicago, because I had naively hoped that they would somehow be “enlightened” and more up-to-date on diabetes technology and treatment. Yet here I was getting the same frustrating, canned advice that I have gotten from GP’s past.

Now, everything I’ve written so far isn’t worth writing about. Anyone who’s spent 5 minutes talking online with other diabetics has run into this. This mind-bending disconnect between what we see as ignorant, or willfully harmful, outdated advice guaranteed to keep us diabetic, progressively more sick, yadda yadda yadda. Conspiracy theories abound. What is interesting is how I decided to react. Instead of going down that well-trod path, allowing myself to become upset, I made a decision to look at it differently.

I would view their advice not as a way to keep me sick but instead as a way to set expectations on what they will give me grief over:

• 45g carbs per meal became she promises to not scold me about a meal unless it’s MORE than 45g carbs.
• 7% A1C became she promises to not give me the third degree unless my A1C is greater than 7.
• 2hr post-meal blood sugar of 180 became she promises to not get on my case about how I’m managing my insulin boluses as long as I don’t go over 180 after 2 hours.

Essentially, rather than looking at everything she recommended in a negative light, I chose to accept it as a contract with my doctor. If I am achieving these targets, then I don’t have to worry about what she’ll say at my next appointment.

I have such a poor relationship with the medical profession, and this was a revelation for me. A huge weight was lifted from my shoulders! I now know exactly what I need to do in order to not dread my next appointment. No more indecision about what to share with them or how they would react. I am hopeful that this will save me a ton of anxiety and help me maintain a healthier relationship with my new doc.

By the time the CDE called me back, I walked her through yesterday’s meals and boluses, asked a few questions about the CGM (to not look like a total geek who has already read 3 books about them in preparation) and left with a CGM prescription. It’s still winding its way through the doctor/insurance/pharmacy obstacle course. But I will be getting one; I’ve earned it.

A few years ago I had a pretty good handle on my diabetes. The coolest kids on the diabetes forums all assured me that diabetes isn’t progressive. If I maintained normal blood sugar levels, aiming beyond what doctors and the ADA settle for, then I could control my diabetes indefinitely.

Unfortunately, I am not as awesome as my online persona may have lead you to believe. Over the past three years my fasting has crept up, up, UP. Before I started insulin this January, I would regularly wake up at 185, and never see a number under 145 for the rest of the day, no matter what I ate. Eight months later, after first admitting that “I need just a little help”, I am now admitting that I need a metric butt-load of help. Here’s an average day in the life, and mind, of Daytona:

• Wake up at 145. Inject 13u of fast-acting Novolog to stop the steady climb and keep it down around 100. Inject 25u of my basal insulin, Levemir. Log all the things on my phone.
• Walk at my treadmill desk and read email, sometimes with a wee bit of coffee, until I am concede that yes, I am in fact awake.
• If I’m feeling masochistic, obsessively test my blood sugar during this time, injecting more insulin in the vain hope that I could get my blood sugar under 100 to my target of 80. I’ve mostly given up on this and don’t look again until lunch.
• Test before lunch, usually around 125. Combine my correction (5u) and pre-bolus (2u) into a single injection about 30 minutes before lunch.
• Fart around and pretend to work until I can eat.
• Scarf down my salmon, broccoli and soul bread (9g of carbs total) while working.
• 2 hours after eating, get a 115 and let it ride.
• An hour later remember that I forgot to record the last 2 tests and my injection on my phone, dig up my meter and redo the math for my bolus and reproduce what I most likely did.
• Go back to work and do my best to not think about eating a snack.
• Give up and eat a snack, then feel bad about not bolusing for it. But I’m not really sure the best way to bolus for a 7g fatty snack and I am not really confident 5g of those carbs are real. Should I pre-bolus, or do it afterwards? I can’t wait that long and an hour ago thought that I could make it through the afternoon without a snack and now I’m grumpy and want it NOW! Also I don’t want to see that I’ve yet again failed to hit my target and then have to decide if I should correct too. In the end, it’s two hours of fighting in my head and then 1 minute of guilt-ridden nomming on a single square of 100% unsweetened chocolate with a tsp of unsweetened peanut butter plopped on top. Seems like a good use of my time.
• Stop working and test my blood sugar again, oops 136. Do another combined correction (6u) and pre-bolus (8u) 30 minutes before dinner. I’m tired of everything at this point, and for some reason I hurt all over, so I order my go-to meal of 5 plain chicken wings, a small french fry with some delicious melted american cheese (46g of carbs). The cheese is for the wings. Slimey yet satisfying!
• Pickup my dinner and eat the cheesy wings first. Look longingly at my cooling fries, managing to hold off on eating them until I’ve finished the wings, about 15 minutes later.
• Test 1 hour after I started eating the fries, and pat myself on the back for the 133.
• Check again at 2 hours, turds, 163. Wonder why sometimes this meal works and other times it doesn’t. Feel bad about not shopping and making home-cooked meals, then feel bad about being too tired to do that, then wonder if the new endo is going to actually read my logs. Maybe she is a low-carber who will helpfully point out that if I just didn’t eat carbs, I could go off insulin and all my problems would go away? Console myself with the knowledge that most doctors are high-carb, and instead I will be scolded for eating so much protein/fat and not enough quinoa or kale. Have a good cry because no matter what I do, the doctor will rightfully see through my bullshit and know that I am pathetic excuse for a human being, with no self-respect or willpower who brought this on herself and doesn’t deserve her time or treatment…
• Put on my big-boy pants, calculate my IOB (7u), then take another 4u because I just don’t trust that the 7u is going to really bring me down another 70pts.
• Check again an hour later, 136. Leave well enough alone, inject 25u of Levemir and go to bed.

That’s a pretty good day actually, only 7 tests, no highs over 200, and just 6 injections.

So yeah, I need help, probably therapy. And god help me, I wish I had some Xanax right about now. But as I tell myself every night before falling asleep, “Tomorrow everything is going to be different”.

For two years, I was camping in that magical range. Not bad enough to get anyone with a prescription pad to take me seriously, but evidently bad enough to cause trouble.

One day while eating breakfast, I had a sharp stabbing pain in my right thumb. I yelped and clutched my hand, wondering what the hell had just happened. For the next 15 minutes, anytime I bent my thumb, the pain would return and I couldn’t think or move. Just waited for it to go away. This happened on/off for a week before I saw my doctor. They assumed that I must have somehow injured my thumb and had me splint it for 2 weeks. While splinted, my thumb didn’t hurt but when my two weeks were up and I took off the splint, the pain kept coming back.

I’m going to skip the very long rant/sob story where I spent the next 12 months seeing doctor after doctor, the best specialists money could buy in Chicago, and enduring three very painful (and failed) steroid injections. By the end of that year, they had investigated a number of possible diagnoses from trigger finger to carpel tunnel, but my thumb was still just as bad, and now both my hands were aching day and night as well.

Let me step back for a moment. I am a computer programmer and when I introduce myself I like to joke that “I am paid to type”. What I was going through wasn’t just about the pain, it was a threat to my entire career and sense of self. I was severely limited in how much I could work, and thanks to all the hoops I was jumping through with my keyboard and mouse to minimize the pain, was noticeably reducing my productivity. I didn’t know why but I was quickly becoming crippled, too disabled to work, play with my nephews, clean the house, button my pants…

Then I got lucky. In tears, I explained to my doctor that this was killing me and I needed an option other than exploratory surgery. She sent me to a physical therapist because she didn’t know what else to do with me.

The therapist measured the range of motion in my thumb, fingers and wrists then very bluntly said that if I didn’t figure out the cause, I really would be crippled. She showed me how my hands could barely open up anymore. I had “claws” instead of hands and was doing little things every day to compensate for it. I started a course of treatment, where she would massage my hands for an hour 3 times a week, which sounds pleasant until you see how she did it!

She would press those metal tools deep into my skin, working along the tendons, between the bones in my hands and in my joints. I could feel it scraping against these gritty lumps that I didn’t even know where underneath my skin. They were everywhere but especially on my tendons. Slowly, this “massage” broke up the insidious scar tissue and I could open my hands a bit further. After each session, my hands would double in size, hot angry red and I’d immerse them in ice for an hour afterwards, not feeling the cold.

It was some tough love but it worked. Over the weeks, I learned that this was from my diabetes. It wasn’t “just trigger finger” like the over-paid specialists thought. It was deposits caused by high blood sugar, coating my joints, sticking to my muscles and tendons.

After 3 months, the treatment was complete, or rather my insurance was done paying for it. She sent me on my way with instructions on how to massage my hands 10 times a day, flexing and pulling my fingers to prevent the claws from coming back. It’s been a year since I stopped treatment. I still follow what she says every day. Not because I’m a trooper, but because if I skip this for even ½ a day, my hands stiffen up. If I skip for a week, the thumb pain comes back in full force.

I was nearly crippled by my diabetes. My blood sugar wasn’t scary high. My worst A1c was 6.9, but most of the time was “just” 6.1. After fighting with doctors for over a year, I’m finally on Metformin and basal insulin, bringing my blood sugar down bit by bit. My hands are getting better since starting insulin; I only have to massage and go through my therapy routine 4 times a day.

I’m not sharing this to solicit advice or sympathy. I just want you to know that this or something else could happen to you. If your doctor is anything like the five that I have gone through, they may tell you that your blood sugar is fine. Don’t believe them.

I was describing to someone new to diabetes how I “chuck my pen like a dart”, and realized that my silly metaphor was causing confusion instead of providing reassurance on how easy injecting insulin can be.

A couple points:

• Insulin pens are awesome and syringes give me the willies.
• Hold the pen like a dart, lightly between your fingers.
• With the cap on, practice pretending to “throw” the pen like a dart. A single, smooth motion moving at a reasonable pace.
• Do NOT put the needle up to your skin and push it in.
• I much prefer my hips or the side of my fat tire to my belly.

With this, 99% of the time I don’t feel the injection at all, and wouldn’t know that I had just poked myself if I wasn’t watching.

Below are my previous reviews of cat litter:

• Dr. Elseys Cat Litter
• Blue Buffalo Naturally Fresh Walnut Cat Litter

I have been field testing crystal cat litter for 6 months. “Crystal” cat litter is made from Silica, just like those little packets of crystal beads with the warning “do not eat!” you often find in packaging to keep things fresh.

I started with Dr. Elsey’s Precious Cat Long Haired Litter because I like their clay litter and it was available at my local pet store. It was a bit pricey though and isn’t sold in bulk quantities so I have tried a few others, notably PetSmart’s ExquisiCat Crystals and Petco Crystal Cat Litter.

They are simiar enough that I’m lumping them all together and will call out any important differences.

Clumping

Crystal litter does not clump which is a big difference from most litters. The way it works is that you scoop out any “solids” and the “liquids” are absorbed by the crystals which are replace regularly. FYI, I love euphemisms for poop and pee! :–)

Silica is extremely absorbant and holds many times its own weight in urine. It starts out clear/white and each time you scoop, you stir up any yellow spots to spread it out and prevent their favorite corners from becoming saturated while other parts of the box go unused. After a 2-3 weeks, when the litter is a uniform light yellow, I dump the entire box, scrub it and start over.

Odor Control

Each of the brands include some extra ingredient to deal with urine odors. I don’t notice any fragrance or smell from the fresh litter, which is my preference. I want my house to smell like I don’t have cats, not like their litter, even if it is clean!

None of the brands covered up the smell of poop as well as traditional litters. I believe that’s because the crystals don’t completely coat and cover like clay. I find that after scooping, I have to immediately take out the trash and can’t get away with putting it in a temporary trash can like I could with clay. Not a huge issue for me since it’s 2 steps to the trash chute.

I was pleasantly surprised at how well the crystal litter dealt with the urine odor. As long as I stirred the box when I scooped, I never smelled the urine, even towards the end of the “litter cycle” when the litter was almost ready to be changed. Maybe that means I could go even longer between changes but once it looks yellow, I can’t help but change it.

Weight

This is the best part of this litter. It is very light. Normally I put 40lbs of litter in the box at a time (it’s a big box for my Maine Coon) and now I only need about 20 lbs.

One quick note is that many of the brands suggest only using 1.5 inches but I find that is just not enough. So I end up using more per box than what the manufacturer recommends. Maybe my cats are just prolific pee-ers but unless I use about 3 inches, I find that their urine soaks all the way to the bottom of the box which makes cleaning more difficult.

Dust

This is one area where the brands differed. Dr. Elsey’s by far has the least amount of dust, both when pouring and scooping. ExquisiCat came in second. Petco Crystal litter has the most dust, especially when I’m stiring up the pee spots. I would say of all the types of litter I have tried so far (clay, corn, wheat, walnut) that this has the least dust.

Another difference was in crystal size. Dr. Elsey’s has very small fine crystals which is best for fishing out the turds as I don’t have to sift or shake the scoop which helps prevent kicking up dust. ExquisiCat’s crystals were just too big, making it exteremely difficult to scoop. If you go with that brand I recommend finding a scoop with very large spaces between the tines. Petco Crystal litter is in-between. Sometimes I get crystals stuck in my scoop (a litter lifter) but for the most part, the crystals fall through with 1-2 shakes.

Tracking

I have found that the crystals do track out of the box but don’t make it very far before working themselves loose. Traditional litter would find its way throughout my house but with the crystal I only need to sweep the first 10 feet from the box. I haven’t noticed any dust making its way out of the box or sticking to the cats feet.

With both the clay and walnut litter, I had to clean my cat’s feet to remove the dust which clings and clumps in-between their toes. I was briefly concerned that the cats would eat the crystals or have trouble from licking it from their feet but luckily that has not been an issue.

Price

As always, these alternative litters are more expensive than clay… The most expensive litter is Dr. Elseys at $1.8/lb. Which explains why even though it is my favorite, I have settled on the Petco litter, which can be purchased in bulk at $1/lb.

Final Thoughts

I am quite happy with the crystal litter. Overall it seems healthier than the clay as I hear fewer kitty sneezes after they use the box and it doesn’t stick to their feet (and end up eaten when they clean their paws). I do wish that I could remove the urine as well each time I scooped the box but I think that’s a trade off as clumping litters all get stuck in my cats’ fur…

If you decide to give it a try, let me know how it goes or if you find a good brand. I do wish I could find Dr. Elsey’s in bulk as that is my favorite but I go through enough litter than I can’t justify paying almost 2x as much for it.

The internet has probably invented this already and with a better name to boot. But I don’t care. I threw this together in my kitchen late one desperate night. See I have been cutting out dairy for the past 2 months, in the hopes that it would help with my chronic stuffed nose. It’s been a rough, mouth-breathing fall and I needed dessert!

Ingredients

• 1 can of full fat coconut milk, mine has 15g per 1/3 cup serving
• 2 tbsp of peanut butter
• 1 square (1 oz) of baking chocolate
• 2 tbsp cocoa powder
• 4 scoops (168 mg) of pure Kal stevia

Steps

1. Pour the liquid from your coconut milk into another container for later. This leaves me with about ¾ of a can of solid coconut fat. If yours doesn’t do this… you don’t have a good brand of coconut milk and should find one with more fat. I am using the Jewel (Albertsons) store brand, which is cheap to boot. Lucky me!
2. Put the coconut fat in a small food processor or in a container for use with an immersion blender. Mix until smooth.
3. Melt the baking chocolate in the microwave. Mine takes 1 minute on high.
4. Combine the remaining ingredients and mix.
5. I usually add back 2 tbsp of the coconut liquid if it is too thick to mix well.
6. Taste for sweetness and adjust as you see fit. Also if you really don’t like the flavor of coconut oil (I don’t!), more peanut butter will hide it.
7. Portion into containers and leave in the refrigerator for 1 hour to set. I usually get 4 ½ cup portions.

It comes out with a smooth, creamy soft fudge consistency. I cannot resist this stuff!

Nutrition Info

I am not convinced that the carb count is correct on this. Maybe it is the high fat but I don’t get a spike as I would expect from ~10g of carbs. Perhaps most of the carbs in coconut milk are in the liquid? I am not sure…

I am moving my blog off of WordPress and Feedburner. Unfortunately I made the mistake of using Feedburner’s URL for my feed instead of figuring out something that wouldn’t go away when I (inevitably) moved to a new service… From now on I’m using my own URL so it shouldn’t ever change again. I hope you make the switch and keep getting updates!

I have made a few changes and included some nutritional information which you may find helpful.

Ingredients

• 4 cups mozzarella cheese
• 1/2 cup of your favorite mixed cheese, like a Mexican, Italian or cheddar blend.
• 4 oz cream cheese
• 1.5 cups almond flour
• 1/2 cup of pizza sauce or spiced tomato sauce
• Garlic salt
• (Optional) Dried ground fennel
• (Optional) Dried ground oregano
• (Optional) Dried parseley

Steps

1. Preheat oven to 425 degrees.
2. Line a baking sheet with parchment paper. My recipe fills an entire 1/2 sheet pan.
3. In a microwave safe bowl, combine 3 cups (436g) of mozzarella cheese and 4 oz of cream cheese. Microwave and stir every minute until smooth and mixed.
4. Add some dashes of garlic salt, parsley, oregano and fennel. If you are short on spices, the only one that really matters (in my opinion) is the garlic salt… mmm salt!
5. Add 2 whole eggs and 1.5 cups of almond flour. Stir like a mad-woman until it is all mixed.
6. Dump out onto your lined baking sheet.
7. Now smoosh out the dough to make a crust. I like to put my hand in a sandwich bag and pour a few drops of olive oil onto it so that nothing sticks.
8. Lightly cover the crust with garlic salt.
9. Bake for 10 minutes. If you see major bubbles, feel free to attack them with a fork.
10. Continue baking about 4-6 minutes, until the crust fully cooked and slightly brown on top.
11. Add the pizza sauce, remaining cheese (1 cup mozzarella and 1/2 cup of cheese blend) and any toppings.
12. Shake out a wee bit more garlic salt on top… :)
13. Place back in the oven under the broiler for 2-3 minutes, until the cheese is melted and bubbly brown.
14. Remove from the oven and let it cool in a safe place (I use my cutting board). After 5 - 10 minutes it is ready to cut without causing a cheese landslide.

Nutritional Information

This makes 16 square slices, and I am quite stuffed with 4 slices, or ¼ of the pizza. So my serving clocks in at 15.2 g of carbohydrate (or 10.4g net). The nutrition info below is calculated using the recipe above, with just cheese for the topping.

See I had just quit my job and on my last day they let me know that all the money I had contributed to my FSA (Flexible Spending Account) would be forfeited to my soon to be ex-employer. As I wracked my brain to think of a way to use my my FSA in 1 day, I hit upon direct blood tests. You can go online and directly order pretty much any blood test, they will have their in-state doctor review your information and order the test. So I loaded up my cart with “goodies” and tried to checkout. Lucky me, even though my FSA coverage didn’t end until the next day, my employer had cancelled my FSA early… boo I called up the FSA company and they gave me the news that I could pay for the tests myself and then submit a claim to be reimbursed. My bill was for $1,200 so after a bit of nail biting (would they really reimburse me?!) I went ahead and ordered the tests on my own dime. Wonder of wonders, the check just arrived in the mail. I feel like I won the lottery. :)

The Tests

Okay! Back to the tests. I had ordered some tests that I had heard were critical for diagnosing some of my issues but could never get a doctor to care enough about to order the test for me. Here is what I ended up getting:

Diabetes

I had been diagnosed with Type 2, based on my weight but I had always been concerned that I may be a Type 1.5. So these test would be helpful in finally answering that question.

• A1C
  Tells me how well I have been managing my blood sugar, I know I had not been doing well so it seemed like a good idea to get a baseline of how bad I had let things get.
• Insulin
  Tells me how much insulin I am still making and if I have insulin resistance
• C-Peptide
  Indicates insulin production See Blood Sugar 101’s explanation
• GAD-65 Antibodies
  Tests for Type 1 / Type 1.5, where your body’s immune system is attacking your pancreas

Celiac

When I learned that gluten is what has been causing me such extreme pain, chronic diarrhea and other bathroom fun, I removed it from my life and am a happier person. However I had heard that if one has Celiac, then it is important to avoid gluten beyond just for the benefits of a happy pooper. If one is regularly getting small doses of it, but not enough to send you do the throne, it can still lead to long term health issues down the road, like cancer. Plus I was tired of people asking if I was just following a “fad diet” or if I had “a real allergy”… grrr

It was a Celiac Disease Comprehensive Antibody Profile, but here are all the items the test for:

• Deamidated Gliadin Abs, IgA
• Deamidated Gliadin Abs, IgG
• t-Transglutaminase (tTG) IgA
• t-Transglutaminase (tTG) IgG
• Endomysial Antibody IgA
• Immunoglobulin A, Qn, Serum

Thyroid

I continue to have issues with weight gain, very cold hands and feet (they turn white), dry skin and hair loss. I also have an enlarged thyroid. My doctors have only ever tested for TSH and total T4, which I have read is not enough to identify all possible thyroid problems, just the most obvious.

• TSH
  Is your pituitary gland screaming at your pancreas for more thyroid hormones?
• Total T4
  Inactive thyroid hormone
• T4 - Free
• Free T4 Index
• Total T3
  Active thyroid hormone
• T3 Uptake
• T3 - Free
• Reverse T3
  Unusable T3

Misc.

• Leptin
  Identifies leptin resistance, an issue with most overweight people
• NMR Lipid Profile
  Measures the size of the lipoproteins

The Results

I just got the results today and am not familiar enough with some of the tests to interpret the results just yet. However a few jumped out at me:

• My A1C has gone up from 5.0 to 5.8. Plus my fasting insulin has gone up from 4 to 24. Hello insulin resistance! Proof once again to myself that my diet is not a cure, it is control. Hop back on that wagon silly pants!
• I came back positive for a few of the Celiac antibodies. Considering I have been strictly gluten-free for 6 months (stupid Christmas…), I do not plan on the standard course of action of eating gluten for weeks then taking a bowel biopsy for a conclusive diagnosis. This is enough for me to say yes I have Celiac and I should never again let myself have “just a bit” during holidays.
• My GAD-65 (pancreas antibodies) came back as ”< 1.0", hurray for a somewhat working pancreas and a solid Type2 diagnosis!

That’s all I know for now and will report back later when I have figured out the other test results. This has served as the well-deserved kick in the pants go back to my original ketogenic diet and stop listening to all those silly doctors, nurses and blogs out there suggesting that anything other than very low-carb is healthier for me.

If you are one of my 10 regular readers, waves, then you may have noticed that I have been absent lately, from my blog, site, twitter, online forums, etc. Long story short, 1 year ago I quit my stressful job to get a grip on my health and figure out my life. HA! On one level that worked, the anxiety/stress induced physical symptoms have all gone, no more “Am I having a heart attack?” moments. On the other hand, not having a job for a year has brought about its own brand of stress… mostly depression.

I hadn’t tested my blood sugar in six months, my one drink a month was turning into one a week, I stopped caring if I ate gluten-free carbs, wasn’t tracking my food logs or weight… I am sure you can fill in how well that was working out for me. Things I had once enjoyed, like my pet-project Bytes for Health, I stopped caring about or didn’t have the energy to bother with. Boo hoo, poor me and all that jazz.

The other week someone from my online diabetes forum reached out to me, sharing her own troubles with depression and sticking to the whole “caring about dying from diabetes” deal that usually motivates me but lately hadn’t. If you are reading this, you know who you are and thank you. While she didn’t give me a very well-deserved kick in the pants, she did inspire me to try to get a handle on things again. And that’s where things have started picking up!

I started by taking 5-HTP, 50 mg between meals. Maybe I’ll write a post about it later, in short it is a serotonin precursor. Since carbs lately were improving my mood substantially, and carbs raise serotonin, it seemed worth a shot. I also reordered my old favorite, GABA, to help with anxiety. “The internet” suggested that taking it before bed could help with my insomnia and …. I think it is actually helping. Last night was the third night in a row where I slept (most) of the night through.

Maybe I am jinxing myself by with my silly title, but I feel like I am making progress. I finally hauled my cookies back to the doctor to get a prescription for test strips and am testing my blood glucose multiple times a day. I registered for a professional conference that should be a great learning experience (who knows maybe I’ll meet a future employer too). I even worked up the courage to make Oopsie Rolls (aka low-carb hamburger buns) for our Memorial Day cookout. Plus I am back to terrorizing the household with my off-key, goofy singing. The jury is still out on whether or not that is improvement. :)

Wish me luck in keeping hold of my rediscovered motivation!

Here is my understanding of his key points:

• Land deteriorates into desert when it is bare and not covered with vegetation. The soil is then unable to retain water and rainfall either evaporates or washes away (with topsoil).
• When grazed incorrectly, livestock does increase the rate at which grassland turns to desert. So does modern farming…
• When livestock are grazed in a similar pattern to how they would graze in the wild, e.g. in large herds which move constantly to avoid predators, they actually restore the grassland. He explains why in the video, in short “manure + urine + trampled grass = fertilizer and compost”.
• If the majority of our grasslands adopted these livestock techniques we would be able to a) feed more people and b) capture enough carbon in the ground to bring down our carbon levels to pre-industrial era levels. This would help combat climate change.

It is an interesting perspective and is heartening to learn that using these techniques they have helped restore previously barren land, giving the indigenous people a way to sustain themselves without foreign aid.

Well I think I may have finally figured out why I was still hungry even on a ketogenic diet! Before I share, I’d like to start from the beginning.

Over Christmas, I decided to eat some desserts that contained gluten. Well one meal turned into a few more… you know how it goes and by New Years, my digestive system was seriously pissed at me. I was in a ton of pain and things were not working right in the poop department. :) So I decided to give my guts a break. My husband had recently brought home a protein powder that tasted very good so quite arbitrarily I started a protein shake “reset”.

The first day I had 2 shakes, each shake is 12g carb / 27g protein / 52g fat, about 600 calories. I was hungry and cranky in between meals but I was ready to do whatever it took to get my digestion back in working order. The second day, I had my first shake in the morning and then lunch rolled past… and I WASN’T HUNGRY!

By the third day it finally sunk in that something about my silly reset had completely nuked my constant gnawing hunger, cravings and thoughts of food. I was eating 2-3 shakes a day with maybe a small snack of bacon or some faux chocolate mousse. In total it has been between 1,400 – 1,700 calories a day. Which is a huge reduction from what I have been doing lately, which has been around 2,200 (all the while still hungry I might add!). This was absolutely NOT originally a diet attempt. I was simply suddenly not hungry and this just happened to be how much I felt like eating.

I have been trying this for 2 weeks now and am still experiencing the same freedom from the constant hunger. As I have been transitioning from the shakes back to normal food, I think I know why the shakes were so successful. With the shakes, I am 100% confident that I know exactly how much carb/protein/fat I was eating. There just isn’t that much variation in either the powder or the heavy cream I was mixing it with.

The same can’t be said about what I usually eat, e.g. deli ham, pork shoulder, beef brisket, pork chops and ribeye steak. All are considered high fat foods and according to my food logs, I was getting at least 75% of my calories from fat when eating these foods. But really there is a lot of variation, sometimes I get a great piece of meat, well marbled and it’s amazing. Other times, maybe it’s leaner or when I cook it, much of the fat renders and is lost. What I am saying is that I am not nearly so confident in my macronutrient ratio when eating “real food”. I would not be surprised at all if the amount of fat is much lower and the protein much higher than expected.

My theory is that I was hungry because despite my best weighing, counting and logging efforts, I wasn’t really eating as high fat and low protein as I am currently with these shakes. Which could also explain why I was having such a hard time getting above the mythical 0.5 ketone reading….

I am not perfectly sure if that is really what is going on but for the moment I want to just bask in the glory of not being hungry for the first time in months. Oh dear lord what a difference it makes to be able to have my stomach shut up and get some peace and quiet. It feels absolutely wonderful and I am just hoping like crazy that I can figure out how to replicate this with real food.

When it comes to ketones, there are a couple things to look at:

1. Are you measuring using a blood ketone meter or a urine strip? If you are using a blood meter, it usually registers highest in the evening and lowest in the morning. If you are using the strips, it’s the opposite, higher in the morning and lower in the evening.

2. How long have you been eating a ketogenic diet? It can take weeks for your body to adapt and make an adequate amount of ketones. If you are measuring using a blood ketone meter, the range is 0.5 – 5.0.

3. How much protein are you eating? Your body can convert a portion of the protein you eat into glucose. Have you tried calculating your suggested protein and seeing if you are within range? Try to find an amount that keeps you satisfied, as I’ve found going too low while it may raise your ketones, causes me to be constantly hungry! :–)

4. How much fat are you eating? When doing a ketogenic diet, please don’t try to go low-fat! Make sure you are getting enough healthy fats (saturated and mono-unsaturated, like avocado, pastured eggs, butter and animal fats). When doing a ketogenic diet, the majority of your calories will come from fat.

If you are “doing everything right” and have given yourself enough time, you may want to try eating more coconut oil or MCT (medium chain triglyceride) oil as they are converted to ketones easily. Another idea is to switch up when you test. For example, since I have diabetes, my blood sugar rises quickly in the morning and that causes my morning ketones to read very low. However after eating breakfast, they rebound nicely.

One more thought is to ask yourself why you want higher ketones (assuming they are at least registering). Is it because you are feeling tired or experiencing poor blood sugar control? Or is it because you believe that higher ketones will result in better weight loss? If it’s the former, then keep tinkering and hopefully you will find what works best for you. If it’s the latter, I wish you the best of luck but must caution that I and a few others have found that there isn’t a great correlation between high ketones and weight loss.

I just found out about a research project that is starting up, American Gut. I believe the way it works is that you donate some money, some poo, and they will analyze it. You can find out what types of bacteria are in your gut, what’s dominant, enzymes, DNA… Interesting stuff!

They are also having participants fill out a questionnaire about their diet so that they can correlate gut bacteria and diet. FOR SCIENCE!

I am struggling with the $99 part but it would be very interesting to see what is going on in there. Plus since I keep pretty detailed food logs, I am full of … good data. Besides, who doesn’t want to know their pooper better? I know I do!

What do you think?

After months of coding, my big plans are finally going into effect! Bytes for Health is finally here and ready for beta testing. It is a health tracking website, where you can record any aspect of your health, food logs, weight, blood sugar, ketones, etc and use that information to identify associations and improve your health.

For the first few weeks the beta will be invitation only, while I work on any bugs. If you would like an invitation, register and you will be notified when you can join.

I am still on a mission to find a cat litter that is safe, convenient and affordable. Blue Naturally Fresh Walnut litter didn’t work out for me. So I decided for a while to switch back to clay but at least something less dusty. I picked Dr. Elsey’s Cat Attract or Precious Cat litter as it is recommended by one of my favorite cat ladies.

Just a quick note, I have tried Cat Attract, Precious Cat Classic and Precious Cat Ultra this month. Honestly I cannot tell the difference between them! So my review is for the brand as a whole.

Clumping

I find the clumping to be mostly acceptable. The clumps usually stay together when I sift them out. The exception being when they pee against the side of the box and don’t cover the mess. That usually ends in pieces which is difficult to completely remove. If you cats don’t pee standing up or are good about covering their mess, then it shouldn’t be an issue.

Odor Control

What I like about Dr. Elsey’s is that they don’t add perfumes or baking soda. I have a reaction to all perfumes and have found that even “unscented” litters usually have a noticeable odor. Not so with this stuff, a new bag of clean fresh litter doesn’t really have an odor. My laundry room smells pretty neutral which I prefer.

I clean the boxes twice a day and can’t smell the box at all in-between cleanings. I was pretty surprised at how well it hides odor without any sneeze inducing additives.

Weight

This stuff is heavy! The clay alternative cat litters are all lighter.

Dust

I am happy to report that reality matches their advertising when it comes to this being a low-dust litter. I noticed immediately that the litter is mostly clay pebbles and doesn’t have a bottom layer of dust. I can pour an entire 18lb bag of litter into the box without having to cover my face (which I could NOT say for other clay litters like Arm and Hammer or Tidy Cat). Also when a kitty leaps out of the box and runs directly to me to be petted, they don’t have a fine layer of dust trapped in their coat.

Tracking

This seems to track the same as any other clay clumping litter. Luckily the clumps stick together very well so at least they don’t track any wet litter around the house like they did with the Blue Walnut litter…

Price

Cat Attract is more expansive than Precious Cat and since I can’t tell the difference between the two… I would go with whichever is cheaper. Cat Attract retails at $16 for a 20lb bag and Precious Cat at $9 for an 18 lb bag. However I have run into sales on both that end up making one much cheaper than the other or sometimes cheaper than my old standby Arm and Hammer.

Final Thoughts

If you are going to use clumping clay litter, I would go with Dr. Elsey’s without reservation. Yes, it still has silica in it but of all the clay litters I have tried, it has the lowest amount of dust. I LOVE that it truly is unscented too, not just “neutral” scented like some litters. Plus if you keep an eye out for sales, Precious Cat costs about the same as other brands.

However I have not given up on my goal of a clay alternative. I am working on getting the kitties to use World’s Best Cat Litter (slowly transitioning the test box from clay). Once they start using the test box on a regular basis, I will let you know how it went!

• 8g per wrap. They barely spike my blood sugar. When I tested with a ham and cheddar sandwich I spiked 13 points and came back down to my baseline in 2 hours.

Sopapillas

Sopapillas are a delicious Hispanic dessert that I just love. Think cinnamon twists from Taco Bell but … you know … real. :) I made this by heating a nonstick skillet and melting a bit of butter or coconut oil. Then lightly fry the wrap on each side until it starts to brown. Place on a paper towel and sprinkle with cinnamon and sweetener (I used Truvia). It will quickly crisp up as it dries and become crunchy and crumbly.

Chocolate Twist

It is killing me that I can’t remember the name of the candy I am trying to imitate (chocolate filled layered twist in the shape of a tube) but we persevere! I am calling it a Chocolate Twist and if you know what candy I am talking about, let me know!

Melt some chocolate (store bought, homemade or coconut oil themed) and paint/spread it over a wrap. Roll up and let it set in the refrigerator or freezer for a few minutes. Cut into whatever portions you think best. :)

Other Uses

I have used the Pure Wraps in a few other less sexy ways. They have a slightly sweet taste so I don’t like them so much with roast beef but they work great with ham.

I have made a grilled ham and cheese sandwich with less than stellar success. I grilled the ham and let the cheese melt on top then placed it on the wrap. Unfortunately the wrap immediately soaked up all the moisture from the ham and become a soggy mess. That’s the tough thing about these wraps, they are very thin and don’t do well with wet ingredients.

Have you tried Pure Wraps yet? Let me know if you have any novel uses for them!

After listening to The Paleo View’s podcast on dairy, I finally decided to listen to that little voice that has been telling me for years that “You are allergic to milk you dummy! Why are you still eating butter and heavy cream!?” See, I was diagnosed with a milk allergy as a kid and instead of taking it seriously, I spent my teens figuring out exactly how much and how often I could get away with dairy before the symptoms became too much. When I went paleo a year ago, I heard that some people allow dairy in their primal diet if they tolerate it… and well… I am a lazy contradiction filled SOB and decided to continue my grand experiment of seeing how much high-fat dairy I could get away with.

Well no more! The last of the heavy cream is out of the house and I have placed the coconut oil prominently on the counter to replace butter. My hope is that my chronic sinus inflammation will subside and I can breath easier at night. Yes, you would think breathing and sleeping are important enough that I would never have played games like this but it is amazing what we tell ourselves when we really want to do something even if we know it is bad for us.

Also, I am going full autoimmune protocol. I have two autoimmune related diseases, diabetes and endometriosis, and maybe this will help sooth the savage immune system. I have never in my life tolerated most of the foods banned on the autoimmune list like onions, peppers or most spices. Funny that I have no problem avoiding those other foods, but can’t stay away from dairy, even though both make me sick. I just learned that dairy activates opiate receptors in the brain, so I am making that my official excuse!

The only food on the autoimmune list that I actually want to eat are eggs. Lately every time I make deviled eggs, I get wicked heartburn, even when I tried making “Angel Eggs” stuffing the whites with avocado. So I figure, go full monk, cut it all out and watch for signs of improvement.

So starting today I am cutting out the following foods: ALL dairy, eggs, nightshades (potato, peppers, paprika, tomatoes, etc) and nuts. I am sure there are more items on the list to avoid, and I will cut them out as well as soon as I read up a bit more on the autoimmune protocol and learn what they are. :)

Wish me luck!