Today I had my meeting with a nurse, dietitian and a Doctor, all of whom specialize in diabetic treatment. Because of my change in regime due to my training I came armed with a bunch of questions as well as the past week and a half of documented sugars levels, insulin and food intake. I see the same people every 3-6 months and have a blood test a couple of weeks before I go. The blood test is Hba1c and once a year I have a full panel to check my kidney function, cholesterol and a few other things. The most recent Hba1c result was 7.4% up from 7.0% the previous test 6 months earlier. I was a little disappointed. With my change in regime I was really hoping for an improvement in my result. Sadly no, I have got my weight down from 91Kg to 87Kg (fully clothed). I am happy about that but I really want to get down towards 80Kg. I am sure that will come with time.
Both the appointments with the Dietitian and Doctor were productive. I have an additional appointment with the dietitian and someone who can advise me on sport in a couple of weeks. I hope that will be useful too. I had a number of questions that I needed answering plus we talked about how my training was affecting my blood sugar. The most interesting thing was that I have been making a mistake with my long term insulin. I have been told to keep that constant and only vary the amount I eat and the amount of short term insulin that I take before and after exercise. Additionally we calculated that I should be eating about half what I eat every hour. I eat about 30g of carbs in energy gels and bars, I need to try to eat 15g on every hour. I should also eat some slow burn carbs before I ride and take a small amount of short term insulin.
Hopefully my next meeting I will learn more about the food and insulin intake that I need to do long rides without hitting the wall and without having hypos during and then having huge swings after.
I had some questions prepared for the appointments, I have listed the ones that I have already discussed above with the answers I was given:
I have hard bumps around my injection sites, they are more noticeable to the touch not that I have lost some weight. Is it hard insulin, and can it be released slowly into my system. Will they ever go away?
A: It is not hard insulin. I didn't fully understand (a consequence of us both speaking to each other in our second language) but I believe what she told me was that it is fibrous tissue that forms at the injection site as a reaction to too many injections in the same place over too short period. They do not go away. (sadly as I am losing weight they are becoming more noticeable)
Can I get a Continuous Blood Glucose monitor?
A: No currently I am not eligible on my current Kupat Cholim (health plan) - Maccabi Gold. I am not at risk enough and they are very expensive. I am free to buy them at my own cost but they are very expensive. Dexcom Medtronic Abbot.
Should I eat late in the ride to stop excessive glycogen breakdown?
A: I should eat throughout the ride to try to keep constant levels of blood glucose and avoid large swings in either direction.
Where can I get a medic alert bracelet?
A: The Israel association of diabetes has information about them on their website.
If I have a chocolate chip cookie that weights 45g total (it is home made so I know its flour, sugar, butter and chocolate) how much insulin do I need to take for it?
A: About 50% carbohydrate to 20 to 22.5g when estimating how much sugar to take. Bear in mind that the chocolate and butter are fats which slows the uptake of sugar. This makes such a food item less suitable for recovering from hypos
Why is my Hba1c so high?
A: Not sure, possibly from the high swings after riding.