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the first five months

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the first five months

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Instead of going to work, I started out yesterday at the doctor's office. I have had a lot of appointments this year, because after being without insurance for a while, when I got coverage again back at the end of April, I went to get a physical and was diagnosed with diabetes.

There has been a lot going on inside my head about the process of dealing and adapting since then, but I haven't written any of it down, because I would have written it here, and it always seems like I should do a backstory post first, and I hadn't, and wasn't. I meant to, but I kept putting it off; I tried several times to just skip it and write about something that came after, but I couldn't seem to bring myself to do so. I kept going back into that same "how I got here" story, and I didn't want to write it. This same process just happened again with this post, but I don't feel that I can put it off any more - I need to be making a record of some of what's happening right now, and the thing about backstory is that it only gets longer as time passes (though mine is dull - I haven't died even ONCE!), and so I guess it's time to bite the damn bullet.

The news was a shock but not a surprise. Diabetes runs in my father's family, and unfortunately I am not one of those people who outgrow that childhood sweet tooth. I've written in the past about my boyfriend Sugar Jones - and lemme tell ya, he is hard on a girl, the bastard. Keeping in mind my need for a steady flow of willpower to hold in place the changes I've made, I've kinda decided it will be most productive for me at this point to go with the terminology from the South Beach diet - sugar addiction. I've regularly made some really poor choices, denying it can do me nothing but harm - and anyone who could see inside my head the shit I WANTED to do but DID resist would probably have all their teeth fall out, just out of sympathy or enamel solidarity or something.

So, freshly diagnosed, I nonetheless had educated myself to some extent beforehand - I knew I was high risk and what it would mean, I just hadn't considered that I might have moved past the point of risk to fact. As soon as I moved past that initial stunned "Oh noes!" moment, I had a general plan: find out whether my pancreas was still salvageable and, if possible, try to get it together to the point that it could work on its own again, by making a ton of changes while also taking meds, shooting for the goal of not needing them any more, at least for a couple of years if not a decade or two. I chose the least invasive medicine to start with (metformin, a glucophage to help with insulin resistance), to see what I could do with just that and lifestyle changes - but oh so many changes, to be made all at once. It was fairly daunting.

In spite of that, I started out strong - I dove right in, changed my diet, stuck to the daily meds, and, ah, I thought a lot more frequently about exercise, and did a bit more than the miniscule amount I had been. Although I had a head full of all the things I hadn't yet managed when I went in to my first checkup a month later, I was a lot happier when I came out, as my numbers (my daily blood sugar levels plus the whatever they are, A6 something, it slips out of my brain as soon as I walk out of that office) looked great, and really showed all the improvements I had managed to make. If she'd looked at that test not knowing I was taking the glucophage, she would not have been able to diagnose me as diabetic.

Ideally, I would have found that a motivator to aspire to ever higher goals. After three months, though, I had not even maintained my initial momentum. This diagnosis is not the only stressor in my life right now, not by a long shot, and I find that the discipline required to maintain the lifestyle changes is dependent on my not falling below a particular emotional benchmark. By mid-August, I had only slipped a little bit off the straight and narrow and was gearing up for a renewed thrust of willpower when a really unpleasant family rift occurred unexpectedly, and I tanked instead.

This wasn't all bad. I'd raised the bottom line of my behaviour - there are some things I just plain don't do any more, and I didn't go back to those... but I was not riding much higher than the new bottom line by the time of my next visit, and it showed. I was still much better on September 23 than I had been when I first walked in the office, but unlike at the one month point, my blood sugar was what the nurse practitioner I've been seeing classed as "uncontrolled. Boo to that.

So. Had it been possible for me to do what I hoped just taking metformin? I'll never know now. I actually have a strong mental antipathy toward taking any medications - I'll try to wait out stomach pain, headache, anything I know is minor and temporary, the only exception being that I'll take something the night after huge unusual exertion to try to head off stiffness and soreness and keep from losing any benefits of said exertion by being practically an invalid for the next three days. Because of that mindset, I liked the idea of doing what I wanted to do on the minimum amount of drugs possible. Metformin loses its efficacy over time, however. Having failed to keep up my good head start, I didn't have good information on whether the drug had failed me or I had failed the drug... or whether it was a mutual kind of thing. Whatever the reason or reasons, though, the most important factor was that what I was doing didn't work. At the appointment, she told me she wanted me to go to a stronger drug, and I agreed.

There are two drugs she recommended: pioglitazone (min pill form with metformin in the same pill, marketed as Actoplus) and exenatide (injectable with the same metformin pills I have been taking accompanying, marketed as Byetta). She gave me samples for the pill form, which I started taking after I returned from my trip, because that was the beginning of a week and the best time to switch - but while on my trip I considered the injectable. I'd established with her that I could switch from the one to the other with little to no harm, so I gave myself time to do that thinking.

While in Chicago, I decided to go with the Byetta and see how it does for me. I had a couple of reasons for this: Byetta is the more aggressive of the two medicines, doing more to preserve and restore the pancreatic health of someone who has not had diabetes for that long and still has at least some function function; it has a slightly more palatable set of side effects than the other one; and I also had the feeling that injections might help me to take the whole more seriously, as an added motivator to keep me going in the right direction through any future low spots. The appointment yesterday was the one to get trained on how to use the pen and get a sample, to test my response to the drug before I commit money to it. I already showed an improvement on the other drug, though I can't say how much of that was due to me re-mending my ways - but I'm optimistic, and for the moment, I feel peaceful on this one subject, because I have a plan in place.
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